Chiang IH, Tzeng YS, Chang SC, et al.
International wound journal. Date of publication 2017 Dec 1;volume 14(6):929-936.
1. Int Wound J. 2017 Dec;14(6):929-936. doi: 10.1111/iwj.12730. Epub 2017 Mar 1.
Is hyperbaric oxygen therapy indispensable for saving mutilated hand injuries?
Chiang IH(1), Tzeng YS(1), Chang SC(2)(3).
Author information:
(1)Division of Plastic and Reconstructive Surgery, Department of Surgery,
Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,
Republic of China.
(2)Division of Plastic and Reconstructive Surgery, Department of Surgery,
Hyperbaric Oxygen Therapy Center, Shuang-Ho Hospital, Taipei, Taiwan, Republic of
China.
(3)Department of Surgery, School of Medicine, College of Medicine, Taipei Medical
University, Taipei, Taiwan, Republic of China.
Mutilated hand injuries are a profound challenge to the plastic surgeon, and such
injuries often lead to limb loss and severe functional impairment. Hyperbaric
oxygen therapy (HBOT) appears to counteract tissue hypoxia and stimulate acute
wound healing. This study was performed to evaluate the efficacy of HBOT as an
adjunctive therapy in patients with a mutilated hand injury. Between January 2006
and December 2014, 45 patients with a mutilated hand injury were enrolled. After
reconstruction or revascularisation, patients underwent 120 minutes of HBOT with
oxygen at 2·5 atmospheres absolute while breathing 100% oxygen. Outcomes such as
amputee survival and surgery-related complications were recorded. The patients
were 38 men and 7 women with average age of 37·2 years (range 18-62). The mean
defect area was 131·5 cm2 (range 40-300). Most patients experienced a pure crush
injury (53%). The average number of operations from the initial debridement to
the first reconstruction was 3·8 (range 1-6). A total of 33 patients (73%)
underwent replantation during the initial reconstruction. For flap coverage, most
patients received a free flap using an anterolateral thigh flap (18 patients) or
local flap using an abdomen/groin flap (nine patients). The average time from the
first reconstruction or revascularisation to the first HBOT was 6·5 hours (range
2-12). The average number of HBOT sessions was 9·1 (range 6-14 sessions). The
survival rate of the replanted fingers was 81%, and the survival rate of the
palms was 100%. Most complications in the initial reconstruction involved partial
loss of an avulsed flap, and most complications in the chronic stage (≥3 months)
involved scar contracture. When combined with delicate microsurgery, early
intervention using adjunctive HBOT was effective in preserving partially viable
tissue and restoring hand function in patients with a mutilated hand injury.
© 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.
DOI: 10.1111/iwj.12730
PMID: 28251838
