Hyperbaric Oxygen Therapy in the Treatment of Necrosis and Gangrene

Historically, hyperbaric oxygen therapy has been used for treatment of decompression sickness in deep-sea divers. Today, hyperbaric oxygen is commonly used for the treatment of wide variety of surgical and non-surgical conditions, and has persuasively proved its high clinical efficiency in many areas. Currently, established indications include different bacterial (mostly anaerobic) and fungal infections, arterial gas embolism, poorly healing diabetic wounds , osteomyelitis, radiation tissue injury, carbon monoxide poisoning, crush injuries, gangrene, brain abscesses, burns, skin grafts or skin flaps at risk of compromised tissue perfusion, severe anemia, and also conditions like long-standing neurologic deficit, cerebral palsy or autism, and many more. The existing trend of ever-expansion indications to previously untouched areas holds for decades. The purpose of this review is to examine advantages and disadvantages of the hyperbaric oxygen therapy, and also to explore the underlying physiological mechanisms of the hyperbaric oxygen actions in the ischemic, necrotic and otherwise compromised tissues. This review will mostly be focused on the discussion of clinical efficacy and practical approach to HBOT use in the treatment of different types of gangrene and necrotizing fasciitis. Role and place of hyperbaric oxygen therapy in the treatment of ischemic and diabetic chronic wounds and ulcers will also be explored. With currently recommended clinically tested protocols and using contemporary equipment, administration of hyperbaric oxygen therapy is generally considered very safe. However, it is not absolutely innocuous, and certain contraindications, ranged from medical problems to physical abnormalities, while mostly relative, should be carefully considered in every case. The only absolute contraindication for hyperbaric oxygen therapy is untreated tension pneumothorax. Other contraindications include: 1. Severe chronic obstructive pulmonary disease with carbon dioxide 2. retention, pulmonary blebs, and/or dyspnea with slight exertion; restrictive airway disease (possibility of air trapping with barotraumas ensued) 3. Optic neuritis 4. Acute viral infection 5. Congenital spherocytosis 6. Uncontrolled, acute seizures disorders 7. Upper respiratory tract infection 8. Uncontrolled high fever