[abstract]A CASE OF FROSTBITE RESPONDS WELL TO ADJUNCTIVE HYPERBARIC OXYGEN THERAPY AND ADVANCED WOUND CARE TECHNIQUES

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[abstract]A CASE OF FROSTBITE RESPONDS WELL TO ADJUNCTIVE HYPERBARIC OXYGEN THERAPY AND ADVANCED WOUND CARE TECHNIQUES

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Title: [abstract]A CASE OF FROSTBITE RESPONDS WELL TO ADJUNCTIVE HYPERBARIC OXYGEN THERAPY AND ADVANCED WOUND CARE TECHNIQUES
Author: Sanders RW; Anderson CA
Abstract: INTRODUCTION: Frostbite is an acute thermal injury: pathophysiology includes both immediate and delayed cold-induced cell death mediated by an inflammatory cascade. Through edema mitigation, prevention of reperfusion injury, and support of hypoxic/watershed tissues, hyperbaric oxygen (HBO2) therapy should be an ideal adjunctive therapy. BACKGROUND: A 23-year-old Marine spent five days performing cold-weather drills. Daily his feet became wet and numb, recovering each evening. On the sixth day his feet did not recover, remaining numb and white. The emergency physician recommended “watchful waiting,” with the possibility of amputation. Knowing this impact on his career, the Marine sought another option. At a second ED, the physician discussed HBO2 therapy, and the patient was referred to our facility. METHODS: On presentation, patient had third-degree frostbite: severe edema, hemorrhagic blisters and dusky skin of both feet. With no contraindications, HBO2 therapy was begun immediately (twice-daily HBO2 at 2.4 atm abs for 90 minutes of 100 percent oxygen for three days, then once daily for 11 more days). He was then transferred home, where 20 daily treatments were administered for a total of 37 (during transfer, a delay of six days occurred and his disease progressed to fourth-degree frostbite with black eschar formation). Aggressive wound care was performed including excisional debridement of well-demarcated necrotic tissue and bone. Hemorrhagic bullae were debrided; topical antimicrobial dressings maintained and Alloderm graft was successfully placed. No oral antibiotic therapy was administered. RESULTS: Patient tolerated HBO2 well, with salvage of all toes and remarkable cosmesis/functionality. Patient regained distal sensation with minimal oral analgesics. CONCLUSIONS: Hyperbaric oxygen was an integral part of this patient’s care. This case is not unique, with multiple cases in the literature having similar outcomes. While our experience dictates the use of HBO2 as an adjunctive treatment for frostbite, a large randomized trial is essential for acceptance as an HBO2 indication.
Description: Undersea and Hyperbaric Medicine : Journal of the Undersea and Hyperbaric Medical Society, Inc.
URI: http://archive.rubicon-foundation.org/10708
Date: 2013

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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