Postoperative Hyperbaric Oxygen Therapy Research Articles

Impact of Hyperbaric Oxygen on Tissue Healing around Dental Implants in Beagles.

BackgroundThe impact of hyperbaric oxygen (HBO) on the healing of soft tissues around dental implants was studied in a beagle model.Material/MethodsBeagle dogs were randomized to receive implants, followed by postoperative HBO therapy or not (n=10 per group). On postoperative days 3, 7, and 14, tissue specimens were paraffin-embedded and analyzed by hematoxylin-eosin and Masson staining, as well as immunohistochemistry against CD31.ResultsScores for inflammation pathology based on hematoxylin-eosin staining and mean optical density of collagen fibers were significantly different between the HBO and control groups on postoperative days 3 and 7 (P<0.05), but not on day 14. Mean optical density due to anti-CD31 staining was significantly higher in the HBO group on postoperative days 3, 7, and 14 (P<0.05).ConclusionsThese results suggest that HBO may promote early osteogenesis and soft tissue healing after implantation.

The Clinical Effect of Postoperative Hyperbaric Oxygen Therapy on Idiopathic Normal Pressure Hydrocephalus: A Retrospective and Comparative Analysis of 61 Patients with Ventriculoperitoneal Shunt.

The aim of the study was to examine the clinical effect of postoperative hyperbaric oxygen (HBO) therapy on symptoms and signs in the ventriculoperitoneal (VP) shunt insertion treatment of idiopathic normal pressure hydrocephalus (iNPH). We conducted a retrospective analysis of 61 patients treated at our institution for iNPH since 2007. Patients were stratified into 2 groups according to undergoing pure VP shunt with gravitational valves (group 1) or combined with postoperative HBO therapy (group 2). Clinical improvements as well as complications were compared between the 2 groups. There was no significant difference between the 2 groups regarding age, sexual proportion, body mass index, education years, and the average Normal Pressure Hydrocephalus Scale score before the surgery, as well as the complication rate after the surgery (P > 0.05). On average, the total Normal Pressure Hydrocephalus Scale scores were both increased in the 2 groups at 1, 3, and 6months after shunting, with no significant differences (P> 0.05). However, group 2 tended to increase more compared with group 1, especially 6 months later after shunting. The increase of cognitive functions was more significant in group 2 (P < 0.05). HBO therapy combined with VP shunt is expected to improve the effect of iNPH treatment, especially for cognitive performance.

Therapeutic improvement of colonic anastomotic healing under complicated conditions: A systematic review.

To identify therapeutic agents for the prophylaxis of gastrointestinal anastomotic leakage (AL) under complicated conditions. The PubMed and EMBASE databases were searched for English articles published between January 1975 and September 2014. Studies with the primary purpose of improving anastomotic healing in the colon or rectum under complicated preoperative and/or intraoperative conditions were included. We excluded studies investigating the adverse effects or risk assessment of an active intervention. Furthermore, investigations of biophysical materials, sealants, electrical stimulation and nutrients were excluded. The primary study outcome was biomechanical anastomotic strength or AL. The meta-analysis focused on therapeutic agents that were investigated in one animal model using the same outcome by at least three independent research groups. The 65 studies included were divided into 7 different complicated animal models: Bowel ischemia, ischemia/reperfusion, bowel obstruction, obstructive jaundice, peritonitis, chemotherapy and radiotherapy. In total, 48 different therapeutic compounds were examined. The majority of investigated agents (65%) were reported as beneficial for anastomotic healing. Twelve of the agents (25%) were tested more than once in the same model, whereas 13 (27%) of the agents were tested in two or more models of complicated healing. Two therapeutic agents met our inclusion criteria for the meta-analysis. Postoperative hyperbaric oxygen therapy significantly increased anastomotic bursting pressure in ischemic colon anastomoses by a mean of 28 mmHg (95%CI: 17 to 39 mmHg, P < 0.00001). Granulocyte macrophage-colony stimulating factor failed to show a significant increase in anastomotic bursting pressure (95%CI: -20 to 21 mmHg, P = 0.97) vs controls in experimental chemotherapeutic models. This systematic review identified potential therapeutic agents, but more studies are needed before concluding that any of these are useful for AL prophylaxis.

Evaluation of TCOM/HBOT practice guideline for the treatment of foot burns occurring in diabetic patients

ObjectivesA multidisciplinary team developed an evidence-based guideline for the management of foot burns occurring in diabetic patients that included transcutaneous oxygen measurements (TCOM) and application of hyperbaric oxygen therapy (HBOT) to selected patients. This report represents an evaluation of preliminary TCOM/HBOT data. MethodsThis is a retrospective review of patients with diabetes mellitus (DM) who were admitted to a single American Burn Association (ABA) verified burn center for the treatment of foot burns. Patients were treated via the guideline if they were over the age of 16, admitted for the initial care of burns involving the feet between 4/01/2012 and 7/22/2013, and had a known or new diagnosis of DM. ResultsEighteen patients were treated according to the guideline, 14 men and 4 women. Average age was 54 years+14.78. Average BMI was 30.63+6.34. Median burn size was 0.88% TBSA (median partial thickness of 1% and median full thickness of 0.5%). The average HbA1c was 9.08+2.42. Seven patients received pre-operative HBOT, two received post-operative HBOT and three patients healed their wounds with HBOT alone. Average hospital length of stay was 13.39 days+9.94 and was significantly longer for the group receiving HBOT. Admission HbA1c was not a predictor of the need for HBOT. ConclusionsWhile TCOM/HBOT therapy has not been widely applied to the management of diabetic foot burns, the use of an evidence-based guideline incorporating TCOM/HBOT can provide a systematic way to evaluate the patients’ microcirculation and ability to heal burns of the foot. The incorporation of TCOM determination and application of HBOT in selected patients with DM and burns of the feet warrant continued study.

Healing under pressure: hyperbaric oxygen and myocutaneous flap repair for extreme persistent perineal sinus after proctectomy for inflammatory bowel disease

Persistent perineal sinus (PPS) following proctectomy for inflammatory bowel disease affects about 50% of patients. Up to 33% of cases of PPS remain unhealed at 12months and the most refractory cases are unhealed at 24months despite optimal conventional therapy. Reports of hyperbaric oxygen therapy (HBOT) for chronic wounds and Crohn's perianal disease led us to explore perioperative HBOT with rectus abdominis myocutaneous (RAM) flap repair in a highly selected group of patients with extreme PPS who had failed all other interventions. Patients with extreme PPS received preoperative HBOT (a 90-min session at 2.2-2.4 atmospheres, five times per week for 5-6weeks, for a total of up to 30 sessions), before abdominoperineal PPS excision and perineal reconstruction with vertical or transverse RAM flap repair within 2-4 weeks of completing HBOT. Postoperative HBOT (10 further 90-min sessions) was administered within 2weeks where practicable. Between 2007 and 2011, four patients with extreme PPS underwent RAM flap repair with preoperative HBOT; two also received postoperative HBOT. The median (range) duration of PPS before HBOT was 88.5 (23-156) months. All patients had previously failed multiple (5 to >35) surgical procedures. Complete healing occurred in all patients at a median (range) follow-up of 2.5 (2-3) months. There were no further hospital admissions for PPS at a median (range) follow-up of 35 (8-64) months. Hyperbaric oxygen therapy combined with PPS excision and perineal reconstruction with a RAM flap led to complete perineal healing in four patients with extreme PPS and appears a safe and effective extension to the therapeutic pathway for exceptionally treatment-refractory PPS.

Development of a Patient-Reported Outcome Measure for Recurrent or Metastatic Head-and-Neck Cancer: Management of Recurrent Head-and-Neck Squamous Cell Carcinoma

However, a significant percentage of these patients have persistent or recurrent disease and undergo salvage surgery as a secondary curative option. Surgery after radiation or chemoradiation is, however, associated with significantly higher morbidity rates when compared with primary surgical intervention. Hyperbaric oxygen therapy (HBOT) has been widely studied in the area of wound healing with promising results in the prevention of osteoradionecrosis, treatment of diabetic wounds and improved tissue perfusion in previously irradiated tissue. However, the evidence supporting the efficacy of its use for the prevention of post-operative wound complications in the area of salvage surgery remains limited. The primary objective of the study is to assess the efficacy of HBOT in the prevention of post-operative complications within the study population. Materials/Methods: 175 patients who underwent a clean-contaminated head and neck procedure following previous radiation or chemoradiation treatment for head and neck cancer from January 2006 to June 2013 were identified at a large academic tertiary care center. 134 of these patients did not receive post-operative HBOT and were designated for the control cohort. 41 patients received prophylactic post-operative HBOT and were designated for the study cohort. Patient co-morbidities, clinicopathologic data, and morbidity outcomes were analyzed. Results: The control and study cohorts were statistically matched in age, gender, history of previous chemotherapy, and time between completion of radiation therapy and surgical intervention. The overall rates of surgical complications in the control and study cohorts were 43% and 48%, respectively (p Z 0.59). The rates of major surgical complications, which resulted in significant morbidity or increased hospital stay to the patient, were 21% and 22% in the control and study cohorts, respectively (p Z 0.78). Similarly, the length of hospital stay (p Z 0.88), need for additional surgical intervention (p Z 0.13) and hospital re-admission rates (p Z 0.66) were not statistically different between the two groups. The 2-year overall survival in the control cohort was 40% and 36% in the study cohort. Conclusions: Prophylactic HBOT following salvage surgery does not decrease rates of postoperative complications, length of hospital stay or need for additional surgical intervention. Author Disclosure: A. Marcinow: None. T. Teknos: None. A. Agrawal: None. E. Ozer: None. R. Carrau: None. D. Schuller: None. M. Old: None.

Successful total replantation of a forearm after 11 hours of warm ischaemia

We present a case of a young female patient who underwent total replantation of an amputated forearm after 11 h of warm ischaemia. The immediate and long-term outcome of the procedure was totally satisfactory in terms of limb survival and satisfactory enough in terms of functionality. This outcome was due in part to the use of post-operative hyperbaric oxygen therapy, to minimize the effects of ischaemia-reperfusion injury. Considering that replantation of amputated limbs usually results in poor outcomes after 6 h of ischaemia, the present success represents a rare case.

The Effects of Hyperbaric Oxygen Therapy on Experimental Colon Anastomosis After Preoperative Chemoradiotherapy

The aim of the present study was to investigate the effect of hyperbaric oxygen therapy (HBOT) on colon anastomosis after chemoradiotherapy (CRT). Sixty female Wistar-Albino rats were divided into 5 groups and underwent left colon resection and end-to-end anastomosis. CRT simulation was performed on 2 sham groups before the anastomosis, and 1 of these groups was administered additional postoperative HBOT. Two groups were administered CRT before the anastomosis, and 1 of them received additional postoperative HBOT. On postoperative day 5, all groups underwent relaparotomy; burst pressure was measured and samples were obtained for histopathologic and biochemical analysis. There was a significant weight loss in the CRT groups and postoperative HBOT had an improving effect. Significantly decreased burst pressure values increased up to the levels of the controls after HBOT. Hydroxyproline levels were elevated in all groups compared to the control group. Hydroxyproline levels decreased with HBOT after CRT. No significant difference was observed between the groups regarding fibrosis formation at the anastomosis site. However, regression was observed in fibrosis in the group receiving HBOT after CRT. Preoperative CRT affected anastomosis and wound healing unfavorably. These unfavorable effects were alleviated by postoperative HBOT. HBOT improved the mechanical and biochemical parameters of colon anastomosis in rats.

Hyperbaric oxygen in the treatment of postoperative infections in paediatric patients with neuromuscular spine deformity

The aim of this study is to evaluate possible benefits of hyperbaric oxygen (HBO) therapy in the treatment of deep postoperative infections in six high risk paediatric patients with neuromuscular spine deformity. The study involved review of medical records including radiology, office visits, and telephone contacts for six patients, referred for postoperative HBO therapy in 2003-2005. Infection control and healing without removal of implants or major revision surgery with a minimum of 2-year follow-up after index surgery were considered to represent success. All infections were resolved. Median time for wound healing, normalisation of blood tests and antibiotic weaning were 3months. Radiological bony fusion, intact implants without any signs of radiolucent zones were seen in all cases at a mean follow-up of 54months (37-72). Side effects of HBO treatment were minor. HBO is a safe and potentially useful adjuvance in the treatment of early deep postoperative infections in complex situations with spinal implants in high risk paediatric patients.

Safety and efficacy of early postoperative hyperbaric oxygen therapy with restriction of transfusions in patients with HCC who have undergone partial hepatectomy

Recent studies have shown that intraoperative blood loss and blood transfusions promote postoperative recurrence of hepatocellular carcinoma (HCC). Hyperbaric oxygen therapy (HBOT) is a specific method of oxygen administration, which is independent of fluid therapy or blood transfusion. The aim of the present study was to assess the usefulness of acute HBOT after liver resection for patients with HCC in order to minimize the requirement for perioperative blood transfusions. Forty-one consecutive patients who showed Hb level < 9.0 mg/dl at the end of hepatic resection were randomly assigned to a control group (n = 21) or an HBOT group (n = 20). HBOT at 2.0 atm. with inhalation of 100% oxygen for a duration of 60 min was performed at 3, 24, and/or 48 h after the end of the hepatectomy. Regarding postoperative hepatic hemodynamics, liver function tests, and outcome data, prospective comparisons were completed in both groups. The two groups of patients were similar with respect to results from preoperative assessments. In six patients from the HBOT group, who experienced intraoperative major bleeding or showed fatal hepatic hypoxia (ShvO(2) < 50%), the levels of ShvO(2) and serum lactate were significantly improved after HBOT. When compared to the control group, the HBOT group showed better changes of ShvO(2), serum lactate, and bilirubin levels for the first 3 postoperative days following surgery. Additionally, the HBOT group did not experience any fatal complications and had a lower incidence of postoperative hyperbilirubinemia than the control group. We also observed that postoperative NK cell activity and cancer-free survival in the HBOT group tended to be better than in the control group, although the differences did not reach significance. These results suggest that acute HBOT after hepatectomy, aimed at reducing perioperative erythrocyte transfusions, may be employed for overcoming deficiencies in systemic and hepatic oxygen supply and thus diminishing postoperative complications. As an added benefit, such therapy may affect postoperative immunological responses and long-term survival after liver resection in HCC patients. Further analyses of the use of HBOT is warranted to confirm surgical outcome data and to assess the economic impact on healthcare costs.

Aspectos morfológicos e funcionais dos autoimplantes esplênicos em ratos tratados com oxigenio hiperbárico

To study the functional and morphological features of splenic autoimplants in rats subjected, or not, to postoperative hyperbaric oxygen therapy. One hundred and five male Wistar rats, weighing 251.6 g ± 29.5 g, were studied ot early (11th day) and late (70th day ) postoperative periods. For each period the animals were distributed in the following groups: A (n=40), splenic manipulation; B (n=65),splenic autoimplants, not treated (nt) (A11nt--n=10, B11nt--n=21, A70nt--n=10, B70nt--n=18) and treated with hyperbaric oxygen (t) ( A11t--n=10, B11t--n=15, A70t--n=10, B70t--n=11). Blood was collected for measurement of lipids and immunoglobulins, platelet and Howell-Jolly body count before and after surgery. The spleen and autoimplants were removed for histologic analyses. There was an increase of total cholesterol (p=0.00068), LDL-cholesterol (p=0.002), VLDL-cholesterol and triglycerides (p=0.0033) in B11nt group. There was an increase of total cholesterol (p=0.0007) and LDL-cholesterol (p=0.0000) in B70nt group, and no alterations were observed in the other groups. IgM decreased in B groups (p=0.0000) and no changes were observed in the splenic manipulation group. Number of Howell-Jolly bodies were lesser in Bt groups than in Bnt groups (p=0.03). Platelets were increased in B11t and B11nt groups (p=0.0000) and remained unchanged in the other groups. Autoimplants microscopic viability was better in Bt groups than in Bnt. The splenic autoimplants of rats treated with hyperbaric oxygen therapy showed a better functionality and viability than those subjected to other procedures.

Distraction Osteogenesis in Irradiated Rabbit Mandibles With Adjunctive Hyperbaric Oxygen Therapy

The purpose of this study was to evaluate the effect of hyperbaric oxygen therapy on bone regeneration during distraction of irradiated rabbit mandibles. Twenty New Zealand white rabbits were randomly sub-divided into 4 groups. Group 1 served as control, group 2 received preoperative radiation therapy, group 3 received pre- and postoperative hyperbaric oxygen (HBO) therapy, and group 4 received preoperative radiation therapy and pre- and postoperative HBO therapy. All rabbits underwent a corticotomy of the left body of the mandible after placement of a distraction device. Distraction, at a rate of 1 mm/day and a rhythm of 1 turn/day, began after a 3-day latency period for 14 days. Thirty days after completion of the distraction protocol, the animals were euthanized, and histomorphometric and radiographic data of the distraction segments were obtained. Histomorphometric analysis of new bone fill was greatest in the non-irradiated groups compared to groups receiving radiation therapy, regardless of HBO therapy (P = .03). Pre-corticotomy bone density measurements showed a significant increase in bone density over time (P = .0007). This resulted in a significant relationship between HBO therapy, radiation therapy, and time (P = .0050). The results of the study support the use of HBO therapy during distraction osteogenesis. Any additional therapeutic benefit of HBO therapy in irradiated bone would require additional investigation.

Islet Transplantation at Subcutaneous and Intramuscular Sites

The subcutaneous site is ideal for clinical islet transplantation because it has the advantage of being accessible and can be biopsied when needed. Sadly, the results at subcutaneous sites were disappointing. The reason for this failure is not known, but poor vascularization may play a role. We tested the hypothesis that islet grafts would do better if more vasculature or oxygen could be supplied. Six hundred isolated C57BL/6 mouse islets were syngeneically transplanted into inbred streptozotocin-diabetic recipients at a subcutaneous site on the back with (Group A, n = 6) or without (Group B, n = 8) postoperative hyperbaric oxygen (2.4 ATA, 100% O 2) therapy, or at a calf muscle (Group C, n = 9). During 13-week posttransplantation follow-up, recipients’ blood glucose decreased and body weight increased significantly in all 3 groups ( P < .05). However, there was no significant difference among the 3 groups. At 13 weeks, the insulin contents of the graft was also comparable among the 3 groups. Our data indicate the following: (1) postoperative hyperbaric oxygen therapy did not improve the outcome of islet transplantation at a subcutaneous site; and (2) a muscular site was not superior to a subcutaneous site for islet transplantation.

Effect of hyperbaric oxygen on survival of the composite ear graft in rats.

In this study the authors set out to determine whether postoperative hyperbaric oxygen (HBO) therapy increases the survival rate of the composite graft in the rat ear model. A composite graft (1 x 0.5 cm2) that included skin, subcutaneous tissue, and cartilage was created from the left ear, and was transferred onto the posterior auricular site of the right ear. The animals were divided into two groups: a control group (N = 10) and an experimental group receiving HBO (N = 10). The experimental group was given HBO immediately following reattachment for 4 hours, and then for 6 hours each day for 5 days (2 atm). The results showed the average ear flap survival area in the experimental group was 82%, and it was 26.5% in the control group (p < 0.01). Histology demonstrated the existence of neovascularization in the experimental group. We have concluded that postoperative HBO therapy increases the survival of the rat ear composite graft, and that the effect of this therapy is influenced by the magnitude (size and thickness) of the graft.