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J Am Acad Orthop Surg, Vol 12, No 6, November/December 2004, 376-384.
© 2004 the American Academy of Orthopaedic Surgeons
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Hyperbaric Oxygen Therapy in Extremity Trauma

J. Eric Greensmith, MD, PhD

Dr. Greensmith is Staff Anesthesiologist, St Elizabeth Hospital, Appleton, WI.

Reprint requests: Dr. Greensmith, St Elizabeth Hospital, 1506 South Oneida Street, Appleton, WI 54915.

Hyperbaric oxygen therapy potentially can provide enhanced oxygen delivery to peripheral tissues affected by vascular disruption, cytogenic and vasogenic edema, and cellular hypoxia caused by extremity trauma. After appropriate resuscitation, macrovascular repair, and fracture fixation/stabilization, adjunctive hyperbaric oxygen therapy can enhance tissue oxygen content. In patients with crush injury or early compartment syndrome, hyperbaric oxygen therapy may reduce the penumbra of cells at risk for delayed necrosis and secondary ischemia. Animal experiments and human case series suggest the benefits of such therapy, and recent randomized, prospective studies on trauma patients have confirmed its efficacy in those with extremity trauma. However, more data are necessary to determine additional indications as well as optimal timing and dosing for hyperbaric oxygen therapy.




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