Original scientific paper
Influence of Adjuvant Hyperbaric Oxygen Therapy on Short-term Complications During Surgical Reconstruction of Upper and Lower Extremity War Injuries: Retrospective Cohort Study
Zdravko Roje
; Division for Plastic Surgery and Burns, Department of Surgery, Split University Hospital Center, Croatia
Željka Roje
; Department of Surgery, Dubrava University Hospital, Zagreb, Croatia
Davor Eterović
; Division of Nuclear Medicine, Split University Hospital Center, Croatia
Nikica Družijanić
; Department of Surgery, Split University Hospital Center, Split, Croatia
Ante Petričević
; Department of Surgery, Split University Hospital Center, Split, Croatia
Tinka Roje
; Department of Physical Medicine and Rehabilitation, Split University Hospital Center, Split, Croatia
Vesna Čapkun
; Division of Nuclear Medicine, Split University Hospital Center, Croatia
Abstract
Aim To determine the effects of hyperbaric oxygen (HBO) therapy on shortterm
complications of complex war wounds to the upper and lower extremities
in patients who were and those who were not treated according to North Atlantic
Treaty Organization (NATO) emergency war surgery recommendations.
Method We retrospectively analyzed data of 388 male patients undergoing reconstructive
surgery for Gustilo type III A, B, and C war wounds to the extremities
at the Department of Reconstructive Surgery, Split University Hospital
Center, between 1991 and 1995. The occurrence of main wound complications
(deep infection, osteomyelitis, skin grafts lyses, and flap necrosis) during hospitalization
and time from wounding to granulation formation were analyzed
with respect to the use of HBO therapy as a risk factor. Odds ratio (OR) with
95% confidence intervals (CI) was calculated for the occurrence of wound complications
with respect to HBO therapy and adjusted for NATO surgical strategy
by logistic regression.
Results Of 388 patients, 310 (80%) were initially treated according to the
NATO surgical strategy and 99 (25%) received HBO therapy. Deep soft-tissue
infection developed in 196 (68%) patients who did not receive HBO therapy
and in 35 (35%) who received it (P<0.001, χ2 test). Osteomyelitis developed in
214 (74%) patients who did not receive HBO therapy and in 62 (63%) who received
it (P = 0.030). Skin graft lysis occurred in 151 (52%) patients who did not
receive HBO therapy and in 23 (23%) who received it (P<0.001). Flap necrosis
occurred in 147 (51%) patients who did not receive HBO therapy and in 15
(15%) who received it (P<0.001). Median time to granulation formation was 9
(5-57) days in patients who received HBO therapy, and 12 (1-12) days in those
who did not (P<0.001, Mann-Whitney test). These results were consistent over
the groups of patients stratified according to the wound severity and remained
unaltered after the adjustment for NATO surgical strategy. The effect of HBO
therapy was greater in non-NATO than in NATO treated patients in case of
deep soft-tissue infection (OR, 10.7 vs OR, 3.8; P = 0.031 for interaction).
Conclusion HBO therapy reduced the frequency of wound complications in
patients with Gustilo type III wounds and shortened the time to granulation
formation. HBO therapy was more effective in non-NATO than in NATO
treated patients for the prevention of deep soft-tissue infection but not flap necrosis.
Keywords
complications; hyperbaric oxygenation; surgical procedures, operative; war; wounds and injuries
Hrčak ID:
26173
URI
Publication date:
15.4.2008.
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