Hyperbaric Oxygen Therapy in Plastic Surgery.ppt

HBOT Mechanism in wound healing

1. COMMAND CLINICAL
MEETING
29 DEC 202229 DEC 2022

2. UTILITY OF HBOT IN
PLASTIC SURGERY

3. Hyperbaric Oxygen
has been described as
“A therapy in search of diseases”

4. Indications in Plastic Surgery

Vascular Compromise Vascular Compromise

Infective Conditions Infective Conditions

Problem Wounds Problem Wounds

Radiation Injury Radiation Injury

Burns Burns

Neurological Neurological

5. VASCULAR COMPROMISE INDICATIONS

Compromised Skin Flaps and Grafts Compromised Skin Flaps and Grafts

Reimplanted Severed limbs and digits Reimplanted Severed limbs and digits

Tendon and ligament injuries, repaired Tendon and ligament injuries, repaired

Crush / degloving injuriesCrush / degloving injuries

Compartment SyndromeCompartment Syndrome

Fracture healing and nonunion Fracture healing and nonunion

Bone grafting Bone grafting

Peripheral arterial insufficiency Peripheral arterial insufficiency

Buerger's disease, TAO Buerger's disease, TAO

Frostbite Frostbite

6. Infective Conditions

Myonecrosis Myonecrosis

Clostridial Clostridial

Non-Clostridial Non-Clostridial

Necrotising Fasciitis Necrotising Fasciitis

Chronic Osteomyelitis Chronic Osteomyelitis

Refractory Mycoses Refractory Mycoses

LeprosyLeprosy

Actinomyces israelii infectionsActinomyces israelii infections

7. Problem Wounds

Diabetic Ulcers Diabetic Ulcers

Venous UlcersVenous Ulcers

Arterial insufficiency UlcersArterial insufficiency Ulcers

Stump healing problems Stump healing problems

Decubitus Ulcers Decubitus Ulcers

Sternal wound dehiscence Sternal wound dehiscence

Spider BiteSpider Bite

Snakebite - rattlesnakeSnakebite - rattlesnake

8. Delayed Radiation Injury

Osteoradionecrosis Osteoradionecrosis

Soft Tissue RadionecrosisSoft Tissue Radionecrosis
Burns

HeatHeat

Smoke inhalationSmoke inhalation

Electrical Electrical

Neurological Neurological

Bell’s palsyBell’s palsy

Peripheral neuropathyPeripheral neuropathy

9. Mechanisms of Action of HBOT
Increases Increases O
2
concentration in all tissues,
even with reduced blood flow
 
Hyperoxic Vasoconstriction  edema
Rebound arterial dilatation after HBOT,
improves bl flow to compromised organs
 
Stimulates adaptive increase in SOD
(superoxide dismutase) - antioxidant

10. Cellular & biochemical benefits

Promotes Promotes angiogenesis and wound healing and wound healing
fibroblast fibroblast  collagen & fibronectin collagen & fibronectin 
Neovascularization

Reduces Reduces WBC adhesion in in reperfusion
injury, preventing release of proteases & , preventing release of proteases &
free radicals which cause vasoconstriction free radicals which cause vasoconstriction
and cellular damage and cellular damage

11. HBO actions which combat infection

Tissue rendered hypoxic by infection Tissue rendered hypoxic by infection
is supported by Ois supported by O
22

Bacterial growth is inhibitedBacterial growth is inhibited
Bactericidal to anaerobes

Bacteriostatic to many
microaerophils and some species of
Escherichia and Pseudomonas,
Salmonella, Shigella and Proteus

12. HBO actions which combat infection
Restores neutrophil killing of aerobic
bacteria in previously hypoxic tissues &
makes it better than normal
Machrophage activity is enhanced
Inhibits release of clostridial alpha toxins
Antagonises the harmful effects of E. coli
endotoxin
Antibiotic action is potentiated.
Fluoroquinolones, amphotericin B,
aminoglycosides, vancomycin , vancomycin

13. Distally based
calf flap
vascular compromise

14. Lt medial
Decrease edema, improve oxygenation, limit
muscle necrosis, help neurological recovery
Rt medial

15. REIMPLANTATION
Decrease reperfusion injury
Improve oxygenation

16. Blast Injury

17. Crush injury

18. Degloving injury

19. HBOT used to avert
possibility of
non-union &
osteomyelitis

20. Latissimus Dorsi myo-cut free flap
Aid flap survival & bone regeneration

21. Osteomyelitis

22. Electric Burns

23. Burns &
Inhalation
Injury

25. Necrotizing Fasciitis

27. Cervical Necrotizing
Soft Tissue Infection

28. 48 hrs later
2
nd
wide excision
Wide excision
Mucormycosis
HBOT potentiates action
of amphotericin B,

29. Inguinal liposarcoma
Post- radiation NSTI &
bone necrosis

34. Snakebite

35. Sacral pressure sore

36. Stump healing problems