Hyperbaric oxygen therapy for pediatric “hypospadias cripple”devaluating the advantages regarding graft take

SummaryIntroductionHypospadias cripple patients pose a major surgical chal lenge with high complication rates attributed mainly to graft contraction. Hyperbaric oxygen therapy (HBOT) is an established treatment for compromised grafts and used extensively as a salvage therapy for compromised grafts and ischemic non-healing wounds.ObjectiveWe evaluated the graft-take rates in hypospadias cripple cases undergoing a staged tubularized autograft repair (STAG) and compared between patients treated with orwithout preemptive HBOT.Materials and methodsAll patients underwent a STAG. Patients receiving pre emptive HBOT were compared with patients receiving the standard surgical procedure without HBOT. The HBOT pro tocol included a daily session, 5 days per week for four weeks before the surgery and 10 additional daily sessions immediately after first-stage surgery. Each HBOT sessionincluded 90 min exposure to 100% O2 at 2 atmospheres ab solute with 5 min air breaks every 20 min. The primary endpoint was graft take. Sequential tubularization withouttension at second stage was defined as success.ResultsSeven boys received HBOT and 14 boys comprised the con trol group. All patients in the HBOT group had good graft take with no graft contraction. In the control group, 57%had good graft take and could proceed to the second-stage surgery and 43% had graft contraction (Table). Except for one patient who had claustrophobia while entering thechamber, no significant side-effects developed during the HBOT.DiscussionThe basic pathophysiology of compromised flaps includes both ischemia and reperfusion injury, which can be atten uated by HBOT. The beneficial effects of HBOT relates to several mechanisms, including hyperoxygenation, fibroblast proliferation, collagen deposition, angiogenesis, and vas culogenesis. Graft contraction is a well-known complication in hypospadias cripple population with reported failure rate of 39e63%. The HBOT procedure was found to be very effective and the entire HBOT group had a good graft take.Accordingly, all patients in the HBOT group proceeded to a successful second-stage tubularization. In addition, HBOT was found to be safe and generally well tolerated by thispediatric population. Study limitations were a relative small, non-homogenous sample size and lack of prospective randomization. Success was defined as sufficient graft elasticity sufficing for tubularization of the neourethra, and exact graft measurements are lacking in this study.Conclusions Preemptive HBOT can be used safely in the hypospadias cripple pediatric population and can potentially reduce the expected high surgical failure secondary to graft contraction

Categories: Medical clinic, Pediatrics, Surgery and transplant