Is hyperbaric oxygen therapy indispensable for saving mutilated hand injuries

AbstractMutilated hand injuries are a profound challenge to the plastic surgeon, and suchinjuries often lead to limb loss and severe functional impairment. Hyperbaric oxygentherapy (HBOT) appears to counteract tissue hypoxia and stimulate acute woundhealing. This study was performed to evaluate the efficacy of HBOT as an adjunctivetherapy in patients with a mutilated hand injury. Between January 2006 and December2014, 45 patients with a mutilated hand injury were enrolled. After reconstructionor revascularisation, patients underwent 120 minutes of HBOT with oxygen at 2⋅5atmospheres absolute while breathing 100% oxygen. Outcomes such as amputeesurvival and surgery-related complications were recorded. The patients were 38 menand 7 women with average age of 37⋅2 years (range 18–62). The mean defect area was131⋅5 cm2 (range 40–300). Most patients experienced a pure crush injury (53%). Theaverage number of operations from the initial debridement to the first reconstructionwas 3⋅8 (range 1–6). A total of 33 patients (73%) underwent replantation during theinitial reconstruction. For flap coverage, most patients received a free flap using ananterolateral thigh flap (18 patients) or local flap using an abdomen/groin flap (ninepatients). The average time from the first reconstruction or revascularisation to the firstHBOT was 6⋅5 hours (range 2–12). The average number of HBOT sessions was 9⋅1(range 6–14 sessions). The survival rate of the replanted fingers was 81%, and thesurvival rate of the palms was 100%. Most complications in the initial reconstructioninvolved partial loss of an avulsed flap, and most complications in the chronic stage(≥3 months) involved scar contracture. When combined with delicate microsurgery,early intervention using adjunctive HBOT was effective in preserving partially viabletissue and restoring hand function in patients with a mutilated hand injury.