HBO IN THE TREATMENT OF CRUSH INJURY

Evaluation of the use of HBO in the multidisciplinary treatment of upper limb trauma with complete or incomplete section, reïmplantation or reconstruction using musculocutaneous flap(s).

Multiplace hyperbaric chamber in hospital setting – closely connected to ICU environment

Transcutaneous oxygen pressure monitoring (PtcO2)

• 4 electrodes in traumatised area
• 2 controlateram electrodes
• 1 reference subclavicular electrode

• Domestic, industrial or traffic trauma to upper limb, necessitating urgent plastic surgery intervention
• Age > 18 years
• Informed consent
• Multidisciplinary treatment initiated < 4 hours post-trauma

• Age < 18 years
• Patient refusal
• Contra-indications for HBO therapy
• Concurrent pathology: diabetes, (symptomatic) arteriosclerosis, psychiatric illness
• Haemodynamic instability necessitating vasoactive drugs
• Pregnancy

• After urgent surgical stabilisation, ENT evaluation and pre-hyperbaric examination: randomisation into one of two treatment groups
• HBO group:
• day 1: 1 HBO treatment, 90 min 2.5 ATA 100% O₂
• days 2 – 10 : 2 HBO treatments / day, 90 min, 2.5 ATA, 100% O₂
• duration of HBO treatment : to be determined
• non-HBO group:
• classical treatment, no HBO
• Evaluation of skin oxygenation at traumatised limb: daily in all patients
• In HBO group: rise in PTcO₂ = "responder" (cfr. Lille protocol for diabetics) – if "non-responder" after three days of treatment: secondary exclusion from study
• Associated therapeutical measures:
• Early surgical intervention with re-operation as required
• Daily wound dressing changes, photographic evaluation
• Antibiotics – first on empirical grounds, then according to culture
• Adequate analgesia