Hyperbaric
oxygen improved wound healing and infection rates in previously irradiated
patients requiring major soft-tissue procedures.
Clinical Bottom Line:
1.
The application of a 20/10 protocol of hyperbaric oxygen treatment before and
after major soft-tissue repair into an irradiated area resulted in improved
wound healing and lower infection rates.
Appraised
by: Mike Bennett, Dept of Diving and
Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Thursday, 15 April 1999
Clinical
Scenario: A patient presented requiring a
myocutaneous flap to cover a previously irradiated area. We wondered if
hyperbaric oxygen would improve healing.
Three-part
Question: In patients requiring soft
tissue flaps into an area previously irradiated with at least 6,400 cGy, does
the peri-operative administration of hyperbaric oxygen result in improved wound
healing and successful grafting?
Search
Terms: radiotherapy, soft-tissue
grafts
The
Study:
Randomised controlled trial, no
detail.
Patients requiring major soft
tissue surgery or flap introduction into a previously irradiated area.
Control group (N = 80; 80
analysed): Usual peri-operative program with surgery as planned.
Experimental group (N = 80; 80
analysed): As above, but given 20 treatments breathing 100% oxygen at (?2.4ATA)
before surgery and 10 similar treatments following surgery
The
Evidence:
|
Outcome |
Time
to Outcome |
Control
group |
HBO
group |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
Major
wound breakdown |
unknown |
0.325 |
0.038 |
88% |
0.287 |
3 |
|
95%
CI: |
|
|
|
54%
to 100% |
0.176
to 0.398 |
3
to 6 |
|
Wound
infection |
unknown |
0.237 |
0.063 |
73% |
0.174 |
6 |
|
95%
CI: |
|
|
|
28%
to 100% |
0.067
to 0.281 |
4
to 15 |
|
Extended
hospital stay to heal |
unknown |
0.55 |
0.113 |
79% |
0.437 |
2 |
|
95%
CI: |
|
|
|
56%
to 100% |
0.308
to 0.566 |
2
to 3 |
Comments:
1. Brief report in a textbook
only. No peer review or methodology details.
2. The author used hyperbaric
oxygen as part of the protocol to heal wounds with delayed healing or dehiscence
in both groups in this study. The numbers of wounds ultimately healed is not
given.
Expiry date: April 2003
References:
1. Marx RE. Clinical applications of hyperbaric oxygen. In:
Hyperbaric Medicine Practice, 2nd edition,Kindwall EP (ed). Best Publishing, Arizona
1999:681-682.
