title: Severe lower limb crush injury and the role of hyperbaric oxygen treatment: a case report.
abstract: Open fractures with severe soft-tissue injury and critical local ischaemia of the lower limbs are usually difficult to treat and require a multidisciplinary approach. A 33-year-old Caucasian female with crush injury of the right foot (Gustillo IIIC) was admitted to hospital after a car accident. Despite surgical interventions, a persistent state of hypoxia was present because of the severe vessel injury, and amputation was suggested. Seventy-two hours after admission she was referred to the hyperbaric medicine unit for hyperbaric oxygen treatment (HBOT) to define the limits of viable tissues prior to amputation. After six sessions, clinical improvement was so obvious that the decision to amputate was rejected and she underwent a total of 32 HBOT in addition to frequent debridement and administration of antibiotics. After the HBOT course, she underwent successful surgical reconstruction with a vascularised cutaneous flap. Full healing was achieved. Given the fact that hyperbaric oxygen mechanisms of action target the pathophysiology of crush injuries it should be considered not only for the definition of viable tissue limits but also to enhance viability, even in the most serious situations. HBOT may prove a valuable supplement in the therapeutic armamentarium of these patients.
authors.affiliation: Hyperbaric and Diving Medicine Department, St Paul General Hospital, Thessaloniki, Greece.
authors.forename: Styliani
authors.initials: S
authors.lastname: Stefanidou
authors.affiliation: Hyperbaric and Diving Medicine Department, St Paul General Hospital, Thessaloniki, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Kotsiou
authors.affiliation: Hyperbaric and Diving Medicine Department, St Paul General Hospital, Mitropoleos 99 54622, Thessaloniki, Greece Phone: +30-(0)6937-392662, Fax: +30-(0)2310-451727, E-mail: hyperbaricunit@yahoo.gr.
authors.forename: Theodore
authors.initials: T
authors.lastname: Mesimeris
mesh_terms: D000328:Adult; D003444:Crush Syndrome / Q000628:therapy*; D005260:Female; D018409:Foot Injuries / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Hyperbaric oxygen therapy; case reports; trauma and stress; wounds