Hyperbaric Oxygen

Hyperbaric oxygen (HBO) has been used as an adjunct in the treatment of Fournier's gangrene. The usual protocol is multiple sessions at 2.5 atm for 90 min with 100 % oxygen inhalation every 20 min (Pizzorno et al. 1997).

HBO increases oxygen tension levels in the tissues and has various beneficial effects on wound healing. Oxygen free radicals are liberated from hypoxic tissues, which are directly toxic to anaerobic bacteria. Fibro-blast activity increases, with subsequent angiogenesis leading to accelerated wound healing.

However, HBO is expensive and logistically cumbersome. It is contraindicated where closed air spaces in the body can cause damage due to expansion upon returning to normal atmospheric pressure, such as sinusitis, otitis media, asthma, and bullous pulmonary disease. Care should be taken with diabetic patients, as hy-poglycemia may be exacerbated by HBO.

Some authors question the efficacy of empirical HBO, suggesting that patients should be selected only if there is large body surface area involvement or poorly responding anaerobic infection. It is important to note that HBO is only an adjunct and should not delay prompt antibiotic therapy and surgical debridement (Paty and Smith 1992; Laucks 1994; Benizri et al. 1996; Pizzorno et al. 1997; Mindrup et al. 2005).

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