Marx1
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: December 2019
References: 1. Marx RE. Clinical applications of hyperbaric oxygen. In: Hyperbaric Medicine Practice, 2nd edition,Kindwall EP (ed). Best Publishing, Arizona 1999:681-682.
