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Successful treatment of frostbite with hyperbaric oxygen treatment.

Dwivedi DA, Alasinga S, Singhal S, Malhotra VK, Kotwal A - Indian J Occup Environ Med (2015 May-Aug)

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, 153-GH, Leh, Jammu and Kashmir, India.

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Dear Sir, A 22-year-old soldier with no comorbidities was air-evacuated from height of ~18,000 feet to this center located at 11,500 feet with black discoloration and loss of sensation in a great toe and first two digits of the right foot... Then, he felt tingling sensation in his feet and also noticed that the tips of great toe and first two digits of the right foot had blackened/grey appearance... With no significant response with supportive care, literature on management of frostbite was reviewed... As per documented benefit of hyper-baric oxygen therapy (HBOT) in various case reports, we thought of early HBOT, which may avoid the amputation in a young soldier... In the scenario of inadequate response to routine medical management, the patient showed a remarkable response to HBOT showing complete recovery with no requirement of debridement or distal amputation... In the case report describing frostbite in an 11 years boy with third degree frostbite (as in our patient) in fingers of both hands HBOT for 14 days resulted in complete recovery without affecting the epiphysis... The possible mechanisms by which HBOT is likely to benefit in frostbite is reduced reperfusion injury possibly due to reduced endothelial adherence of neutrophils by b2 integrins and improved microvascular endothelial oxidative stress resistance, cell proliferation and tube formation... Better endothelial oxidative stress resistance contributes to better microvascular recovery and salvage of damaged tissue... In addition to these benefits, HBOT does affect the antibacterial functions of neutrophils this promotes effective healing even in cases of infections... Frostbite is a condition common in physically active individuals venturing in areas of extreme cold for occupational or recreational activities... The condition is associated with considerable morbidity especially postamputation in otherwise a young and productive population... Hyperbaric oxygen therapy can be considered as an effective adjunct to mainstay therapy in cases of frostbite to minimize posttreatment sequelae.

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Remarkable recovery after hyperbaric oxygen therapy
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Figure 2: Remarkable recovery after hyperbaric oxygen therapy

Mentions: In our hospital, examination revealed that the patient's involved areas were blackened and hard to touch. Based on history of cold exposure, symptoms and signs of absence of capillary circulation in affected toes, blackish discoloration and absence of superficial and deep sensation patient was diagnosed to have frostbite-grade-III [Figure 1]. Initially patient was continued on re-warming with lukewarm water, tablet pentoxifylline, and analgesics. With no significant response with supportive care, literature on management of frostbite was reviewed. As per documented benefit of hyper-baric oxygen therapy (HBOT) in various case reports, we thought of early HBOT, which may avoid the amputation in a young soldier. He was started on HBOT (2.0 ATA, total time: 90 min/session, twice/day) along with the continuation of basic medical care. On 5th day of his hyper-baric oxygen (HBO) treatment, the tissue color showed improvement in patches at the tip of great toe. After receiving 20 HBO sessions, and basic medical care over a period of 14 days, the patient had a remarkable recovery [Figure 2].


Successful treatment of frostbite with hyperbaric oxygen treatment.

Dwivedi DA, Alasinga S, Singhal S, Malhotra VK, Kotwal A - Indian J Occup Environ Med (2015 May-Aug)

Remarkable recovery after hyperbaric oxygen therapy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596071&req=5

Figure 2: Remarkable recovery after hyperbaric oxygen therapy
Mentions: In our hospital, examination revealed that the patient's involved areas were blackened and hard to touch. Based on history of cold exposure, symptoms and signs of absence of capillary circulation in affected toes, blackish discoloration and absence of superficial and deep sensation patient was diagnosed to have frostbite-grade-III [Figure 1]. Initially patient was continued on re-warming with lukewarm water, tablet pentoxifylline, and analgesics. With no significant response with supportive care, literature on management of frostbite was reviewed. As per documented benefit of hyper-baric oxygen therapy (HBOT) in various case reports, we thought of early HBOT, which may avoid the amputation in a young soldier. He was started on HBOT (2.0 ATA, total time: 90 min/session, twice/day) along with the continuation of basic medical care. On 5th day of his hyper-baric oxygen (HBO) treatment, the tissue color showed improvement in patches at the tip of great toe. After receiving 20 HBO sessions, and basic medical care over a period of 14 days, the patient had a remarkable recovery [Figure 2].

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, 153-GH, Leh, Jammu and Kashmir, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Sir, A 22-year-old soldier with no comorbidities was air-evacuated from height of ~18,000 feet to this center located at 11,500 feet with black discoloration and loss of sensation in a great toe and first two digits of the right foot... Then, he felt tingling sensation in his feet and also noticed that the tips of great toe and first two digits of the right foot had blackened/grey appearance... With no significant response with supportive care, literature on management of frostbite was reviewed... As per documented benefit of hyper-baric oxygen therapy (HBOT) in various case reports, we thought of early HBOT, which may avoid the amputation in a young soldier... In the scenario of inadequate response to routine medical management, the patient showed a remarkable response to HBOT showing complete recovery with no requirement of debridement or distal amputation... In the case report describing frostbite in an 11 years boy with third degree frostbite (as in our patient) in fingers of both hands HBOT for 14 days resulted in complete recovery without affecting the epiphysis... The possible mechanisms by which HBOT is likely to benefit in frostbite is reduced reperfusion injury possibly due to reduced endothelial adherence of neutrophils by b2 integrins and improved microvascular endothelial oxidative stress resistance, cell proliferation and tube formation... Better endothelial oxidative stress resistance contributes to better microvascular recovery and salvage of damaged tissue... In addition to these benefits, HBOT does affect the antibacterial functions of neutrophils this promotes effective healing even in cases of infections... Frostbite is a condition common in physically active individuals venturing in areas of extreme cold for occupational or recreational activities... The condition is associated with considerable morbidity especially postamputation in otherwise a young and productive population... Hyperbaric oxygen therapy can be considered as an effective adjunct to mainstay therapy in cases of frostbite to minimize posttreatment sequelae.

No MeSH data available.