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HBO & Compartment Syndrome

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Compartment Syndrome: In compartment syndrome, pressures in skeletal muscle compartments are sufficiently raised to reduce or halt vascular flow and for this reason, prompt surgical decompression is the accepted first treatment to restore tissue perfusion. Fasciotomy may be performed entirely on clinical grounds, or proposed when measured compartmental interstitial pressures exceed 30mmHg. Yet following inadvertent calf compression and intra-operative hypotension, intra-compartmental calf pressures in excess of 35mmHg have been controlled by prompt HBO treatment without the need for fasciotomy (Van Poucke S, Leenders T, Saldien V, Verstreken J, Beaucourt L, Adriaensen H. 2001 Hyperbaric oxygen (HBO) as useful, adjunctive therapeutic modality in compartment syndrome. Acta Chir Belg, 101: 73-74).

In another series, ten symptomatic patients were treated with HBO when compartment pressures were elevated between 15 and 48mmHg, but before surgery was indicated. All recovered without the need for surgery (Strauss MB, Hart GB. 1989. Hyperbaric oxygen and the skeletal muscle compartment syndrome. Contemp Orthop, 18: 167-174). It is not suggested that HBO therapy should replace fasciotomy in established cases. Yet in presentations where compartment syndrome is a risk, the early addition of HBO into the standard care of repeated examination and pressure readings may prevent progression. No randomised trials have been performed into this pre-operative indication. In the post-operative phase following fasciotomy, the potential for preservation of marginally ischaemic tissue provide good reason for considering adjunctive treatment with HBO (Greensmith JE. 2004. Hyperbaric oxygen therapy in extremity trauma. J Am Acad Orthop Surg, 12: 376-384).

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