Hyperbaric oxygen therapy accelerates vascularization in keratinized oral mucosal surgical flaps

PD22-12 COMPARISON OF OUTCOMES AFTER PRIMARY ARTIFICIAL URINARY SPHINCTER PLACEMENT IN POST-RADIATION PATIENTS WITH AND WITHOUT HYPERBARIC OXYGEN THERAPY

Brain abscesses are still characterized by substantial case fatality rates and a high risk of permanent functional impairment. Standard treatment consists of long-term antimicrobial therapy and various neurosurgical interventions. In a few institutions, hyperbaric oxygen therapy (HBOT) is used as an additional treatment modality. The purpose of this study was to evaluate the effects of adjuvant HBOT on neurological and radiological outcomes in patients with brain abscesses. 55 patients with brain abscesses treated at the Medical University Clinic of Graz between 2004 and 2022 were included in this retrospective analysis. Thirty patients (54.5%) received standard therapy, consisting of long-term antimicrobial therapy and at least one neurosurgical intervention. Twenty-five patients (45.5%) additionally underwent HBOT. After three months, 24% of patients in the HBOT group and 10% in the non-HBOT group exhibited no residual abscess or pathological enhancement; at six-month follow-up, the percentage increased to 80% in the HBOT group compared to 46.7% in the non-HBOT group (p = 0.009). At 12-month follow-up, a symptom-free status (modified Rankin Scale 0) was attained by 60% of HBOT group patients and 30% of non-HBOT group patients (p = 0.046). The 12-month mortality rates for HBOT and non-HBOT groups were 12% (n = 3) and 20% (n = 6), respectively. No adverse effects related to HBOT were noted. Adjuvant HBOT significantly improved radiological outcome after 6 months, neurological outcome after 12 months and reduced mortality. HBOT may be taken into consideration in all patients with brain abscesses, particularly in cases with deep seated or multiple lesions and when antimicrobial and surgical treatment had failed.

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2-3 trial.

To evaluate the effects of hyperbaric oxygen therapy (HBOT) on inflammation, oxidative stress, and bladder damage in a cyclophosphamide (CP)-induced hemorrhagic cystitis (HC) rat model. Forty male Wistar albino rats received a single intraperitoneal dose of 200mg/kg CP to induce HC. Rats were assigned to either the HBOT or control groups and sacrificed on days 3, 7, and 14. The HBOT group received 6, 14, or 28 sessions of 100% oxygen at 2.4 ATA for 90min. Outcomes included mortality, weight loss, bladder weight, macroscopic edema and hemorrhage scores, histopathology, Ki-67 immunostaining, and levels of cytokines (IL-1β, IL-4, IL-6, MCP-1, TNF-α) and malondialdehyde in bladder tissue, serum, and urine. Cytokines were quantified using the Luminex assay and malondialdehyde by ELISA. Mortality and weight loss were similar between groups. On day 3, the HBOT group showed significantly lower bladder weights and hemorrhage scores (p < 0.01), with no significant differences in edema. On day 7, IL-1β and MCP-1 levels were higher in the HBOT group (p = 0.02). Malondialdehyde levels were significantly elevated in the control group on day 3. Histopathological and other cytokine findings showed no significant differences. HBOT may provide early but transient benefits in alleviating HC based on macroscopic findings; however, these effects were not supported by sustained histopathological or molecular improvements. The high-dose CP model may have masked the potential therapeutic effects of HBOT. Further studies using lower or fractionated CP dosing and extended observation periods are warranted to better evaluate the therapeutic potential of HBOT.

Background: Postoperative scarring can significantly impact physical function, aesthetic outcomes, and overall quality of life. Effective scar management is crucial to mitigate these effects. This study aimed to compare the efficacy of silicone sheets (SS) and hyperbaric oxygen therapy (HBOT) in minimizing postoperative scar formation and improving wound healing outcomes. Methods: A total of 40 patients with clean, non-infected linear postoperative wounds were enrolled in a 12-week prospective observational study. Participants were randomly assigned to either the HBOT or SS group. The HBOT group underwent seven sessions of HBOT starting 4 weeks postoperatively, while the SS group applied silicone sheets to the wound from 4 to 12 weeks postoperatively. Scar outcomes were evaluated at 4, 8, and 12 weeks using the Patient and Observer Scar Assessment Scale (POSAS), which measures various parameters, including vascularity, pigmentation, thickness, relief, pliability, surface area and overall opinion. Results: After applying exclusion criteria, 33 patients completed the study, with 18 in the HBOT group and 15 in the SS group. Both interventions significantly improved scar parameters such as vascularity, thickness, relief, pliability, and overall opinion over 12 weeks. SS was particularly effective in reducing pigmentation, while HBOT achieved greater reductions in scar surface area. By the study's conclusion, SS demonstrated superior outcomes in vascularity, pigmentation, scar thickness, relief, pliability, and overall appearance, whereas HBOT excelled in reducing surface area. Conclusion: Both HBOT and SS are effective scar management options, each with unique benefits. Selecting the appropriate treatment based on patient-specific needs and wound characteristics is essential to achieve optimal outcomes and enhance patient satisfaction.

To review surgical outcomes in the management of advanced mandibular osteoradionecrosis (ORN) with aggressive debridement and microvascular reconstruction. Retrospective cohort study. Tertiary care referral center. Thirty patients with Marx stage III ORN of the mandible who underwent debridement with microvascular reconstruction. Two types of patients with stage III disease were included: those who had not received prior hyperbaric oxygen (HBO) therapy but who presented with a pathologic fracture, orocutaneous fistula, or bony resorption of the inferior border of the mandible (group 1, n = 9), and those who were classified as having stage III disease as a result of failure of previous debridement and HBO therapy (group 2, n = 21). Clinical resolution of ORN as well as surgical perioperative complications. Debridement and primary free flap reconstruction in all patients; Perioperative HBO therapy in 3 patients. The overall complication rate was 43%, but 29 (97%) of 30 patients had clinical resolution of their ORN. There were no flap failures. After smoking status and use of perioperative HBO were adjusted for, patients with Marx stage III disease who had received prior HBO therapy (group 2) were significantly more likely to have postoperative wound infection (P =.01) and overall surgical complications (P =.04) than were patients with stage III disease who had never been treated with HBO (group 1). Perioperative HBO therapy was provided too infrequently to comment on its effectiveness. Microvascular reconstruction is effective in the treatment of patients with mandibular ORN. Management of mandibular ORN can be successfully achieved without the use of perioperative HBO therapy. Because only 3 patients received perioperative HBO therapy, we are unable to comment on its potential benefit. Patients in whom prior HBO therapy has failed are significantly more likely to have surgical complications than are other patients with Marx stage III disease, and further study is required to improve outcomes in this subgroup of patients.

The effects of hyperbaric oxygen treatment for non-arteritic central retinal artery occlusion (HBOT-CRAO).

Idiopathic sudden sensorineural hearing loss (ISSNHL) is an otologic emergency for which hyperbaric oxygen therapy (HBOT) is a potential treatment. This study aimed to evaluate the effectiveness of HBOT in treating ISSNHL, with a focus on the timing of treatment and its impact on hearing outcomes, while also considering other factors such as demographic characteristics, clinical parameters, and treatment methods. This retrospective cohort study analysed 70 ISSNHL patients (April 2019 to August 2024) who received steroid treatment (oral, intratympanic or both). Patients were divided into early HBOT (< 12 days), late HBOT (13-22 days), salvage HBOT (> 22 days), and no HBOT groups. Hearing improvement, measured by pure-tone audiometry (PTA), defined the treatment outcome. Significant PTA improvements were observed in most groups (median changes: early HBOT 33.8 dB [n = 15], late HBOT 6.9 dB [n = 16], salvage HBOT 0.0 dB [n = 5], no HBOT 11.9 dB [n = 34]), with early HBOT showing greater gains than late HBOT (P < 0.001), salvage HBOT (P = 0.001), and no HBOT (P = 0.002). Receiver operating characteristic (ROC) analysis indicated that treatment within 10.5 days predicted marked improvement (AUC = 0.883, P < 0.001), and linear regression showed that each day's delay reduced PTA improvement by 0.832 dB (P < 0.001). HBOT is effective in restoring hearing in patients suffering from ISSNHL and early treatment is associated with better outcome.

Hyperbaric Oxygen Therapy for Late-Onset Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation and Effective Factors Prediction

BackgroundAcute ischemic stroke is a leading cause of mortality and long-term disability, and profiles of endothelial progenitor cells (EPCs) reflect the degree of endothelial impairment. This study tested the hypothesis that hyperbaric oxygen therapy (HBOT) both improves the clinical short-term outcomes and increases the number of circulating EPCs and antioxidant capacity.MethodsThe numbers of circulating EPCs [CD133+/CD34+ (%), KDR+/CD34+ (%)], biomarkers for oxidative stress (thiols and thiobarbituric acid-reactive substances), and clinical scores (National Institutes of Health Stroke Scale [NIHSS], Barthel index [BI], and modified Rankin Scale [MRS]) were prospectively evaluated in 25 patients with acute non-cardioembolic stroke under HBOT at two time points (pre- and post-HBOT). The biomarkers and clinical scores were compared with those of 25 age- and sex-matched disease controls.ResultsThe numbers of KDR+/CD34+ (%) in the HBOT group following HBOT increased significantly, whereas the numbers of CD133+/CD34+ (%) also showed a tendency to increase without statistical significance. The mean high-sensitivity C-reactive protein levels showed significant decrease post-HBOT follow-up in the HBOT group. The changes in KDR+/CD34+EPC (%) numbers were positively correlated with changes in clinical outcomes scores (BI, NIHSS, and MRS) in the HBOT group.ConclusionsBased on the results of our study, HBOT can both improve short-term clinical outcomes and increase the number of circulating EPCs in patients with acute non-cardioembolic stroke.

Hyperbaric oxygen therapy (HBOT) is a clinical treatment in which a patient breathes pure oxygen for a limited period of time at an increased pressure. Although this therapy has been used for decades to assist wound healing, its efficacy for many conditions is unproven and its mechanism of action is not yet fully clarified. This study investigated the effects of HBOT on wound healing using a diabetes-impaired pressure ulcer rat model. Seven weeks after streptozotocin-induced diabetes in rats (n = 55), a pressure ulcer was created on dorsal skin. Subsequently, animals received HBOT during 6 weeks following a standard clinical protocol (HBOT group with varying endpoints up to 42 days post-wounding) versus controls without HBOT. Capillary venous oxygen saturation (SO2) showed a significant increase in the HBOT group on day 24; however, this increase was significant at this time point only. The quantity of hemoglobin in the micro-blood vessels (rHB) showed a significant decrease in the HBOT group on days 21 and 42, and showed a trend to decrease on day 31. Blood flow in the microcirculation showed a significant increase on days 17, 21 and 31 but a significant decrease on days 24 and 28. Inflammation scoring showed significantly decreased CD68 counts in the HBOT group on day 42, but not in the early stages of wound healing. Animals in the HBOT group showed a trend for an increase in mean wound breaking strength on day 42.

IntroductionSeveral urological conditions that share an impairment of tissue oxygenation can benefit from hyperbaric oxygen therapy; limited evidence is available of its impact on patients undergoing male‐to‐female gender affirmation surgery.AimTo evaluate the efficacy and safety of hyperbaric oxygen therapy as adjuvant treatment for surgical site infections in patients undergoing male‐to‐female gender affirmation surgery.MethodsThis research was conducted as an observational retrospective study. Patients undergoing male‐to‐female gender affirmation surgery at the principal investigators’ institution from January 2009 to September 2019, with a discharge diagnosis of complicated superficial or deep wound infections, were included. All patients underwent standard management of wound infection. Subjects received/not‐received hyperbaric oxygen therapy at the surgeon's discretion and were assigned to the hyperbaric oxygen therapy versus non‐hyperbaric oxygen therapy group accordingly. Complete wound healing rate (primary outcome), duration of antibiotic therapy, perineal drain time, bladder catheter time, and hospital stay were recorded. All adverse events that occurred during the study period were described.ResultsA total of 156 patients underwent male‐to‐female gender affirmation surgery in the study period. Thirty‐three patients were enrolled. Fifteen subjects belonged to the hyperbaric oxygen therapy group, the other 18 to the non‐hyperbaric oxygen therapy group. No statistically significant differences were found between the two groups at baseline. Penile inversion vaginoplasty and intestinal vaginoplasty were performed in nine (60%) and six (40%) patients of the hyperbaric oxygen therapy group. Only penile inversion vaginoplasty was performed in subjects of the non‐hyperbaric oxygen therapy group. Complete wound healing was obtained in 15 patients (100%) of the hyperbaric oxygen therapy group and 17 patients (94.4%) of the non‐hyperbaric oxygen therapy group (p = 0.35). Duration of antibiotic therapy, perineal drain time, bladder catheter time, and hospital stay were significantly lower in the hyperbaric oxygen therapy group (p < 0.05).ConclusionOur preliminary data suggest a role of hyperbaric oxygen therapy as adjuvant treatment for surgical site infection in patients undergoing male‐to‐female gender affirmation surgery. Randomized controlled trials properly powered are needed to confirm our findings.

Background: Neuronal apoptosis and inflammation in the ventral horn of the spinal cord contribute to denervated muscle atrophy post-burn. Hyperbaric oxygen therapy (HBOT) exerts anti-inflammation and neuroprotection. Furthermore, hypoxia-inducible factor (HIF)-1α has been reported to promote inflammation and apoptosis. We investigated the therapeutic potential of HBOT and the role of HIF-1α post-burn.Methods: Sprague-Dawley rats were divided into three groups: a control group, an untreated burn group receiving burn and sham treatment, and a HBOT group receiving burn injury and HBOT. The burn injury was induced with 75ºC ± 5ºC at the right hindpaw. HBOT (100% oxygen at 2.5 atmosphere, 90 min/day) and sham HBOT (21% oxygen at 1 atmosphere, 90 min/day) was started on day 28 after burn injury and continued for 14 treatments (days 28-41). Incapacitance (hind limb weight bearing) testing was conducted before burn and weekly after burn. At day 42 post-burn, the gastrocnemius muscle and the spinal cord ventral horn were analyzed.Results: HBOT improved burn-induced weight bearing imbalance. At day 42 post-burn, less gastrocnemius muscle atrophy and fibrosis were noted in the HBOT group than in the untreated burn group. In the ventral horn, HBOT attenuated the neuronal apoptosis and glial activation post-burn. The increases in phosphorylated AKT/mTOR post-burn were reduced after HBOT. HBOT also inhibited HIF-1α signaling, as determined by immunofluorescence and western blot.Conclusions: HBOT reduces burn-induced neuronal apoptosis in the ventral horn, possibly through HIF-1α signaling.

Background: Necrotizing fasciitis in the head and neck (NF-HN) is a rare and potentially life-threatening condition. The use of hyperbaric oxygen therapy (HBOT) in the acute regimen is disputed and there is a lack of evidence of therapeutic effect. This study aims to describe a retrospective cohort of patients with NF-HN and investigate the use of HBOT and consequences thereof.Methods: All patients treated for NF-HN at Aarhus University Hospital (AUH) between 2002 and 2014 were included in this retrospective cohort. Data regarding demographics, treatment and a one-year follow-up was registered. A review of the literature on NF-HN and HBOT was performed.Results: Forty-three patients were consecutively treated for NF-HN during the period. All patients were treated in accordance with current guidelines with HBOT as a variable. Thirty patients received HBOT, and 13 patients were omitted from HBOT for different reasons. In the HBOT group were no mortalities vs. three mortalities in the non-HBOT group two late deaths due to precursory underlying cancer of the head and neck, and one early death shortly after admittance. We found higher rates of complications (63% vs. 25%) and sequelae (77% vs. 40%) among the HBOT group compared to the non-HBOT group.Conclusions: Our findings suggest that HBOT for NF-HN may only be optional and that the decision relies on an individual assessment of each patient. Further research is needed concerning the evidence of HBOT and towards selecting the patients benefitting from HBOT.

There is a need to improve outcome in patients with brain abscesses and hyperbaric oxygen therapy (HBOT) is a promising treatment modality. The objective of this study was to evaluate HBOT in the treatment of intracranial abscesses. This population-based, comparative cohort study included 40 consecutive adult patients with spontaneous brain abscess treated surgically between January 2003 and May 2014 at our institution. Twenty patients received standard therapy with surgery and antibiotics (non-HBOT group), while the remaining 20 patients also received adjuvant HBOT (HBOT group). Resolution of brain abscesses and infection was seen in all patients. Two patients had reoperations after HBOT initiation (10%), while nine patients (45%) in the non-HBOT group underwent reoperations (p = 0.03). Of the 26 patients who did not receive HBOT after the first surgery, 15 (58%) had one or several recurrences that lead to a new treatment: surgery (n = 11), surgery + HBO (n = 5) or just HBO (n = 1). In contrast, recurrences occurred in only 2 of 14 (14%) who did receive HBOT after the first surgery (p < 0.01). A good outcome (Glasgow Outcome Score [GOS] of 5) was achieved in 16 patients (80%) in the HBOT cohort versus 9 patients (45%) in the non-HBOT group (p = 0.04). HBOT was associated with less treatment failures and need for reoperation and seemingly with improved long-term outcome. Further, HBOT was well tolerated and safe. Prospective studies are warranted to establish the role of HBOT in the treatment of brain abscesses.