The physiological effects of hyperbaric oxygen extend beyond the elevation of oxygen concentration in body tissues, and clinical data is available to support its use in more than gas bubble diseases. Hyperbaric medicine is discussed within the context of its recognized mecha nisms of action. The experimental data and clinical ex perience for hyperbaric oxygen therapy are reviewed for the following conditions: clostridial myonecrosis, necrotizing soft-tissue infections, chronic refractory os teomyelitis, radiation necrosis, refractory cutaneous ul cerations, compromised skin grafts and flaps, crush in jury and acute peripheral ischemia, carbon monoxide poisoning, arterial gas embolism, decompression sick ness, and thermal burns. Risks associated with hyper baric oxygen therapy are discussed, and cost analysis data are noted for specific conditions.

Analytic Reviews : Hyperbaric Oxygen Therapy:

• Fournier's gangrene is defined classically as a fulminant, rapidly spreading infection of the scrotum that also involves the perineum, penis, and abdominal wall. The pathologic findings are described as synergistic gangrene secondary to a polymicrobial flora with a poorly defined portal of entry. In our experience with 12 cases, the portal of entry was well defined and the causative organisms were those typically found in the lower bowel. Portals of entry were perirectal abscesses in five patients, urethral infections in three, and surgical procedures in four patients. All patients required aggressive surgical debridement, broad-spectrum antibiotics, and adjunctive measures. The fact that four patients died in spite of aggressive treatment demonstrates the lethal nature of this disease. This study suggests that this syndrome is no longer "idiopathic" but is primarily a necrotizing cellulitis of the perineum with subsequent involvement of the genitalia and surrounding tissues. ( Arch Surg 1983;118:38-40)

Fournier's Gangrene of the Scrotum: A Poorly Defined Syndrome or a Misnomer?

background. Hyperbaric oxygen remains the sole treatment capable of inducing growth of new blood vessels. However, systemic hyperbaric oxygen therapy risks central nervous system and pulmonary toxicity.



objective. To describe topical hyperbaric oxygen therapy for the treatment of recelcitrant open wounds.



methods. Topical and systemic hyperbaric oxygen treatments are described and contrasted from one another. Applications of topical hyperbaric oxygen therapy are described.



conclusion. Topical hyperbaric oxygen therapy is useful only for open wounds. The advantages of topical hyperbaric oxygen therapy include low cost, the lack of systemic oxygen toxicity, and effectiveness, allowing this treatment to be prescribed for many patients early in the course of their disease rather than as a last resort.

Topical Hyperbaric Therapy for Problem Skin Wounds

Anaerobic soft tissue infections are still life-threatening infections. Even if uncommon nowadays, they remain severe conditions because often associated with major systemic effects leading to patient death if not promptly recognized and aggressively treated. Their origins are often traumatic or surgical but they can also develop from an ulcer or a small wound in patients at risk (i.e. diabetics, patients with peripheral vascular disease, etc). Hypoxia, traumatic muscle injury, heavy bacterial contamination as well as errors in antibiotic prophylaxis are major causes. Treatment includes antibiotic therapy adapted to both the anaerobic and associated aerobic bacteria; early and extensive surgical debridement; and intensive Hyperbaric Oxygen Therapy (HBO). Unfortunately, physicians are insufficiently aware of the first sign of these infections which explains why the management is often inadequate initially. Strict preventive measures must be taken to avoid their occurrence

Necrotizing Soft Tissue Infections

Les infections anaérobies des tissus mous

Two Japanese males developed spontaneous gangrene of the scrotum and penis. Antibiotics were given and surgical treatments were performed successfully. The latter consisted of debridement of the wound, local flaps and free skin grafts. We failed to obtain significant bacterial cultures. Histology revealed thrombosed and thickened small vessels in the reticular dermis near the border of the gangrenous scrotal tissue.

Akiko Sonoda

Papers

Spontaneous gangrene of the scrotum and penis (Fournier's gangrene).