HYPERBARIC-OXYGEN THERAPY FOR NECROTIZING FASCIITIS REDUCES MORTALITY AND THE NEED FOR DEBRIDEMENTS

Authors:
  • WZWA ZAMBONI
    WA ZAMBONI
  • ACA CURTIS
    A CURTIS
  • DGDR GRAHAM
    DR GRAHAM
  • HKHR KONRAD
    HR KONRAD
  • DRDS ROSS
    DS ROSS
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  • 1 November 1990
    • journal article
    • research article
    • Vol. 108  (5) , 847-850
    • PMID:2237764
Abstract
Twenty-nine patients with necrotizing fasciitis were treated from 1980 to 1988. This study evaluates how the addition of hyperbaric oxygen (HBO) therapy to surgical treatment has affected mortality and the number of debridements required to achieve wound control in these patients. Two groups of patients were viewed: group 1 (n = 12) received surgical debridement and antibiotics only; group 2 (n = 17) received HBO (90 minutes at 2.5 atm, average 7.4 treatments) in addition to surgery and antibiotics. Both groups were similar in age, race, sex, wound bacteriology, and antimicrobial therapy. Body surface area affected was similar; however, perineal involvement was more common in group 2 (53%) than in group 1 (12%). The admitting conditions of patients in group 1 (non-HBO) were diabetic, 33%; white blood cell count more than 12,000 50%; and shock, 8%. The admitting conditions of patients in group 2 (HBO) were diabetic, 47%; white blood cell count more than 12,000, 59%; and shock, 29%. Although group 2 patients receiving HBO were more seriously ill on admission, mortality was significantly lower (23%) compared to group 1 (66%) (p < 0.02). In addition, only 1.2 debridements per group 2 patients were required to achieve wound control versus 3.3 debridements per group 1 patient (p < 0.03). The addition of HBO therapy to the surgical and antimicrobial treatment of necrotizing fasciitis significantly reduced mortality and wound morbidity (number of debridements) in this study, especially among nonclostridial infections. We conclude that HBO should be used routinely in the treatment of necrotizing fasciitis.

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