Crush Injury And Other Acute Traumatic Ischemia

Armin Kemmer

Department of Anaesthesia & Intensive Care Medicine, Centre for Hyperbaric Oxygen Therapy, Berufsgenossenschaftliche Unfallklinik Murnau, Germany

Abstract: Crush injury and other acute traumatic ischemia are characterized by a vicious circle of ischemia, hypoxia, oedema, disturbed microcirculation, and secondary ischemia in the border area of the tissue affected by the primary trauma. In hypoxic tissues mechanisms of infection control and healing are impaired so that the risk of infection and wound healing problems are definitely higher than after other kinds of injuries. Restoration of perfusion can lead to reperfusion injury. Hyperbaric oxygen ameliorates the effects of acute traumatic ischemia through four mechanisms: hyperoxygenation, vasoconstriction, influence on reperfusion and host factors. Besides adequate shock management, direct surgical intervention with debridement and repair of soft tissues and of any damaged vessels and stabilization of bony elements are of paramount importance. Adjuvant hyperbaric oxygen therapy (HBOT) should be administered as soon as possible; when it is given early it can prevent large expanses of ischemic necrosis, minimize the frequency and extent of amputations, reduce oedema, control infection, support healing, and prevent reperfusion injury. However, an early start of HBOT and an uncompromising application without restrictions to established surgical treatment and intensive care therapy is essential

Keywords: Hyperbaric oxygen; Crush injury; Traumatic ischemia; Wound healing; Oedema

0 0

Post a comment