Severe trauma to the body, like fractures, soft tissue trauma, burns, but even complex surgical interventions may lead to acute traumatic ischemia of tissues. The compromise of the circulation to tissues can result either from injury to major blood vessels, as in open fractures with interruption of

arteries or at the microcirculation level can be caused by oedema, as in severe crush injuries, muscle compartment syndromes or burns. The consequence is insufficient oxygen availability for tissues to meet their metabolic needs. Cell dysfunction and sometimes cell death are the consequences. Furthermore tissue hypoxia in these cases leads to a self-perpetuating process such that a gradient of injury continues even after primary surgical management. The risk of necrosis or amputation and secondary complications such as infection, non healing wounds and nonunion of fractures frequently develop.

Desired Outcomes in crush injury management:

• Reduced tissue loss

• Reduced complications as:

- Functional loss and scarring

- Infection

- Non union

- Chronic pain

• Accelerated rehabilitation

• Reduced operations

• Reduced length of stay and lower costs

The rationale for using hyperbaric oxygen therapy (HBO) in acute traumatic ischemia is based on the direct influence on the pathophysiology of these injuries by hyperbaric oxygen (HBO). The role of HBO in the adjunctive treatment of crush injury and other acute traumatic ischemias has been proven by a large number of experimental studies and growing clinical experience. HBO is accepted as an adjuvant treatment modality by UHMS1 and EUBS. In this chapter the main emphasis will be given to crush injury and compartment syndrome. Compromised flaps, burns and replantation will be discussed in chapter 2.2.7.

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