Holland JA, Hill GB, Wolfe WG, Osterhout S, Saltzman HA, Brown IW Jr, et al.
Surgery. Date of publication 1975 Jan 1;volume 77(1):75-85.
1. Surgery. 1975 Jan;77(1):75-85.
Experimental and clinical experience with hyperbaric oxygen in the treatment of
clostridial myonecrosis.
Holland JA, Hill GB, Wolfe WG, Osterhout S, Saltzman HA, Brown IW Jr.
At Duke University Medical Center, 49 patients with proved clostridial
myonecrosis were treated with hyperbaric oxygen (HBO) during the past 10 years.
Survival in patients with involvement confined to the extremities was 92.3
percent. Survival in patients with combined involvement of extremity and trunk
was 53-3 percent, and with primary trunk involvement half of the patients
survived. Survival for the entire series was 73.5 percent. Among the 28 patients
receiving at least five HBO treatments, 24 survived. Extensive experimental
studies were conducted during this same period including in vitro testing and in
vivo experimental infections with C. perfringens. Data from the experimental
models of gas gangrene indicate a therapeutic benefit with HBO by significantly
decreasing both mortality and morbidity rates. The mechanism of action for this
appears to be complex but probably includes a direct bactericidal action,
bacteriostasis, inhibition of toxin production, and improvement in tissue
oxygenation. In the absence of a controlled study, the therapeutic efficacy of
HBO in the treatment of clostridial myonecrosis is not fully proved. Nevertheless
HBO treatment can be recommended on the bases of sound experimental evidence and
the results of favorable clinical experience. Mitigation of this severe but
infrequent illness can best be accomplished through prevention, with strict
adherence to the principles of wound care.
PMID: 162815 [Indexed for MEDLINE]
