| 6 |
Clinical Research
|
Complex hypospadias repair: the use of adjunctive hyperbaric oxygen therapy Caesar Anderson, MD, Edward Myer, MD, George Perdrizet, MD, PhD, FACS, Fernando Ferrer, MD Introduction: Hypospadias is considered the most frequent malformation of the genitourinary tract within the United States. Single-stage surgical correction is currently the standard of care. While successful single stage, or planned multi-stage reconstruction, is possible in most of hypospadias repair today, children still present for reoperation after multiple failed attempts at repair. These children typically have scarred and poorly vascularized local tissues and, as a consequence, redo operations carry a significant failure rate. Timely administration of adjunctive hyperbaric oxygen therapy (HBO2T) to tissues threatened by ischemia can significantly reduce tissue loss and improve outcomes. Methods and Materials: We present the first case of complex redo-reconstruction utilizing adjunctive hyperbaric oxygen therapy. Utilizing Medline Search Engine, the current available literature regarding the principles of HBO2T as an adjunct to reconstructive surgery in general and hypospadias in particular, was reviewed. Results: Successful re-operation utilizing adjunctive HBO2T is described. Available literature supports the role of HBO2T as a safe adjunct to children undergoing re-operative procedures when the vascularity of local flaps is questioned. Conclusions: We report the use of postoperative HBO2T as adjunctive therapy in a complex re-operative repair of hypospadias in an 11-year-old boy with Denys-Drash syndrome. Further studies exploring the potential use of HBO2T to improve outcomes in hypospadias reconstruction are warranted. Simmons GR, Cain MP, Casale AJ, et al. Repair of hypospadias complications using the previouly utilized urethral plate. Urology. 1999;54:724Ð726 Castanon Garcia-Alix M, Martin Hortiguela ME, Rodo Salas J: Complications in hypospadias repair: 20 years of experience. Cir Pediatr. 1995;8:118Ð122 Nemiroff PM, Merwin GE, Brant T, and Cassisi NJ. Effects of hyperbaric oxygen and irradiation on experimental skin flaps in rats. Otolaryngol Head Neck Surg. 1985;93(4):485Ð491 Feldmeier, JJ. The Hyperbaric Oxygen Therapy Committee Report. Undersea and Hyperbaric Medical Society. 2003;101Ð107 Kaelin CM, Im MJ, Myers RA, Manson PN, Hoopes JE. The effects of hyperbaric oxygen on free flaps in rats. Arch Surg. 1990;125(5):607Ð609 Richards L, Lineaweaver WC, Stile F, Zhang J, Zhang F. Effect of hyperbaric oxygen on the tubed pedical flap survival in a rat Model. Ann Plast Surg. 2003;50(1):51Ð56 Perrins DJD, Cantab MB. Influence of hyperbaric oxygen on the survival of split thickness skin grafts. Lancet. 1967;1:868Ð871 Moinews-Chass I, Hashmonai M. Hyperbaric oxygen treatment as an adjunct to reconstructive vascular surgery in trauma. Injury. 1975;8:274Ð277 Tai YJ, Birely BC, Im MJ, Hoopes JE, and Manson PN. The use of hyperbaric oxygen for preservation of free flaps. Ann Plast Surg. 1992;28(3):284Ð287 Bowersox JC, Strauss MB, Hart GB. Clinical experience with hyperbaric oxygen therapy in the salvage of ischemic skin flaps and grafts. J Hyperb Med. 1986;1:141Ð149 |
|