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Case Study
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Hyperbaric oxygen therapy for soft tissue radiation injury Darci Hillert, BSN, RN, Dennis Boysen, MD, Kerenza Kerrigan, BSN,RN Sixty one-year-old woman with complex scalp wound. History of temporoparietal meningioma with total of 3 craniotomies in 7 years. Received radiation treatment on 2 separate occasions. Received a total of 5400 cGY. Patient received trapezius rotational flap in 2005 with minimal success. Patient also received total of 2 Integra applications which both developed a pseudomonas infection causing removal of the Integra. Doctors felt that only option left for patient was a skin graft but wanted Hyperbaric Oxygen Therapy to assist with support of skin graft. Patient has a history of CVA with residual weakness, depression, memory loss and confusion due to radiation and CVA. Upon presentation, the wound to left scalp measured 11.0 cm x 9.0 cm x 0.5 cm. Bone was visible on the superior aspect of the wound. Hyperbaric oxygen(HBOT) was ordered to oxygenate the tissue and induce neovasculariztion to support planned surgical intervention of a split thickness skin graft. Treatment profile is 2.5 ATA for 90 minutes with two 10 minute airbreaks. Pt. completed 20 treatments prior to split thickness skin grafting. Post skin grafting, patient completed HBOT on 9/2/05. The skin graft did not become infected postoperatively. Pt. had small amount of superior bone/scalp open with numerous islands of tissue present on the bone. The large defect below exposed bone continued to have graft intact and no signs or symptoms of infection The purpose of hyperbaric oxygen is to stimulate collagen production and capillary angiogenesis. With increased number of treatments, capillary density increases up to 80% of normal values. HBOT should be performed for 20 treatments prior to any surgical intervention and should be followed with 10 treatments to support the site after surgical intervention. HBOT offers a truly therapeutic modality by stimulating angiogenesis for tissue damaged by radiation. While it is not a cure-all, approximately 60%Ð80% of patients will experience either imporvement or complete resolution of soft tissue injury. |
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