Acute Traumatic Ischemia Hyperbaric Evaluation and Treatment

Trauma to a limb, leading to direct tissue damage plus local hypoxic conditions from resulting edema, causes acute traumatic peripheral ischemia. The trauma can vary from mild to irreversible and may involve major blood vessels and nerve injuries. For severe injuries, amputations may be required. Vascular repair and reimplantation may sometimes be required for the limb to be viable. Examples of trauma include crush injury and thermal injury. Even without major vascular injuries, the tissue damage may lead to edema formation causing tissue hypoxia, leading to more edema formation. This vicious cycle can lead to compartment syndrome within poorly compliant muscle compartments, which then presents a surgical emergency to salvage the limb. Threatened flaps also fall into the category of acute traumatic peripheral ischemia, where hyperbaric oxygen has been shown to improve ischemia. Surgical treatment and hyperbaric oxygen are not competing treatment modalities; they should be used in complementarity to provide the best outcome for the patient. Treating acute traumatic peripheral ischemia is 1 of the 13 approved hyperbaric oxygen indications by the Undersea and Hyperbaric Medical Society. It is also approved by the Centers for Medicare and Medicaid Services (CMS). The organization states that when a patient has acute traumatic peripheral ischemia or when a patient is suffering from crush injuries, and surgeons have sutured severed limbs, HBO therapy is a valuable, supplementary treatment physician may use in combination with accepted, standard, therapeutic measures when patients may lose function, limb, or life.