Bentur Y, Shupak A, Ramon Y, Abramovich A, Wolfin G, Stein H, Krivoi N
Israel Naval Medical Institute, IDF Medical Corps, Department of Orthopedics, Western Galilee Hospital, Haifa.
Plast Reconstr Surg. 1998 Sep;102(3):822-4. doi: 10.1097/00006534-199809030-00030.
A 24-year-old female diabetic patient was hospitalized because of ketoacidosis and a necrotic wound on the hand. Debridement and antibiotic therapy failed to halt the process. After demonstration of Mucor in cultures from the wound, the patient underwent extensive surgery and amphotericin B was administered. When the necrotic process continued despite these measures, adjunctive hyperbaric oxygen (100% O2 at 2.5 ATA for 90 minutes) was administered daily for a total of 21 treatment sessions. She gradually improved, and at 2 months follow-up most of the wound had healed. Although the mortality rate of cutaneous/soft-tissue zygomycosis is markedly lower than that of the rhinocerebral form, morbidity is still considerably high. Successful use of hyperbaric oxygen has been reported in rhinocerebral zygomycosis, and it may have been of benefit in this high-risk patient by preventing local and systemic spreading of the fungus. This report is the first case of the use of hyperbaric oxygen for cutaneous/soft-tissue zygomycosis. It is suggested that hyperbaric oxygen be considered for this indication in diabetic patients as an adjunct to surgery and amphotericin B.
一名24岁的女性糖尿病患者因酮症酸中毒和手部坏死性伤口入院。清创和抗生素治疗未能阻止病情发展。伤口培养物中发现毛霉菌后，患者接受了广泛的手术，并使用了两性霉素B。尽管采取了这些措施，坏死过程仍在继续，于是每天给予辅助高压氧治疗（在2.5个绝对大气压下使用100%氧气，持续90分钟），共进行21次治疗。她的病情逐渐好转，在2个月的随访中，大部分伤口已经愈合。虽然皮肤/软组织接合菌病的死亡率明显低于鼻脑型，但发病率仍然相当高。据报道，高压氧在鼻脑型接合菌病中使用成功，对于这名高危患者，它可能通过防止真菌的局部和全身扩散而发挥了作用。本报告是首例将高压氧用于皮肤/软组织接合菌病的病例。建议在糖尿病患者中考虑将高压氧作为手术和两性霉素B的辅助手段用于该适应症。
