HBOT Therapy For Compartment Syndrome/ Post Fasciotomy

In compartment Syndrome, groups of organs or muscles are organized into areas called compartments. Strong webs of connective tissue called fascia form the walls of these compartments. After an injury, blood or edema (fluid resulting from inflammation or injury) may accumulate in the compartment. The tough walls of fascia cannot easily expand, and compartment pressure rises, preventing adequate blood flow to tissues inside the compartment. Severe tissue damage can result, with loss of body function or even death. The legs, arms, and abdomen are most prone to developing compartment syndrome. Causes include:

  • Crush injuries.
  • Burns.
  • Overly tight bandaging.
  • Prolonged compression of a limb during a period of unconsciousness.
  • Surgery to blood vessels of an arm or leg.
  • A blood clot in a blood vessel in an arm or leg.
  • Extremely vigorous exercise, especially eccentric movements (extension under pressure).

Benefits of HBOT :

HBOT is used Post Fasciotomy. The Undersea and Hyperbaric Medical Society (UHMS) have approved the use of HBOT as an adjunctive therapy post fasciotomy in the following situations: continuing oedema or ischaemic tissue; unclear demarcation between viable and nonviable tissue; residual neuropathy; or prolonged ischemia time. 1–2 daily HBOT treatments are indicated for up to 7–10 days post fasciotomy, with the resolution of symptoms and complications guiding the decision to cease HBOT. Through minimising both hallmark features, hypoxia and oedema, HBOT has a number of benefits post fasciotomy and in compartment syndromes generally. HBOT boosts arterial oxygen partial pressure, directly increasing oxygen supply to hypoxic tissue, as well as minimising cellular metabolic dysfunction. This also helps stimulate angiogenesis and activate fibroblasts and macrophages to aid wound healing. By minimising endothelial dysfunction, HBOT reduces reactive oxygen species production, reducing their direct insult to local tissue. Fasciotomies performed for compartment syndrome and ischemic vascular disease often require closure in 2 to 4 weeks by skin graft. This leaves the patient with an unsightly scar and a limb with reduced strength. These patients had closure of the fasciotomy wounds in 3 to 18 days. Lastly, hyperoxygenation achieved through HBOT induces vasoconstriction, reducing blood flow to damaged tissues by up to 20% as well as producing a direct osmotic effect, reducing local oedema whilst maintaining oxygen delivery.