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Michael B Strauss
American journal of orthopedics (Belle Mead, N.J.) 12/2008; 37(11):553; author reply 592.
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ABSTRACT: Hyperbaric oxygen (HBO) exposure involves the breathing of 100% oxygen under conditions of elevated atmospheric pressure and is used to increase the oxygen content of the plasma fraction of arterial blood. The purpose of this study was to determine the effects of acute HBO exposure on selected physiological responses and performance in response to maximal lower extremity or upper extremity short-term, high-intensity exercise. The study was performed with 2 separate experiments incorporating double-blinded and randomized protocols. In experiment 1, 9 subjects ran on a treadmill at a speed of 268 m x min(-1) with a predetermined grade. In experiment 2, 9 different subjects performed a repetitive bench press exercise. Both exercise protocols were designed to induce fatigue within 1-2 minutes. Within each experiment, subjects received either a 1-hour HBO exposure inspiring 100% O2 at 202.6 kPa (2.0 atmospheres absolute pressure [ATA]) or a 1-hour sham exposure inspiring ambient air at 121.5 kPa (1.2 ATA) before exercise. No significant differences (p > or = 0.05) were observed in postexercise blood lactate concentrations, peak heart rate, ratings of perceived exertion, or performance as determined by treadmill running time or number of completed lifts. Unlike other methods that elevate oxygen content of the blood, acute HBO exposure appears to have no significant effect on subsequent high-intensity running or lifting performance.
The Journal of Strength and Conditioning Research 12/2007; 21(4):1037-41. · 1.83 Impact Factor
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Michael B Strauss
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ABSTRACT: The surgical treatment of foot wounds in patients with diabetes is an art and a science. I summarize the surgical management presentation of The Diabetic Foot Wound Symposium at the 2004 Musculoskeletal Infectious Disease Society meeting in Pittsburgh, PA. The science of surgical management of the diabetic foot wound is seen in the accurate diagnosis of its severity. This is accomplished by a simple to use five assessment wound score that grades wound base appearance, size, depth, bio-burden and perfusion each from 0 (worse) to 2 (best) using objective criteria. The resultant 0 to 10 score quantifies the severity and provides a guideline for what treatments should be done. The art of surgically treating foot wounds in patients with diabetes is exemplified in doing minimally invasive surgeries in the office or their more complex counterparts in the operating room. The surgeries are classified into five types: debridements, correction of deformities, wound closures, partial amputations, and miscellaneous procedures including nail care and Charcot arthropathy treatment. The information presented in this paper reflects my 25 years of experience caring for problem foot wounds in patients with diabetes.
Clinical Orthopaedics and Related Research 11/2005; 439:91-6. · 2.53 Impact Factor
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ABSTRACT: We review seven classification systems for foot wounds in patients with diabetes and evaluate them in a table format based on 10 criteria judged to be the most important for assessing their effectiveness. Criteria include such factors as objectivity, versatility, ability to measure progress, validity and reliability, and five other grading parameters. Concomitantly, the Wound Score, a paradigm for evaluating the problem wound, is described in detail and evaluated on the same ten criteria. Five assessments including appearance of the wound base, size, depth, bio-burden, and perfusion are each graded on a 0 to 2 scale and summated to generate the Wound Score. From the score three levels of seriousness become apparent: "healthy wounds" with scores of 8 to 10, "problem wounds" with scores of 4 to 7 and "futile wounds" with scores of 0 to 3. Because of its simplicity, user friendliness, ability to integrate wound and patient information, and design to reflect progress, the Wound Score scored better on the 10 evaluation criteria than any other foot wound evaluation system for patients with diabetes. The objectivity of grading the five assessments used to generate the Wound Score make this scoring system ideal for evaluating treatment interventions and outcomes of wounds of equal seriousness.
Clinical Orthopaedics and Related Research 11/2005; 439:79-86. · 2.53 Impact Factor
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Michael B Strauss
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ABSTRACT: Few topics in diabetic wound management generate as much "heated" discussion as hyperbaric oxygen (HBO). Hyperbaric oxygen is an intermittent inhalation therapy in which the patient breathes oxygen at greater than 1 atm of pressure. This requires placement of the patient into a sealed vessel (chamber) which is capable of withstanding pressurization. This article discusses the role of HBO as an adjunct to the management of diabetic problem foot wounds from evidenced-based, approved (by Medicare) indications and cost-effectiveness perspectives.
The Foot and Ankle Online Journal 02/2005; 26(1):15-8. · 1.22 Impact Factor
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Michael B Strauss
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ABSTRACT: Foot ulcers in individuals with diabetes often are the precursors to lower extremity amputation. The multidisciplinary team approach is highly effective in the prevention and treatment of diabetic foot morbidity. This article focuses on the role of the orthopaedic surgeon as a member of the wound care team for the diabetic foot.
The Foot and Ankle Online Journal 02/2005; 26(1):5-14. · 1.22 Impact Factor
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Michael B Strauss
Orthopedics 02/2004; 27(1):9; author reply 9. · 2.66 Impact Factor
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ABSTRACT: Controversy exists as to what transcutaneous oxygen (P(tc)O2) levels are required for wound healing and what role hyperbaric oxygen has for this. Current information suggests that 30 to 40 mmHg juxta-wound oxygen tensions in room air are required. We recorded P(tc)O2 measurements in room air and with hyperbaric oxygen in 190 patients with foot wounds; then looked retrospectively and prospectively whether there was any effect on healing. Transcutaneous oxygen measurements under hyperbaric oxygen conditions defined a responder group (P(tc)O2 > 200 mmHg) with a sensitivity of 0.80 and a positive predictive value of 0.88 for healing, regardless of room air measurements when hyperbaric oxygen was used as an adjunct to wound management. This information helps to objectify the indications for hyperbaric oxygen and predict healing especially in those patients with problem wounds of the foot and ankle.
The Foot and Ankle Online Journal 10/2002; 23(10):933-7. · 1.22 Impact Factor
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ABSTRACT: Healing of forefoot cleft wounds can be a difficult management problem in patients with peripheral vascular disease, diabetes or both. This is a prospective review of 15 patients with these conditions with nonhealing middle-ray cleft wounds managed with a temporary mini-external fixator to close the cleft wound. Fourteen (93%) of the 15 patients had a successful obliteration of the cleft and skin coverage. Twelve (80%) of 15 were able to resume their previous level of activity with the reconstructed, mechanically sound forefoot. Fourteen (93%) of the 15 patients received hyperbaric oxygen treatments as an adjunct to wound healing. All patients avoided a transmetatarsal or higher amputation.
The Foot and Ankle Online Journal 06/2002; 23(5):433-9. · 1.22 Impact Factor
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ABSTRACT: This cutting edge article discusses the most frequent uses of hyperbaric oxygen for the orthopedic surgeon. Hyperbaric oxygen therapy is an adjunct to orthopedic interventions when healing problems are anticipated due to wound hypoxia or uncontrolled infection.
Orthopedics 04/2002; 25(3):303-10. · 2.66 Impact Factor
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Advanced emergency nursing journal 03/1984; 6(1):9-24.
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ABSTRACT: Gas gangrene is not a disease of the past. Despite improved awareness, earlier care of trauma victims, new antibiotics, and advanced monitoring techniques, histotoxic clostridia continue to cause loss of life and limb. A 20-year literature review on gas gangrene (Part I) indicates that a combined therapy approach with early recognition, surgical intervention, appropriate antibiotics, and hyperbaric oxygen (HBO) provides optimal care.
Part II, a 15-year clinical experience, appears to be the largest English-language series reported using the combined therapy of antibiotics, surgery, and hyperbaric oxygen.
One hundred thirty-nine patients (95 males and 44 females), average age, 38 years, were admitted with clostridial myonecrosis. Sixty-seven were in shock at admission and the 27 deaths occurred in this group. One hundred twelve patients (81%) survived the infection. There was a 5% mortality in post-traumatic extremity clostridial myonecrosis. Age and concurrent disease increased the mortality rate, as did delay from time of diagnosis to aggressive combined treatment.
(C) Williams & Wilkins 1983. All Rights Reserved.
The Journal of Trauma and Acute Care Surgery. 10/1983; 23(11).
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ABSTRACT: In this study we investigate whether differences exist in human skeletal muscle (MM) and subcutaneous (SC) tissue gas tensions between chronic cigarette smokers and non-smokers measured under room air and hyperbaric conditions.
Gas tensions in resting MM and SC tissues were recorded using a mass spectrometer at four-minute intervals during two and one-half to three-hour period in smokers and non-smokers during normobaric, normoxic (room air) and hyperbaric conditions. Two hyperbaric oxygen (HBO2) protocols were utilized: Protocol A employed the continuous breathing of oxygen (O2) at 2 ATA, a typical monoplace hyperbaric chamber treatment, while Protocol B utilized intermittent air breaks between O2 breathing periods at 2 ATA representative of a multiplace hyperbaric chamber treatment.
All tissue gas tensions changed significantly (repeated measures of variance, p=0.00001) with time as pressures and gas mixtures breathed were altered. Significant Individual Step Analysis (ISA) differences occurred with unloading of nitrogen (N2) from the muscle compartment in both protocols (T-test and Wilcoxon Rank Sum). The interaction of grouping variable and time revealed significant differences between smokers and non-smokers in unloading MM N2 in both protocols: Protocol A (p=0.02) and in Protocol B (p=0.022). Carbon dioxide (CO2) levels in both protocols decreased significantly with time when exposed to HBO2 while increasing when breathing air at 2 ATA.
This study demonstrates: 1) Smokers release MM N2 more slowly than nonsmokers during hyperbaric oxygen exposures regardless of the treatment protocol used; 2) There were no significant differences in O2 loading of MM and SC tissues during HBO2 exposures between smokers and nonsmokers; 3) The CO2 levels in both protocols decrease with time when exposed to HBO2 while increasing with breathing air at 2 ATA; 4) The known vasoconstriction effect in subcutaneous tissue from nicotine lasts less than one hour with the topical adiabatic heating increasing the O2 loading specifically in the SC tissues of smokers; 5) Wounds heal more slowly due to the chronically injured endothelium from carbon monoxide, hydrogen cyanide, and other toxic products in smoke rather than from the transient elevations of nicotine.
Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc 37(2):73-87. · 0.80 Impact Factor
