No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Effect of Perioperative Hyperbaric Oxygen on Bruising in Face-lifts
Abstract
Thirteen female patients with a mean age of 59 years (age range, 47-71 years) were entered into the study, with 6 electing to undergo HBO therapy. Eleven patients underwent a deep plane face-lift, and 2 patients, 1 each in the control group and the treatment group, underwent an extended superficial musculoaponeurotic system face-lift. There were no surgical or medical complications. One patient in the control arm missed a single postoperative appointment on POD 5, with that value unavailable for analysis. Overall, 102 photographs and 1020 data points were analyzed. On POD 1, the average degree of color change in the cheek soft-tissue flap in the HBO group was 38.5 and in the control group was 43.7. This difference was not statistically significant (P = .28). The degree of color change in the HBO group on POD 5 was 39.0 and in the control group was 45.6. Again, this difference was not statistically significant (P = .13). On POD 7, the average degree of color change in the treatment group was 27.5 and in the control group was 42.2 (P = .005), with a 35% reduction in color change in the treatment group over the control group. The average degree of color change on POD 10 was 22.0 in the treatment group and 31.6 in the control group (P = .03), with an average of 30% reduction in color change in the treatment group when compared with the control group. Figure 2 outlines the comparison between the patients undergoing HBO and the control patients.
Thirteen female patients with a mean age of 59 years (age range, 47-71 years) were entered into the study, with 6 electing to undergo HBO therapy. Eleven patients underwent a deep plane face-lift, and 2 patients, 1 each in the control group and the treatment group, underwent an extended superficial musculoaponeurotic system face-lift. There were no surgical or medical complications. One patient in the control arm missed a single postoperative appointment on POD 5, with that value unavailable for analysis. Overall, 102 photographs and 1020 data points were analyzed. On POD 1, the average degree of color change in the cheek soft-tissue flap in the HBO group was 38.5 and in the control group was 43.7. This difference was not statistically significant (P = .28). The degree of color change in the HBO group on POD 5 was 39.0 and in the control group was 45.6. Again, this difference was not statistically significant (P = .13). On POD 7, the average degree of color change in the treatment group was 27.5 and in the control group was 42.2 (P = .005), with a 35% reduction in color change in the treatment group over the control group. The average degree of color change on POD 10 was 22.0 in the treatment group and 31.6 in the control group (P = .03), with an average of 30% reduction in color change in the treatment group when compared with the control group. Figure 2 outlines the comparison between the patients undergoing HBO and the control patients.
... In a randomised, prospective, double-blinded study of lower-extremity crush injuries, Bouachour et al. found a higher rate of complete healing in patients older than 40 years with Gustilo grade III injuries who were given HBOT (14). A prospective controlled study by Stong and Jacono found that adjunctive HBOT reduced facial ecchymosis and hastened recovery in patients undergoing facelift surgery (15). ...
Mutilated hand injuries are a profound challenge to the plastic surgeon, and such injuries often lead to limb loss and severe functional impairment. Hyperbaric oxygen therapy (HBOT) appears to counteract tissue hypoxia and stimulate acute wound healing. This study was performed to evaluate the efficacy of HBOT as an adjunctive therapy in patients with a mutilated hand injury. Between January 2006 and December 2014, 45 patients with a mutilated hand injury were enrolled. After reconstruction or revascularisation, patients underwent 120 minutes of HBOT with oxygen at 2·5 atmospheres absolute while breathing 100% oxygen. Outcomes such as amputee survival and surgery-related complications were recorded. The patients were 38 men and 7 women with average age of 37·2 years (range 18–62). The mean defect area was 131·5 cm2 (range 40–300). Most patients experienced a pure crush injury (53%). The average number of operations from the initial debridement to the first reconstruction was 3·8 (range 1–6). A total of 33 patients (73%) underwent replantation during the initial reconstruction. For flap coverage, most patients received a free flap using an anterolateral thigh flap (18 patients) or local flap using an abdomen/groin flap (nine patients). The average time from the first reconstruction or revascularisation to the first HBOT was 6·5 hours (range 2–12). The average number of HBOT sessions was 9·1 (range 6–14 sessions). The survival rate of the replanted fingers was 81%, and the survival rate of the palms was 100%. Most complications in the initial reconstruction involved partial loss of an avulsed flap, and most complications in the chronic stage (≥3 months) involved scar contracture. When combined with delicate microsurgery, early intervention using adjunctive HBOT was effective in preserving partially viable tissue and restoring hand function in patients with a mutilated hand injury.
Continued interest in the optimization of recovery in aesthetics has led to the exploration of adjunctive therapies. Hyperbaric oxygen therapy (HBOT) serves as one such therapy that may have an impact in this field. HBOT is hypothesized to improve ischemia, reduce swelling, and minimize secondary hypoxic tissue damage. Its application in aesthetic procedures aims to improve healing, reduce downtime, and enhance the overall quality of outcomes.
A systematic review was performed, searching the PubMed database. The protocol was developed following the Preferred Reporting for Items for Systematic Reviews-Protocols (PRISMA) guidelines. Included studies evaluated the use of HBOT in aesthetic surgery, medicine, and longevity and anti-aging. Selected studies matched predetermined criteria according to the employed intervention and outcomes.
The systematic review was performed in April 2024, with the primary search yielding 591 articles. Abstract review resulted in 53 articles of potential relevance. Comprehensive review of the articles and manual reference checks was performed, independently, by two authors. This yielded a total of 15 articles meeting inclusion criteria.
HBOT may serve a valuable adjunct in aesthetic surgery, medicine, and anti-aging. However, the evidence to support its use, and justify its cost, is limited. This review serves as an update, capturing the currently available literature on HBOTs use in aesthetics, and provides the first discussion of HBOTs role in anti-aging. It underscores the need for future large-scale, randomized trials with standardization of HBOT protocols being employed to allow for full assessment of HBOTs utility in this clinical space.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Hyperbaric oxygen (HBO) is a treatment modality with the primary mechanism of therapy being the delivery of oxygen to hypoxic tissues. A review of HBO applications in the field of head and neck reconstruction and facial cosmetic surgery is provided. HBO can be useful in the management of radiation sequelae and treatment of compromised flaps and grafts. It may also have application in tissue compromise following cosmetic surgery and dermal fillers. We provide evidence from the available literature as well as highlight our experience in using HBO in head and neck reconstruction.
Complications of rhytidectomy are well known, yet often preventable. A thorough preoperative history and physical along with realistic patient expectations provide the surgeon and patient with insight into potential complications and postoperative management. Understanding of surgical pitfalls and avoidance are crucial in beginning to manage facelift complications. Possible complications of facelift techniques should not discourage surgeons from pursuing a particular technique as the majority of complications are temporary. Though, a strong patient-physician relationship is critical when complications occur. Complications may be frustrating for both the patient and surgeon, yet are overwhelmingly temporary and manageable without surgical intervention.
Background
Sub-SMAS rhytidectomy techniques are considered to have a higher complication profile, especially for facial nerve injury, when compared to less invasive SMAS techniques. This results in surgeons avoiding sub-SMAS dissection.
Objective
Aggregate and summarize data on complications among different SMAS facelift techniques.
Methods
A broad systematic search was performed. All included studies: (1) described a SMAS facelifting technique categorized as SMAS plication, SMASectomy/imbrication, SMAS flap, high lateral SMAS flap, deep plane, and composite; and (2) reported the number of postoperative complications in participants. Meta-analysis was performed in accordance with PRISMA guidelines.
Results
183 studies were included. High lateral SMAS (1.85%) and composite rhytidectomy (1.52%) had the highest rate of temporary nerve injury and were the only techniques to show a statistically significant difference when compared to SMAS plication (OR = 2.71 and 2.22, respectively, p < 0.05). There was no difference in the risk of permanent injury amongst techniques. An increase in major hematoma was found for the deep plane (1.22%, OR 1.67, p < 0.05) and SMAS imbrication (1.92%, OR 2.65, p < 0.01). Skin necrosis was higher with the SMAS flap (1.57%, OR 2.29, p < 0.01).
Conclusions
There are statistically significant differences in complication rates between SMAS facelifting techniques for temporary facial nerve injury, hematoma, seroma, necrosis, and infection. Only high lateral SMAS and composite rhytidectomy techniques showed a statistically significant increase in the odds ratio of temporary neuropraxia. Because these complications occur at such a low rate, they are of limited clinical significance. Technique should be selected based on quality of results and not the complication profile.
Background:
The purpose of this study was to evaluate the efficacy of postoperative intense pulsed light therapy on patients who undergo bilateral eyelid surgery.
Methods:
Patients presenting over a 3-month period for bilateral eyelid surgery were asked to participate in an institutional review board-approved study. Intense pulsed light therapy was administered three times to the same randomly assigned side on postoperative days 1 to 2, 5 to 7, and 10 to 12. Sham light therapy was administered to the contralateral side. Patient surveys and physician ratings were obtained based on photographic evaluation of ecchymosis, edema, and erythema. Three physicians, including the senior author (A.E.W.), submitted ratings, and these ratings were assessed for interobserver reliability.
Results:
Twenty-eight patients who underwent bilateral eyelid surgery followed by intense pulsed light therapy were enrolled. The mean age of the patients was 66 years (range, 44 to 81 years). Eighty-six percent of patients were female. The change in ratings between postoperative days 1 to 2 and 10 to 12, in the treatment and control groups, was statistically significant for severity of bruising by both patient and physician assessment and for color of bruising only by patient assessment. The interobserver reliability reached the greatest agreement in the ecchymosis category at each time point for the treatment group.
Conclusion:
In a series of patients who underwent eyelid surgery, intense pulsed light therapy decreased the degree of ecchymosis compared with sham treatment in postoperative eyelid surgery patients.
Clinical question/level of evidence:
Therapeutic, II.
This paper presents a computational system for three-dimensional reconstruction and surface extraction of the human lower limb as a new methodology of visualizing images of multifaceted ecchymosis on the lower limbs. Through standardization of image acquisition by a mechanical system, an algorithm was developed for three-dimensional and surface reconstruction based on the extraction of depth from silhouettes. In order to validate this work, a three-dimensional model of the human lower limb was used inside a virtual environment. At this environment the mechanical procedure of image acquisition was simulated, resulting in 100 images which was later submitted to all algorithms developed. It was observed that the systems for three-dimensional reconstruction and surface extraction of the object were able to generate a new visualization method of the lesion. The results allow us to conclude that the developed systems provided adequate three-dimensional and two-dimensional visualization of the surface of the simulated model. Despite the lack of experiments with real ecchymoses, the systems developed in this work show great potential to be included in the standard methods for the visualization of ecchymoses.
Hyperbaric oxygenation consists in exposing patients to increased gas pressures while inhaling pure oxygen. It involves the use of hyperbaric chambers that can double or triple gas pressure inside them. Hyperbaric oxygenation may be useful in different clinical situations, but mostly for the treatment of decompression syndrome. In the last decades, it has been used for the management of different kinds of wounds. Hyperbaric oxygenation not only increases the delivery of oxygen to damaged tissues, but also stimulates angiogenesis, collagen synthesis, stem cell migration and local immune response. Clinical trials that have addressed the use of hyperbaric oxygenation are difficult to compare due to their heterogeneity in terms of experimental design, kind of injuries involved and assessment of outcome. Even though, most studies support the concept that hyperbaric oxygenation accelerates the healing process.
After studying this article, the participant should be able to: 1. Thoroughly recognize the factors that contribute to hematoma after face lift. 2. Describe and apply the current evidence for which technique gives superior results in outcomes after face lift. 3. Use the current evidence to determine whether to incorporate fibrin sealant into the practitioner's intraoperative routine, and its effects on bleeding, fluid accumulation, and bruising. 4. Explain an approach for controlling blood pressure in the perioperative period after face lift. 5. Describe the benefits of controlling nausea and vomiting after face lift. 6. Use appropriate measures to reduce the risk of venous thromboembolism when performing face lift. 7. Assess the role of different forms of local anesthetic in reducing postoperative hematoma.
This article provides a review of the latest evidence regarding the preoperative assessment and perioperative management of patients undergoing face lift. The effects of various pharmacologic interventions and surgical techniques on postoperative complications are also reviewed. In addition, a meta-analysis of recent literature was performed to compare the rates of postoperative hematoma formation following various face lift techniques.
Adjunctive hyperbaric oxygen therapy is a safe and effective modality with which to increase tissue oxygenation and aid in healing of difficult wounds. The majority of the literature surrounding hyperbaric oxygen therapy supports its use in chronic wounds, but its use in acute wounds, flaps, and grafts is less well supported.
The authors reviewed the Ovid, PubMed, and Cochrane Library databases, and selected studies, level III and above, using hyperbaric oxygen therapy in the treatment of complicated acute wounds, flaps, and grafts.
A total of eight studies were found to meet criteria for evaluation of adjunctive hyperbaric oxygen therapy in the treatment of complicated acute wounds, flaps, and grafts.
When combined with standard wound management principles, hyperbaric oxygen therapy can augment healing in complicated acute wounds. However, it is not indicated in normal wound management. Further investigation is required before it can be recommended as a mainstay in adjuvant wound therapy.
Therapeutic, II.
Objective: To test the hypothesis that homoeopathy is a placebo by examining its effect in patients with allergic rhinitis and so contest the evidence from three previous trials in this series.Design: Randomised, double blind, placebo controlled, parallel group, multicentre study.Setting: Four general practices and a hospital ear, nose, and throat outpatient department.Participants: 51 patients with perennial allergic rhinitis.Intervention: Random assignment to an oral 30c homoeopathic preparation of principal inhalant allergen or to placebo.Main outcome measures: Changes from baseline in nasal inspiratory peak flow and symptom visual analogue scale score over third and fourth weeks after randomisation.Results: Fifty patients completed the study. The homoeopathy group had a significant objective improvement in nasal airflow compared with the placebo group (mean difference 19.8 l/min, 95% confidence interval 10.4 to 29.1, P=0.0001). Both groups reported improvement in symptoms, with patients taking homoeopathy reporting more improvement in all but one of the centres, which had more patients with aggravations. On average no significant difference between the groups was seen on visual analogue scale scores. Initial aggravations of rhinitis symptoms were more common with homoeopathy than placebo (7 (30%) v 2 (7%), P=0.04). Addition of these results to those of three previous trials (n=253) showed a mean symptom reduction on visual analogue scores of 28% (10.9 mm) for homoeopathy compared with 3% (1.1 mm) for placebo (95% confidence interval 4.2 to 15.4, P=0.0007).Conclusion: The objective results reinforce earlier evidence that homoeopathic dilutions differ from placebo.
Port-wine stains can be treated with a flash-lamp-pumped pulsed-dye laser, but it is uncertain whether this treatment is more effective if administered early in life, when the skin is thinner and the lesion is smaller.
We prospectively studied 100 patients with a previously untreated port-wine stain of the head or neck. They were treated with the flash-lamp-pumped pulsed-dye laser and divided into four age groups (0 to 5, 6 to 11, 12 to 17, and 18 to 31 years). The outcome measure was lightening of the port-wine stain (reduction in the difference in color between the skin with the stain and contralateral healthy skin) as measured with a colorimeter after an average of five treatments (range, three to seven) of the entire lesion.
Of the 100 patients, 11 could not be included in the analysis because they had received fewer than three or more than seven treatments, had an erroneous base-line color measurement, or were lost to follow-up. The sizes, locations, and colors of the port-wine stains were similar among the groups. When all 89 patients were analyzed together, the average reduction in the difference in color between the skin with the port-wine stain and contralateral healthy skin was 40 percent. The differences between age groups in the average reduction in color differences were not significant (P= 0.26). By the end of the study, only 7 of 89 patients had completed laser therapy, and in no case was clearance complete. Treatment was discontinued in all seven because the last three treatments did not lead to further lightening.
We found no evidence that treatment of port-wine stains with the flash-lamp-pumped pulsed-dye laser in early childhood is more effective than treatment at a later age.
: A generally accepted method to assess the clinical outcome of laser treatment of portwine stains is not available. This paper describes the development and evaluation of a comprehensive questionnaire for the assessment of the following portwine stain characteristics: color (hue and lightness), sharpness of boundary, pigmentation, size, shape, skin surface-structure, and hypertrophy of underlying tissue. The questionnaire was applied to photographs of 70 patients with previously untreated portwine stains in the head/neck area. Photographs were taken before treatment and after five treatments of the entire portwine stain with a flashlamp pumped pulsed dye laser. Each photograph was evaluated separately by a panel of five professionals: the treating physician, two plastic surgeons, a dermatologist, and a clinical photographer. Treatment results were assessed by comparing ratings before and after treatment. Agreement among raters was acceptable for all portwine stain characteristics, as was shown by weighted kappa analysis. The reliability of the answers was further improved by taking the average rating of the five panel members. The scores thus obtained were very reliable, with Cronbach alpha coefficients of 0.8 on average. After five treatments of the entire portwine stain, the most considerable changes were measured in the ratings for color (lightening of the stain by 33 percent), boundary (sharpness reduced by 38 percent), and size (13-percent decrease). Using the questionnaire can be helpful in the design of comparative clinical trials on portwine stain treatment and may facilitate comparison of treatment results between different treatment centers and/or different lasers. (Plast. Reconstr. Surg. 102: 42, 1998.) (C)1998American Society of Plastic Surgeons
Assessing the results of laser treatment of port-wine stains (PWS) is very subjective. Most publications use scoring systems that physically describe the change in PWS after treatment. For results derived from such an analysis to be meaningful, the observers must be able to produce results that not only have a small interobserver variability but are also reproducible. Previous studies have addressed the former but not the latter. The present study was undertaken to investigate this area of concern. Six professionals, experienced in laser work, blindly assessed the response to laser treatment of 20 PWS, on two occasions, 1 month apart. Twenty pairs of comparable clinical photographs (one pretreatment and one post-treatment) were assessed using three different scoring systems commonly used in previous publications. Intrarater concordance between the two sessions was then assessed. Our results demonstrated that the judges could only consistently score results at the extremes of outcome. There was little agreement in the assessment of results lying between these. The judges were, however, consistently able to place a similar proportion of patients in each outcome category. We conclude that, as yet, there is no satisfactory method of monitoring the progress of an individual’s PWS following laser treatment. However, the scoring systems examined would seem to be reasonable for presenting the data from patient series.
Hyperbaric oxygen (HBO) therapy is increasingly being used in different areas of medical practice. While demonstrated to be effective in several settings, its mechanism of action is not well understood. In the present study, we determined the effects of HBO on wound epithelialization and neovascularization in an in vivo hairless mouse ear “impaired” wound model. To impair wound healing, macrophages were depleted by pretreatment with iota-carrageenan. Wound epithelialization and neovascularization were measured using intravital microscopy and computerized planimetry. Metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitor of metalloproteinase-1 (TIMP-1), and tumor necrosis factor-α (TNF-α) were measured on days 2 and 7 using immunohistochemistry. In nonimpaired healing wounds, the rate of epithelialization and neovascularization was significantly accelerated in the groups treated with HBO. Time to wound closure was significantly delayed in impaired compared with nonimpaired healing wounds and HBO treatment completely reversed this delay. Neither HBO treatment nor macrophage depletion caused significant alterations in MMP-2 expression in wounds. In contrast, TNF-α, MMP-9, and TIMP-1 were significantly up-regulated in the impaired healing group receiving HBO treatment. These results show that HBO therapy effectively reversed the negative effect exerted by macrophage reduction on wound epithelialization and neovascularization. This beneficial effect could be due to stimulation of TNF-α production and, to a lesser degree due to release of metalloproteinases.
A double blind trial, was designed, in which 118 patients undergoing the removal of impacted wisdom teeth were randomly divided into the following groups; 41 patients received Metronidazole, 39 patients received Arnica Montana, 38 patients received the placebo. Metronidazole was more effective in pain control than Arnica (p less than 0.001) and placebo (p less than 0.01). It prevented swelling better than Arnica (p less than 0.01) and placebo (p less than 0.05) and was more effective in promoting healing than Arnica (p less than 0.01) and placebo (p greater than 0.02). Arnica Montana appeared to give rise to greater pain than placebo (p less than 0.05) and caused more swelling than the placebo (p less than 0.01).
Homoeopathic potencies of arnica have been used for many years to aid postoperative recovery. The effects of arnica C30 on pain and postoperative recovery after total abdominal hysterectomy were evaluated in a double-blind, randomized, controlled study.
Of 93 women entered into the study, 20 did not complete protocol treatment: nine were excluded because they failed to comply with the protocol, nine had their operations cancelled or changed within 24 h and two had to be withdrawn because of the recurrence of previously chronic painful conditions. Those who did not complete protocol treatment were equally divided between the arnica (nine patients) and placebo groups (11 patients). 73 patients completed the study, of whom 35 received placebo and 38 received arnica C30. The placebo group had a greater median age and the arnica group had slightly longer operations; nevertheless, no significant difference between the two groups could be demonstrated.
We conclude that arnica in homoeopathic potency had no effect on postoperative recovery in the context of our study.
To determine whether homeopathic Arnica 30X can reduce muscle soreness following long-distance running more than a placebo.
Randomized, double-blind placebo-controlled trial.
Long-distance runs taking place in the community.
A total of 519 runners anticipating delayed-onset muscles soreness after long-distance races.
A homeopathic medicine (Arnica 30x) and an indistinguishable placebo.
Subjects completed a visual analog scale and Likert scale of muscle soreness every morning and evening for the 5 days following their race. Race time was also recorded. The main outcome measure was mean 2-day visual analog scores.
Results were obtained from 400 subjects. Groups were well matched at baseline. Mean 2-day visual analog soreness scores for Arnica and placebo were 45.2 mm and 41.0 mm, respectively. The 95% confidence interval was between 8.81 mm in favor of placebo and 0.51 mm in favor of Arnica. No differences were found for Likert scores or race time.
Homeopathic Arnica 30x is ineffective for muscle soreness following long-distance running.
The use of antibiotics in the initial treatment of acute otitis media is currently being questioned. Homeopathy has been used historically to treat this illness, but there have been no methodologically rigorous trials to determine whether there is a positive treatment effect.
A randomized double blind placebo control pilot study was conducted in a private pediatric practice in Seattle, WA. Seventy-five children ages 18 months to 6 years with middle ear effusion and ear pain and/or fever for no more than 36 h were entered into the study. Children received either an individualized homeopathic medicine or a placebo administered orally three times daily for 5 days, or until symptoms subsided, whichever occurred first. Outcome measures included the number of treatment failures after 5 days, 2 weeks and 6 weeks. Diary symptom scores during the first 3 days and middle ear effusion at 2 and 6 weeks after treatment were also evaluated.
There were fewer treatment failures in the group receiving homeopathy after 5 days, 2 weeks and 6 weeks, with differences of 11.4, 18.4 and 19.9%, respectively, but these differences were not statistically significant. Diary scores showed a significant decrease in symptoms at 24 and 64 h after treatment in favor of homeopathy (P < 0.05). Sample size calculations indicate that 243 children in each of 2 groups would be needed for significant results, based on 5-day failure rates.
These results suggest that a positive treatment effect of homeopathy when compared with placebo in acute otitis media cannot be excluded and that a larger study is justified.
Wide variations in port-wine stains and their responses to various therapies pose a need for the development of an objective method to evaluate the effects of treatment. Several techniques such as laser Doppler, reflectance spectrometry, and tristimulus colorimetry have been used to evaluate the color of port-wine stains, but these techniques are limited by cost, small test size area, and other factors. Therefore, we developed a simple and cost-effective method of evaluating treatment results on port-wine stains using the L*a*b* color coordinate system in combination with a personal computer. For 22 patients with port-wine stains, the slide photographs were digitized using a slide scanner. L*a*b* color differences of the normal control and port-wine stain sites were obtained before and after treatment, and treatment effect (percent) was calculated. By calculating each color difference between the lesion and normal skin both before and after treatment, problems arising from different illuminating conditions during photography were minimized. The results were compared with the visual evaluation conducted by three experienced plastic surgeons. The treatment effects analyzed by L*a*b* color coordinate ranged from 4 to 95 percent, with a mean of 48.1 percent, whereas treatment effects evaluated by the plastic surgeons ranged from 15 to 92 percent, with a mean of 51.1 percent. The subjective clinical grades correlated well with the treatment effects obtained by the proposed color analysis system (correlation coefficient, 0.89). The maximum difference in the effect of treatment for a patient evaluated by the three clinicians was up to 60 percent, which means that visual judgment is very subjective and variable. The color analysis system proposed as a result of this study is very easy, objective, quantitative, cost-effective, and can be useful for the evaluation of treatment effects on colored skin lesions such as port-wine stains.
The effect of hyperbaric oxygen is known to increase survival of ischemic tissue but its mechanism is not fully understood. The purpose of this study was to evaluate the effect of hyperbaric oxygen on a rat musculocutaneous flap versus ischemia-reperfusion injury, focusing on the mechanism involving the expression of adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1) of endothelial cells and CD18 of neutrophils. A transverse rectus abdominis musculocutaneous (TRAM) flap (6 x 5 cm) supplied by a single superior epigastric vascular pedicle was elevated in 100 Sprague-Dawley rats. The rats were divided into 4 groups: group 0, sham (n = 10); group I, 4 hours of ischemia followed by reperfusion (n = 30); group II, 4 hours of ischemia and hyperbaric oxygen (100% oxygen, 2.5 atm absolute, during the last 90 minutes of ischemia before reperfusion) followed by reperfusion (n = 30); and group III, 4 hours of ischemia followed by reperfusion and hyperbaric oxygen (100% oxygen, 2.5 atm absolute, after reperfusion for 90 minutes; n = 30). The study consisted of gross examination for flap survival, histology, immunohistochemical staining, myeloperoxidase assay, flow cytometric study of CD18, and Northern blot analysis on ICAM-1 messenger ribonucleic acid expression. Gross measurement of the flap showed increased survival in groups II and III compared with group I (P < 0.05). The leukocytes adherent to the endothelium were counted at 24 hours and on day 5. Group I leukocytes were significantly increased compared with groups II and III (P < 0.05). The myeloperoxidase assay of TRAM flaps at 24 hours revealed a significant increase in group I compared with groups II and III (P < 0.05). The expression of CD18 was similar between groups I, II, and III. Immunohistochemical staining for ICAM-1 and Northern blot analysis on ICAM-1 messenger ribonucleic acid showed decreased expression in groups II and III compared with group I. Throughout the analysis, groups II and III did not show any significant differences. These results suggests that hyperbaric oxygen reduces the accumulation of leukocytes in the TRAM flap, but not enough to prevent adhesion of neutrophils on endothelial cells; ischemia-reperfusion injury increases the expression of CD18 and ICAM-1 and causes increased adhesion of leukocytes on the endothelium; hyperbaric oxygen does not alter the expression of CD18 but decreases the expression of ICAM-1; and the point of application for hyperbaric oxygen, whether applied before or after reperfusion, did not show any differences in outcome. In conclusion, the application of hyperbaric oxygen against ischemia-reperfusion injury increases flap survival and the beneficial effect may be explained by a protective mechanism involving downregulation of ICAM-1 on endothelial cells.
Auricular composite grafts are a useful reconstructive option, particularly for nasal reconstruction. This study evaluates the effect of hyperbaric oxygen (HBO) therapy on auricular composite graft survival in rabbits. Circular chondrocutaneous composite grafts of 0.5, 1, or 2 cm in diameter were resected from the ears of rabbits. The grafts were sutured back into position. Half the rabbits in each group received HBO postoperatively, consisting of 90 minutes at 2.4 atm. Rabbits received 7 treatments in 5 days. Control rabbits did not receive HBO. On day 21 the percentage area of graft survival was calculated from gross and histologic examination. Two-centimeter grafts treated with HBO (n = 8) had a mean graft survival rate of 85.8 +/- 15.7% compared with a survival rate of 51.31 +/- 38.5% for the control group (n = 8; P = 0.0478). There was no such benefit in smaller grafts. HBO could prove clinically useful for larger composite grafts.
To design a model for performing reproducible, objective analyses of skin color changes and to apply this model to evaluate the efficacy of homeopathic Arnica montana as an antiecchymotic agent when taken perioperatively.
Twenty-nine patients undergoing rhytidectomy at a tertiary care center were treated perioperatively with either homeopathic A. montana or placebo in a double-blind fashion. Postoperative photographs were analyzed using a novel computer model for color changes, and subjective assessments of postoperative ecchymosis were obtained.
No subjective differences were noted between the treatment group and the control group, either by the patients or by the professional staff. No objective difference in the degree of color change was found. Patients receiving homeopathic A. montana were found to have a smaller area of ecchymosis on postoperative days 1, 5, 7, and 10. These differences were statistically significant (P<.05) only on postoperative days 1 (P<.005) and 7 (P<.001).
This computer model provides an efficient, objective, and reproducible means with which to assess perioperative color changes, both in terms of area and degree. Patients taking perioperative homeopathic A. montana exhibited less ecchymosis, and that difference was statistically significant (P<.05) on 2 of the 4 postoperative data points evaluated.
This study evaluates the possibility of enhancing the beneficial effect of the delay procedure by using hyperbaric oxygen therapy, and the possibility of lessening the time required for maximal effect of delay procedure.
Eight male Wistar rats were used in each of 10 groups. The surgical delay method was applied to the caudally based dorsal rat flap by incising the longitudinal borders and undermining the flap. In the first five groups, 3-, 7-, 10-, 14-, and 21-day delay periods were applied, and in the other five groups, hyperbaric oxygen therapy was applied during the delay periods. Blood circulation was measured with a laser Doppler flowmeter, and flap survival lengths were recorded. Histological analysis for vascular counting and determining vascular areas and microangiographic analysis for monitoring vascular status were performed.
In addition to the flap viabilities being increased, the maximum effect of the delay procedure could be achieved earlier with hyperbaric oxygen therapy. Blood circulation in the flaps, vascular counts, and vascular areas were increased by applying hyperbaric oxygen during the delay period. Microangiographic results confirmed the beneficial effect of hyperbaric oxygen treatment.
Hyperbaric oxygen treatment during the delay period can lessen the time period needed for the delay procedure and increase the effect of the delay itself.