Necrotizing Soft Tissue Infections
A number of types of soft tissue infections may benefit from adjunct treatment with hyperbaric oxygen and are included in the category of “necrotizing soft tissue infections.” Names of such clinical syndromes include crepitant anaerobic cellulitis, progressive bacterial gangrene, necrotizing fasciitis, and nonclostridial myonecrosis. Gas gangrene (clostridial myositis and myonecrosis) is a separate entity and is reviewed elsewhere in this information.
Necrotizing soft tissue infections may result from either a single strain or a mixed population of bacteria and typically occurs after trauma, surgery and/or contact with foreign bodies. The individual affected by such infections frequently has complicating conditions such as diabetes or vascular disease.
In addition to pre-existing complications, necrotizing soft tissue infections themselves may induce conditions adverse to control of the infection by normal defense mechanisms. The infections commonly lower tissue oxygen levels, impairing the ability of the white blood cells (neutrophils) to fight infection. Toxins produced by bacteria may also inhibit neutrophil activity.
The primary treatments for necrotizing soft tissue infection are surgical removal of infected tissue and administration of the appropriate antibiotics. In selected cases, the addition of hyperbaric oxygen therapy may be both lifesaving and cost effective. Hyperbaric oxygen may be beneficial in several ways. Some of the bacteria involved in necrotizing soft tissue infections are “anaerobic,” growing most rapidly in a low oxygen environment. In the hyperbaric chamber, tissue oxygen levels may be raised sufficiently to inhibit bacterial growth. In addition, hyperbaric oxygen treatment may enhance the ability of neutrophils to kill bacteria.
The use of hyperbaric oxygen for treatment of necrotizing soft tissue infections should be individualized. In specific instances where risk of morbidity and mortality are high, adjunct hyperbaric oxygen therapy should be considered.
- Mader JT, Adams KR, Sutton TE. Infectious diseases: Pathophysiology and mechanisms of hyperbaric oxygen. J Hyperbaric Med 1987;2:133-140.
- Knighton DR, Fiegel VD, Halverson T, Schneider S, Brown T, Wells CL. Oxygen as an antibiotic: The effect of inspired oxygen on bacterial clearance. Arch Surg 1990;125:97-100.
- Brogan TV, Nizet V, Waldhausen JHT, Rubens CE, Clarke WR. Group A Streptococcal necrotizing fasciitis complicating primary varicella: A series of fourteen patients. Pediatr Infect Dis Jour 1995;14:588-594.
- Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, Ross DS. Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery 1990;108-847-850.
- Hollabaugh RS, Dmochowski RR, Hickerson WL Cox CE. Fournier’s Gangrene: Therapeutic impact of hyperbaric oxygen. Plast Reconstruct Surg 1998;101:94-100.