Hyperbaric oxygen therapy does not change the amputation level in patients with fasciotomy after an earthquake: Our single-center experience after 2023 Kahramanmaras earthquake

Abstract

Objectives: This study aims to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the amputation level in patients undergoing fasciotomy with a Mangled Extremity Severity Score (MESS) score of ≥7 after 2023 Kahramanmaras earthquake.

Patients and methods: Between February 6^th, 2023 and March 10^th, 2023, a total of 23 patients (14 males, 9 females; mean age: 36.8±13.2 years; range, 17 to 64 years) who needed amputation with a MESS score of ≥7 and refused amputation were included in the study. All fasciotomies were performed in an external center, and five of them was incomplete. First, incomplete fasciotomies were completed with debridement due to deep muscle necrosis. Daily two HBOT sessions were performed for the first three days. In the following days, daily one HBOT session was performed. The HBOT was terminated for the patients who were decided by the council that they did not benefit from HBOT treatment.

Results: Six (26.08%) of the patients had a bone fracture (n=2 forearm, n=1 femur, n=2 tibia, and n=1 ankle fracture). The mean number of HBOT session was 13.24±5.4 (range, 7 to 30) and the mean duration of HBOT was 26.5±10.8 (range, 14 to 60) h. The mean MESS score was 9.96±1.36 (range, 7 to 12). All of the patients were trapped under the rubble with a mean time of 12.3±5.4 (range, 6 to 23) h. All fasciotomies were performed within the first 30 h. Twenty-two of the patients were amputated at the level previously determined by the experienced trauma surgeons. The amputation level changed in only one patient. After 38 h of HBOT, transradial amputation was performed to the patient in whom transhumeral amputation level was determined previously. None of the patients had any adverse event related to HBOT.

Conclusion: Our study results suggest that the MESS is a useful scoring system for amputation decision after a high-energy trauma, such as an earthquake, with a high accuracy rate. The outcomes of HBOT are not satisfactory for high-energy traumas, such as earthquakes, in those requiring fasciotomy having more muscle necrosis and a MESS score of ≥7.

Citation: Kilic E, Bingol O, Durgal A, Karlidag T, Keskin OH, Ozdemir G. Hyperbaric oxygen therapy does not change the amputation level in patients with fasciotomy after an earthquake: Our singlecenter experience after 2023 Kahramanmaras earthquake. Jt Dis Relat Surg 2023;34(2):516-522. doi: 10.52312/jdrs.2023.1104.

The study protocol was approved by the Ankara City Hospital Clinical Research Ethics Committee (date: 22.02.2023, no: E1-23-3334). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Idea/concept: E.K., G.O.; Design, control/supervision: G.O., O.B.; Data collection and/or processing: A.D., T.K., O.H.K.; Analysis and/or interpretation, references and fundings: E.K., T.K.; Literature review: E.K., A.D.; Writing the article: E.K., O.B., O.H.K.; Critical review: G.O., E.K., O.B.; Materials: E.K., T.K., A.D.; Other: T.K., O.H.K., A.D.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.

A written informed consent was obtained from the parents and/or legal guardians of the patients.

The data that support the findings of this study are available from the corresponding author upon reasonable request.