Ischemic Injury

Michael B. Strauss, M.D., FACS, AAOS, ABPM/UHM


Crush injuries are directly associated with trauma while skeletal muscle compartment syndromes arise from ischemia, venous outflow obstruction, exertion, external compression as well as trauma. They have the following in common: 1) Ischemia and hypoxia at the injury site, 2) A gradient of injury, and 3) The potential for self-perpetuation of the injury. Management of the most severe presentations of these conditions almost always requires surgery. Hyperbaric oxygen (HBO2) is an effective intervention that counteracts the pathophysiological events which occur with these conditions. Studies show statistically significant reductions in the loss of muscle function, metabolites associated with muscle injury, edema, and muscle necrosis when HBO2 is used in crush injury, compartment syndrome models (1-6). Consequently, HBO2 should be used as a therapeutic adjunct for these conditions when their severity makes expectations of complications and/or less than optimal outcomes likely with usual surgical and medical interventions. Hyperbaric oxygen also should be considered for several conditions with related pathophysiology, namely, burns, threatened flaps, grafts and replantations, and frost bite.1



1 Hyperbaric Oxygen 2003: Indications and Results, The Hyperbaric Oxygen Therapy Committee Report by John J. Feldmeier, D.O., Chairman and Editor. Copyright 2003, Undersea and Hyperbaric Medical Society, Inc., Kensington, MD.