[abstract] HYPERBARIC OXYGEN THERAPY (HBOT) IN THE DELAYED TREATMENT OF 8000 METER PEAK CLIMBER FROSBITES.

Abstract

BACKGROUND: HBOT in frostbite lesions is still considered investigational in many countries. At the present time, in Italy HBOT use in these conditions is allowed as extension of “peripheral vascular insufficiency with trophic lesions” indication. With this kind of access, we have already successfully treated the freezing cold injury case of an inadequately clothed heroin-addicted subject. MATERIALS AND METHODS: Four expert climbers arrived at our attention with cold-related illness; such occurrences were registered at the end of complicated ascensions. Two of them (A, B; patient code: 3124, 3125) were from the well-known "Cortina's Squirrels" climbing group, at the end of the 2004 K2-Expedition (August 2004), the other two cases (C, D; patient code: 3527, 3610) regarded two independent ascensionists (August and November 2005). An accurate mild progressive re-warming was applied at the base-camp trying to limit, during a prolonged thawing phase, that additional reperfusion component of the injury. Corresponding to the above mentioned cases: -A: lesion to left hand's middle finger distal phalanx, -B: serious injury affecting right hand, left and right foot, -C: mild frostbite involving both first fingers of patient's feet, -D: grade three cold-related gangrene of the right hand. Cases A, C and D underwent 5 HBO-Tx on their arrival at our institution [@2.5 ATA (15msw, 147,1 kPa), 25'x3 in O2 plus 5'x2 'air'-pause interposed] with further treatment (up to 15Tx in a home DHM-unit); Case B underwent 15 HBO-Tx, at same depth and O2-exposures. The highly predictive technetium99 bone scanning was not applied within the usual 48-72 hour interval, due to logistic limitations. CONCLUSIONS: Clearly improved the functional end result, with single case minimal differences as per light subamputation needs. A 24 and 12 months follow-up confirmed: 1) the good general conditions, 2) the protection to the known higher morbidity in the following months to further easier frostbites, and 3) the better course compared to the expected end scenery.