[Effects of hyperbaric oxygen therapy (HBO) during treatment of infected free bone transplants. A Case report]

Abstract

Background: Hyperbaric oxygen therapy (HBO) leads to a significant increase of oxygen supply in poorly perfused tissue. Several physiological mechanisms of this treatment modality are suitable for having a positive effect on infected large autologous free bone transplants.

Case report: In a 49-year-old male with a metastasized squamous cell carcinoma of the floor of the mouth radical tumour surgery with subsequent radiation was performed. Nine years later an infected osteoradionecrosis of the mandible emerged which required a continuity-resection with simultaneously performed reconstruction of the mandible using an autologous free transplanted iliac bone graft. Four days post surgery wide intraoral dehiscence with complete denuding of the bone graft occurred. For this reason initiation of an adjuvant hyperbaric oxygen therapy in addition to high dose antibiotic therapy and local wound care. Combined therapy led to granulation tissue on the surface of the transplanted bone with subsequent epithelization. Complete incorporation and conversion of the bone transplant with full rehabilitation concerning function and aesthetics was noted.

Discussion: Without HBO treatment the large volume infected autologous free bone transplant would have been lost. Beside other capabilities of HBO the induction of rapid neovascularisation and increasing oxygen diffusion radius are the reasons that the infected transplant was saved. Only under these conditions it was possible to erradicate the bacterial infection effectively with antibiotics.