HYPERBARIC OXYGEN THERAPY FOR WOUND COMPLICATIONS AFTER SURGERY IN THE IRRADIATED HEAD AND NECK: A REVIEW OF THE LITERATURE AND A REPORT OF 15 CONSECUTIVE PATIENTS

Background. Radiotherapy, which is often used for cancer in the head and neck, leads to damage of tissue cells and vasculature. Surgery in such tissues has an increased complica- tion rate, because wound healing requires angiogenesis and fi- broplasia as well as white blood cell activity, all of which are jeopardized. Hyperbaric oxygen therapy (HBO) raises oxygen levels in hypoxic tissue, stimulates angiogenesis and fibroplasia, and has antibacterial effects. Methods. In this consecutive retrospective study, 15 patients with soft-tissue wounds without signs of healing after surgery in full-dose (64 Gy) irradiated head and neck regions were treated with HBO and adjuvant therapy. The patients in this study were also compared with patients examined in an earlier study, with corresponding wounds treated without HBO. Results. The healing processes seemed to be initiated and accelerated by HBO. In the HBO group, 12 of 15 patients healed completely, 2 patients healed partially, and only 1 patient did not heal at all. There were no life-threatening complications. In the reference group, only 7 of 15 patients with corresponding wounds without signs of healing eventually healed without surgical inter- vention, and 2 patients had severe postoperative hemorrhage, which in one case was fatal. Conclusion. Evaluation of obtained results supports the hy- pothesis that HBO therapy has a clinically significant effect on initiation and acceleration of healing processes in irradiated soft tissues. © 1997 John Wiley & Sons, Inc. Head Neck 19: 315-322, 1997.