RADIATION TISSUE DAMAGE (RADIONECROSIS) Radiation tissue damage includes soft tissue radionecrosis, osteoradionecrosis, radiation mucositis, dermatitis, enteritis, laryngeal radionecrosis, cystitis, etc. and surgical wounding in radiation-damaged tissues. Hyperbaric oxygen (HBO2) therapy must be part of an overall plan in which debridement, resection of nonviable tissues, bone grafting, myocutaneous flap reconstruction, and specific antibiotic therapy may be included. Pre and postoperative HBO2 is indicated to achieve a resolution. RATIONALE: At some time after irradiation for therapy of malignancies, a small percentage of patients develop disabling, painful, and potentially fatal tissue breakdown. The basic physiology of this process is a progressive obliterative endarteritis with resultant tissue ischemia. In soft tissue radionecrosis, newer reconstructive techniques often allow total excision of the involved area with repair by vessel-bearing myocutaneous flaps. However, in some cases, particularly in the mandible and maxilla, total surgical ablation would be disfiguring and reconstruction impossible. HBO2 therapy for radiation-damaged tissue was introduced in the early 1970's. With daily elevation of oxygen tension in hypoxic, hypocellular, and hypovascular bone and soft tissue near regions of functioning capillaries, fibroblast proliferation, collagen synthesis, and angiogenesis proceed. The killing ability of leukocytes is enhanced with the elevation of tissue oxygen tensions. Preoperative HBO2 prepares a vascular, noninfected wound to enable the surgeon to successfully debride and later reconstruct such entities. Unplanned but required surgery in previously irradiated tissue has an increased incidence of complications. Adjunctive HBO2 is indicated postoperatively in this clinical setting. Source: Hyperbaric Oxygen Therapy: A Committee Report. Undersea and Hyperbaric Medical Society. 1996 Revision Approved Indications Air or Gas Embolism Carbon Monoxide Poisoning and Smoke Inhalation Carbon Monoxide Poisoning Complicated by Cyanide Poisoning Clostridial Myonecrosis (Gas Gangrene) Crush Injury, Compartment Syndrome, Acute Traumatic Ischemias Decompression Sickness (the "Bends") Enhancement of Healing in Selected Problem Wounds Exceptional Blood Loss (Anemia) Necrotizing Soft Tissue Infections Osteomyelitis (Refractory) Radiation Tissue Damage (Osteoradionecrosis) Skin Grafts and Flaps (Compromised) Thermal Burns Chico Hyperbaric Center Telephone: Email: Chico Hyperbaric Center Web Site Developed & Hosted by Access Now 2000. Copyright © 1999-2001. All Rights Reserved. #