Issn Print: 0090-3493
Publication Date: 2006/12/01
HYPERBARIC THERAPY FOR NON HEALING RADIATION INDUCED PLEURO-CUTANEOUS FISTULA.: 601
Pavan Kumar Gona; Lavanya Petchetti; Chandra Padmaraju; Zev Carrey
Excerpt
Radiation induced Plerocutaneous fistula's are intractable to heal secondary to effects of radiation.Here we present a case of pleurocutaneous fistula managed with unique, integrative approach of hyperbaric and surgery. 50 year old male with a 50 pack year smoking history, underwent right pneumonectomy in 1997 for adenocarcinoma right lung, followed by radiation therapy at a dose of 5040 cGy in 28 fractions over a 40 day period. Following surgery, the irradiated tissue would not heal normally and resulted in a pleural fistula and persistent communicating pneumothorax that ventilated as the patient breathed. In the preparation for the surgery, the patient received a course of hyperbaric oxygen (HBO) therapy and antibiotics. After 38 outpatient HBO treatments, the patient successfully had flap surgery with complete closure of the fistula. Patient was able to resume activities such as swimming, bathing independently and was no longer clinically depressed.This was a challenging case, as the patient had underlying emphysematous changes in the left lung from his smoking. Special care has to be taken in such patients because of the pressure gradient in the HBO chamber, which might actually cause barotrauma to the chest. And about 5% of patients with tissues radiated to dosages > 5000 cGy, a progressive destruction of the capillary microcirculation occurs. Because this tissue is Hypoxic, Hypovascular, Hypocellular, it is often referred to as “Triple-H” tissue. Though these tissues are viable, they may breakdown spontaneously, when challenged. Transcutaneous oximetry testing of the irradiated tissue in our patient, had oxygen tensions less than 20 mm Hg and with subsequent HBO treatments, the tensions increased to over 50mm Hg. HBO therapy significantly induces capillary angiogenesis and fibroplasias in these compromised tissues, which actually healed our patient.This patient shows one of novel ways of closing a pleurocutaneous fistula with integrative approach of hyperbaric therapy and surgery.
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