Use of Hyperbaric Oxygen For Frostbite Saves Patient From Amputation and Opens a New Research Opportunity for Local Doctor
Thursday, October 27, 2011
Rod Johnson stepped out of his rig and looked around. He had been past this intersection of Interstate 80 many times and never enjoyed putting chains on his 18-wheeler.
Photo: Boris Volshteyn, M.D.
Today, it was especially cold and windy. He put several chains on with his gloves but then realized he had a hard time feeling the metal. “Let’s just be done with it,” he thought. He took his gloves off and quickly finished. The rest of the trip was not too bad, and he arrived home late. When he woke up, he felt shaky, and his fingers were stinging and blistering. He waited for a day, hoping his fingers would get better; however, they started turning dark.
That’s when he thought it was time to see a doctor.
Johnson arrived at the hospital with first- and second-degree frostbite to eight of his fingers.
“The fingers were so swollen that the circulation was cut off to some of the digits, requiring emergency surgery,” says Boris Volshteyn, M.D., a board-certified plastic surgeon and Medical Director of Sierra Plastic Surgery, who was involved in Johnson’s case. Multiple medical problems — including diabetes, atherosclerosis, history of blood clots and being on anticoagulation regimen — added complications to the case.
“I was very concerned that traditional warming techniques would not be very effective. We had to improvise a little bit,” says Dr. Volshteyn. Via creative modification of the typical blood pressure regimen, Steve Recchia, M.D., was able to stimulate peripheral vasodilation; however, the progress was still very slow. The problem with frostbite is that the separation, or demarcation, takes several months. This is why many surgeons say, “Frostbite in January, amputate in July.”
Reviewing medical literature, physicians came across two U.S. articles advocating use of hyperbaric oxygen therapy for frostbite recovery. Traditionally, frostbite is not one of the 14 approved indications for hyperbaric oxygen therapy (HBOT); however, physicians started treatments at Reno Hyperbaric Center, an in-house, freestanding facility of Sierra Plastic Surgery. Usually specializing in postsurgical and diabetic wounds and radiation-related conditions, surgeons found frostbite to be a new indication.
Just as research articles had stated, it was amazing to see that only after three or four treatments, the demarcation had already begun. After 25 treatments, the patient was completely healed. He did not lose any fingers and was able to return to work with minimal disability. Compared to traditional techniques, it was a significant achievement.
Dr. Volshteyn was so impressed with the effectiveness of HBOT for the treatment of Johnson’s frostbite, he was prompted to coauthor a review article on the topic — in collaboration with the University of Missouri School of Medicine department of plastic surgery — which supports this new indication.
“We never stop learning, and our patients are our best teachers,” he says. “That is what makes our practice exciting.”
Sierra Plastic Surgery
Boris Volshteyn, M.D., treats frostbite with HBOT
MD News May 2011, Reno/Tahoe/Carson City