Role of Hyperbaric Oxygen Therapy and Vasodilators in Repeat Genital Surgery
Alan Katz, MD1, Moneer K. Hanna, MD,FRCS2.
1Hyberbaric Medical Solutions, New York, NY, USA, 2New York Presbyterian-Cornell, New York, NY, USA.
BACKGROUND: When treating hypospadias, multiple surgeries often leads to varying degrees of scarring and hypo-vascularity. To reduce the reported high post-operative complication rate (40-66%), we instituted a prospective treatment protocol in 63 patients.
METHOD: From May 2014 to December 2017 we treated patients (2-19 years old) who underwent three or more prior hypospadias surgeries using our trimodal protocol. Nitroglycerine ointment 2% was applied at the conclusion of the surgery to enhance blood flow, followed by daily Hyperbaric Oxygen Therapy (HBOT) for ten days. Six to eight weeks later local steroid cream (Betamethasone) was applied daily for 3 months to reduce the probability of keloid formation.
RESULT: There were 2 groups, the first Group (31 patients) who followed the above protocol and second group (32 patients) who did not receive HBOT. Surgical complications including dehiscence, fistula, stricture, and urethral diverticulum, were 3/31 (9.7%) and 11/33 (35.2%) respectively. The follow up ranged between 1-4 years.
CONCLUSION: Nitroglycerine is a potent vasodilator which when applied to skin flaps post operatively has been proven to reduce flap necrosis. Furthermore, HBOT is an established treatment for salvage of compromised grafts and flaps. HBOT reverses tissue hypoxia, promotes angiogenesis, reduces inflammation, and stimulates the release of stem cells. The addition of HBOT resulted in improved outcome. This preliminary report warrants further study in a larger number of patients.
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