Often the result of deaths and illness, with a mortality rate of over 40% ¹, Fournier gangrene lives up to the word menacing. Despite this, when treated with the correct regimen, it can make a whole difference.

Adjuvant treatment with Hyperbaric Oxygen Therapy is one of these life-saving regimens. Regardless of the condition, it has an undefeated effect on your quality of life. In Fournier gangrene, it makes a significant impact by relieving specific symptoms like:

• Painful microbial-infected wound
• Characteristic swelling of your sacred or private areas 

Hence, let's dive into the world of HBOT in Fournier gangrene.

Overview of Fournier's gangrene and hyperbaric oxygen therapy 

What is Fournier gangrene?

Dr Alfred Fournier discovered this hidden condition characterised by the following events:

• Sepsis 
• Rapid Tissue damage
• A high death rate 

Dr Alfred Fournier named this condition after himself, naming it Fournier gangrene. Fournier gangrene is a subdivision of necrotising fasciitis. It has a rapid progression, which affects the deep and surface tissues of the body at a fast rate. The following are structures the condition affects:

• Perineal 
• Perianal
• Genitalia
• Anterior Abdominal fascia

What is hyperbaric oxygen therapy?

Hyperbaric Oxygen therapy (HBOT) is a life-saving procedure that leads to two outcomes: hyperoxemia and hyperoxia. HBOT supplies 100% oxygen under 2-3 atmospheric absolutes (ATA) in an incubator-like machine called a hyperbaric chamber. 

There are two types of chambers used in HBOT:

• Multiplace chamber 
• Monoplace chamber 

The type of chamber used is dependent on factors such as:

• The number of patients 
• The severity scale of the disease 
• The need for patient monitoring 

A brief history of hyperbaric oxygen therapy 

Innovation has been a critical aspect of medical growth. In 1662, a British man named Henshaw used a form of HBOT, he built a pressurised room to help his patients with pulmonary and digestive issues. Although he thought of it first, he is not the inventor, the accolades go to John Priestley. He saw the potential benefit of 100% oxygenation under a pressurised environment. 

Although John Priestley had invented HBOT by 1772, its use met a 100-year delay. This disuse was due to the side effects Lavioser and Seguin's works suspected. The father of HBO physiology, Paul Bert, fueled this scare when his work showed the procedure could have CNS side effects. Despite all this, researchers and physicians took a bold step by using HBO in research and clinical trials, proving its safety and potential benefit.

Ten indications for the use of hyperbaric oxygen therapy 

According to the Undersea and Hyperbaric Medical Society,² here are ten indications for HBOT.

• Air or Gas embolism
• Carbon monoxide poisoning or carbon monoxide poisoning complicated by cyanide 
• Crush injury 
• Compartment syndrome
• Acute traumatic ischaemia 
• Decompression Sickness 
• Burns
• Arterial insufficiencies
• Severe Anemia 
• Refractory Osteomyelitis 

Ten contraindications for the use of hyperbaric oxygen therapy 

Pneumothorax is an absolute no-no when it comes to HBOT. Despite this, here are ten other contraindications to HBOT: 

• Uncontrolled hypertension
• Diabetes mellitus (>300 or <100)
• Congestive Heart failure ( < 35% ejection rate)
• Claustrophobia
• Congenital spherocytosis 
• Current respiratory tract infection
• Fever
• Chronic sinus infection
• Contact lens
• Untreated cancer

Use of hyperbaric oxygen therapy (HBOT) in fournier gangrene 

How does HBOT help fournier gangrene patients?

Microbial infestation is a major factor in wound deterioration. It is even inevitable in this instance, as bacteria is a huge culprit in Fournier gangrene. Both aerobic and anaerobic bacteria play a role in this condition. 

These bacteria cause tissue hypoxia, which leads to cell death. HBOT helps this situation because of its bactericidal effects on anaerobic infection of either type of bacteria. Some of these bacteria are:

• Enterobacteriaceae 
• Bacillus fragilis
• Klebsiella pneumoniae
• Escherichia coli

What are the side effects of using hyperbaric oxygen therapy in Fournier gangrene?

HBOT is an advanced therapy that has provided the world with a relatively safe and efficient solution. Despite this, the following are side effects of HBOT, with barotrauma and claustrophobia being the most common complications:

• Middle ear barotrauma
• Sinus and paranasal sinus trauma
• Ocular side effects 
• Hypoglycemia
• Oxygen induced seizure
• Claustrophobia
• Hypertension 
• Hypotension
• Dyspnea
• Meatal stenosis

These side effects often occur when :

• Your physician subjects you to a pressure greater than 2ATA 
• You have undergone more than ten hyperbaric oxygen therapy sessions

How to prepare for hyperbaric oxygen therapy 

You should take certain precautions for your HBOT appointments to prevent specific side effects— hence, here are things to do and avoid.

DO

• Have a balanced diet a few hours before your therapy
• Maintain your water intake
• Notify your physician if you have or are experiencing symptoms of a cold or the flu
• Make arrangements for transport after the treatment because you will be dizzy 

AVOID

• Perfumes, oils, and lotions
• Alcohols
• Smoking
• Tobacco-related products 
• Contact lenses and glasses
• Carbonated drinks 
• Pieces of jewellery
• Electronic devices
• Fresh acrylic nails or nail polish
• Hair extensions, hair sprays or hair products 
• Body piercings

The quality of life of patients using hyperbaric oxygen therapy in Fournier gangrene 

HBOT in Fournier gangrene provides you with a second chance in a deadly condition. Studies such as³ documented a higher survival rate of all patients who agreed to undergo HBOT. 

Hence, it may disrupt your daily routine, but it is worth the steps to a healthy life again. 

FAQs

Does hyperbaric oxygen therapy work for Fournier's gangrene?

Yes, HBOT works on several conditions, and Fourier gangrene is one of them. Studies such as³ have driven deeper to confirm the success rates that other studies claim. This success proves that HBOT is against Fourier gangrene's usual progression into a worsened state. 

What is the best treatment for Fournier's gangrene?

Although HBOT is beneficial to you as a Fournier gangrene patient, it is not the primary treatment. Early, deliberate and aggressive surgical debridement is the primary treatment to help you return to health. Despite this, you must note that HBOT is an adjuvant treatment. It is Adjuvant because it is like an ingredient in a sandwich. Physicians use HBOT in combination with other therapies to achieve positive outcomes. 

When do i not use hyperbaric oxygen therapy?

Physicians use HBOT when a microbial-infected wound or wound healing is crucial. Despite this, there are contraindications that make this treatment unsafe. An absolute no-no is the condition pneumothorax. Some of the other previously mentioned above are:

• Uncontrolled hypertension
• Diabetes mellitus (>300 or <100)
• Congestive Heart failure ( < 35% ejection rate)
• Claustrophobia

How long does hyperbaric oxygen therapy last? 

The length of treatment depends on the condition. Your physician may prescribe as few as 20 sessions or as many as 60 sessions. Despite this, HBOT sessions take about 1.5-2 hours and can be over 2-3 sessions daily. 

Is there an alternative to hyperbaric oxygen therapy?

Despite its therapeutic success, there is an alternative to HBOT—Normobaric Oxygen Therapy (NMOT). NMOT is a cheaper and safer way to go than HBOT. It is safer because when HBOT starts at 2 ATA, at the least, NMOT starts at 1 ATA. You cannot compare its performance to HBOT despite its cheaper and safer advantages.

Does hyperbaric oxygen therapy heal bones?

Physicians target HBOT at wounds, not bones. This procedure is of importance when:

• There is inflammation present 
• When there is a need for fast wound healing 
• Microbial infestation present in a wound 
• There is a need for increased immune cell function 
• There is a need for increased oxygen levels in the blood

Where can i receive hyperbaric oxygen therapy?

If you have none of the contraindications, you should be able to receive HBOT at any equipped facility. 

What are the benefits of Fournier's gangrene in hyperbaric oxygen therapy?

The following are the advantages of HBOT in Fournier gangrene: 

• Reduced inflammation
• Reduced systemic toxicity
• Increased wound healing rate 
• Prevention of infection spread

Summary

Fournier gangrene is a condition discovered in 1883 with a detrimental progression. Before the advent of HBOT, this would have made the patient's life tedious. Fortunately, today, HBOT is here and regarded as safe and efficient. This is not limited to Fournier gangrene— physicians have noted its usage across different conditions. Some noteworthy ones include:

• Covid-19
• Cancer 
• HIV

In essence, HBOT is a messiah despite its side effects.