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Abstract
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Background and Aims Upper limb trauma presents significant challenges, with decision regarding salvage versus amputation crucial due to functional implication. Ozone exhibits beneficial effects as a disinfectant, oxygen donor, inducer of endothelial nitric oxide synthase, and stem cell activator. We hypothesized that combining ozone therapy with surgery could effectively manage mangled upper limbs. Besides optimal control of pain, RA could play a role in improving tissue perfusion due to sympathetic block and switching inflammation off.
Methods A 34-year-old man endured severe upper limb trauma with marked tissue loss, multiple fragmented open fractures and muscular necrosis leading to septic shock, rhabdomyolysis, and multi-organ failure. He underwent numerous interventions of surgical curettages, VAC-therapy, iv antibiotic therapy. Considering the high risk of disarticulation, we performed daily autohemotherapy with a 500 ml blood-oxygen-ozone blend (40 mcg/ml) for 10 days, followed by twice-weekly sessions for 2 weeks. We repeatedly performed supraclavicular block using ropivacaine 0.5% 20 ml to allow surgery and manage perioperative pain.
Results Significant improvement was noted after the first session, with reduced putrescent tissue and improved limb perfusion. Progressive clinical improvement led to definitive osteosynthesis and flap grafting 42 days after admission.
Conclusions Managing major upper extremity trauma is challenging, and the decision between amputation and limb salvage remains controversial due to limited evidence. Ozone therapy could have been synergic to RA in defusing inflammatory cascade and recruiting microcirculation in order to improve mangled tissue perfusion. This case report represents a potentially successful and safe approach to salvage limbs, avoiding destructive amputation surgery.
Preoperative mangled upper limb
Intraoperative mangled upper limb
Mangled upper limb: last definitive surgery