Background and Goal of Study: The Hyperbaric Medicine Service (HMS) is part of the Anesthesiology Department of Divino Espírito Santo Hospital, where one of the few devices available in Portugal is located. The doctors collaborate in the consultations and follow the patients that are indicated for the treatment with hyperbaric oxygen therapy (HOT).
Necrotizing soft tissue infections, such as necrotizing fasciitis, fournier´s gangrene and gangrenous cellulitis, can progress rapidly to sepsis and multiorgan failure, with very high mortality rates. This study aims to demonstrate the effect of the use of HOT in patients with necrotizing soft tissue infection.
Materials and Methods: A retrospective study was carried out in which 12 patients, referred to the Hyperbaric Medicine Service (HMS) between January 2012 and September 2014, were diagnosed with necrotizing fasciitis (7), fournier´s gangrene (3) or gangrenous cellulitis (2).
Results and Discussion: Of the referenced users only 8 completed HOT, performing on average 18 sessions (in each session they fulfilled 90 min of O2 to 100% to 2.4 ATM). The remaining 4 patients, despite presenting OTH criteria, did not performed it because of need for ventilatory support (2), refusal of treatment (1) and lack of conditions to perform the treatment - long term oncologic disease (1). All patients underwent surgical debridement and systemic wide-spectrum antibiotic therapy. In the users that completed the HOT sessions, there was a favorable healing evolution with a marked improvement in the affected areas, reinforcing the benefits of the blood supply with greater content in oxygen.
One patient did not completed the treatment because he was transferred to his origin country, resulting in a loss of follow-up. 
Conclusion: A multidisciplinary approach using HOT, accompanied by surgical debridement and adequate antibiotic therapy proved to be quite effective in controlling the pathologies in question, optimizing the conditions of local healing and the control of the systemic disease. The use of negative pressure and plastic surgery can be advantageous for the surgical reconstruction of the affected areas.
References: 1) MATHIEU, Daniel - Handbook on Hyperbaric Medicine. Netherlands: Springer, 2006. ISBN 10 1-4020-4448-8.

Effects of hyperbaric oxygen therapy (HOT) in the treatment of severe soft tissue infections