Oxigenoterapia Hiperbarica para ayudar con
Infecciones Necrotizantes de Tejidos Blandos
¿CON QUE PUEDE AYUDAR LA CÁMARA HIPERBÁRICA EN NECROSIS O INFECCIONES NECROTIZANTES DE TEJIDOS BLANDOS ?
Las cámaras hiperbáricas puede ayudar como coadyuvante, usando presiones por arriba de las 2.0 ATA. Aquí hay varias formas en las que la oxigenoterapia hiperbárica (OHB) puede ayudar en el tratamiento de INTB:
Mejora el suministro de oxígeno: La OHB proporciona oxígeno puro a altas presiones, lo que aumenta significativamente la cantidad de oxígeno que la sangre puede transportar. Esto es crucial para los tejidos afectados por la infección, ya que el oxígeno es esencial para la función celular y la curación de heridas. Al mejorar el suministro de oxígeno a las áreas afectadas, se promueve la supervivencia de los tejidos y se fomenta la cicatrización.
Frena la cascada inflamatoria del cuerpo: La OHB puede ayudar a reducir la inflamación asociada con INTB. Esto es importante porque la inflamación excesiva puede contribuir al daño tisular. Al reducir la inflamación, la OHB puede ayudar a limitar la propagación de la infección y prevenir un mayor daño a los tejidos.
Mayor eficacia de los antibióticos: La oxigenoterapia hiperbárica puede potenciar la acción de los antibióticos utilizados en el tratamiento de INTB. Los antibióticos funcionan mejor en un entorno bien oxigenado, y la OHB puede mejorar la penetración de los antibióticos en los tejidos afectados, lo que ayuda a combatir la infección de manera más efectiva.
Apoyo a la función del sistema inmunológico: La OHB puede estimular la respuesta del sistema inmunológico del cuerpo, lo que puede ser beneficioso en la lucha contra la infección.
Función Bactericida y Bacteriostático: La OHB ayuda a activar el sistema inmunológico y ayuda a combatir bacterias y controlar su crecimiento.
Prevención de la progresión de la infección: En algunos casos, la OHB puede ayudar a detener la propagación de la infección y reducir la necesidad de extirpar grandes áreas de tejido infectado. Esto puede limitar la necesidad de cirugías extensas y reconstrucción posterior.
- Estimula la formación de tejido de granulación: La formación de tejido de granulación es un paso crucial en la cicatrización de heridas. La TOHB puede estimular la proliferación de células que forman este tejido, acelerando así el proceso de cicatrización.
LA TERAPIA HIPERBÁRICA COMO COADYUVANTE EN EL TRATAMIENTO DE LA FASCITIS NECROTIZANTE
La cámara hiperbárica es útil en la fascitis necrotizante, una infección grave de tejidos blandos, porque suministra oxígeno puro bajo presiónes arriba de 2.0 ATA. Esta oxigenación mejorada favorece la supervivencia celular y limita la propagación de la infección. La alta presión de oxígeno reduce la inflamación y mejora la efectividad de los antibióticos al facilitar su penetración en los tejidos afectados. Además, estimula la respuesta inmunológica del cuerpo y evita la progresión de la infección, lo que puede reducir la necesidad de cirugías extensas.
En conjunto, la oxigenoterapia hiperbárica complementa tratamientos tradicionales y aumenta las posibilidades de recuperación en casos de fascitis necrotizante.
CÓMO SIRVE LA TERAPIA EN CÁMARA HIPERBÁRICA PARA NECROSIS, INFECCIONES NECROTIZANTES DE TEJIDOS BLANDOS Y FASCITIS NECROTIZANTE
Mas detallado con estudios de soporte Usando presiones arriba de 2.0-2.4 ATA
Investigaciónes y Fuentes
Liceaga, D. E. (2014). GUÍAS CLÍNICAS DE DIAGNÓSTICO Y TRATAMIENTO DEL SERVICIO DE CÁMARA HIPERBÁRICA. Ciudad de Mexico: Hospital General de Mexico.
Undersea and Hyperbaric Medical Society. (2021). Indications for Hyperbaric Oxygen Therapy. Retrieved from https://www.uhms.org/resources/hbo-indications.html
127. Levett D, Bennett MH, Millar I. Adjunctive hyperbaric oxygen for necrotizing fasciitis (Protocol). Cochrane
Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007937
Chapter 11: Necrotizing Soft Tissue Infections
Caesar A. Anderson MD, MPH, Irving Jacoby MD, FACP, FACEP, FAAEM, FUHM
REFERENCES
1. Kao LS, Lew DF, et al. Local variations in the epidemiology, microbiology, and outcome of necrotizing soft tissue
infections: a multicenter study. Am J Surg 2011;202:139.
2. Wilkinson D, Doolette D. Hyperbaric Oxygen treatment and survival from necrotizing soft tissue infection. Arch
Surg. 2004;139:1339 -1345.
3. Escobar SJ, Slade JB. Adjuvant hyperbaric oxygen therapy for treatments of necrotizing fasciitis reduces mortality
and amputation rates. Undersea and Hyperb Med. 2006;32(6):437-443.
4. Anaya DA, Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg. 2005.
5. Shupak A, Shoshani O, Goldberg I, et al. Necrotizing fasciitis: An indication for hyperbaric oxygen therapy?
Surgery. 1995;118:873-878.
6. Shaw JJ, Psoinos C, Emhoff TA, et al. Not just full of hot air: Hyperbaric oxygen therapy increases survival in cases
of necrotizing soft tissue infections. Surg Infect (Larchmt). 2014;15:328-335.
7. Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: Review and current
concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014 August;51(8):344-362.
8. Sudarsky LA, Laschinger JC, et al. Improved results from a standardized approach in treating patients with
necrotizing fasciitis. Ann Surg. 1987;206:661-665.
9. Faraklas I, Yang D, et al. A Multicenter Review of Care Patterns and Outcomes in Necrotizing Soft Tissue
Infections. Surgical Infections. 2016;Volume 17(6).
10. Mandell G. Bacteriacidal activity of aerobic and anaerobic polymorphonuclear neutrophils. Infect Immun.
1974;9:337-341.
11. Mader JT, Adams KR, Sulton TE. Infectious diseases: pathophysiology and mechanisms of hyperbaric oxygen. J
Hyperbaric Med. 1987;2:133-140.
12. Hunt TK, Linsey M, Grislis G, et al. The effect of differing ambient oxygen tension on wound infection. Ann Surg.
1975 Jan;181(1):35-39.
13. Thom SR, Mendiguren I, Hardy K, Bolotin T, Fisher D, Nebolon M, et al. Inhibition of human neutrophil beta2–
integrin-dependent adherence by hyperbaric O2. Am J Physiol. 1997 Mar;272(3 Pt 1):C770-777.
14. Park MK, Muhvich KH, Myers RA, Marsella L. Hyperoxia prolongs the aminoglycoside-induced postantibiotic
effect in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1991;35(4):691-695.
15. Jones J. Surgical Memoirs of the War of the Rebellion. Investigation Upon the Nature, Causes, and Treatment of
Hospital Gangrene as Prevailed in the Confederate Armies 1861-1865. United States Sanitary Commision;New
York, NY. p.1871.
16. Meleney FL. Hemolytic streptococcus gangrene. Arch Surg. 1924;9:317-364.
17. Wilson B. Necrotizing fasciitis. Am Surg.1952;18:416-431.
18. Simonsen E, Orman E, et al.Cellulitis incidence in a defined population. Epidemiol Infect. 2006;134(2):293-299.
19. Gozal D, Ziser A, et al. Necrotizing fasciitis. Arch Surg. 1986;121:233.
20. Anaya DA, Patchen Dellinger E. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis.
2007;44:705-710.
21. Miller LG, Perdreau-Remington F, Rieg G, Mehdi S, Perlroth J, Bayer AS, Tang AW, Phung TO, Spellberg B.
Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N
Engl J Med. 2005;352:1445-1453.
22. Giuliano A, Lewis F, et al. Bacteriology of necrotizing fasciitis. Am J Surg.1977;1134(1):52-57.
23. Miller L, Carrick M, et al. Necrotizing fasciitis caused by community associated methicillin-resistant Staphylococcal
aureus in Los Angeles. N Engl J Med. 2005;352(14):1445-1453.
24. Bryant AE, Stevens DL, et al. clostridial myonecrosis: new insights in pathogenesis and management. Curr Infect
Dis Rep. 2010;12(5):383-391.
25. Stevens DL, Aldape MJ, et al. Life threatening clostridial infections. Anaerobe. 2011;18(2):254-259.
26. Eke N. Fournier’s gangrene: a review of 1726 cases. Br J Surg. 2000;87:718.
27. Toro C, Castillo A, et al. Cervical necrotizing fasciitis: Report of 6 cases and review of literature. European Annals
Otorhinolaryngology, Head and Neck Diseases. 2014;131:357-359.
28. Flanagan C, Daramola O, et al. Surgical debridement and adjunctive hyperbaric oxygen in cervical necrotizing
fasciitis. Otorhinolaryngology, Head and Neck Diseases. 2009;140 (5):730-4.h
29. Stevens DL, Bryant AE. Necrotizing soft tissue infections. N Engl J Med. 2017;377:2253.
30. Shiroff A, Herlitz G, Gracias V. Necrotizing soft tissue infections. J Intensive Care Med. 2014;29(3):138-144.
31. Darenberg J, Luca-Harari B, et al. Molecular and clinical characteristics of invasive GAS infection in Sweden. Clin
Infect Dis. 2007;45:450.
Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc.
32. Goodell J, Jordan M, et al. Rapidly advancing necrotizing fasciitis caused by Phytobacterium (Vibrio) damsel: a
hyperagressive variant. Crit Care Med. 2004;32(1):278-281.
33. Hau V,Ho CO. Necrotizing fasciitis caused by Vibrio vulnificans in the lower limb following exposure to seafood on
the hand. Hong Kong Med J. 2011;17:335.
34. Brogan TV, Nizet V, Waldhausen JHT, Rubens CE, Clarke W. Group A streptococcal necrotizing fasciitis complicating primary varicella: a series of fourteen patients. Pediatr Infect Dis J. 1995;14:588-594.
35. https://www.fda.gov/downloads/drugs/drugsafety/ucm618466.pdf
36. Stevens DL, Bryant AE, et al. Necrotizing soft tissue infections. N Engl J Med. 2017;377:2253.
37. Hamilton SM, Bayer CR, Stevens DL, and Bryant AE. Effects of selective and nonselective nonsteroidal antiinflammatory drugs on antibiotic efficacy of experimental Group A Streptococcal myonecrosis. Jour Infect Dis.
2014; 209:1429-1435.
38. Bell AL, Adamson H, Kirk F, McCaigue MD, Rotman H. Diclofenac inhibits monocyte superoxide production ex
vivo in rheumatoid arthritis. Rheumatol Int. 1991;11:27-30.
39. Stevens DL. Could nonsteroidal anti-inflammatory drugs (NSAIDS) enhance the progression of bacterial infections
to toxic shock syndrome? Shock. 2013;21(4):977-980.
40. LaRock CN, Todd J, LaRock DL et al. IL-1ß is an innate immune sensor of microbial proteolysis. Sci. Immunol.
2016;1,eaah3539.
41. Sawin RS, Schaller RT, Tapper D, Morgan A, Cahill J. Early recognition of neonatal abdominal wall necrotizing
fasciitis. Am J Surg. 1994;167:481-484.
42. Wang TL, Hung CR. Role of tissue oxygen saturation monitoring in diagnosing necrotizing fasciitis of the lower
limbs. Ann Emerg Med. 2004;44:222-228.
43. Lally KP, Atkinson JB, Wooley MM, Mahour GH. Necrotizing fasciitis: a serious sequela of omphalitis in the
newborn. Ann Surg. 1984;199:101-103.
44. Sawin RS, Schaller RT, Tapper D, Morgan A, Cahill J. Early recognition of neonatal abdominal wall necrotizing
fasciitis. Am J Surg. 1994;167:481-484.
45. Keung E, Liu X, et al. Immunocompromised status in patients with necrotizing soft tissue infections. JAMA Surg.
2013;148(5):419-426.
46. Stamenkovic I, Lew PD. Early recognition of potentially fatal necrotizing fasciitis: the use of frozen-section biopsy. N
Engl J Med. 1984;310:1689-1693.
47. Carbonetti F, Cremona A, et al. The role of contrast enhanced computed tomography in the diagnosing of
necrotizing fasciitis and comparison with the Laboratory risk indicator for Necrotizing fasciitis (LRINEC). Radiol
Med. 2016 Feb;121(2):106-121.
48. Wysoki MG, Santora TA, Shah RM, Friedman AC. Necrotizing fasciitis: CT characteristics. Radiology.
1997;203:859-863.
49. Schmid MR, Kossman T, Duewell S. Differentiation of necrotizing fasciitis and cellulitis using MR imaging. Am J
Roentgenol. 1998;170:615-620.
50. Wong C, Khin L, et al. The LRINEC (laboratory risk indicator for necrotizing fasciitis) score: a tool for
distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535-1541.
51. Bechar J, Sepehripour S, et al. Laboratory risk indicator for necrotizing fasciitis (LRINEC) score for the assessment
of early necrotizing fasciitis: a systematic review of the literature. Ann R Coll Surg Engl. 2017;99:341-346.
52. Borschitz T, Schlicht S, et al. Improvement of a clinical score for necrotizing fasciitis: ‘pain out of proportion’ and
high CRP levels aid the diagnosis. PLoS One 2015;10(7):e0132775.
53. Hansen M, Rasmussen L, et al. Pentraxin-3 as a marker of disease severity and risk of death in patients with
necrotizing soft tissue infections: a nationwide, prospective, observational study. Critical Care. 2016;(20)40.
54. Su YC, Chen HW, et al. Laboratory risk indicator for necrotizing fasciitis score and outcomes. ANZ J Surg.
2008;78:968-972.
55. Hansen MB, Rasmussen LS, et al. Association between cytokine response, the LRINEC score and outcome in
patients with necrotizing soft tissue infection: a multicenter, prospective study. Sci Rep. 2017; 7:42179.
56. Stevens DL, Bisno AL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue
infections:2014 update by the infectious diseases society of America. Clin Infect Dis. 2014;59:147.
57. Faraklas I, Yang D, et al. A Multicenter Review of Care Patterns and Outcomes in Necrotizing Soft Tissue
Infections. Surgical Infections. 2016; Volume 17(6).
58. Sablier F, Slaouti T, et al. Nosocomial transmission of necrotizing fasciitis. Lancet. 2010;375:1052.
59. Bilbault P, Castelain V, et al. Life threatening cervical necrotizing fasciitis after a common dental extraction. Am J
Emerg Med. 2008;26:5-7
Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc.
60. Soh CR, Pietroban R, Freiberger JJ, et al. Hyperbaric Oxygen therapy in necrotizing soft tissue infections:a study of
patients in the US Nationwide Inpatient sample. Intensive Care Med. 2012;38:1143.
61. Wilkinson D, Doolette D. Hyperbaric oxygen treatment and survival from necrotizing soft tissue infection. Arch
Surg. 2004;139:1339-1345.
62. Escobar SJ, Slade JB, Hunt TK, Cianci P. Adjuvant hyperbaric oxygen therapy (HBO2) for treatment of necrotizing
fasciitis reduces mortality and amputation rate. Undersea Hyperb Med. 2006;32(6):437-443.
63. Brown DR, Davis NL, Lepawsky M, Cunningham J, Kortbeek J. A multicenter review of the treatment of major
truncal necrotizing infections with and without hyperbaric oxygen therapy. Am J Surg. 1994;167:485-489.
64. Monestersky JH, Myers RAM. Letter to the editor: hyperbaric oxygen treatment of necrotizing fasciitis. Am J Surg.
1995;169:187-188.
65. Anaya DA, McMahon K, Nathens AB, Sullivan SR, Foy H, Bulger E. Predictors of mortality and limb loss in
necrotizing soft tissue infections. Arch Surg. 2005;140:151-157.
66. McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue
infections. Ann Surg. 1995;221:558-563.
67. Hsieh WH, Yang, PH, Chao HC, Lai JY. Neonatal necrotizing fasciitis: report of 3 cases and review of the literature.
Pediatrics. 1999;103(4):e53. Available at: http://pediatrics.aappublications.org/cgi/content/full/103/4/e53
68. Lally KP, Atkinson JB, Wooley MM, Mahour GH. Necrotizing fasciitis: a serious sequela of omphalitis in the
newborn. Ann Surg. 1984;199:101-103.
69. Sawin RS, Schaller RT, Tapper D, Morgan A, Cahill J. Early recognition of neonatal abdominal wall necrotizing
fasciitis. Am J Surg. 1994;167:481-484.
70. Gozal D, Ziser A, Shupak A, Ariel A, Melamed Y. Necrotizing fasciitis. Arch Surg. 1986;121:233-235.
71. Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, and Ross DS. Hyperbaric oxygen therapy for
necrotizing fasciitis reduces mortality and the need for debridements. Surgery. 1990;108:847-850.
72. Laor E, Palmer LS, Tolia BM. Outcome prediction in patients with Fournier’s gangrene. J Urol. 1995;154:89-92.
73. Dahm P, Roland FH, Vaslef SN, Moon RE, Price DT, Georgiade GS, Viewig J. Outcome analysis in patients with
primary necrotizing fasciitis of the male genitalia. Urol. 2000;56:31-36.
74. Mallikarjuna M, Vijayakumar A, et al. Fournier’s gangrene: current practices. ISRN Surgery 2012(ID 942437):1-8.
75. Hollabaugh RS, Dmochowski RR, Hickerson WL. Fournier’s gangrene: therapeutic impact of hyperbaric oxygen.
Plast Reconstr Surg. 1998;101:94-100.
76. Pizzorno R, Bonini F, Donelli A, Stubinski R, Medica M, Carmignani G. Hyperbaric oxygen therapy in the
treatment of Fournier’s disease in 11 male patients. J Urol. 1997;158:837-840.
77. Korhonen K, Him M, Niinikoski J. Hyperbaric oxygen in the treatment of Fournier’s gangrene. Eur J Surg.
1998;164:251-255.
78. Willy C, Rieger H, et al. Hyperbaric oxygen therapy for NSTI. Chirug 2012;83:960.
79. Eggerstedt M, Gamelli RL, et al. The care of necrotizing soft tissue infections. Patterns of definitive intervention at a
large referral center. J Burn Care Res. 2015;36:105-110.
80. Holena DN, Mills AM, et al. Transfer status: A risk factor for mortality in patients with necrotizing fasciitis. Surgery.
2011;150:363-370.
81. Davaney B, Frawley G, et al. Necrotising soft tissue infections: the effect of hyperbaric oxygen on mortality. Anaesth
Intensive Care. 2015;43:6.
82. Gore M. Odontogenic necrotizing fasciitis: a systematic review of the literature. BMC Ear, Nose and Throat
Disorders. 2018;18:14.
83. Shaw JJ, Psoinos C, Emhoff TA, et al. Not just full of hot air: Hyperbaric oxygen therapy increases survival in cases
of necrotizing soft tissue infections. Surg Infect (Larchmt). 2014;15:328-335.
84. Torp KD, Carraway MS. Safe administration of hyperbaric oxygen after bleomycin:a case series of 15 patients.
Undersea Hyperb Med. 2012;39:873.
85. Karagoz B, Suleymanoglu S, et al. Hyperbaric Oxygen therapy does not potentiate doxorubicin-induced
cardiotoxicity in rats. Basic Clin Pharmacol Toxicol. 2008;102:287.
86. Stone HH, Martin JD. Synergistic necrotizing cellulitis. Ann Surg. 1972;175:702-711.
87. Bessman AN, Wagner W. Nonclostridial gas gangrene. JAMA. 1975;233:958.
88. Cullen TS. A progressively enlarging ulcer of abdominal wall involving the skin and fat, following drainage of an
abdominal abscess, apparently of appendiceal origin. Surg Gynecol Obstetr. 1924;38:579-582.
89. Ledingham IM, Tehrani MA. Diagnosis, clinical course and treatment of acute dermal gangrene. Br J Surg.
1975;62:364-372.
90. Chayakulkeeree M, Ghannoum MA, Perfect JR. Zygomycosis: the re-emerging fungal infection. Eur J Clin Microbiol Infect Dis. 2006;25:215-229.
Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc.
91. McNulty JS. Rhinocerebral mucormycosis: predisposing factors. Laryngoscope. 1982;92:1140-1143.
92. Windus DW, Stokes TJ, Julian BA, Fenves AZ. Fatal Rhizopus infections in hemodialysis patients receiving
deferoxamine. Ann Int Med. 1987;107:678-680.
93. Boelaert JR, Van Roost GF, Vergauwe PL, Verbanck C, De Vroey C, Segaert MF. The role of deferoxamine in
dialysis-associate mucormycosis: report of three cases and review of the literature. Clin Nephrol. 1988; 29:261-266.
94. Cocanour CS, Miller-Crouchett P, Reed RL, Johnson PC, Fischer RP. Mucormycosis in trauma patients. J Trauma.
1992;32:12-15.
95. Tedder MJ, Spratt JA, Anstadt MP, Hegde SS, Tedder SD, Lowe JE. Pulmonary mucormycosis: results of medical
and surgical therapy. Ann Thorac Surg. 1994;57:1044-1050.
96. Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Revs. 2000;13:236-301.
97. Murray HW. Pulmonary mucormycosis with massive fatal hemoptysis. Chest. 1975;68:65-68.
98. Michalak DM, Cooney DR, Rhodes KH, Telander RL, Kleinberg F. Gastrointestinal mucormycosis in infants and
children: a cause of gangrenous intestinal cellulitis and perforation. J Pediatr Surg. 1980;15:320-324.
99. Chamilos G, Marom EM, Lewis RE, Lionakis MS, Kontoyiannis DP. Predictors of pulmonary zygomycosis versus
invasive pulmonary aspergillosis in patients with cancer. Clin Infect Dis. 2005;41:60-66.
100. Diamond RD, Haudenschild CC, Erickson III NF. Monocyte-mediated damage to Rhizopus oryzae hyphae in vitro.
Infect Immun. 1982;38:292-297.
101. Waldorf AR. Pulmonary defense mechanisms against opportunistic fungal pathogens. Immunol Ser. 1989;47:
243-271.
102. Waldorf AR, Ruderman N, Diamond RD. Specific susceptibility to mucormycosis in murine diabetes and bronchoalveolar macrophage defense against Rhizopus. J Clin Invest. 1984;74:150-160.
103. Ibrahim AS, Spellberg B, Avanessian V, Fu Y, Edwards, Jr. E. Rhizopus oryzae adheres to, is phagocytosed by, and
damages endothelial cells in vitro. Infect Immun. 2005;73:778-783.
104. Imperatore F, Cuzzocrea S, De Lucia D, Sessa M, Rinaldi B, Capuano A, Liguori G, Filippelli A, Rossi F. Hyperbaric
oxygen therapy prevents coagulation disorders in an experimental model of multiple organ failure syndrome.
Intensive Care Med. 2006;32:1881-1888.
105. Buras JA, Holt D, Orlow D, Belikoff B, Pavlides S, Reenstra WR. Hyperbaric oxygen protects from sepsis mortality
via an interleukin-10-dependent mechanism. Crit Care Med. 2006;34(10):2624-2629.
106. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC,
Chu JH, Kontoyiannis DP. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Inf Dis.
2005;41:634-653.
107. Almyroudis NG, Konoyiannis DP, Sepkowitz KA, De Pauw BE, Walsh TJ, Segal BH. Issues related to the design
and interpretation of clinical trials of salvage therapy for invasive mold infection. Clin Inf Dis. 2006;43:1449-1455.
108. Bentur Y, Shupak A, Ramon Y, Abramovich A, Wolfin G, Stein H, Krivoi N. Hyperbaric oxygen therapy for
cutaneous/soft-tissue zygomycosis complicating diabetes mellitus. Plastic and Reconstr Surg. 1998;102:822-824.
109. Temple ME, Brady MT, Koranyi KI, Nahata MC. Periorbital cellulitis secondary to Conidiobolus incongruous.
Pharmacotherapy. 2001;21(3):351-354.
110. Powers JH. Salvage therapy trials in fungal disease: challenges and opportunities. Clin Inf Dis. 2006;43:1456-1459.
111. Trifilio SM, Bennett CL, Yarnold PR, McKoy JM, Parada J, Mehta J, Chamilos G, Palella F, Kennedy L, Mullane
K, Tallman MS, Evens A. Scheetz MH, Blum W, Kontoyiannis DP. Breakthrough zygomycosis after voriconazole
administration among patients with hematologic malignancies who receive hematopoietic stem-cell transplants or
intensive chemotherapy. Bone Marrow Transplant. 2007;39:425-429.
112. Greenberg RN, Mullane K, van Burick J-AH, Raad I, Abzug MJ, Herbrecht R, Langston A, Marr KA, Schiller G,
Schuster M, Wingard JR, Gonzalez CE, Revankar SG, Corcoran G, Kryscio RJ, Hare R. Posaconazole as salvage
therapy for zygomycosis. Antimicrob Agents and Chemother. 2006;50(1):126-133.
113. Langford JD, McCartney DL, Wang RC. Frozen section-guided surgical debridement for management of rhino–
orbital mucormycosis. Am J Ophthalmol. 1997;124:265-267.
114. Jallali N, Withey S, Butler PE. Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis.
Am J Surg. 2005;189(4):462-466.