Editorial comment

The story of hyperbaric oxygen continues

Necrotizing soft tissue infections (NSTIs) represent life-threatening events that require aggressive surgical intervention, systemic antibiotic therapy, and effective supportive management. NSTIs are a heterogeneous group which may be caused by Clostridium perfringens, Streptococcus pyogenes, Staphylococcus aureus, or by a polymicrobial microflora of gram-positive, gram-negative, and anaerobic bacteria. Virtually all bacterial species and even fungal organisms are associated with NSTI. They are locally aggressive infections that may involve only the skin and subcutaneous tissue, or they may encompass extensive necrosis of skeletal muscle. External evidence of the extensive nature of NSTI may be subtle early in the disease, and requires the clinician to have a high index of suspicion when patients have a rapidly increasing soft tissue inflammatory process associated with a systemic inflammatory response. The hallmark feature of NSTIs is the presence of increasing pain and tenderness that is disproportionate to the apparent cutaneous injury or infection.

Soon after the discovery of oxygen, experiments began on the use of oxygen for therapeutic purposes, including subcutaneous administration of oxygen, on humans and animals. The history of subcutaneous oxygen therapy (SQOT) is examined in the context of the growing understanding of the use and methods of oxygen administration. Little was written about this therapy until the 19th century, despite an advocacy for its use in some circles. There was resurgence in the use of SQOT in the early 20th century. Investigators in the field of anesthesia, including such notable figures as Paul M. Wood, Ralph M. Waters, and John Henry Evans, contributed to the growth in popularity of the therapy and to the literature on the subject. Although SQOT has been supplanted by other means of administration, it may have a role in management of some inflammatory or pain conditions.