- Patient with motorcycle accident injury recovered through combined ECM and HBOT treatment approach.
- Hyperbaric oxygen therapy reduces anaerobic conditions in traumatized tissue, improving oxygen supply.
- This combination therapy may offer new options for patients with mutilated foot injuries.
A team of researchers from Croatia has successfully treated a severe motorcycle accident victim using a combination of extracellular matrix (ECM) application and hyperbaric oxygen therapy (HBOT), potentially opening new avenues for treating devastating foot injuries that might otherwise require amputation.
The case study, authored by a multidisciplinary team led by researchers from Rijeka University Hospital Centre in Croatia, demonstrates how combining surgical intervention with advanced supportive therapies may improve outcomes for patients with mutilated foot injuries.
Understanding Mutilated Foot Injuries
Mutilated foot injuries typically result from high-energy trauma, most commonly in industrial accidents or vehicle crashes. These severe injuries cause skin and subcutaneous tissue to detach from underlying bone structures, often leading to tissue necrosis due to compromised blood circulation.
Without effective treatment, such injuries frequently require extensive plastic reconstructive procedures or even amputation. Traditional approaches to these injuries focus primarily on surgical intervention, but the Croatian team’s approach incorporates additional therapeutic modalities.
The Combined Treatment Approach
The treatment protocol described in the case study followed several key steps:
- Initial necrectomy (removal of dead tissue) and fixation of bone fragments using K-wires
- Immediate hyperbaric oxygen therapy sessions
- Secondary necrectomy after necrotic tissue demarcation on day seven post-trauma
- Application of extracellular matrix material with partial thickness skin grafting
- Continuation of HBOT for a total of 27 treatments over one month
The hyperbaric oxygen therapy component serves as a supportive method that addresses the fundamental issue in these injuries: impaired tissue blood supply, particularly in areas with compromised microcirculation. The early administration of HBOT after surgical treatment helps reduce anaerobic conditions in traumatized tissue and ensures adequate oxygen delivery to healing tissues.
Meanwhile, the extracellular matrix component provides a scaffold for tissue regeneration. ECM consists of complex protein and carbohydrate-based macromolecules organized in tissue-specific arrangements, forming a fundamental component of biological tissue.
Clinical Outcome
According to the researchers, the healing process was “satisfactory locally,” suggesting that the combination of surgical treatment with these supportive therapies yielded positive results. This approach may represent a viable alternative to more radical surgical interventions for similar injuries.
Dr. Marin Marinović from Rijeka University Hospital Centre led the research team, which included specialists from multiple institutions across Croatia and Italy. The interdisciplinary nature of the team highlights the complexity of treating such injuries and the benefits of collaborative medical approaches.
Broader Implications
This case study raises important questions about current treatment protocols for severe foot trauma. Could this combination therapy reduce amputation rates in patients with mutilated foot injuries? How might wider implementation of this approach affect patient outcomes and rehabilitation timelines?
For patients facing potential amputation after severe foot injuries, this treatment combination might offer hope for limb preservation. However, additional research with larger patient populations will be necessary to validate these findings and determine optimal treatment protocols.
The application of hyperbaric medicine continues to expand beyond its traditional uses in decompression sickness and carbon monoxide poisoning. This case adds to growing evidence supporting HBOT’s role in trauma care, particularly when combined with advanced wound care techniques like ECM application.
Looking Forward
While promising, this single case study requires follow-up research to establish broader clinical applications. Future studies should examine long-term functional outcomes, cost-effectiveness compared to traditional approaches, and identify which patients might benefit most from this combined therapy.
As medical technology and regenerative medicine techniques continue to advance, combinations of supportive therapies may increasingly complement surgical interventions for severe traumatic injuries, potentially changing the standard of care for patients with mutilated extremities.
Reference
Marinović, Marin & Batinac, Tanja & Slivšek, Goran & Jendrašic, Ivica & Radović, Endi & Muzic, Vedrana & Bandalović, Ante & Radović, Klara & Markic, Dean & Primc, Davor & Kukuljan, Melita. (2025). The Combination of Extracellular Matrix (ECM) and Hyperbaric Oxygen Therapy (HBOT) in the Treatment of Mutilated Foot Injury: A Winning Combination?. 10.13140/RG.2.2.15557.15845.
