Hyperbaric oxygen (HBO2) treatment for a failing facial flap.

Hyperbaric oxygen (HBO2) is an approved treatment for 13 pathological entities. One of these indications--a failing facial flap--is presented in this case report of a traumatic wound to the face and right axilla after an unprovoked pit bull attack on a 4 year old girl. Surgical repair was started acutely but the facial flap became congested and ischaemic, indicating deterioration of the blood supply. HBO2 treatments were initiated twice a day, resulting in remarkably decreased swelling and discomfort after the first treatment. Leeching was also used to assist with reduction of venous congestion in the flap. The patient was discharged 5 days later with a well perfused, mostly intact, incision with minimal tenderness. Surgical repair was required for a small area of wound dehiscence. Photographs documenting the patient's progress with HBO2 are presented. A discussion of the mechanisms of action of HBO2 and its beneficial effects is provided in this case.

Transcatheter PFO closure in an aircrew member with cryptogenic stroke: aeromedical disposition.

Stroke is an uncommon event among military aircrew, partly because that population tends to be younger and healthier than typical stroke victims. Aircrew members suffering stroke rarely have identifiable risk factors or etiology that can be treated or modified such that return to flying duties is a consideration. In this case, an aircrew member was found to have a patent foramen ovale (PFO) during his stroke evaluation. Several studies support the association between PFO and cryptogenic stroke, but literature clearly defining the need for PFO repair in the context of cryptogenic stroke is still incomplete. On clinical recommendation from his providers, this aircrew member underwent elective closure of his PFO with a transcatheter device. After complete recovery from his stroke and an apparently successful PFO closure, he requested return to flying duties. History of stroke and PFO closure with transcatheter device were both disqualifying conditions according to United States Air Force Instructions. This case is presented as an example of an aeromedical decision-making process when confronted with an unusual case such as this.

Permanent flying disqualifications of USAF pilots and navigators (1995-1999).

BACKGROUND: The USAF devotes great financial and medical assets to the identification and evaluation of USAF aircrew who have been grounded from flying duties for medical conditions thought to be dangerous to the flying mission or personal safety. The purpose of this study is to update the literature and to demonstrate that USAF efforts during the past 19 yr have improved our ability to retain experienced aviators. METHODS: The USAF waiver file was reviewed to quantify the number of USAF pilots and navigators receiving permanent medical disqualifications from flying duties during 1995-1999. We identified 157 cases, which were stratified by age group and sex. RESULTS: The number of disqualifications increased incrementally by age group. The most common diagnoses resulting in permanent disqualification were coronary artery disease, hypertension, back pain and disk abnormalities, migraine headaches, diabetes mellitus, and substance/alcohol abuse. DISCUSSION: These results are very similar to those reported in a 1984 USAF study and other studies of aviation populations. The rate of permanent flying disqualifications in this study was equal to 0.18% per year compared to 4.1% per year in 1984. This decrease in the rate of disqualifications could be due to modification of USAF standards, utilization of clinical management groups, better screening of applicants, new technology or therapies, and effective preventive medicine efforts throughout the Air Force.