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Kumar et al. Plast Aesthet Res 2020;7:29 I http://dx.doi.org/10.20517/2347-9264.2019.71 Page 7 of 11

More
cellular
damage

Cell injury causing
A self-propagating
mechanism for Refractory release of
Secondary distant shock proinflammatory
direct cell injury MOF & Death cytokines

SIRS

The wheel of death (A diagrammatic representation of Cytokine storm) [25]

Figure 2. Diagrammatic representation of cytokine storm - the wheel of death. MOF: multiple organ failure; SIRS: systemic inflammatory
response syndrome

Hyperbaric oxygen (HBO): in an experimental study on rats with contused calf muscle injury, following
7 days of treatment with 100% oxygen in a HBO chamber at 2.5 atmospheres pressure for 2 hours/day.
HBO was found to reduce edema and inflammation, and accelerated myogenesis. This indicated beneficial
effects of HBO against secondary damage. The mechanisms of healing following HBO therapy for muscle
[32]
injuries have yet to be explained however .
Anticytokine and antimediator therapy: has been tried in SIRS and MODS with limited success.

Forced diuresis and dialysis is recommended to prevent and treat renal dysfunction following
myoglobinuria/hemoglobinuria .
[33]
Neurological/neurosurgical management and rehabilitation of neurological secondary injury has been
advised [34,35] .

Advanced wound management using special modern dressing significantly reduces infection rates and the
need for corrective surgeries .
[36]

LAD protocol in trauma
LAD is applied over the affected part after saline wash. After surgical removal of obviously dead tissue,
application of antimicrobial agents, and complete hemostasis, LAD is applied. Pressure bandaging and
appropriate splints are applied as required. Continuous or intermittent negative pressure is applied as per