Flap Salvage Using Topical Oxygen Therapy (Natrox) in a Pediatric Foot Degloving Injury: A Case Report

Background: Foot degloving injuries are associated with extensive soft-tissue disruption, compromised perfusion, and a high risk of flap necrosis. Hyperbaric oxygen therapy (HBOT) is known to enhance tissue oxygenation and support flap survival; however, its application in pediatric patients may be limited due to poor cooperation, intolerance to chamber-based treatment, and limited accessibility. Case Presentation: A 7-year-old girl presented with a crush injury to the left foot after being run over by a vehicle, resulting in severe soft-tissue damage. Evaluation revealed a dorsal foot degloving injury, a proximal phalanx fracture of the great toe, and dislocations of the fourth proximal interphalangeal and fifth distal interphalangeal joints. Emergency surgery included open reduction, K-wire fixation, debridement, and artificial dermal grafting using Pelnac. On postoperative day 1, the flap showed signs of compromised perfusion. As HBOT was not feasible, topical oxygen therapy using Natrox was applied continuously for 17 days. Serial wound assessments demonstrated gradual improvement in flap viability. Although ischemic changes developed in the toes, necrosis remained superficial and was successfully managed with local debridement and dressings. Residual skin defects with partial necrosis were treated with split-thickness skin grafting, which healed without major complications. The patient resumed ambulation after splint removal. Conclusions: In pediatric patients with compromised flaps in whom HBOT is not feasible, topical oxygen therapy may serve as a practical adjunctive treatment option. Although its independent effect cannot be established in a single case, this report suggests its potential role in flap salvage and in limiting tissue necrosis.