Hyperbaric Oxygen Therapy
The following information is from the
Undersea and Hyperbaric Medical Society, Inc.
10531 Metropolitan Avenue
Kensington, Maryland 20895
UHMS Publication Number 30 CR (HBO) 1992
Rationale:
In an hypoxic environment, wound healing is halted by
decreased fibroblast proliferation collagen production, and
capillary angiogenesis (1). Hypoxia also allows growth of
anaerobic organisms, further complicating wound healing.
Hyperbaric oxygen therapy provides a significant increase in
tissue oxygenation in the hypoperfused, infected wound. It
influences the rate of collagen deposition, angiogenesis, and
bacterial clearance in wounds. The greatest benefits are
achieved in tissues with compromised blood flow and oxygen
supply.
Diabetic Wounds:
The increased wound oxygen tension achieved with HBO
promotes wound healing, increases the host antimicrobial
defenses and has a direct bacteriostatic effect on anaerobic
microorganisms.
Venous Stasis Ulcers:
HBO therapy has a very limited role. It is only indicated
in highly selected patients in the preparation of a
granulating bed over debrided venous ulcer for eventual skin
grafting. (2)
Pressure Ulcers:
HBO therapy may be useful when underlying osteomyelitis is
present or to improve the soft tissue envelope for
reconstruction.
Arterial Insufficiency Ulcers:
HBO therapy may be of benefit in selected cases,
especially when a wound fails to heal despite maximum
revascularization.
Treatments:
HBO treatments are performed at 2.0 to 25 ATA for 90 to
120 minutes of oxygen breathing. The initial treatment
schedule is dictated by the severity of the disease process.
In the presence of limb-threatening infection after
debridement or compromised surgical flaps following
amputation the patient should be treated twice daily. When
the infection is under control and the soft tissue envelope
improves, once daily treatments are adequate.
References:
- La Van FB, Hunt TK: Oxygen and wound healing, Clinics in
Plast Surg 1990; 17 (3): 463-472.
- Chang N, Goodson WH III, Gottrup F, Hunt TK: Direct
measurement of wound and tissue oxygen tension in
postoperative patients, Ann Surg 1983; 197:470-478.
|
