Hyperbaric Chamber Treatment and Wounds

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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.

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