Types of Wounds
Hyperbaric oxygen therapy may be used as either primary or adjunctive care in:
Select Problem Wounds:
In a hypoxic environment, wound healing is halted by a decrease in fibroblast proliferation, collagen production and capillary angiogenesis. Hyperbaric oxygen therapy can restore a favorable tissue environment in which healing and antibacterial mechanism can occur.
Skin Grafts, Flaps and Replants:
Following ischemia or vascular repair in cases where there has been decreased microcirculation, hyperbaric oxygen therapy has been demonstrated to maximize the viability and final functional level of the compromised nerve and muscle tissue.
Crush Injuries, Compartment Syndrome, and Other Acute Traumatic Ischemias*:
Hyperbaric oxygen therapy increases tissue oxygen tension to levels which allow host responses to infections and ischemia to become functional. Effects include enhanced oxygenation at the tissue level, increased oxygen delivery per unit of blood flow and edema reduction.
Radiation Tissue Damage:
Hyperbaric oxygen therapy is the gold standard of care in reconstructive surgery involving irradiated bone or soft tissue. In proper coordination with surgical treatment, it has reoriented the approach to the repair of radiation damaged tissue. It has been shown to stimulate growth of functioning capillaries, fibroblastic proliferation and collagen synthesis in the irradiated bone and soft tissue. Improved healing rates and reduced complication rates are seen in a coordinated reconstructive program using adjunctive hyperbaric oxygen therapy.
Chronic Refractory Osteomyelitis:
Hyperbaric Oxygen Therapy stimulates osteoclast formation and improves leukocyte function in infected bone tissue. It is used as an adjunct to antibiotics, debridement, nutritional support and reconstructive surgery. In cases of superficial, localized (e.g. sterna wounds) and diffuse osteomyelitis, particularly in the presence of localized or systemic host compromise, hyperbaric oxygen therapy has proven adjunctive therapeutic value. In these most difficult to resolve infections, hyperbaric oxygen therapy can often save life or limb.
Necrotizing Soft Tissue Infections:
As an adjunct to debridement and systemic antibiotics, hyperbaric oxygen therapy adversely affects anaerobic bacterial growth and enhances leukocyte bacterial killing. Certain toxins (e.g. clostridial) may be inactivated by high oxygen tension. Published studies indicated adjunctive hyperbaric oxygen therapy use can decrease mortality by two-thirds.
* Requires immediate consultation for optimal results. For best results, suspicious hypoxic wound complications should be addressed as early as possible. In particular, potential skin grafts, flap failures or crush injuries should be treated within the first four hours of the onset of pathology.