Hyperbaric Oxygen Therapy for Healing Problem Wounds

ENHANCEMENT OF HEALING
IN SELECTED PROBLEM WOUNDS

Problem wounds are those which fail to respond to established medical/surgical management. These wounds usually present in compromised hosts with multiple local and systemic factors which inhibit tissue repair. These include:

Diabetic Wounds
Compromised Amputation Sites
Nonhealing Traumatic Wounds
Vascular Insufficiency Ulcers

Regardless of etiology, the basic mechanism of nonhealing wounds is an interplay between varying degrees of tissue hypoperfusion and infection. All have the underlying problem of tissue hypoxia and its sequela as common denominators. Tissue oxygen tensions in or near such wounds usually measure below 20 mmHg. In a hypoxic environment, wound healing is halted by decreased fibroblast proliferation, collagen production and capillary angiogenesis. Hypoxia also impairs oxygen-dependent intracellular leukocyte bacterial killing of the most common aerobic organisms found in wound infections and creates the ideal environment in which anaerobic and microaerophilic organisms flourish.

RATIONALE: Hyperbaric oxygen (HBO₂) treatment provides a significant increase in tissue oxygenation in the hypoperfused, infected wound. This elevation in oxygen tension induces significant positive changes in the wound repair process. HBO₂ promotes wound healing by directly enhancing fibroblast replication, collagen synthesis, and the process of neovascularization. Providing oxygen at the cellular level also increases leukocyte bacterial activity and has a direct lethal effect on anaerobic organisms. In summary, tissue oxygen tension influences the rate of collagen deposition, angiogenesis, and bacterial clearance in wounds. Hypoxia is deleterious and hyperoxia will enhance the wound healing process. HBO₂ elevates oxygen tensions in ischemic and infected wound tissue. The greatest benefits are achieved in tissues with compromised blood flow and oxygen supply.

Source: Hyperbaric Oxygen Therapy: A Committee Report. Undersea and Hyperbaric Medical Society. 1996 Revision.

Approved Indications

Chico Hyperbaric Center
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