Problem Wounds

The Robert M. Lombard Hyperbaric Oxygenation Medical Center, Inc.

Problem wounds are defined as non-healing wounds resistant to established management: surgery, antibiotics, and wound care. These chronic wounds are usually seen in diabetic feet and legs, compromised amputations, non-healing traumatic wounds, radiation-induced damage, and wounds where there is vascular insufficiency.

Hyperbaric oxygenation therapy (HBOT) is useful where sufficient blood flow exists to increase the partial pressure of oxygen (pO₂) in tissues to a tension greater than 600 mg of mercury (Hg) when a person is under hyperbaric oxygen conditions. Transcutaneous Oximetry measures the effect of hyperbaric oxygen around the wound site.

Medicare and many insurance companies will reimburse for HBOT for diabetic wounds classified as Wagner Grade III refractory wounds resistant to healing after 6 months of traditional wound-care management. Many insurers also cover other types of problem wounds.

Hyperbaric oxygenation therapy for chronic wounds:

· Increases oxygen to tissues

· Increases diffusion gradient

· Enhances immune system function for removal of dead tissue

· Enhances bone formation

· Enhances collagen production for repair of tissues

· Is most effective in diffuse micro-vascular arterial disease

· Requires sufficient arterial flow to the extremity

Although hyperbaric oxygen for wound healing is generally covered by insurance, wounds must be evaluated every 30 days and must demonstrate some degree of healing for continued coverage.

Suggested treatment schedule:

One daily treatment, five days/week over a 30-day span, followed by wound reevaluation. Additional treatments scheduled as necessary. Individual responses vary.

Undersea and Hyperbaric Medical Society:

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

· Non-healing Traumatic Wounds

· Vascular Insufficiency Ulcers

The basic mechanism of non-healing wounds is interplay between varying degrees of tissue hypoperfusion (decreased blood supply) and infection. All have the underlying problem of tissue hypoxia (reduction in oxygen). 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.

Hyperbaric oxygen for wound healing is generally covered by insurance. Wound healing must be evaluated every 30 days for continuation of HBO₂therapy.