Early, advanced wound care intervention can prevent a wound from becoming an acute or chronic condition that could require extensive treatment, including amputation. If a wound becomes chronic — that is, if it has not started to heal in two weeks or has not healed completely in four to six weeks — hyperbaric oxygen therapy can bring relief to the patient.
Hyperbaric oxygen therapy is one of the most important elements of advanced wound care and has medical applications for a large variety of other conditions. It increases the efficiency of the body’s oxygen-dependent, wound-healing mechanism by saturating the blood plasma with oxygen. This allows the plasma to carry 15 to 20 times the normal amount of healing oxygen to the body’s tissues. Oxygen-rich blood stimulates your body to release substances called growth factors and stem cells, which promote healing.
Vasoconstriction also results from hyperbaric oxygen therapy. Although this actually reduces blood flow, the oxygen-rich blood still reaches the tissues. Vasoconstriction decreases edema (swelling) of the injured tissues, which is important in burns, crush injuries and injured tissues in general.
During treatment the patient reclines on a bed enclosed in a clear Plexiglas chamber. He or she breathes pure oxygen at an air pressure of 1.5 to three times normal atmospheric pressure. An HBOT technician supervises the therapy. Treatments are administered for 90 to 120 minutes at a time, and patients can nap or watch a movie during the treatment.
Patients start with four or five treatments per week for several weeks. Most patients receive 30 to 50 treatments. As the wound heals, the number of required treatments can decrease.
The Food and Drug Administration has approved hyperbaric oxygen therapy for treating, among other conditions:
• Problem wounds stemming from an injury or illness, including diabetes.
• Gangrene .
• Bacterial infections that kill tissue.
• Tissue damage and delayed bone damage caused by radiation treatments for cancer.
• Limb salvage, reattachment and amputation.
• Skin grafts compromised by inadequate blood supply.
• Traumatic crush injuries.
• Carbon monoxide and cyanide poisoning.
• Brain abscess.
Advanced wound care that includes hyperbaric oxygen therapy is critical for patients with diabetes and its associated foot ulcers. Without appropriate care, these chronic wounds can lead to amputation. According to Nevada State Health Division statistics, more than 215, 000 Nevada adults have diabetes-related conditions that lead to chronic wounds. In 2005, more than 45 percent of the people who received lower-extremity amputations had a primary diagnosis of diabetes.
Besides losing part of a limb, studies show that people with diabetes who have an amputation then have a 35 percent greater demand on the heart and lungs when they are mobile. Most do not live beyond five years after the amputation because of complications from diabetes.
To be most effective, hyperbaric oxygen therapy should be administered under the supervision of a physician. Northern Nevada Medical Center’s Wound Care Center provides this care, and patients should ask about physician supervision before seeking treatment at any wound care center. In clinical studies, hyperbaric oxygen therapy administered under the supervision of a physician has shown an almost 90 percent success rate in healing chronic wounds that previously would not heal.
To learn more about wound care and hyperbaric oxygen therapy, call the Wound Care Center at Northern Nevada Medical Center at 352-5353. The Wound Care Center is located at the Vista Medical Terrace at 2345 E. Prater Way.
Todd Inman, MD, is a family medicine physician at the Northern Nevada Medical Group and medical director for the Wound Care Center at Northern Nevada Medical Center. Dr. Inman earned his medical degree and completed his residency from the University of Nevada School of Medicine in Reno.