DDRC Healthcare, Plymouth, Devon

Emergencies & Hyperbaric Referrals
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Problem wound healing

To refer a patient please follow this link.

For more information on the patient experience please follow this link.

Chronic wounds

We routinely treat selected patients here with problematic poor healing wounds. This is currently NHS funded with consultant referral.

Oxygen plays a key role in many of the steps throughout wound healing.  During the initial inflammatory phase of wound healing oxygen is essential for platelet aggregation. During the proliferative phase high levels of oxygen are required for angiogenesis to occur. Finally, during the remodelling phase it is essential for collagen formation and to aid the strengthening of the extracellular matrix. 

Wounds that do not heal with standard medical and surgical therapy are often underperfused with resultant poor oxygen tensions within the tissue. They may also be chronically infected. This infection may be the cause of hypo-perfusion (by interrupting wound healing) or may perpetuate the chronic wound hypoxia.

HBOT increases the diffusion gradient of oxygen in subcutaneous tissue by about 10-20 fold to allow hyperoxygenation of ischaemic tissue thus:

  • Reducing inflammatory cytokines
  • Stimulating growth factors
  • Enhancing antibacterial activity, including production of oxygen free radicals
  • Reducing non-specific activation of inflammatory cells
  • Promoting transmigration of stem cells to infected wound tissue
  • Altering leukocyte-endothelial adhesion
  • Promote collagen formation

This is based on numerous animal and clinical studies.(Eggleton,2015)

However, it is important to assess each wound as some chronic wounds will not respond to HBOT.  Each wound is assessed with TCOM (Transcutaneous Oxygen Monitoring). This is a system whereby a probe is placed on the skin by the wound. Each probe detects the baseline oxygen tension in the skin, which is used as a marker of perfusion. A rise in oxygen tension should be seen as the patient is exposed to increased oxygen levels.

Diabetic Foot Ulcers

We routinely treat diabetic foot ulcers in patients who have failed to respond to treatment with standard multidisciplinary foot clinic input, in particular to try and avoid surgical intervention if at all possible.

HBOT should be used in conjunction with gold standard wound care and in these circumstances evidence suggests that HBO will improve healing. There is also evidence with some studies where long term follow up occurred that a continued benefit was seen. (Eggleton,2015)

In summary there are some key papers

Doctor et al 1995 – Thirty patients were randomised to receive HBOT or conventional treatment alone. The HBOT was an unconventional treatment protocol. However, there was a significant reduction in amputation above the ankle joint in the HBOT group compared with the control.

Faglia et al 1996 – A significant reduction of major amputations in patients with diabetic foot ulcers was seen in the HBOT group.

Abidia 2001 – Investigated the therapeutic effect of HBOT on diabetic foot ulcers in patients with peripheral arterial disease. At 1 year follow up the majority of patients in the HBOT group remained healed, whereas no healed wounds were present in the control group. However, this was a very small trial with only 16 patients.

Kalani et al 2002 – Compared outcomes of patients with diabetic foot ulcers treated with or without HBOT at 3 years. Those in the HBOT group had better outcomes – healed wounds, less amputations and no deaths.

Treatment entails up to 40 sessions of HBO over a 8 week period subject to response to treatment.

References

Eggleton (2015)    

Eggleton P, Bishop A, Smerdon G

 “Safety and efficacy of hyperbaric oxygen therapy in chronic wound management:current evidence”

 Due for publication

Please email info@ddrc.org to request from authors

Doctor (1995)       

Doctor N, Pandya S, Supe

 “Hyperbaric oxygen therapy in diabetic foo

 J Postgrad Med

1992;38(3):112-114

Faglia (1996)        

Faglia E, Favales F, Aldeghi A, et al

 “Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. A randomised study “

Diabetes Care

1996;19(12):1338-1343

Abidia (2001)      

Abidia A, Laden G, Kuhan G et al

“The role of hyperbaric oxygen therapy in ischemic diabetic lower extremity ulcers:a double-blind randomised-controlled trial

Eur J Vasc Endovasc Surg

2003;25(6):513-518

Kalani(2002)        

Kalani M, Jorneskog G, Naderi N, Lind F, Brismar K.

“Hyperbaric oxygen (HBO)therapy in treatment of diabetic foot ulcers. Long-term follow

J Diabetes Complications

2002;16(2) 153-158

UHMS Hyperbaric Oxygen Therapy Indications 13th Edition 

 

 

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