Chronic wounds
We routinely treat selected patients here with problematic poor healing wounds. These patients are referred to us by their treating hospital consultant.
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.
Hyperbaric Oxygen Therapy (HBOT) increases the diffusion gradient of oxygen in subcutaneous tissue by about 10-20 fold to allow hyperoxygenation of ischaemic tissue. Numerous animal and clinical studies have shown that this results in:
- Reduced inflammatory cytokines
- Stimulation of growth factors
- Enhancement of antibacterial activity, including production of oxygen free radicals
- Reduction in non-specific activation of inflammatory cells
- Promotion of transmigration of stem cells to infected wound tissue
- Alteration of leukocyte-endothelial adhesion
- Promotion of collagen formation
However, it is important for us to assess each wound prior to HBOT as some chronic wounds will not respond to hyperbaric oxygen. Each wound is assessed with TCOM (Transcutaneous Oxygen Monitoring); probes detect 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.
Further information regarding the Referral and Funding process can be found here.
Treatment entails up to 40 sessions of HBO over a 8 week period subject to response to treatment.
References
Abidia A, Laden G, Kuhan G, Johnson BF, Wilkinson AR, Renwick PM, Masson EA, McCollum PT. The role of hyperbaric oxygen therapy in ischaemic diabetic lower extremity ulcers: a double-blind randomised-controlled trial. Eur J Vasc Endovasc Surg. 2003 Jun;25(6):513-8. doi: 10.1053/ejvs.2002.1911. PMID: 12787692.
Doctor N, Pandya S, Supe A. Hyperbaric oxygen therapy in diabetic foot. J Postgrad Med. 1992 Jul-Sep;38(3):112-4, 111. PMID: 1303408.
Faglia E, Favales F, Aldeghi A, Calia P, Quarantiello A, Oriani G, Michael M, Campagnoli P, Morabito A. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. A randomized study. Diabetes Care. 1996 Dec;19(12):1338-43. doi: 10.2337/diacare.19.12.1338. PMID: 8941460.
Kalani M, Jörneskog G, Naderi N, Lind F, Brismar K. Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers. Long-term follow-up. J Diabetes Complications. 2002 Mar-Apr;16(2):153-8. doi: 10.1016/s1056-8727(01)00182-9. PMID: 12039398.
Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32. doi: 10.28920/dhm47.1.24-32. Erratum in: Diving Hyperb Med. 2017 Jun;47(2):131-132. doi: 10.28920/dhm47.2.131-132. PMID: 28357821; PMCID: PMC6147240.