Hyperbaric Oxygen Therapy in Chronic Vascular Wound Management.
Abstract
Many nonhealing tissues are hypoxic, with oxygen tensions frequently ranging from 5 to 15 mmHg. In such an environment, the normal wound healing sequence is disrupted or halted and phagocytic killing activity depressed. So the adjunctive use of hyperbaric oxygen (HBO), based on physiologic data and clinical observations, can provide the substrate necessary to initiate and sustain the healing process.
During a twelve-month period, 20 patients with a nonhealing wound were referred to the hyperbaric center : chronic arterial insufficiency ulcers in 9 cases, diabetic wounds (foot lesions) in 11 cases.
Adjunctive HBO therapy, initiated twice a day, consisted of pure oxygen, 2.5 ATA, 90 min. The average length of sessions was 46 (15-108). Complete healing was observed in 15 of 20 cases.
The wound management can be helped with the transcutaneous oxygen measurements under hyperbaric oxygen. The distal TCPO2 at 2.5 ATA pure oxygen is a reliable test to predict final outcome (healing or no change), when these values were not different in normal air and in normobaric oxygen:
Distal No TCPO2 Healing Change air 32 ± 31 NS 12 ± 4 1 ATA O2 75 ± 70 NS 18 ± 10 2 ATA O2 635 ± 388 p = 0.003 45 ± 20
In hyperbaric oxygen therapy, when the distal TCPO2 value was inferior to 100 mmHg, all patients showed either no improvement or aggravation, and when the value was higher than 100mmHg, wound healing was achieved with all patients.
Hyperbaric Oxygen Therapy in the Management of Crush Injuries: A Randomized Double-Blind Placebo-Controlled Clinical Trial.
Bouachour, G. MD; Cronier
Abstract
Hyperbaric Oxygen (HBO) therapy is advocated for the treatment of severe trauma of the limbs in association with surgery because of its effects on peripheral oxygen transport, muscular ischemic necrosis, compartment syndrome, and infection prevention. However, no controlled human trial had been performed until now to specify the role of HBO in the management of crush injuries.
Thirty-six patients with crush injuries were assigned in a blinded randomized fashion, within 24 hours after surgery, to treatment with HBO (session of 100% O2 at 2.5 atmosphere absolute (ata) for 90 minutes, twice daily, over 6 days) or placebo (session of 21% O2 at 1.1 ata for 90 minutes, twice daily, over 6 days).
All the patients received the same standard therapies (anticoagulant, antibiotics, wound dressings). Transcutaneous oxygen pressure (Ptco2) measurements were done before (patient breathing normal air) and during treatment (HBO or placebo) at the first, fourth, eighth, and twelfth sessions. The two groups (HBO group, n = 18; placebo group, n = 18) were similar in terms of age; risk factors; number, type or location of vascular injuries, neurologic injuries, or fractures; and type, location, or timing of surgical procedures.
Complete healing was obtained for 17 patients in the HBO groups vs. 10 patients in the placebo group (p < 0.01). The Bilateral Perfusion Index (BPI = Ptco2 of the injured limb/Ptco2 of the uninjured limb) at the first session was better in the HBO group than the non-HBO.
In conclusion, this study shows the effectiveness of HBO in improving wound healing and reducing repetitive surgery in crush trauma involving vascular, tissue and bone injury.
