LYMPHEDEMA HYPERBARIC WOUND TREATMENT
Difficult-to-heal wounds can result from traumatic injury, diabetes, peripheral vascular disease, complications following surgery, rheumatoid arthritis, congestive heart failure, arterial or venous ulcers, lymphedema and many other conditions which compromise circulation.
Prescribed hyperbaric oxygen therapy is 100 percent oxygen delivered in a pressurized environment. The air we normally breathe is 21 percent oxygen and 79 percent nitrogen. In hyperbaric treatments, the pressure is typically increased 2.4 times greater than normal and may even be increased to six times greater, depending on the case.
Breathing pure oxygen under pressure causes a larger amount of oxygen to be dissolved in the blood and subsequently delivered to the rest of the body. This also explains why placing a wounded area in an oxygen "tent" cannot be effective - the oxygen must be delivered to all parts of the body by the blood stream.
Oxygen delivered under pressure actually dissolves in your blood stream and is carried in a solution like the fizz in a capped soda bottle. While small blockages may prevent the red cells from delivering oxygen to damaged tissues, oxygen dissolved in the "stream" of your tissue can reach those damaged areas and help fuel the healing process. The results is hyperbaric oxygen promotes healing and decreases infection.
Preparation for hyperbaric therapy involves serveral concepts:
1. You should not use any tobacco products while receiving hyperbaric oxygen therapy. Smoking is prohibited since it prevents full oxygen transport by the blood due to the decrease in blood vessel size.
2. Ensure the hyperbaric physician is aware of all the medications you are taking or if any have been changed.
3. If you become ill (cold, sinus, congestion, diarrhea, nausea, difficulty breathing, chest pains, low blood sugar, etc.) during your weeks of hyperbaric oxygen treatment and have to cancel a treatment, please contact us as soon as possible.
4. If diabetic, check your blood sugar prior to eating your first meal of the day so you will be able to tell the staff when asked. We strongly recommend you eat well before arriving for treatment. Hyperbaric oxygen can increase the effect of insulin on lowering your blood sugar. Maintain your blood sugar in the high normal range.
(Thnx to Edmond Medical Center for the treatment preparation information)
Unfortunately, there are only two studies out indicating how well this technique works with the chronic wounds we experience.
However, the concept is clinically documented on other types of wounds and if you are experiencing a nonhealing lymphemdea ulceration or wound, you may well want to talk to you wound doctor about this method and if it might be applicable in your situation. (Thnx to Edmond Medical Center for the treatment preparation information)
June 22, 2008
Hyperbaric Wound Treatment
Hyperbaric Oxygen Therapy is a medical
treatment providing you with high
pressure amounts of oxygen which aids in the healing process of
damaged tissues. The treatment is received while comfortably lying in a
specially designed pressurized chamber where you will breathe 100%
oxygen - a
significant increase - versus the 21% in the air you normally breathe.
benefit of hyperbaric oxygen therapy results from an oxygen-enriched
- not from the oxygen's direct contact with the wound.
Based on your specific need, hyperbaric oxygen therapy can provide you with one or more of the following effects:
• Advanced wound healing
• Increased oxygen delivery to injured tissue
• Preservation of damaged tissue
• Greater blood vessel formation
• Improved infection control
• Elimination and reduced effects of toxic substances
• Reduction or elimination of gas bubble obstructions
What will my treatment be like?
The treatment occurs with you lying comfortably inside the chamber. The chamber is spacious and you will feel almost like you were lying in your own bed. You can nap, watch television, or listen to music while undergoing the therapy.
The treatment is painless, although at times you may experience a sensation of "fullness" in your ears, similar to that which you may have experienced while driving in the mountains or flying. The "fullness" feeling occurs as your eardrums respond to the change in pressure being exerted on them. Prior to starting your treatment, the hyperbaric staff will teach you how to relieve this pressure so you can avoid the ear discomfort. Your hyperbaric nurse remains with you while you undergo the treatment and will adjust the rate of compression according to your tolerance level and coach you on relieving any discomfort you might experience.
A temporary increase in chamber temperature may also be noticed during the compression period. This phase of the treatment usually lasts 10-15 minutes, depending upon how effective you are in clearing your ears.
Once you reach the prescribed pressure level, you will no longer feel the "fullness" in your ears. At this point you may nap, watch television, or listen to music during the remainder of the treatment, which may last between 90 minutes and 2 hours.
Near the end of your treatment, over a 10-15 minute time period, the pressure gradually decreases to the normal level. During the decompression phase, you may experience a "popping" sensation in your ears. This is a normal occurrence and there is no need to be concerned.
Will I have any side effects?
Generally, you will not experience any side effects from undergoing hyperbaric oxygen therapy. However, some patients do report a "crackling" sensation in their ears between treatments. This can be relieved the same way your ears are cleared of pressure changes during the treatment. If the crackling should continue, please report this to a hyperbaric staff member.
Some patients also report feeling lightheaded for a few minutes following a treatment. This is a brief occurrence, and shortly thereafter patients are able to continue with their daily activities.
In rare occurrences, patients develop temporary changes in eyesight. Studies have shown that any altered vision returns to pretreatment levels within six to eight weeks after treatment ends.
As with all medical treatment, hyperbaric oxygen therapy presents some risks, but these are quite rare and will be discussed with you before you consent to therapy.
How many treatments will I need?
The number of treatments will be based on your individual need as the treatment plan is tailored to each patient. Some emergency cases require a few treatments, while other wound healing situations may require 20-40 treatments where the healing effect is gradual. Your case will be reviewed with you by the hyperbaric team.
Hyperbaric treatment is generally administered once a day, five or six days a week.
How do I prepare for Hyperbaric Oxygen Therapy?
The specific preparations you need to make will be reviewed with you in detail by your hyperbaric medicine team. Some of the preparations include:
No Smoking — Patients who smoke are required to stop smoking throughout their hyperbaric oxygen therapy treatment. This is necessary in order to benefit from the effects of the oxygen therapy, as tobacco products constrict blood vessels and limit blood and oxygen delivery to these tissues.
Medication List — Some medications are not compatible with hyperbaric oxygen therapy. Each drug you are taking will be reviewed individually in relation to the therapy and will be discussed with your physician if changes are necessary.
Colds and other symptoms — It is important that you notify the nursing or hyperbaric staff if you experience symptoms of a cold, flu, cough, sore throat, nausea, vomiting, headaches, diarrhea or generalized body aches. These symptoms may require a temporary delay in your treatment. When your symptoms resolve, treatment can be resumed.Metodist Hospitals
(Link no longer available)I
Indications for Hyperbaric Oxygen Therapy (HBOT)
Problem wounds are those which fail to respond to established medical and surgical management. Such wounds usually develop in patients with multiple local and systemic factors contributing to poor tissue healing. These include diabetic foot ulcers, compromised amputation sites, vascular insufficiency ulcers (ulcers with poor circulation) and non-healing traumatic wounds. All share the common problem of tissue hypoxia (low tissue oxygen levels), usually related to impaired circulation.
Diabetic foot wounds are one of the major complications of diabetes and an excellent example of the type of complicated wound which can be treated with hyperbaric oxygen. Many diabetics have impaired arterial circulation in their feet and have great difficulty with wound healing of foot ulcers.
The elevation in tissue oxygenation which occurs in the hyperbaric chamber induces significant changes in the wound repair process that promote healing. When the hyperbaric chamber is used in conjunction with standard wound care, improved results have been demonstrated in the healing of difficult or limb threatening wounds.
Successful care of problem wounds requires an integrated team approach using surgery, antibiotics, physical therapy together with adjunct hyperbaric therapy when appropriate.
What is Hyperbaric Oxygen Therapy?
Dr. Jeffrey Stone: Leading the Field in Hyperbaric Therapy from Wounds 1 by Erin K. Blakeley
Hyperbaric oxygen therapy (HBOT) is the process whereby the patient breathes 100% oxygen in a room or chamber that is pressurized at a level greater than sea level (sea level represents one atmosphere absolute). It is a systemic therapy in which increased levels of oxygen are absorbed through the lungs. It is not a topical therapy. HBOT increases the amount of dissolved oxygen in the blood plasma which in turn delivers increased concentrations of oxygen to all areas of the body perfused by blood plasma.
What is the medical use for Hyperbaric Oxygen Therapy?
The Undersea and Hyperbaric Society approved the use HBOT as a primary treatment for three conditions: air or gas embolism, decompression sickness, and carbon monoxide poisoning. It also approved it as a secondary form of treatment for the following conditions: radiation tissue damage (soft tissue and osteoradionecrosis), gas gangrene, compromised skin grafts and flaps, necrotizing soft tissue infections (subcutaneous, muscle, fascia), crush injury, compartmental syndrome, acute traumatic ischemias, chronic refractory osteomyelitis, and problem non-healing wounds.
Why does it work for wound healing?
HBOT works in wound healing by allowing the increased concentrations of oxygen in the plasma to circulate and oxygenate wounds that are hypoxic. It also increases the distance that oxygen molecules can diffuse from the vessels into the tissues. Research has demonstrated it causes vasoconstriction (reducing edema), increases collagen synthesis and the formation of new blood vessels, and enhances leukocyte function (fighting infection). We know for fibroblast proliferation (a building block of new tissue) you need to have at least fifteen millimeters of oxygen tension. In some hypoxic wound environments this minimal level of oxygen tension does not occur. Certainly the key to wound healing in the patient with a large vessel occlusion is to be revascularized. HBOT is enhanced if the vascular pathway to the wound is open and efficient.
Diabetic wound patients often have great difficulty healing their wounds. We have to look at the total picture of wound healing: is there an infection, is the wound off-loaded, is there exposed bone, is the dressing correct, debridement, patient compliance, glycemic control, and revascularization of occluded vessels. I always stress the importance of revascularization if it is appropriate or possible. There is a subset of patients, whom even after revascularization of their blood vessels, that fail to improve. These patients have microangiopathic (small vessel disease) problems with their circulation. We screen these patients to see if breathing increased levels of oxygen increases the concentration of oxygen at the tissue level near the wound (Transcutaneous Pressure Oximetry). If tests results indicate increased oxygen levels, the patient may certainly benefit from HBOT.
Do you consider hyperbarics for other wounds, such as venous leg ulcers?
Well, not really. The underlying problem for venous leg ulcers is usually not inadequate levels of oxygen. The pathology responsible for venous leg ulcers is venous congestion and elevated pressures in the venous system. The key treatment for venous leg ulcers is adequate debridement, infection and excessive drainage control, compression therapy and manual lymph drainage.
You received an American Diabetes Association grant to study hyperbarics in wound therapy. Do you believe hyperbarics may emerge as the standard of care for advanced wounds?
I think that for certain hypoxic wounds, hyperbaric therapy is very appropriate. I think there is a wealth of data to support the use of HBOT for wound healing. In April of 1999 the ADA developed a consensus statement on the diabetic foot stating that HBOT was beneficial as an adjunctive therapy in certain diabetic ischemic wounds.
Hyperbarics have been around for 40 years. Are there other unexplored modalities?
I think so. Growth factor therapy and bioengineered dressings are both emerging therapies. I think we are in the infancy of advanced wound care. Research scientists are still discovering the intricate sequence of events necessary for acute and chronic wound healing. It is an exciting field.
TREATING WITH HYPERBARIC MEDICINE
Approximately 25% of persons seeking care at a wound care center may benefit from hyperbaric oxygen therapy (HBO 2 T).
The Wound Center houses a state-of-the-art 10-person hyperbaric oxygen chamber, which is the only chamber of its kind located within a medical facility in the New England region. The environment within the chamber is compressed air, which is adjusted to 2-3 times greater than atmospheric or sea level pressure. While inside, individuals wear oxygen delivery hoods which provide 100% oxygen.
Patients typically spend 2 hours in the chamber and receive daily treatment for 20-40 days, depending upon their diagnosis and response rate. An attendant is present inside the chamber assisting patients and monitoring their clinical status. A physician trained in HBO 2 T is present continuously during treatments.
The Hyperbaric Medicine Program, in addition to providing support to the Wound Center, will function on a 24-hour, 7-day a week basis to treat emergent diagnoses such as decompression sickness, venous or arterial gas embolization, carbon monoxide poisoning, traumatic crush injuries, and necrotizing soft-tissue infections. The chamber is capable of providing therapy for critically ill, ventilator-dependent adult and pediatric patients.
The Hyperbaric Medicine Program is an active member of the Divers Alert Network (DAN).
Who Might Benefit?
When a wound fails to heal following 8 weeks of standard medical care, it is considered a “problem wound” and has the potential to benefit from the services offered by a wound healing center. The Center for Wound Healing and Hyperbaric Medicine at Hartford Hospital provides high quality, cost-effective treatment for individuals with problem wounds.
Diagnoses typically referred to a wound care center include:
These wounds typically occur in persons suffering from:
..........................................Hyperbaric Oxygen Therapy
In an hypoxic environment, wound healing is halted by decreased fibroblast proliferation collagen production, and capillary angiogenesis (1). Hypoxia also allows growth of anaerobic organisms, further complicating wound healing. Hyperbaric oxygen therapy provides a significant increase in tissue oxygenation in the hypoperfused, infected wound. It influences the rate of collagen deposition, angiogenesis, and bacterial clearance in wounds. The greatest benefits are achieved in tissues with compromised blood flow and oxygen supply.
The increased wound oxygen tension achieved with HBO promotes wound healing, increases the host antimicrobial defenses and has a direct bacteriostatic effect on anaerobic microorganisms.
Venous Stasis Ulcers:
HBO therapy has a very limited role. It is only indicated in highly selected patients in the preparation of a granulating bed over debrided venous ulcer for eventual skin grafting. (2)
HBO therapy may be useful when underlying osteomyelitis is present or to improve the soft tissue envelope for reconstruction.
Arterial Insufficiency Ulcers:
HBO therapy may be of benefit in selected cases, especially when a wound fails to heal despite maximum revascularization.
HBO treatments are performed at 2.0 to 25 ATA for 90 to 120 minutes of oxygen breathing. The initial treatment schedule is dictated by the severity of the disease process. In the presence of limb-threatening infection after debridement or compromised surgical flaps following amputation the patient should be treated twice daily. When the infection is under control and the soft tissue envelope improves, once daily treatments are adequate
Non-randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema and tissue fibrosis after radiotherapy for early breast cancer.
The Role of Oxygen in Wound Healing: A Review of the Literature. - May 2008
The use of hyperbaric oxygen therapy to treat chronic wounds: A review. - May-June 2008
Topical Oxygen Therapy Induces Vascular Endothelial Growth Factor Expression and Improves Closure of Clinically Presented Wounds
Cost-effectiveness and budget impact of adjunctive hyperbaric oxygen therapy for diabetic foot ulcers. - Spring 2008
Hyperbaric oxygen therapy: types of injury and number of sessions--a review of 1506 cases. - Jan Feb 2008
Effects of hyperbaric oxygen on full-thickness meshed sheet skin grafts applied to fresh and granulating wounds in horses. - Jan 2008
Pyoderma gangrenosum: dermatologic application of hyperbaric oxygen therapy. - Dec 2007
Hyperbaric Oxygen Therapy - Wound Care Information Network
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