Diabetic Wounds of the Lower Extremity
Many diabetes patients develop skin ulcers on the feet, most often found by the sole of the foot and around the heel. Bacteria can cause an infection through small cracks (fissures) that can develop in the dry skin around the heel and on other parts of the foot or through corns, calluses, blisters, hangnails, or ulcers. If not treated, the bacterial infection can destroy skin, tissue, and bone or spread throughout the body.
The ulcers/wounds result from the inflammation and degeneration of peripheral nerves. If the foot wound is not treated properly, hospitalization and possibly amputation could result by allowing anaerobic organisms to flourish. For patients with diabetes mellitus with accelerated atherosclerosis (hardening of the arteries), their resistance to infection is reduced and the lower extremity amputation rate is increased.
Most hyperbaric oxygen treatment is used as an adjunctive therapy in the management of diabetes complications, particularly diabetic foot ulcers that often result in amputation of toes, feet, or legs. Early, aggressive wound care strategies, combined with hyperbaric oxygen therapy treatment, can prevent osteomyelitis (inflammation of bone) and amputations and help improve the quality of life for diabetic patients.
Hyperbaric oxygen therapy works to improve and heal the hypoxic areas through a significant increase in oxygen to the tissues. The elevation in oxygen tension in ischemic (restricted in blood supply) and infected wound tissue induces healing by enhancing fibroblast (a cell in connective tissue which produces collagen and other fibers) replication, collagen synthesis and the neovascularization (natural formation of new blood vessels) process. It works best as an adjunctive therapy to multi-disciplinary wound care.
Chronic, Non-healing Wounds
When wounds don’t respond to traditional medical and surgical care methods, hyperbaric oxygen therapy is a scientifically proven adjunct therapy used to expedite the healing process. Problem wounds have poor blood flow and are often infected. Contributing factors are a patient’s age, nutrition, radiation damage, smoking, and medical conditions such as diabetes, kidney disease, or immune diseases.
Many non-healing wounds result from vascular insufficiency ulcers, complications from diabetes, radiation necrosis, soft tissue infections, compromised amputation sites, bone infection (refractory osteomyelitis), and traumatic wounds from crush injuries. Where there is hypoxia (inadequate blood flow), the ability for a wound to heal is halted by reduced fibroblast and collagen production and capillary growth. It also creates the ideal environment for infection by impairing the leukocytes (white blood cells) from killing bacteria.
Hyperbaric oxygen therapy works to make collagen, help the white blood cells fight off infection and promote fibroblasts (wound healing cells) and new blood vessel growth. Treatment duration depends on the severity of the wound. Wounds respond best to hyperbaric oxygen therapy when they’ve become acutely or chronically compromised by hypoxia and infection.
Comprimised Skin Grafts and Flaps
Skin grafting is a surgical procedure to place skin or skin substitute over a burn or non-healing wound to permanently replace damaged or missing skin or provide a temporary wound dressing. Sometimes these grafts fail (or become compromised) due to poor blood flow, swelling, or infection.
Hyperbaric oxygen therapy is an extremely effective therapy for tissues affected by a burn, radiation therapy, or in patients with decreased perfusion or hypoxia. Some skin grafts (from a severe burn) or flaps (a graft which is moved and reattached along with the blood vessel that supplies it) may have trouble healing from swelling or poor blood flow.
Hyperbaric oxygen therapy works to maximize the viability of the compromised tissue, make collagen and reduce the need for re-grafting and repeat flap procedures. The treatment prepares a vascular and cellular tissue within the radiated wound to enable a surgeon to successfully remove damaged tissue or foreign objects from and later reconstruct the wound.