Complex Non-Healing Wounds
Regardless of the primary etiology of problem wounds, a basic pathway to nonhealing is the interplay between tissue hypoperfusion, resulting hypoxia, and infection. A large body of evidence exists which demonstrates that intermittent oxygenation of hypoperfused wound beds, a process only achievable in selected patients by exposing them to hyperbaric oxygen treatment mitigates many of these impediments and sets into motion a cascade of events that leads to wound healing.
Hyperbaric oxygenation is achieved when a patient breaths 100% oxygen at an elevated atmospheric pressure.
Arterial PO2 elevations to 1500mmHg or greater are achieved with 2 to 2.5 atms abs with soft tissue and muscle PO2 levels elevated correspondingly. Proper oxygenation of the vascularized connective tissue compartment is crucial to the efficient initiation of the wound repair process and becomes an important rate-limiting factor for the cellular functions associated with several aspects of wound healing. Neutrophils, fibroblasts, macrophages, and osteoclasts are all dependent upon an environment in which oxygen is not deficient in order to carry out their specific inflammatory or repair functions.
Three groups of induced responses occur:
1 Increased leukocyte function of bacterial killing, antibiotic potentiation, and enhanced collagen synthesis occur during periods of elevated tissue PO2.
2 Suppression of bacterial toxin synthesis, blunting of systemic inflammatory responses, and prevention of leukocyte activation and adhesion following ischemic reperfusion are effects that may persist even after completion of hyperbaric oxygen treatment.
3 Vascular endothelial growth factor (VEGF) is released, and platelet derived growth factor (PDGF) is induced. The net result of several hyperbaric oxygen exposures is improved local host immune response, clearance of infection, enhanced tissue growth and angiogenesis with progressive improvement in local tissue oxygenation, and epithelialization of hypoxic wounds.
* The above information is from the 2003 Hyperbaric Oxygen Therapy Committee Report by John Feldmeier, D.O. et al.
* Photographs property of Joseph V. Boykin, Jr., M.D., Director, Institute for Plastic & Reconstructive Surgery, Medical Director, Problem Wound Center and Department of Hyperbaric Medicine, Metropolitan Hospital, Richmond, VA.
sumber :Mt. Diablo Hyperbaric 2010,ditayangkan ulang oleh dr.erick supondha (hyperbaric &diving medicine consultant) dokter ahli hiperbarik dan kesehatan penyelaman , jakarta indonesia 021 99070050