Problem wounds are those which fail to respond to established medical and surgical management. Such wounds usually develop in compromised hosts with multiple local and systemic factors contributing to inhibition of tissue repair. These include diabetic feet, compromised amputation sites, non healing traumatic wounds, and vascular insufficiency ulcers (ulcers with poor circulation).

All share the common problem of tissue hypoxia (low tissue oxygen level, 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. Fifty percent of all lower extremity amputations in the United States are due to diabetes, at a cost of more than one billion dollars per year. It is well known that many diabetics suffer circulatory disorders that create inadequate levels of oxygen to support wound healing.

Hyperbaric oxygen therapy is a treatment in which patients receive high concentrations of oxygen under pressure in order to increase the oxygen level in the blood and tissues. The elevation in tissue oxygen which occurs in the hyperbaric chamber induces significant changes in the wound repair process that promote healing. When hyperbaric treatment is used in conjunction with standard wound care, improved results have been demonstrated in the healing of difficult or limb threatening wounds as compared to routine wound care alone.

References

1. Cianci P. Adjunctive hyperbaric oxygen in the treatment of problem wounds: An economic analysis. In: Kindwall E, ed. Proceedings of the Eighth International Congress on Hyperbaric Medicine. San Pedro, CA: Best Publishing. 1984:213-216.
2. Cianci P, Petrone G, Drager S, Lueders H, Lee H, Shapiro R. Salvage of the problem wound and potential amputation with wound care and adjunctive hyperbaric oxygen therapy: An economic analysis. J Hyperbaric Med 1988;3:127-141.
3. Hunt TK. The physiology of wound healing. Ann Emerg Med 1988;17:1265-1273.
4. Stone JA, Cianci P. The adjunctive role of hyperbaric oxygen therapy in the treatment of lower extremity wounds in patients with diabetes. Diabetes Spectrum 1997;10:118-123.