After Extensive Literature Review, Medicare Now Recognizes The Benefits Of Hyperbaric Oxygen Therapy27-Sep-2013
Approximately 17 million people in the U.S. (6% of the population) have Diabetes Mellitus, a chronic disease state that greatly effects wound healing through multiple pathways. When a diabetic patient gets wounded, the inflammatory response is diminished secondary to leukocyte malfunction. Thus the risk of infection is a seri-
ous issue from the onset. Even if infection is avoided there are a host of other abnormalities (metabolic, vascular, neurological, etc.) that increase the likelihood of the injury leading to a chronic poorly healing ulceration. Since studies have demonstrated reduced tensile strength and decreased connective tissue within diabetic wounds, even when the wounds appear to heal, the patient is still at risk for future complications. Consequently, diabetic wounds present a challenge to healthcare providers.
For many of these patients, healing is at least partially complicated by diabetic angiopathy, which causes occlusion of the microvascular capillaries. The effects of these changes may be further amplified by the comorbid condition of large vessel occlusion since both conditions result in diminished flow of oxygen and nutrients
to the wound. When these changes have occurred, wounds simply may not heal because the tissues barely receive the requirements they need to survive, much less grow.
In normal wound healing, there are many processes occurring that are known to be oxygen dependent. Angiogenesis, which plays a fundamental role by creating a route for the delivery of oxygen and other nutrients to new tissue, has been shown to proceed most rapidly along a gradient from high to low oxygen tension. Furthermore, collagen deposition, one of the processes that fills tissue deficits and provides structural framework to support angiogenesis, proceeds in proportion to tissue oxygenation. Cell replication is also oxygen dependent, with epidermal cells replicating fastest at a P02 of 700mnMg. Thus it is not surprising that the daily administration of oxygen in concentrations sufficient to elevate P02 above 1 OOmmHg has been shown to enhance the process of wound healing in otherwise hypoxic tissue.
It is important to note that at sea level, only about 1% of oxygen carried in the blood is actually dissolved in the serum. Thus the administration of even 100% oxygen at sea level is unlikely to improve tissue oxygenation sufficiently to create the necessary gradient. However, in the hyperbaric chamber, the amount of oxygen dissolved in the serum is dramatically increased making it possible to create a temporary but significant gradient between normal and ischemic tissue. By repetitively creating this gradient, angiogenesis can occur, which can offset the micro vascular occlusions, creating a favorable environment for the rest of the wound healing process.