Maximizing wound healing using adjunctive advanced wound treatments with hyperbaric oxygen therapy

Hyperbaric oxygen therapy (HBOT) has long been proven effective in the healing of ischemic and infected diabetic foot ulcers. The following cases suggest that the integration of adjunctive therapies within the wound care center support and maximize the affect of HBOT. Combining outcome based wound management with aggressive organized advance wound treatments, seems to benefit wound healing outcomes.

Three patients were followed in this study, all with positive outcomes.

#1; 69 yo male with DMII, and a Wagner grade IV ulcer on the lateral foot, that the patient had self treated for a duration of five years prior to his visit to the wound center. Surgical debridement was done removing soft tissue and bony fragments. Daily IV Vancomycin was administered during HBOT treatments. Negative pressure wound therapy (NPWT), living cell-based wound therapy and serial bedside and surgical debridements were also utilized. Wound was closed after 14 weeks.

#2; 89 yo male with an acute ischemic ulcer of the foot. A surgical stent was placed to assist in revascularization. HBOT was done in conjunction with NPWT and serial debridements. Amputation of the second toe was necessary with the rest of the foot remaining intact and vascularity was restored. Amputation site was resolved to closure in 16 weeks from admission.

#3; 56 yo female with a Wagner III diabetic ulcer to the left heel that had been present for 1 year prior to admission, being treated with topical dressings and offloading. Co-morbidities include non-insulin dependant DM, diabetic neuropathy and hypertension. Baseline vascular testing showed sufficient blood flow to the extremities. Multimodalities included HBOT, NPWT, serial debridements, living cell-based wound therapy, and offloading with total contact casting (TCC). Wound was closed after 14 weeks.

When using outcome based wound management with aggressive organized advance wound treatments, wound healing seems to be beneficial.