A Four Year Case Report of Hyperbaric Oxygen Treatment (HBOT) as Adjunctive Therapy in a Midwest Advance Wound Center (AWC)

Problem: Complex refractory wounds impose physical, psychological, and monetary burden that negatively impacts the quality of life and healthcare resources¹. Research has enhanced the acceptance of HBOT as an adjunctive therapy to treat refractory wounds _².

Past:A Midwest outpatient wound center established 1999 without HBOT, utilized a team approach to coordinate the management of patients with chronic wounds. Patients needing adjunct HBOT had to be referred to another AWC over one hour away. Consequences: patients lost to another health system, palliation of care, wound deterioration leading to hospitalization or even limb loss.

Current: 2 monochambers were added in 2011. Patient selection process followed the Undersea and Hyperbaric Medical Society’s guidelines. HBOT was discontinued if intolerant to treatment, failure to respond to adequate trial, or inability to follow the plan of care.

Outcomes:69 patients initiated HBOT from 10/2011 through 10/2015. Mean age was 57 years, 36 males, 33 females with 34 mean number of dives. 33 patients (48%) attained complete wound closure at the end of HBOT, 15 (22%) wounds improved significantly but did not fully close, 3 patients aborted treatment due to transportation or financial issues, 3 aborted due to medical issues, 6 patients transferred care:  4-surgical repair, 1-amputation, 2-closer HBO facility. Patient diagnosis included: 32 (46%) Wagner Grade 3 DM foot ulcers, 18 (56%) healed; 12 (17%) Chronic osteomylitis without DM; 10 (15%) compromised skin graft; 8 (12%) soft tissue radionecrosis, 3 (4%) Osteoradionecrosis; 3(4%) wound hypoxia, and 1 fistula due to Crohn’s. Manageable adverse events: inability to clear ears (7 (10%) needing pressure equalizer tubes), low blood sugars, and anxiety.  

Conclusions: Adjunct HBOT appears to promote healing especially in patients with Wagner grade 3 DM foot ulcers. This case series supports previous research that HBOT is an effective and safe adjunct to refractory wound healing and limb salvaging^3,4.