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What is
Healing in Selected Wounds?
Selected wounds refer to specific types of injuries that often require specialized care due to their complexity, chronicity, or difficulty in healing. These wounds are typically chosen for advanced treatments, including Hyperbaric Oxygen Therapy (HBOT), based on their characteristics and healing challenges.
Common Sources of
Healing in Selected Wounds
Include:
Key types of selected wounds include:
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Diabetic foot ulcers
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Pressure ulcers (bedsores)
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Venous leg ulcers
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Arterial insufficiency ulcers
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Radiation-induced wounds
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Burn wounds
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Crush injuries
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Compromised skin grafts and flaps
Characteristics of selected wounds often include:
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Chronic nature (lasting more than 30 days)
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Poor vascularization
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High risk of infection
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Presence of necrotic tissue
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Impaired healing due to underlying conditions
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Significant impact on patient’s quality of life
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Resistance to conventional treatments
Factors that complicate healing in selected wounds:
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Diabetes mellitus
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Peripheral vascular disease
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Immunosuppression
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Malnutrition
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Repeated trauma or pressure
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Presence of biofilms
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Tissue hypoxia
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Edema
Early intervention and appropriate treatment selection are crucial for optimal outcomes in these challenging wound types.
How HBOT Helps with
Healing in Selected Wounds
Hyperbaric Oxygen Therapy (HBOT) can be particularly beneficial for healing in selected wounds due to its unique mechanisms of action. Here’s how HBOT helps:
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Enhanced Tissue Oxygenation: HBOT dramatically increases oxygen levels in the blood and tissues, addressing the hypoxia often present in chronic wounds.
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Stimulation of Angiogenesis: The alternating hyperoxic and relative hypoxic states during and after HBOT stimulate the formation of new blood vessels, improving long-term blood supply to the wound area.
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Reduced Inflammation: HBOT modulates the inflammatory response, helping to balance the wound environment for optimal healing.
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Enhanced Collagen Synthesis: Increased oxygen levels stimulate fibroblast activity and collagen production, crucial for wound closure and strength.
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Improved Immune Function: HBOT enhances the function of neutrophils and macrophages, improving the body’s ability to fight infection and clear debris in the wound area.
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Edema Reduction: The hyperbaric environment helps reduce tissue swelling, which can further improve blood flow and healing.
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Stem Cell Mobilization: HBOT has been shown to mobilize stem cells from the bone marrow, which can contribute to tissue repair and regeneration.
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Antimicrobial Effects: High oxygen levels create an environment hostile to anaerobic bacteria and enhance the efficacy of certain antibiotics.
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Growth Factor Upregulation: HBOT increases the production of various growth factors involved in wound healing, including VEGF and TGF-β.
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Mitigation of Ischemia-Reperfusion Injury: HBOT can help prevent damage that occurs when blood flow is restored to oxygen-starved tissues.
What Happens in Our Bodies During HBOT for
Healing in Selected Wounds
During HBOT treatment for healing in selected wounds, several physiological processes occur:
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Hyperoxia Induction: Blood oxygen levels increase dramatically, with oxygen dissolved directly in the plasma, reaching levels up to 20 times normal.
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Tissue Oxygenation: The increased oxygen levels in the blood allow oxygen to penetrate deeper into tissues, reaching areas that may have been deprived due to poor circulation or edema.
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Vasoconstriction and Edema Reduction: HBOT causes vasoconstriction in normal tissues, which can help reduce edema in the wound area without compromising oxygen delivery.
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Nitric Oxide Production: HBOT stimulates the production of nitric oxide, a potent vasodilator that improves microcirculation and promotes wound healing.
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Growth Factor Upregulation: The hyperbaric environment triggers increased production of growth factors such as PDGF, VEGF, and FGF, which are crucial for wound healing.
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Collagen Synthesis: Increased oxygen levels stimulate fibroblast activity and collagen production, essential for wound closure and tensile strength.
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Leukocyte Function Enhancement: HBOT improves the function of white blood cells, enhancing phagocytosis and the body’s ability to fight infection in the wound area.
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Stem Cell Activation and Mobilization: The hyperbaric environment can activate and mobilize stem cells from the bone marrow, contributing to tissue repair and regeneration.
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Modulation of Inflammatory Mediators: HBOT affects the production and activity of various cytokines and inflammatory mediators, helping to optimize the wound healing environment.
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Antimicrobial Activity: The high oxygen levels directly inhibit the growth of anaerobic bacteria and enhance the oxygen-dependent killing mechanisms of leukocytes.
Protocol
HBOT treatment for selected wounds typically involves pressurizing the chamber to 2.0-2.5 atmospheres absolute (ATA) for about 90-120 minutes, with treatments repeated daily or several times a week. The exact protocol may vary based on the type and severity of the wound and the patient’s response to treatment.
It’s important to note that while HBOT can be a valuable adjunctive therapy for healing in selected wounds, it should be used in conjunction with standard wound care practices, including proper cleaning, debridement, dressing, and management of underlying conditions that may impair healing. The effectiveness of HBOT may be most pronounced in cases of diabetic foot ulcers, radiation-induced wounds, and compromised skin grafts or flaps.
References
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Weaver, L. K. (2014). Hyperbaric oxygen therapy indications. 13th edition. Undersea and Hyperbaric Medical Society.
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Cimşit, M., Uzun, G., & Yildiz, S. (2009). Hyperbaric oxygen therapy as an anti-infective agent. Expert Review of Anti-infective Therapy, 7(8), 1015-1026.
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Thom, S. R. (2011). Hyperbaric oxygen: its mechanisms and efficacy. Plastic and Reconstructive Surgery, 127(Suppl 1), 131S-141S.
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Heyboer III, M., Sharma, D., Santiago, W., & McCulloch, N. (2017). Hyperbaric oxygen therapy: side effects defined and quantified. Advances in Wound Care, 6(6), 210-224.
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Bosco, G., Vezzani, G., Mrakic Sposta, S., Rizzato, A., Enten, G., Abou-Samra, A., … & Camporesi, E. (2018). Hyperbaric oxygen therapy ameliorates osteonecrosis in patients by modulating inflammation and oxidative stress. Journal of Enzyme Inhibition and Medicinal Chemistry, 33(1), 1501-1505.
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Kranke, P., Bennett, M. H., Martyn-St James, M., Schnabel, A., Debus, S. E., & Weibel, S. (2015). Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews, (6).
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Mathieu, D., Marroni, A., & Kot, J. (2017). Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving and Hyperbaric Medicine, 47(1), 24-32.
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Harch, P. G. (2015). Hyperbaric oxygen in chronic traumatic brain injury: oxygen, pressure, and gene therapy. Medical Gas Research, 5(1), 9.