TOPICAL HYPERBARIC OXYGEN TREATMENT OF PRESSURE SORES AND SKIN ULCERS

Boguslav H. Fischer, Institute of Rehabilitation Medicine,
New York University Medical Center
New York, New York

The Journal of Dermatologic Surgery - Vol. 1 No. 3, October 1975

Abstract
Skin ulcerations present in patients being treated for other conditions with hyperbaric oqgen were noted to heal at an accelerated rate. This observation led to the concept of topical exposure to hyperbaric oxygen as a treatment of intractable cutaneous ulcers.

Thirty patients, ranging in age from eight to ninety-five years with lesions that had been present from I5 days to six years, were treated with hyperbaric oxygen for ulcers on the leg. The majority had been previously treated by methods which had failed to improve or heal their conditions. The patients did not receive preferential treatment, attention, or care during oxygen therapy. Total healing was achieved in twenty eight patients. In two patients. hybcrbaric oxygen treatment resulted in improvement of the ulcerations with suppression or elimination of pain, but failed to heal the lesions entirely. The treatment was very well tolerated by all patients and no untoward effects were noted.

A controlled study was performed in one case since the patient presented almost identical lesions on both feet. One foot was treated conventionally and the other foot was esposed lo hyperbaric oxygen. The control side was subsequently exposed to hyperbaric oxygen. However, most of the patients served as their own controls since each had a history of past treatment with no improvement.

A hermetic chamber with controlled pressure sealine was constructed to allow unintempted exposure of the infected area to pure oxygen. A pressure not exceeding 22 mm Hg ( 1.03 ntmosphere absolute) was applied to avoid obstruction of capillaw blood flow (Figure 1). The oxygen drive was maintained at four liters/minute with continuous humidification and discharged to free atmosphere. Oxygen treatment was performed twice daily, each session lasting from two to three hours. Normal saline dressing was applied during the oxygen-off hours. After the second or third day of oxygen therapy the demarcation line between the necrotic and viable tissue was clearly visible and debridement was performed when necessary. The patients were treated in a regular ward and customary precautions with the use of oxygen were observed. The oxygen was delivered from tanks or wall outlets. Photographic documentation and serial bactcrial cultures were performed in the majority of patients throughout the course of treatment.