The Effect of Hyperbaric Oxygen on Lower Extremity Ulcerations

ELLIOT DIAMOND. DPM, MARK B. FORST, DPM,
STEVEN A. HYMAN, DPM, SCOTT A. RAND, DPM

Journal of the American Podiatry Association -
Volume 72 • Number 4, April 1982

Abstract

The authors discuss the use of hyperbaric oxygen in the treatment of
lower extremity skin ulcers. In this study, ulcers were of various etiology
and were refractory to outpatient management. This modality was employed
with both medical and surgical management. We report total
healing in all patients.

The treatment of lower extremity ulcerations is most challenging. There are numerous treatment regimens for the various types of ulcers and under lying medical pathologies. Therapy must be tailored to the particular needs of the patient, as well as to the etiology of the ulcer. This paper discusses the use of hyperbaric oxygen, a modality which can be combined with most treatment plans and can be used to treat virtually any ulcer, regardless of cause.

The goal of ulcer treatment is the promotion of healthy granulation tissue and subsequent epithelization. The elimination or control of the underlying etiology, the promotion of circulation, and the, removal of necrotic debris at the ulceration site, requires various modes of therapy, usually in conjunction with each other. Enzymatic debridement is preferred when vascular insufficiency exists. Ischemic ulcerations require great care to prevent infection and trauma to the already fragile tissue. Numerous authors review the use of enzymatic, debridement of ulcers. They have shown to be effective in removing purulent exudate and necrotic tissue. Enzymes have been successfully utilized with decubitus ulcers secondary to peripheral vascular disease or neurological illness.

Porcine skin grafts are also used on decubitus, neuropathic, stasis, and ischemic ulcers. Decubitus and neuropathic ulcers were the most responsive to porcine grafts. Stasis ulcers showed comparatively less granulation while ischemic ulcerations were the moat difficult to treat. The grafts apparently decreased the pain but did little toward achieving a cure. The porcine is thought to work by lessening or eliminating sepsis and serving as a foundation for granulation. Debrisan hydroptulic beads appear to aid ulcer healing by absorbing the exudate. Debriaan is a viable alternative to an enzyme and appears to act more rapidly. Twenty percent benzoyl peroxide solution, applied topically with ulcers, was first used as a protective barrier. Benzoyl peroxide-soaked sterile gauze is applied to the ulcer and covered with plastic wrap. This dressing is then changed every 8 hr and may be used on an outpatient basis. The benzoyl peroxide is believed to release oxygen into the superficial
tissue. Molecular oxygen is necessary for aerobic cellular respiration of the fibroblast and is an essential element in wound healing. Benzoyl peroxide slowly liberates molecular oxygen and constantly increases the oxygen tension in the tissue. Bacteriocidal effects are also noted. An increase in tissue oxygen levels is also achieved by the use of hyperbaric oxygen.