Topical Hyperbaric Oxygenation in the Treatment of
Recalcitrant Open Wounds: A Clinical Report

A. Valentino Upson

Physical Therapy - Vol. 66 No. 9, September 1986

Abstract

Oxygen is essential to wound metabolism for energy production, collagen synihesii. and cell proliferation. A lack of oxygen to the (issue often results from
a decrease in circulation caused by Atherosclerosis is primarily a disease process in which lipid deposits, or atheromatous plaques containing substantial amountsofcholesterol. infiltrate the subintimal layer of the arteries, causing degenerative changes in the arterial wall

Atherosclerosis is clinically important because it affects primarily the coronary, cerebral. and peripheral arteries. It develops insidiously and probably is caused by a combination of environmentaland hereditary factors. Peripheral vascular disease (PVD) is a common form of atherosclerosis that extends into the peripheral arteries. Ischemia usually develops in the affected lower extremity, resulting in edema with areas of redness of the skin. As deeper layers of the skin are affected, an ulcer forms. Oxygen metabolism plays an important role in the healing of ulcers. A decrease in oxygen available to the wound, which already is apparcnt in patients with atherosclerosis, therefore, may result in poor healing. Other factors that limit healing are cigarette smoking because it interferes with oxygen metabolism and concentrations of bactcria greater than 100,000 per gram of skin. Because oxygen metabolism also suppresses bacterial growth, it promotes healing. If therapeutic wound care is unsuccessful for patients with ischemia in their distal lower extremities, amputation may be imminent, and a difficult postoperative course often ensues, especially for elderly patients. The purposes of this clinical report are to 1. discuss various conventional wound-care treatments, 2. discuss the effectiveness of topical hyperbaric oxygenation (THO) in treating ischemic lower extremity ulcers and preventing amputation ofthe limb, 3. provide treatment guidelines to improve the quality ofwound care for recalcitrant casts, and 4. present two case studies supporting the efficacy of THO.