Sacral Unit Case Study: Use of Topical Hyperbaric Oxygen for Treatment of Chronic Woulnds in Long-Term Care Facilities.

Edsberg LE, Brogan MS, Jaynes CD, Fries K.
Natural and Health Sciences Research Center, Daemen College 

Ostomy Wound Management. April, 2003

Abstract
In the United States, $1 billion is spent annually treating chronic wounds. These wounds include pressure ulcers, diabetic ulcers, venous ulcers and arterial ulcers. The incidence of chronic wounds is increasing as our population ages. The wounds are painful, and may lead to a number of complications, including disability or need for assisted living, home care, depression, loss of digit or limb, infection or death. The presence of a chronic wound leads t three times the mortality rate. Treatment of chronic wounds involves inverventions ranging from dressings to surgery. Modalities gaining popularity in clinical settings include topical hyperbaric oxygen (THBO) and electrical stimulation (E-Stim). The premise for hyperbaric oxygen use is that increased tissue oxygen tension in the wound improves and accelerates collagen synthesis, angiogenesis, epithelialization, and resistance to bacteria,. The purpose of theis study was to obtain preliminary data about the effects of THBO therapy and THBO used with E-Stim on the healing rates of chronic wounds. Additionally, we sought to evaluate the specific effects these modalities have on the wound chemistry and the specific proteins present. All subjects were geriatric residents of long-term care facilities with stage III or IV pressure ulcers. THBO was applied daily to the wounds of all 8 subjects. E-Stim was also applied to the wounds of 3 subjects. All wounds were dressed with standard conventional dressings. Wounds were measured and photographed weekly. Initial wound size ranged from 87.75 cm2 to 7.04 cm2 with an average size of 30.1 ± 28.5 (mean ±sd) cm2. Healing rates ranged from 8 to 49 weeks. After 4 weeks of treatment with THBO, average wound size had decreased more than 34.4 ±22.9%. The wounds of 5 of the subjects had decreased more than 20% with an average decrease of 51.8 ±17.9%. Preliminary data indicate that THBO does enhance wound healing and full closure for both diabetic and non-diabetic pressure ulcers. No signigicant differences were observed between diabetic and non-diabetic patients relative to rate of healing. No significant differences in healing were observed between THBO an THBO/E-Stim subjects. Inhibiting factors, such as rolled over edges (epibole), responded favorably to THBO treatment and resolved without additional treatment. Changes in protein levels indicate a dynamic correlation between the concentration of specific proteins and wound healing. Analysis of wound fluids revealed approximately 15 proteins that were consistently present and at least 4 that changed in concentration during the healing process. Use of THBO, both independently and coupled with E-Stim, offers clinicians a treatment which is both efficacious and primising for the treatment of chronic wounds. As a result of the initial findings in this study, a multicenter prospective, randomized, double-blind controlled sutdy is currently underway.