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Common Conditions Treated
At
Hyperbaric Solutions Facilities
The following is a short list of the more
frequently seen indications from the approved list of thirteen (13)
which better fit the services offered in an out-patient setting.
Problem Wounds
Problem wounds are those which fail to
respond to established medical and surgical management. These include
diabetic feet, compromised amputation sites, non-healing traumatic
wounds, and ulcers with poor
circulation. All share the common problem of tissue hypoxia (low tissue
oxygen level, usually related to impaired circulation).
Diabetic foot wounds are one of the major complications of diabetes and
an excellent example of the type of complicated wound which can be
treated with hyperbaric oxygen. Fifty percent of all lower extremity
amputations in the United States are due to diabetes, at a cost of more
than one billion dollars per year. It is well known that many diabetics
suffer circulatory disorders that create inadequate levels of oxygen to
support wound healing.
The Adjunctive Role of Hyperbaric Oxygen Therapy in the Treatment of
Lower Extremity Wounds in Patients With Diabetes
Diabetes Spectrum, Volume 10 Number 2, 1997, Pages 118-123.
Damage from Radiation Therapy
Cancer treatment has improved significantly
over the past decade. Although cure of the cancer is still the highest
priority of treatment, cancer specialists have come to recognize the
ever-increasing importance of quality of life to the cancer survivor.
One-half of the estimated 1.2 million new cases of invasive cancer will
receive radiation therapy as a part of their cancer treatment. Side
effects of this therapy can be very toxic, especially when combined with
chemotherapy. Some people are more sensitive to radiation damage than
others, and there are no reliable tests available as yet to identify
those patients who will experience the worst side effects. Radiation
doses must be adequate to control the cancer; otherwise, there is no
purpose in treating the patient. Most radiation cancer specialists or
oncologists design their treatment protocols to give the best dose to
control the tumor and still have no more than 5% of patients develop
severe reactions to treatment.
Radiation side effects are generally divided
into two categories. First, there are those that happen during or just
after the treatment, called acute reactions. Second, there are those
that happen months or even years after the treatment, called chronic
complications.
The acute side effects almost always resolve
with time and are treated in such a way as to address the patient’s
symptoms. For example, when a patient has a cancer of the mouth or
throat, it becomes very difficult for the patient to eat during and just
after treatment because the lining of the mouth and throat becomes raw
and painful. The cells which make up the linings of the gastrointestinal
tract are sensitive to radiation. Both cancer cells and the cells that
line the gastrointestinal tract have a high rate of growth, and this
rapid growth rate makes them more sensitive to radiation damage.
Fortunately, the normal tissue cells have excellent repair abilities and
within a few weeks after the completion of radiation, this damage is
repaired. In the meantime, the patient is supported with pain medicine
and supplemental nutrition. Unfortunately, chronic complications often
may not get better with time and are likely to get worse. Almost all
chronic radiation complications result from scarring and narrowing of
the blood vessels within the area which has received the treatment. If
this process progresses to the point that the normal tissues are no
longer receiving adequate blood supply, death or necrosis of these
tissues can occur. In the past, a severe level of necrosis would require
surgical removal of the damaged tissue. This would be a devastating blow
for a patient whose cancer has been cured. For example, though it occurs
rarely, a patient who has had cancer of the voice box cured might
require the removal of the voice box due to radiation damage. Chronic
radiation damage is called "osteoradionecrosis" when the bone is damaged
and "soft tissue radionecrosis" if it is muscle, skin or internal organs
which have been damaged by the radiation.
Since the 1970’s, surgeons of the head and
neck region have come to recognize the value of hyperbaric oxygen
treatments in treating damage of the jaw bone due to radiation.
Hyperbaric oxygen has had some of its most dramatic successes in
treating or preventing damage to the jaw bone as a result of radiation
treatments. It has now also been applied to damage of the brain, damage
of muscle and other soft tissues of the face and throat, damage to the
chest wall, abdomen and pelvis as a result of radiation treatment.
Papers in medical journals also report success in treating damage to the
bladder and intestines due to radiation. The high dose oxygen provided
in the hyperbaric chamber is carried in the patient’s circulation to the
site of injury to be available for repair of the damage done by the
narrowing and scarring of the blood vessels. Each treatment typically
takes one to two hours, and usually 30-40 daily treatments are needed
for healing radiation damage.
Most insurance companies, including
Medicare, will provide coverage to pay for hyperbaric treatments for
chronic radiation injuries.
Hyperbaric Oxygen Therapy and Mandibular Osteoradionecrosis: A
Retrospective Study and
Analysis of Treatment Outcomes
Lesley A. David, DDS, FRCD(C)
Compromised Skin Grafts
Reconstructing complex wounds is
accomplished by shifting or transferring tissues to the wound from a
different part of the body. A “skin graft” is the transfer of a portion
of the skin (without its blood supply) to a wound. A “flap” consists of
one or more tissue components including skin, deeper tissues, muscle and
bone. Flaps are transferred with either their own, original blood supply
(pedicle flap) or with detached blood vessels which are attached at the
site of the wound (free flap).
Skin grafts survive as oxygen and nutrients
diffuse into them from the underlying wound. Long-term survival
depends on a new blood supply forming from the wound to the graft. When
the wound bed does not have enough oxygen supplied to it, the skin graft
will at least partially fail. Common causes for this are previous
radiation to the wound area, diabetes mellitus, and certain infections.
In these situations, the availability of oxygen in the wound bed can be
increased with hyperbaric oxygen therapy (HBO) in preparation for skin
grafting. Additionally, HBO can be used after skin grafting to increase
the amount of the graft that will survive in these compromised settings.
Flaps also require oxygen and nutrients to
survive. The outer, visible portion (usually skin) is furthest from the
source of blood supply for the flap. This is the area most likely to be
compromised by inadequate oxygen. Factors such as age, nutritional
status, smoking, and previous radiation result in an unpredictable
pattern of blood flow to the skin. If a flap is found to have less than
adequate oxygen after it has been transferred, HBO can help minimize
the amount of tissue which does not survive and also reduce the need for
repeat flap procedures.
Partial or complete failure of the wound
reconstruction is very difficult for a patient and also very expensive.
HBO can help by assisting in the preparation and salvage of skin grafts
and compromised flaps.
Crush
Injuries
Crush injuries occur when body tissues are
severely traumatized such as in motor vehicle accidents, falls, and gun
shot wounds. These injuries frequently occur in the extremities. When
crush injuries are severe, the rate of complications such as infection,
non-healing of fractures, and amputations range up to 50%.
When used as an adjunct to orthopedic
surgery and antibiotics, hyperbaric oxygen (HBO2) therapy shows promise
as a way to decrease complications from severe crush injuries. HBO2
increases oxygen delivery to the injured tissues, reduces swelling and
provides an improved environment for healing and fighting infection.
Hyperbaric oxygen treatments should be
started as soon after an injury as possible. They are usually continued
for 5 to 6 days. .
Cancer
Medical research in the 1970-80 period
looked at HBO as a treatment for cancer with no success. HBO by itself
is not a magic bullet however the use of HBO as an adjunct therapy in
treating cancer in the future may be possible.
The impact of anemia on cancer patients
undergoing chemotherapy is well established and now the prevalence of
anemia in patients receiving radiotherapy is receiving more attention.
Anemia in cancer patients is being studied for two reasons (1) evidence
that hypoxia (low tissue oxygen levels) adversely affects the
radiosensitivity of the cells (ie. treatment more effective) and (2)
fatigue that cancer patients undergoing treatment experience can greatly
affect their quality of life and sometimes the treatment outcome.
In the case of radiosensitivity, according
to the Kumar reference below, studies have shown that radiation
treatment is 2.5 to 3 times more effective when the tumor tissue
exposed to the radiation is well oxygenated. Further that a patient’s
hemoglobin levels is strong indicator that anemia has been reversed and
hence oxygen levels in the tumor radiated are sufficient for the
chemotherapy / radiotherapy to be effective.
Impact of Anemia in Patients With Head and Neck Cancer
The Oncologist, Vol. 5, Suppl 2, 13-18, June 2000
Stroke
While the use of HBO for stroke is still termed experimental there has
been more awareness of HBO. As in the case of other stroke related
treatments time is of the essence in minimizing the damage from a
stroke. The same mechanisms that HBO is known for in treating other
approved indications may be at work in these situations (ie. increased
oxygen level in the blood to provide immediate support to injured tissue
areas and reduction of blood flow to reduce intercranial pressure and
edema)
One recent technical article from Singapore
(link below) documents a haemorrhagic stroke treated successfully with
HBO. The article further suggests studies using magnetic resonance
imaging (MRI) to prove its effectiveness and mechanisms during
application to stroke victims.
HBO does not replace immediate emergency
assistance but in the future we may see HBO may be used as an adjunct
therapy with approved medicines in a similar fashion that HBO is used
with antibiotics to treat massive bacterial infections to reduce the
extent of the damage.
Management of Haemorrhagic Stroke with Hyperbaric Oxygen Therapy – A
Case Report
J Lim, W K Lim, T T Yeo, Y Y Sitoh, E Low
SINGAPORE MEDICAL JOURNAL Vol 42, Issue 5, May 2001
Sports Injuries
Soft-tissue injuries are commonplace
in sports medicine, and HBO has been used as an adjunctive therapy to
enhance recovery. Several different mechanisms are believed to be
responsible for the beneficial effects of hyperoxygenation including
decreasing blood flow, which reduces edema, or swelling common in the
inflammation accompanying most sports injuries. The higher tissue oxygen
concentrations are thought to also accelerate the development of new
blood vessels and also prevent the development of any bacterial toxins
during the healing process.
How Can Hyperbaric Oxygen Contribute to Treatment?
J. Scott Delaney, MD; D. L. Montgomery, PhD
THE PHYSICIAN AND SPORTSMEDICINE - VOL 29 - NO. 3 - MARCH 2001
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