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Hyperbaric Oxygen Therapy and Chronic Osteomyelitis

Osteomyelitis represents an inflammatory process with a bacterial infection involving bone. The disease involves ischemia as well as infection, and it my be acute, sub acute, or chronic. The term "chronic osteomyelitis" refers to failure to heal despite adequate surgical and antibiotic therapy. Staphylococci (staph) bacteria is a common form of bacteria that is often involved. Staphylocossus Epidermis and Pseudomonas Aeruginosa are also bacteria that are cultured from the wound site. The germs that cause osteomyelitis can enter the bone during an injury. It is an ever-present hazard following compound fractures and must be guarded against whenever the bone is exposed. Germs can reach the bone from a nearby infection or indirectly through the bloodstream.

Hyperbaric oxygen therapy is an adjunctive therapy and should be used with appropriate antibiotics, surgical debridement, and reconstructive surgery. Osteomyelitis can either be acute or chronic. All cases are initially acute. The signs of acute infection are severe pain, swelling, redness at the site of the infection or high fever and general malaise. Chronic osteomyelitis may follow the acute form or may develop over time, when the acute form is not completely cured by treatment. Its symptoms include bone pain, tenderness, local muscle spasm, and fever. Long-term osteomyelitis may go on for years, with periods of worsening or waning symptoms, in spite of treatment.

Osteomyelitis causes a lack of oxygen in the tissues and some bone itself has few blood vessels. Hyperbaric oxygen therapy forces oxygenation which helps fight this disease in three ways.

  • Helps to strengthen the bone cells called osteoclasts that reabsorb dead bone, allowing the osteoclasts to remove bony debris more effectively.
  • Enhances the function of the immune system's white blood cells which depend on oxygen. For this reason, HBOT is especially effective when used with antibiotics as it potentiates the action of the antibiotics.
  • Helps the body to create new blood vessels called capillaries.

As a result of these three factors, the body is able to get rid of the diseased bone and replace it with healthy bone.

Oxygen is also important in wound healing. When the environment of the fibroblast has an oxygen tension of less than 10mmHg, the cell can divide, but it can no longer synthesize collagen. It also cannot migrate to where it is needed for healing. When the oxygen tension is increased, the fibroblast can again carry out these wound-healing functions. The collagen produced by these cells forms a protective fibrous matrix, and new capillaries grow into this matrix. Wound healing is a dynamic process and an adequate oxygen tension is mandatory for this process to proceed to a successful conclusion. Hyperbaric oxygen therapy provides oxygen to promote collagen production, angiogenesis and ultimately wound healing in the ischemic or infected wound. Adequate supply of oxygen is vital in the treatment of osteomyelitis. Patient Medical makes no claims as to Hyperbaric Oxygen Therapy efficacy for any indication, other than the thirteen indications approved by the FDA. Information within this site is provided for informational and educational purposes only. This information is not meant to substitute for the advice provided by your personal physician or any other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. If you have or suspect that you have a medical problem, promptly contact your health care provider.

Hyperbaric Oxygen Therapy and Diabetic Wounds

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 therapy. It is well known that many diabetics suffer circulatory disorders that create inadequate levels of oxygen to support wound healing. Diabetic wounds present a major problem for modern health care. The foot is the most common site of infection in the diabetic. For diabetic patients, foot problems remain the number one reason for hospital admission.

Oxygen is one of the most versatile and powerful agents available to the modern medical practitioner today. The therapeutic use of oxygen under pressure is known as hyperbaric oxygen therapy (HBOT) and has been used to assist wound healing for almost 40 years. HBOT has several specific biological actions, which can enhance wound healing processes:

  • Oxygen used under pressure of hyperbaric oxygen can assist wound healing.
  • Hyperbaric oxygen therapy is considered unnecessary simple, well-perfused wounds, but can be used successfully in hypoxic or ischemic wounds such as diabetic wounds, venous stasis ulcers, failing grafts and flaps, necrotising soft tissue infections and refractory osteomyelitis.
  • In wound healing, hypoxia is an insufficient supply of oxygen which prevents normal healing processes. Hyperbaric oxygen therapy provides the oxygen needed to stimulate and support wound healing.
  • Hyperbaric oxygen therapy is able to combat clinical infection such as gas gangrene by acting directly on anaerobic bacteria, enhancing leukocyte and macrophage activity and enhancing the effects of antibiotics.
  • Hyperbaric oxygen therapy is a safe non-invasive, non-toxic therapy.

Hypoxia (lack of oxygen) can be defined as an insufficient supply of oxygen to allow the healing process to proceed at a normal rate. In a typical wound care treatment, hyperbaric oxygen therapy is capable of providing tissue oxygen levels of greater than 11 times normal values. Most chronic wounds are hypoxic and hyperbaric oxygen therapy provides the oxygen needed to stimulate and support wound healing.

When used in wound healing hyperbaric oxygen therapy provides a short pulse of oxygen - typically 90 minutes in a 24 hour day. Hyperbaric oxygen therapy acts in numerous ways that affect the wound after the treatment has stopped. There are eight principal methods in which Hyperbaric oxygen therapy is capable of affecting tissue:

  • Pressure effects of oxygen
  • Vasoconstrictive effects of oxygen.
  • 100% oxygen concentration effects on the diffusion gradient.
  • Hyperoxygenation of ischemic tissue.
  • Down regulation of inflammatory cytokines.
  • Up-regulation of growth factors.
  • Leukocyte effects.
  • Antibacterial effects.

Hyperbaric oxygen therapy has six actions which have been used to combat clinical infection:

  • Tissue rendered hypoxic by infection is supported by oxygen.
  • Neutrophils are activated and rendered more efficient.
  • Machrophage activity is enhanced.
  • Bacterial growth is inhibited.
  • The effect of antibiotics is potentiated.
  • Support of infected hypoxic tissue.

Soft tissue and bone infections are frequently accompanied by localized areas of tissue hypoxia caused by the inflammatory processes accompanying infection and by subsequent vascular thrombosis. As the infected tissue becomes infiltrated with inflammatory cells the oxygen level falls. Anaerobic bacteria are particularly susceptible to increased concentrations of oxygen.

The incidence of amputation in diabetics remains unacceptably high: 6 per 1,000 patients. Diabetics account for 50 - 70 percent of all amputations performed each year. In 1986, 152,000 amputations were done in America. Ten percent of those surgeries resulted in the loss of a foot, 35% involved the loss of a lower leg, and 30% resulted in the loss of the knee joint. Ipsilateral or higher amputation occurs in 24% of cases. One complication often goes unrecognized: contralateral amputation, which occurs at a rate of 10% per year.

Diabetic amputees also experience other difficulties. Only 50% of the patients survive more than 3 years after the amputation (USA survey data). Although many individuals who lose limbs traumatically can expect to be rehabilitated to full activity, only 40 - 50% of elderly amputees cannot expect to enjoy such a successful outcome. The duration of hospitalization for treatment of diabetic foot infections averages 22-36 days.

Amputation offers a poor solution. Patients pay high personal costs when limbs are lost. When an amputation occurs, patients generally remain hospitalized for 40 days and to maximize walking ability or potential, patients may need an additional 6-9 months of rehabilitation. Many elderly diabetic amputees remain bound to wheelchairs for the rest of their lives because they lack sufficient energy, balance, and strength to walk. Their sedentary existences lead to other health problems. Within 2 years, for example most amputees must undergo stump modification or proximal re-amputation.

Hyperbaric oxygen therapy offers physiological benefits for such patients. They include: improved oxygenation of threatened margins of wounds, generation of granulation tissue, enhanced phagocytosis and killing of select organisms. Still other benefits are enhanced penetration of some organisms by antibiotics whose transmembrane transport is oxygen dependent, and improved wound healing with an increased rate of fibroblast collagen production to support capillary angiogenesis. Hyperbaric oxygen therapy offers beneficial direct bacteriostatic effect on anaerobic micro-organisms.

In short, Hyperbaric oxygen therapy saves limbs and possibly lives in patients with diabetic foot wounds. It appears that it is time to recognize this body of data, reduce healthcare costs, and improve health and outcomes by endorsing Hyperbaric oxygen therapy in the treatment of diabetic foot wounds.

Patient Medical makes no claims as to Hyperbaric Oxygen Therapy efficacy for any indication, other than the thirteen indications approved by the FDA. Information within this site is provided for informational and educational purposes only. This information is not meant to substitute for the advice provided by your personal physician or any other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. If you have or suspect that you have a medical problem, promptly contact your health care provider.

Get Additional Information on Diabetes Here

Next Steps:

While you may find this medical information useful, as the next step we strongly recommend that you make an appointment to see one of our physicians to ensure that your health issues are properly addressed.

To schedule an appointment with our physicians, please call our patient coordinator at 1-212-679-9667, send the form below or an email to: info@patientsmedical.com. We are currently accepting new patients and look forward to being of assistance.

We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, NYC, New York, NY 10017.



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Article Last Updated: 08/26/2015