HYPERBARIC OXYGEN IN WOUND HEALING
by: Dr. Richard Claydon
Although not a new concept or treatment modality as this was the subject of scientific articles dating back to the mid 1980's. Robert Marx even had a specific study article on Osteoradionecrosis published in the Journal of the American Dental Association in 1985. Since then there have been many studies and publications regarding the effectiveness of HBO in improved would healing. Most importantly, in recent years many communities have established centers for wound healing and hyperbaric medicine.
The indications for hyperbaric oxygen include:
- Diabetic wounds of lower extremity
- Gas gangrene of tissues
- Compromised skin grafts and flaps
- Carbon monoxide poisoning
- Delayed radiation injury
- Decompression sickness
- Necrotizing soft tissue infections
- Air or gas embolism
- Osteomyelitis (Refractory)
- Select problem wounds
- Crush injury, compartment syndrome and other acute traumatic ischemia
The principals of hyperbaric oxygen treatment are to increase the dissolved oxygen content in blood plasma and the diffusion distance for oxygen into tissues.
The physiologic benefits are:
- Correction of tissue hypoxia in partially ischemic, infected or irradiated tissue.
- Stimulation and support of fibroblast replication, collagen synthesis and angiogenesis.
- Reduction of local tissue edema by alteration in blood flow with greater diffusion of oxygen into tissue.
- Enhancement of leukocyte killing of microorganisms, improved antibiotic function and direct toxic effects on anaerobic organisms.
When combined with appropriate conventional wound care such as surgical debridement, antibiotics, edema control and pressure relief, many previously non healing wounds can be successfully managed. In our area of involvement, HBO has been shown to provide significant benefit in treating established and preventing new osteoradionecrosis of the jaws in patients at risk.
Patients with established osteoradionecrosis or who have had previous head and neck radiation treatment and who are scheduled for elective dental extractions or oral maxillofacial surgical procedures, should be referred for evaluation for HBO treatment. Of note is that to date HBO therapy has not been shown to be effective in treating jaw osteonecrosis caused by pre oral and maxillofacial surgery bisphosphorate chemotherapy agents specifically Zometa and Aredia.