Hyperbaric Oxygen
Therapy Leads to Fewer Diabetic Amputations
September / October 2005
The treatment of diabetic complications is a major challenge
in health care. It is estimated that greater than seven percent
of all hospitalizations in the United States involve diabetes,
with more than 20 percent of these due to peripheral vascular
disease. Treatment including adjunctive use of hyperbaric
oxygen (HBO) leads to more rapid hospital discharge and better
limb salvage with fewer patients requiring amputations. In
fact, several large randomized trials have proven that HBO
reduces the number of patients that require a large (below-the-knee)
or smaller amputation by 30 to 50 percent.
A large percentage of diabetic patients with lower extremity
ulcerations have an occlusion of the large blood vessels
that feed their lower extremities. Typically, these patients
require bypass or vascular reconstruction surgery. But, patients
who do not have a major proximal blockage or still have refractory
ulcerations in their lower extremities after undergoing bypass
are considered for hyperbaric oxygen therapy.
“Due to long-term diabetes, these patients typically
have fewer small blood vessels in the lower extremities and
poor blood flow. This decreased blood flow makes wound healing
difficult and it is not unusual to have a wound accelerate
from an amputation of one or two toes to a below-the-knee
amputation,” says Stephen
R. Thom, MD, PhD, chief of hyperbaric
medicine in the Institute of Environmental Medicine at Penn.
Within Penn's hyperbaric
chamber system, air pressure
is increased to twice the normal pressure and patients breathe
100 percent oxygen through a facemask for about two hours.
While the air pressure is increasing, patients momentarily
experience sensations similar to being on an airplane as
it lands. After the pressure is increased, patients breathe
normally and relax while watching a movie or reading. A course
of HBO is usually about three weeks of treatment with approximately
20 two-hour treatments. Penn houses the only large, walk-in,
multiple-person hyperbaric chamber in the region.
“The combination of increased air pressure and 100
percent oxygen is what is required to stimulate new blood
vessel growth in the body. The patient's oxygen tension
decreases very quickly after they leave the chamber, but
secondary effects are triggered because of the high oxygen
exposure,” explains Dr. Thom. HBO therapy is effective
and extremely safe and the adverse effects are minimal.
“Through direct inspection of the wound we expect
to see substantial improvement including ‘granulation
tissue formation' which is the formation of the new
capillary network and a healthier looking wound bed,” explains
Dr. Thom. Throughout the course of the HBO treatment aggressive
standard management of the wound is continued including dressing
changes and nutritional support.
Together with the referral physician the hyperbaric medicine
physician decides if the wound will continue to heal with
no further surgical intervention or if a skin graft is necessary.
In most cases, a skin graft is applied and the patient undergoes
an additional 10 HBO treatments post-operatively until the
graft has established itself.
Since 2003 the Department of Health and Human Services
has recommended that reimbursement be provided for use of
hyperbaric oxygen therapy in the treatment of diabetic wounds
of the lower extremities.
|
|
Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
 |
|
|
|
