-Original-

Evaluation of Hyperbaric Oxygen Therapy for Chronic Wounds

Takashi Ueno¹, Tokuya Omi², Eiji Uchida³, Hiroyuki Yokota⁴ and Seiji Kawana¹

¹Department of Cutaneous and Mucosal Pathophysiology, Graduate School of Medicine, Nippon Medical School
²Department of Dermatology, Queen's Square Medical Facilities
³Department of Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
⁴Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Nippon Medical School

Background: Treating chronic wounds is challenging. Despite standard wound care, some chronic wounds fail to heal. Therefore, hyperbaric oxygen therapy (HBOT) was developed as an adjunct to standard wound care.
Objective: To evaluate the efficacy of HBOT for treating chronic wounds due to a variety of causes at our institution.
Methods: We reviewed the medical records of patients with chronic wounds treated with HBOT in addition to standard wound care at the Department of Dermatology, Nippon Medical School Hospital, from 2009 through 2012. Twenty-nine patients were reviewed (14 men and 15 women; mean age, 64.1±14.4 years). The cause of chronic wounds was diabetes mellitus (DM) in 13 patients, venous stasis in 10, polyarteritis nodosa cutanea in 2, and livedoid vasculopathy, pyoderma gangrenosum, chronic renal failure, and systemic sclerosis in 1 patient each. The patients underwent HBOT for 60 minutes with 100% oxygen delivered via a mask in a hyperbaric chamber pressurized to 2.8 atmospheres of absolute pressure. The response of the chronic wounds to HBOT was evaluated according to the following criteria: "excellent": more than 90% wound healing; "good": a greater than 30% reduction in wound size, and wound healing was confirmed on follow-up visits within 6 weeks; "fair": wound healing was achieved with a combination of further invasive interventions; and "poor": the wound showed a less than 30% reducion or worsened during HBOT, or wound healing had not been completed by follow-up visits within 6 weeks.
Results: The response to HBOT was "excellent" in 6 patients, "good" in 8, "fair" in 11, and "poor" in 4. All 4 patients with a "poor" response had DM and had undergone hemodialysis.
Conclusions: HBOT is an effective treatment for patients with chronic wounds, due to a variety of causes, when used in combination with conventional standard therapy or further interventions. However, HBOT is less effective in patients with DM than in patients with venous stasis because hemodialysis, which is more common in patients with DM, has negative effects on wound healing.

J Nippon Med Sch 2014; 81: 4-11

Keywords
hyperbaric oxygen therapy, chronic wound, gangrene, ulcer, treatment

Correspondence to
Takashi Ueno, MD, PhD, Department of Cutaneous and Mucosal Pathophysiology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
takashi-ueno@nms.ac.jp

Received, May 14, 2013
Accepted, June 5, 2013