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Hyperbaric Oxygen Therapy in Functional Limb Salvage

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Functional Limb Salvage

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Abstract

Hyperbaric oxygen therapy (HBO), a treatment in which patients breathe 100% oxygen while pressurized to depths greater than sea level, has been used for hundreds of years as a treatment for multiple medical conditions. Today, HBO is commonly used as a treatment for chronic wounds, including diabetic foot ulceration (DFU). The physiology of HBO in the treatment of problem wounds involves increased angiogenesis, reduction of inflammatory mediators, mitigation of reperfusion injury, and enhanced infection control. Through these mechanisms of action, HBO can result in improved wound healing and decreased need for amputation in selected patient populations. HBO is frequently used as an adjunctive treatment for severe DFU (Wagner grade 3 or greater) and is also used as a treatment for compromised skin grafts and flaps. HBO can be performed in single-person (monoplace) chambers or in larger (multiplace) chambers that are capable of treating multiple patients at once. Patient safety, including fire safety, is a critical tenet of hyperbaric medicine practice, and hospital-based chambers follow strict fire safety codes that allow for the safe treatment of patients in the hyperbaric environment. Adverse events associated with HBO are rarely encountered when the treatment is administered by experienced staff; commonly reported adverse events associated with HBO include middle ear barotrauma, temporary visual acuity changes, and hypoglycemia. Overall, HBO has a favorable safety profile and is a valuable adjunct in the treatment of patients referred for attempts at limb salvage.

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References

  1. Edwards ML. Hyperbaric oxygen therapy. Part 1: history and principles. J Vet Emerg Crit Care (San Antonio). 2010;20(3):284–8.

    Article  PubMed  Google Scholar 

  2. Rendell-Baker L, Jacobson JH II. Hyperbaric oxygenation. Int Anesthesiol Clin. 1965;3:315–54.

    Article  CAS  PubMed  Google Scholar 

  3. Butler WP. Caisson disease during the construction of the Eads and Brooklyn bridges: a review. Undersea Hyperb Med. 2004;31(4):445–59.

    CAS  PubMed  Google Scholar 

  4. Jacobson JH II, Morsch JH, Rendell-Baker L. Clinical experience and implications of hyperbaric oxygenation. THE historical perspective of hyperbaric therapy. Ann N Y Acad Sci. 1965;117:651–70.

    PubMed  Google Scholar 

  5. McCallum RI. Decompression sickness: a review. Br J Ind Med. 1968;25(1):4–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Brecher ME. Transfusion medicine illustrated. The Timken Tank. Transfusion. 2011;51(7):1377–8.

    Article  PubMed  Google Scholar 

  7. Weaver LK, editor. Hyperbaric oxygen therapy indications. Florida: Best Publishing Company; 2014. p. iii.

    Google Scholar 

  8. Bell E, Wallace T, Chouinard I, Shevell M, Racine E. Responding to requests of families for unproven interventions in neurodevelopmental disorders: hyperbaric oxygen “treatment” and stem cell “therapy” in cerebral palsy. Dev Disabil Res Rev. 2011;17(1):19–26.

    Article  PubMed  Google Scholar 

  9. Bennett MH, Mitchell SJ. Emerging indications for hyperbaric oxygen. Curr Opin Anaesthesiol. 2019;32(6):792–8.

    Article  PubMed  Google Scholar 

  10. Thom SR. Hyperbaric oxygen: its mechanisms and efficacy. Plast Reconstr Surg. 2011;127 Suppl 1(Suppl 1):131S–41S.

    Article  PubMed  Google Scholar 

  11. Camporesi EM, Bosco G. Mechanisms of action of hyperbaric oxygen therapy. Undersea Hyperb Med. 2014;41(3):247–52, 259.

    PubMed  Google Scholar 

  12. Sheikh AY, Gibson JJ, Rollins MD, Hopf HW, Hussain Z, Hunt TK. Effect of hyperoxia on vascular endothelial growth factor levels in a wound model. Arch Surg. 2000;135(11):1293–7.

    Article  CAS  PubMed  Google Scholar 

  13. Francis A, Baynosa R. Ischaemia-reperfusion injury and hyperbaric oxygen pathways: a review of cellular mechanisms. Diving Hyperb Med. 2017;47(2):110–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Buras J. Basic mechanisms of hyperbaric oxygen in the treatment of ischemia-reperfusion injury. Int Anesthesiol Clin. 2000;38(1):91–109.

    Article  CAS  PubMed  Google Scholar 

  15. Huang ET, Mansouri J, Murad MH, Joseph WS, Strauss MB, Tettelbach W, Worth ER, UHMS CPG Oversight Committee. A clinical practice guideline for the use of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers. Undersea Hyperb Med. 2015;42(3):205–47.

    CAS  PubMed  Google Scholar 

  16. Koomanachai P, Keel RA, Johnson-Arbor KK, Suecof LA, Nicolau DP, Kuti JL. Linezolid penetration into wound tissue of two diabetic patients before and after hyperbaric oxygen therapy. Undersea Hyperb Med. 2011;38(1):11–6.

    CAS  PubMed  Google Scholar 

  17. Kaide CG, Khandelwal S. Hyperbaric oxygen: applications in infectious disease. Emerg Med Clin North Am. 2008;26(2):571–95, xi.

    Article  PubMed  Google Scholar 

  18. Boerema I, Meyne NG, Brummelkamp WK, et al. Life without blood (a study of the influence of high atmospheric pressure and hypothermia on dilution of the blood). J Cardiovasc Surg. 1959;13:133–46.

    Google Scholar 

  19. Mutluoglu M, Cakkalkurt A, Uzun G, et al. Topical oxygen for chronic wounds: a pro/con debate. J Am Coll Clin Wound Spec. 2015;5:61–5.

    Google Scholar 

  20. Anonymous. UHMS position statement: topical oxygen for chronic wounds. Undersea Hyperb Med. 2018;45(3):379–80.

    Article  Google Scholar 

  21. Feldmeier JJ, Kirby JP, Buckey JC, Denham DW, Evangelista JS, Gelly HB, Harlan NP, Mirza ZK, Ray KL, Robins M, Savaser DJ, Wainwright S, Bird N, Huang ET, Moon RE, Thom SR, Weaver LK. Physiologic and biochemical rationale for treating COVID-19 patients with hyperbaric oxygen. Undersea Hyperb Med. 2021 First-Quarter;48(1):1–12.

    Google Scholar 

  22. Goldman RJ. Hyperbaric oxygen therapy for wound healing and limb salvage: a systematic review. PM R. 2009;1(5):471–89.

    Article  PubMed  Google Scholar 

  23. Huang E, Heyboer M III, Savaser DJ. Hyperbaric oxygen therapy for the management of chronic wounds: patient selection and perspectives. Chronic Wound Care Manag Res. 2019;6:27–37.

    Article  Google Scholar 

  24. Gill AL, Bell CN. Hyperbaric oxygen: its uses, mechanisms of action and outcomes. QJM. 2004;97(7):385–95.

    Article  CAS  PubMed  Google Scholar 

  25. Marx RE, Johnson RP. Problems wounds in oral and maxillofacial surgery: the role of hyperbaric oxygen. In: Davis JC, Hunt KT, editors. Problem wounds: the role of oxygen. New York, NY: Elsevier; 1998. p. 71.

    Google Scholar 

  26. Margolis DJ, Gupta J, Hoffstad O, Papdopoulos M, Glick HA, Thom SR, Mitra N. Lack of effectiveness of hyperbaric oxygen therapy for the treatment of diabetic foot ulcer and the prevention of amputation: a cohort study. Diabetes Care. 2013;36(7):1961–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Fedorko L, Bowen JM, Jones W, Oreopoulos G, Goeree R, Hopkins RB, O’Reilly DJ. Hyperbaric oxygen therapy does not reduce indications for amputation in patients with diabetes with nonhealing ulcers of the lower limb: a prospective, double-blind, randomized controlled clinical trial. Diabetes Care. 2016;39(3):392–9.

    Article  CAS  PubMed  Google Scholar 

  28. Santema KTB, Stoekenbroek RM, Koelemay MJW, Reekers JA, van Dortmont LMC, Oomen A, Smeets L, Wever JJ, Legemate DA, Ubbink DT, DAMO2CLES Study Group. Hyperbaric oxygen therapy in the treatment of ischemic lower-extremity ulcers in patients with diabetes: results of the DAMO2CLES multicenter randomized clinical trial. Diabetes Care. 2018;41(1):112–9.

    Article  CAS  PubMed  Google Scholar 

  29. Kleban S, Baynosa RC. The effect of hyperbaric oxygen on compromised grafts and flaps. Undersea Hyperb Med. 2020 Fourth-Quarter;47(4):635–48.

    Google Scholar 

  30. Zamboni WA, Roth AC, Russell RC, Nemiroff PM, Casas L, Smoot EC. The effect of acute hyperbaric oxygen therapy on axial pattern skin flap survival when administered during and after total ischemia. J Reconstr Microsurg. 1989;5(4):343–7.

    Article  CAS  PubMed  Google Scholar 

  31. Baynosa RC, Zamboni WA. The effect of hyperbaric oxygen on compromised grafts and flaps. Undersea Hyperb Med. 2012;39(4):857–65.

    PubMed  Google Scholar 

  32. Friedman HI, Fitzmaurice M, Lefaivre JF, Vecchiolla T, Clarke D. An evidence-based appraisal of the use of hyperbaric oxygen on flaps and grafts. Plast Reconstr Surg. 2006;117(7 Suppl):175S–90S.

    Article  CAS  PubMed  Google Scholar 

  33. Zhou YY, Liu W, Yang YJ, Lu GD. Use of hyperbaric oxygen on flaps and grafts in China: analysis of studies in the past 20 years. Undersea Hyperb Med. 2014;41(3):209–16.

    CAS  PubMed  Google Scholar 

  34. Lotfi P, Dayan J, Chiu ES, Mehrara B, Nelson JA. Hyperbaric oxygen therapy and mastectomy flap ischemia following nipple-sparing mastectomy and immediate breast reconstruction. Plast Reconstr Surg. 2020;145(6):1114e–5e.

    Article  CAS  PubMed  Google Scholar 

  35. Harl MJ. Defining the role of hyperbaric oxygen therapy as an adjunct to reconstructive surgery. Surg Clin North Am. 2020;100(4):777–85.

    Article  PubMed  Google Scholar 

  36. Lozano DD, Stephenson LL, Zamboni WA. Effect of hyperbaric oxygen and medicinal leeching on survival of axial skin flaps subjected to total venous occlusion. Plast Reconstr Surg. 1999;104(4):1029–32.

    Article  CAS  PubMed  Google Scholar 

  37. Camporesi EM, Bosco G. Hyperbaric oxygen pretreatment and preconditioning. Undersea Hyperb Med. 2014;41(3):259–63.

    PubMed  Google Scholar 

  38. Johnson-Arbor K, Verstraete R. No bad blood-surviving severe anemia without transfusion. JAMA Intern Med. 2021;181(1):7–8.

    Article  PubMed  Google Scholar 

  39. Hart JR, Rubadou CB. Chapter 14: Hyperbaric facilities. In: Hart JR, Rubadou CB, editors. NFPA 99 health care facilities code handbook. 11th ed. Quincy: National Fire Protection Association; 2017. p. 563–633.

    Google Scholar 

  40. Li G, Hopkins RB, Levine MAH, et al. Relationship between hyperbaric oxygen therapy and quality of life in participants with chronic diabetic foot ulcers: data from a randomized controlled trial. Acta Diabetol. 2017;54:823–31.

    Article  CAS  PubMed  Google Scholar 

  41. Hadanny A, Meir O, Bechor Y, Fishlev G, Bergan J, Efrati S. Seizures during hyperbaric oxygen therapy: retrospective analysis of 62,614 treatment sessions. Undersea Hyperb Med. 2016;43(1):21–8.

    CAS  PubMed  Google Scholar 

  42. Manning EP. Central nervous system oxygen toxicity and hyperbaric oxygen seizures. Aerosp Med Hum Perform. 2016;87(5):477–86.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Heyboer Iii M, Wojcik SM, Swaby J, Boes T. Blood glucose levels in diabetic patients undergoing hyperbaric oxygen therapy. Undersea Hyperb Med. 2019 Third Quarter;46(4):437–45.

    Google Scholar 

  44. Stevens SL, Narr AJ, Claus PL, Millman MP, Steinkraus LW, Shields RC, Buchta WG, Haddon R, Wang Z, Murad MH. The incidence of hypoglycemia during HBO2 therapy: a retrospective review. Undersea Hyperb Med. 2015;42(3):191–6.

    PubMed  Google Scholar 

  45. Riedl P, Škiljić D, Arnell P, Wannholt R, Zetterberg M, Andersson Grönlund M. Myopic shift and lens turbidity following hyperbaric oxygen therapy—a prospective, longitudinal, observational cohort study. Acta Ophthalmol. 2019;97(6):596–602.

    Article  CAS  PubMed  Google Scholar 

  46. Churchill S, Deru K, Wilson G, Cable R, Bell JE, Weaver LK. Rates of visual acuity change in patients receiving hyperbaric oxygen in monoplace and multiplace chambers. Undersea Hyperb Med. 2016;43(3):217–23.

    PubMed  Google Scholar 

  47. Palmquist BM, Philipson B, Barr PO. Nuclear cataract and myopia during hyperbaric oxygen therapy. Br J Ophthalmol. 1984;68(2):113–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Gesell LB, Trott A. De novo cataract development following a standard course of hyperbaric oxygen therapy. Undersea Hyperb Med. 2007;34(6):389–92.

    CAS  PubMed  Google Scholar 

  49. Weaver LK, Churchill S. Pulmonary edema associated with hyperbaric oxygen therapy. Chest. 2001;120(4):1407–9.

    Article  CAS  PubMed  Google Scholar 

  50. Howard MA, Asmis R, Evans KK, Mustoe TA. Oxygen and wound care: a review of current therapeutic modalities and future direction. Wound Repair Regen. 2013;21(4):503–11.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. MedStar Georgetown University Hospital, Washington, DC, USA

    Kelly Johnson-Arbor

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  1. Kelly Johnson-Arbor
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Correspondence to Kelly Johnson-Arbor .

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Editors and Affiliations

  1. Department of Plastic Surgery, Georgetown University School of Medicine and MedStar Georgetown University Hospital, Washington, DC, USA

    Christopher E. Attinger

  2. Department of Plastic Surgery, Georgetown University School of Medicine and MedStar Georgetown University Hospital, Washington, DC, USA

    John S. Steinberg

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Johnson-Arbor, K. (2023). Hyperbaric Oxygen Therapy in Functional Limb Salvage. In: Attinger, C.E., Steinberg, J.S. (eds) Functional Limb Salvage. Springer, Cham. https://doi.org/10.1007/978-3-031-27725-2_28

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  • DOI: https://doi.org/10.1007/978-3-031-27725-2_28

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-031-27725-2

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