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Hyperbaric Oxygen Therapy

One of the key components of wound healing is oxygen delivery. Many of the healing processes are oxygen-dependent. Although the body needs to undergo periods of hypoxia as a normal phase of the healing process, it is ultimately more important to insure that appropriate oxygenation is occurring during other periods. There is good evidence that supports intermittent hyperbaric oxygenation for more rapid healing.

Hyperbaric Oxygen Therapy (HBOT) is a form of treatment used to deliver 100% oxygen to a patient under increased atmospheric pressure. This pressure is usually effective at a level greater than 1.4 atmospheres absolute. In general, this treatment, or series of treatments in most cases, is done by our practice in a single (monoplace) chamber. HBOT is almost always used as adjunctive therapy, as part of a comprehensive wound healing program.
There are specific clinical indications for HBOT therapies outlined by Medicare. Our practice treats a wide array of these patients including: Wagner Grade III or higher diabetic foot ulcers (Wagner Grade III includes ulcers with underlying osteomyelitis, osteitis, tendonitis or abscess); refractory osteomyelitis; radiation injuries including osteoradionecrosis, soft tissue radionecrosis and radiation cystitis; compromised flaps or grafts; and acute arterial thrombosis. For the purpose of this article I will discuss the three main clinical indications and the role HBOT plays in their treatment.

Wagner Grade III or Higher Diabetic Foot ulcers

Foot ulcers in the diabetic patient are more difficult to heal for many reasons. Diabetics are usually neuropathic and have difficulty sensing when the wound is deteriorating. There is also increased wound hypoxia secondary to small vessel arterial compromise. It is very important to treat infection, assess arterial flow, carefully debride and ensure effective offloading of these wounds. Our practice utilizes total contact casting, the gold standard of offloading. In patients with Wagner Grade III or higher ulcers, the addition HBOT therapy has been shown to increase much needed oxygenation and decrease the risk of amputation.

Compromised Grafts or Flaps

Most patients who have either full thickness or split-thickness skin grafts have successful outcomes. The same is true with flap patients. However, in a patient who has reduced arterial flow to the wound and/or decreased granulation tissue at the base of the wound, HBOT is a useful adjunct. The graft or flap is in a hypoxic state until new capillary beds can form. HBOT can increase the rate of capillary proliferation. We are able to pretreat the patient with 10 to 40 treatments to prepare the site then treat post procedure to increase success rates.

Radiation Injuries

Many cancer patients receive radiation treatments as either a curative or palliative measure. Unfortunately these patients can sustain soft tissue injuries secondary to these treatments. Blood supply to the area can become compromised after damage to the endothelium sparks cell proliferation. The result is ischemia, necrosis and sometimes fibrosis in the tissue. If a wound develops in this area, healing is difficult without advanced therapy. What is interesting about this type of injured tissue is that there is a gradual increase in pO2 from the wound to the surrounding tissue. This reduced gradient does not signal the body to begin angiogenesis. HBOT creates a more pronounced gradient of pO2, which in theory does stimulate angiogenesis.

Hyperbaric Oxygen Therapy, or HBOT is an invaluable adjunctive therapy in wound healing. It can be used as part of a comprehensive wound program. It is well tolerated and proven to be effective. In some cases it could mean the difference between limb salvage and amputation.


Dr. Michael J. Cascio is Board Certified in Family Medicine and practices Wound Care and Hyperbaric Medicine at Dr. P. Phillips Hospital Comprehensive Wound Center. He also practices at The South Seminole Hospital Wound Care and Hyperbaric Medicine Center and is available for inpatient consultation within the Orlando Health system. He joined Walter A. Conlan, III, MD in 2007 and together they are the only physicians in Central Florida dedicated to wound care and hyperbarics full-time.

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