Long-term wound care

three open perscription bottles

Long-term wound care is responsible for an estimated $3 billion per year in medical costs.Wound debridement, antibiotics, ultrasound and electromagnetic therapy, vacuum-assisted closure therapy, and skin grafts are possible therapy options for slow-healing wounds. HBOT, or hyperbaric oxygen therapy, is another option for wound care treatment that shows great success and speeds up the healing process.

How HBOT Helps Wounds Care Treatment

A healthcare worker caring for a wound

For your body to heal, one of the necessary components is oxygen. With wounds, various causes can disrupt the normal flow of oxygen to your blood and tissue. As a result, wounds heal slow or the healing process halts completely. However, HBOT provides a solution. With HBOT therapy, your body is exposed to 100 percent oxygen under pressurized conditions. As a result, high levels of oxygen reach the damaged tissue. With oxygen, the body can begin the healing process. Oxygen allows the tissues to begin repair and promotes new tissue growth. Damaged blood vessels are repaired or rebuilt, once again allowing for oxygen to flow to the wound. In addition, chronic inflammation is reduced, and the increased oxygen promotes a healthy immune system response.

Studies with HBOT and Wound Care Treatment

Many studies have looked at the benefits of HBOT and wound care and how effective hyperbaric oxygen can be in the healing process. A report published by The Undersea and Hyperbaric Medical Society (UHMS) recommends HBOT treatments for Wagner Grade 3 or higher that have not shown significant improvement with traditional treatments. The addition of HBOT therapy proved to reduce the risk of major amputation and incomplete healing of the wound. Likewise, they recommend HBOT in patients with Wagner Grade 3 or higher that undergo surgical debridement as this too showed a reduced risk of major amputation and incomplete healing.

Inside a hyperbaric chamber

A 1994 study published in Plastic and Reconstructive Surgery looked at the use of HBOT on patients with leg ulcers for at least a year that was not the result of large vessel disease or diabetes. This was a double-blind study with half of the patients receiving HBOT and the others receiving normal air for a total of 30 sessions. The study showed that patients receiving HBOT experienced progressively greater improvement in wound size compared to those receiving standard air. The participants were evaluated 12 weeks after treatments ended. As a result of the treatments, two HBOT subjects were completely healed while no patients in the air group were healed. In the other participants, wound reductions were 56 percent for HBOT patients and 26 percent for air patients. The study concluded that HBOT is a valuable adjunct therapy for non-diabetic leg ulcers that do not respond to traditional treatment.

Report Shows the Importance of Hyperbaric Oxygen for Wound Care

A 2010 review published by Dr. Daniel Ladizinsky from Oregon Health Sciences University discussed the importance of oxygen in the healing process. Also covered were the benefits of HBOT and its ability to deliver high concentrations of oxygen for non-healing wound care. The report reads, “It has been shown that vital cellular functions such as angiogenesis, fibroplasia, epithelialization, and bacterial killing all proceed at a more rapid pace in response to higher oxygen levels. In wound healing, bacterial burden must be removed and a preliminary matrix must be formed in order to allow fibrous tissue formation and epithelial coverage. Oxygen hastens removal of bacterial bioburden, which allows resolution of inflammation and facilitates matrix production, cell division, and ultimate wound closure.”

Four Stages of Wound Healing

Your body’s wound-healing process consists of four different stages and each stage occurs at a certain time and in a certain sequence. Each stage is essential and when something interferes with one, the entire healing process stalls or stops completely. The four stages are:

  • Hemostasis – This is the first stage of the healing process and begins immediately after the injury. The objective here is to stop the bleeding. To begin, platelets come into contact with collagen and begin activation and aggregation. Thrombin, an enzyme in the blood, begins creating a fibrin mesh that clumps everything together, resulting in a blood clot to stop the bleeding.
  • Inflammation – The inflammatory stage is when the body’s defense system takes over. First, neutrophils, a type of white blood cell, target the wound to kill off any bacteria. After the neutrophils do their job, macrophages enter the wound and clear out debris. This helps promote tissue repair. Symptoms that your wound has reached the inflammation stage include pain, swelling, reddening of the skin surrounding the wound, and the wound may feel warm to the touch.
  • Proliferation – The proliferation stage is where the wound begins to fill and close up. There are three main phases of this stage: filling of the wound, contraction of the wound, and epithelialization. In the filling stage, connective tissue fills the wound and creates new blood vessels. During contraction, the wound begins to pull toward the center in an effort to close the wound. In epithelialization, epithelial cells work to cover the wound with epithelium. As a result, the wound will still feel tight.
  • Remodeling – The remodeling, or maturation phase, is the final stage. The new tissue undergoes collagen remodeling and gains strength and flexibility. At this point, the wound closes and the area returns to normal, aside from scarring.

Factors That Affect the Normal Healing Process

There are many different factors that can affect one or all four phases of healing. Factors can directly affect the wound and are considered local factors. A person’s overall health or underlying diseases also affect wound healing. These factors are systemic. Some common underlying factors include:

Local Factors

A healthcare worker comforting an elderly patient
  • Oxygenation – In order to heal, the body needs oxygen. In wounds, blood flow to the wound can be disrupted, resulting in reduced oxygenation and tissue hypoxia. Because of this disruption, the wound is open to infection. Similarly, this reduces the body’s ability to heal damaged tissue.
  • Infection – With an open wound, the chance of infection is high. The open wound allows bacteria to enter the body.
  • Foreign Body – The presence of a foreign body within a wound can affect the healing stages. For example, a sliver of wood left within a deep cut is a foreign body within the wound. The body does not know what to do with this invader and it often slows or disrupts the healing process.
  • Venous Insufficiency – Damaged blood vessels and capillaries can prevent blood and oxygen from reaching the wound.

Systemic Factors

  • Age
  • Gender and Hormones
  • Stress
  • Ischemia – Ischemia is a reduction in blood flow and subsequent loss of oxygenation to the tissue. This can occur from several factors including damage to the veins and capillaries, exposure to cold, and extreme exercise.
  • Obesity
  • Alcoholism and Smoking
  • Underlying Medical Conditions – Diseases such as diabetes, fibrosis, jaundice and hereditary healing disorders can all disrupt the normal healing process.
  • Immunocompromised Conditions – Autoimmune conditions, such as rheumatoid arthritis or lupus as well as AIDS affect the body’s normal immune system and response, thus affecting the healing process.
  • Medications
  • Nutrition –A lack of nutrients, such as vitamin A and C, can impact the healing process.

Diabetes and Wound Healing

Diabetes plays a big factor in wound healing and for diabetics, even the smallest of wounds can become a serious health concern. Hyperglycemia due to low insulin availability can affect the body’s response to an accidental or surgical wound. Immune cells suffer from impaired function. When these conditions slow the healing process, that leaves the wounds open longer and leaves them susceptible to fungal and bacterial infections, as well as gangrene. Simple cuts and grazes on the feet can become very problematic if left untreated and can lead to amputation. Diabetic foot ulcers affect 15 percent of people with diabetes and are the leading cause of amputations.

A diabetic foot ulcer.

For many diabetics, neuropathy reduces a person’s sensitivity to pain, often allowing for small wounds to go unnoticed until they become a big problem. In addition, high blood sugar levels affect the body’s immune system, often leaving it unable to properly fight infection. While inflammation is an essential part of wound healing, this stage often lasts too long in diabetics, often degrading collagen necessary for the wound to heal. It is essential for diabetic patients with slow-healing wounds to closely monitor their blood glucose levels and keep them as stable as possible.

The Warner Grading System

When it comes to diabetic foot wounds or ulcers, doctors use the Wagner Grading System to classify the wound severity. Grade 1 wounds are considered superficial diabetic ulcers. A Grade 2 is an ulcer extension that involves ligament, tendon, joint capsule or fascia. Grade 3 is considered a deep ulcer with an abscess or osteomyelitis. A Grade 4 shows gangrene to a portion of the forefoot. Grade 5 shows extensive gangrene of the foot. HBOT treatment is effective and beneficial at all stages in the grading system. However, insurances typically require Grade 3 or above in order to cover HBOT treatments. If your wound is a grade 1 or 2, contact our office and we will work with you to create an affordable treatment plan.

HBOT, or hyperbaric oxygen treatment, increases the body’s ability to heal and promotes good wound care. With that in mind, if you have a wound that will not heal, despite traditional medical care, give our office a call and see how HBOT can benefit your wound care. Dr. Spiegel and his team will go over your medical history and prior wound care and develop a treatment plan that works best for you. Call our office today at 727.787.7077. You may also visit HERE and fill out our online request form.