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Hyperbaric oxygen therapy for non-healing wounds.

2009; National Institutes of Health; Volume: 11; Issue: 8 Linguagem: Inglês

Moshe Kulikovsky, Tamir Gil, Issa Mettanes, Ron Karmeli, Yaron Har-Shai,

Pressure Ulcer Prevention and Management

c hronic wounds are a significant challenge to the health care system and its professionals. It has been estimated that 1–2% of the population in the industrial world will suffer from leg wounds that might need professional treatment during their lifetime. In 2001, McGuckin et al. [1] estimated that 3 billion dollars a year are expended for the treatment of leg ulcers in the United States. Moreover, this figure does not include the loss of 2 million working days. In 1994 Lazarus and colleagues [2] defined as a that fails to proceed through an orderly and timely process to produce anatomic and functional integrity, or proceed through the repair process and stages without establishing a sustained anatomic and functional result. Another way to define a is by the healing time, i.e., a that does not demonstrate a tendency towards healing after 8 weeks of standard care. Other terminologies that are used in the literature for the treatment of difficult wounds include: wound, hard to heal wound, problem wound and chronic cutaneous ulcer. The treatment approach to non-healing wounds is based on three principles: a) treating the main etiology, b) locating and removing the delaying factors, and c) providing the optimal environment for healing. Local treatment includes: cleansing and debridement, modern dressing, and innovative treatments for healing – such as negative pressure treatment, topical growth factors, cultured skin, and macrophages. Oxygen is an essential component of healing, and the rate of healing can be directly linked to the level of tissue oxygenation. According to Mogford and Mustoe [3], ischemia is, arguably, the most common cause of wound-healing failure. Hyperbaric oxygen therapy is a treatment for hypoxic wounds. It utilizes oxygen as a drug and the hyperbaric chamber as the mechanical tool for elevating its concentration at the target area. During the treatment, the patient breathes 100% of oxygen, while the surrounding atmospheric pressure is higher than at sea level. This review article elaborates on the history of HBOT, the rationale of the physiological treatment, clinical indication and contraindications, patient selection, treatment protocols and side effects.