People often ask us how high-pressure (HBOT) and low-pressure (NPWT) therapy can both be effective in the treatment of diabetic foot ulcers and other chronic wounds. If one works, the other shouldn't, right? In simplest terms, both hyperbaric oxygen therapy (HBOT) and negative pressure wound therapy (NPWT) promote blood circulation in the healing wound bed. Hyperbaric oxygen works directly through the blood vessels below. Negative pressure, or vacuum, therapy works indirectly through the wound dressing above.
NPWT plays a central role in advanced wound care. Major device manufacturers KCI, Smith & Nephew, and Medela (Mölnlycke) are major contributors to the movement that has swooped up HBOT and helped millions suffering with nonhealing chronic wounds.
Last week the FDA issued a Safety Communication Update on serious complications associated with NPWT. The agency reports "a total of 12 deaths and 174 injury reports since 2007" and notes NPWT contraindications and patient risk factors to consider. Most deaths occurred with use at home or in long-term care facilities. Together the FDA, the industry, and the medical community are educating clinicians and patients and closely monitoring outcomes.
O2.0 is the news blog of HyperbaricLink, the independent web guide to hyperbaric oxygen therapy.
Infection control and limb salvage with hyperbaric oxygen therapy is just one of several modern (and strongly preferable) alternatives to this home remedy.
The fight to reduce amputations is perhaps the most effective, best organized, and fastest-growing use of hyperbaric oxygen therapy today. And our aging population makes it a bona fide public health imperative. Consider the standard set of statistics:
23.6 million Americans with diabetes
1.6 million newly diagnosed every year
15% will develop foot ulcers
61% avoid amputation with traditional treatment
89% avoid amputation with traditional treatment plus HBOT
[Note: Those first two numbers come straight from the American Diabetes Association and the 2007 National Diabetes Fact Sheet. The last three we find repeated everywhere but footnoted nowhere by HBOT manufacturers and providers. Citation, please, dear readers? Click comments below, or Contact Us, thanks.]
This television spot, a video news release circulating on local stations this week, reminds us how poorly this blog has covered advanced wound care for patients with diabetes. Such big companies and bright minds have been on the case for years, and wound care clinics seem to be doing so well. Yet providers all across the country tell us they welcome new ideas and better ways to raise awareness, improve education, and drive referrals. Now that's the kind of cause we can really get behind. So if you're listed, consider HyperbaricLink enlisted.
One final word till next time. A new Twitter follower is quick to play the Ounce of Prevention card. Here's some diabetic foot care guidelines from the American College of Foot and Ankle Surgeons: well-grounded advice about inspecting, grooming, bathing, moisturizing, and clothing your feet to avoid foot ulcers and infections in the first place.
Kettering Health Network in suburban Dayton today announced that its members now enjoy access to hyperbaric physicians and chambers at Wright-Patterson Air Force Base. Home to one of the nation's largest multiplace HBOT chambers, with a capacity of 22 people, Wright-Patt is a leader in pressurized medicine for military aviators and is accredited, with Distinction, by the Undersea & Hyperbaric Medical Society (UHMS). KHN also provides hyperbaric woundcare in monoplace chambers at Kettering Medical Center.
As we grow and commercialize our treatment center directories, HyperbaricLink.com will offer free Profile+Plus listings to all US military clinics, whether open to civilians or restricted to servicemembers and veterans. Let's keep 'em flying!
Perhaps the surest indicator of HBOT's future growth is the present success of hundreds of hyperbaric wound care clinics. The current issue of HealthLeaders magazine counts wound care among the top 4 emerging service lines in hospitals today, with continued demand assured by the increasing prevalance of diabetes. Advanced wound care programs featuring hyperbaric oxygen therapy have enjoyed especially high volumes and reliable returns on investment. Most physicians today can handle basic wound care in their own offices, the author observes, and "will only refer to a clinic that can provide more advanced treatments."
If they can find it. Seems all the best advanced wound care clinics are buried a dozen pages deep in their medical center websites. In the days and weeks ahead we'll be working hard to include more HBOT clinics managed by national wound care companies in our treatment center directory, where referring physicians can find and compare them with just a click or two.
And in time, we trust, many of these chambers will be accessible to more physicians and more patients seeking HBOT for diseases and conditions beyond wound care.
There's something pleasingly pure about arithmetic. And it's a whole lot cheaper than a clinical trial. A new paper in PLoS Computational Biology looks at the numbers behind the healing of nonhealing chronic wounds, especially limb- and life-threatening diabetic leg ulcers. It's not light reading. In short, the authors find:
Hyperbaric O2 accelerates healing.
Treatments should continue until healing is complete.
Healing action begins at the capillary tips.
They further hope, as we do, their work is a first step toward better identifying patients and wounds that will benefit most from HBOT.
Because diabetes impedes circulation, it impedes the normal healing process. That's why chronic wounds, especially foot ulcers, so often threaten life and limb in patients with diabetes. We spend billions every year to reduce amputations and increase quality of life.
A review article published June 1 in Podiatry Today cites an impressive body of evidence that HBOT is a cost-effective treatment for diabetic foot ulcers. In fact, the authors observe:
Data confirm that many wounds remain hypoxic even after revascularization. Healing will not occur unless one corrects the hypoxia. Among all modalities tested over the past 10 years, the currently available research has demonstrated that only HBOT corrects tissue hypoxia.
Italics ours. Patient selection (a key to success) and treatment dosages may someday be guided by transcutaneous oxygen tension (TcPO2) or other in-chamber measurements.
