For people with diabetes, among the most common and serious of complications are deep, pervasive pressure sores on the feet that are often resistant to conventional treatment. These sores can reach down to the bone and even threaten the life of the sufferer. In such cases, the traditional treatment of last resort has been amputation.
But things are changing. Thanks to a technology known as hyperbaric oxygen therapy (HBOT), which was originally used to treat scuba divers for decompression sickness, diabetic patients with persistent pressure sores are receiving a new lease on life. While this advanced therapy sounds exotic, the science behind it is solid and straightforward.
So how does HBOT work?
Tissues in the body need an adequate supply of oxygen in order to function properly. When tissue is damaged—as in the case of diabetic-related foot ulcers—it requires even more oxygen to heal.
HBOT simply involves breathing pure oxygen in a room or tube in which the air pressure is three times higher than normal. As the patient breathes in these conditions, the lungs take in more oxygen than they could at normal air pressure. This increased amount of oxygen is carried throughout the body, where it helps fight bacteria and stimulate wound closure, tissue regeneration and new tissue growth.
According to Peter Buckman, MD, medical director of the Sentara RMH Wound Healing Center, the results of HBOT treatment can be dramatic.
“One of my patients, a 55-year-old diabetic, had a significant heel wound that wouldn’t respond to any of the normal treatments,” says Dr. Buckman. “In an effort to avoid amputation, which was the only other medical option for him, we used hyperbaric oxygen therapy. He underwent 68 HBOT sessions, and his wound healed completely. It ended up saving his leg—and in many ways, his life.”
A Wide Range of Uses
Foot ulcers in diabetics aren’t the only wound-related condition for which HBOT is indicated. According to Dr. Buckman, the therapy is also used extensively to treat wounds caused by radiation therapy for treating cancer.
“Radiation can cause healthy skin and soft tissue to die, resulting in the development of a wound at the treatment site,” adds Dr. Buckman. “The condition can be quite serious, resulting in bleeding and significant pain. Thankfully, however, radiation injuries are some of the best indications for HBOT, which can reduce the negative effects of these types of wounds by as much as 90 percent.”
Sentara Martha Jefferson Hospital in Charlottesville began offering outpatient HBOT in April, with medical director John Ligush, MD, at the helm. In addition to foot ulcers and radiation burns, he says, HBOT also is prescribed for patients with carbon monoxide poisoning.
“Carbon monoxide poisoning can occur in people who have been exposed to house fires, or who have wood-burning stoves in their homes,” notes Dr. Ligush. “The purpose of HBOT in these instances is to reduce the amount of carbon monoxide in the blood and restore the oxygen level to normal in as little time as possible.”
“Each treatment session lasts up to 90 minutes,” he continues. “Usually the patient recovers within a few days, although the longer-term effects of carbon monoxide poisoning may persist for days or even weeks.”
Dr. Ligush says the recent addition of HBOT at Sentara Martha Jefferson gives the Charlottesville community an accessible, transportation-friendly option for people who qualify for the treatment.
Meeting the Criteria for HBOT Treatment
Drs. Buckman and Ligush are quick to point out that patients must have an approved condition in order to receive HBOT treatment. In addition, all conventional treatments must first be exhausted. In many cases, the wound healing specialists at both Sentara RMH and Sentara Martha Jefferson can use other advanced methods to effectively treat chronic wounds, which are defined as wounds that take longer than 30 days to heal.
“HBOT treatments are expensive, and frequency is the key, with patients generally receiving 40 treatments, and potentially 60 or more,” says Dr. Buckman. “Medicare and private insurers are very cost-conscious when it comes to HBOT, so potential recipients must meet a rigorous standard of qualification. Still, with HBOT we can help a lot of people.”
In addition to the conditions discussed above, HBOT has been scientifically shown to help in cases of severe anemia, brain abscess, arterial gas embolism, burns, crushing injuries, sudden deafness, gangrene, skin or bone infections, skin grafts at risk of tissue death, and vision loss that is sudden and painless.
“In our area, HBOT has been underutilized because people simply haven’t had access to this kind of treatment,” says Dr. Ligush. “But with Sentara Martha Jefferson and Sentara RMH now both offering HBOT, this therapy is going to prove really beneficial to patients in our communities.”
Sentara Wound Care Centers
Using a variety of treatment methods, including oxygen therapy, the wound care centers at Sentara RMH and Sentara Martha Jefferson treat the following types of wounds:
• Foot or leg ulcers or wounds (diabetic foot ulcers)
• Arterial and venous ulcers
• Connective-tissue disorders
• Internal injuries or open wounds from radiation therapy
• Nonhealing surgical wounds
• Nonhealing skin grafts or surgical flaps
• Acute traumatic wounds
• Any chronic wound that has not healed or is not anticipated to heal by at least 40 percent in four weeks
Do You Need to See a Wound Healing Specialist?
Your physician can refer you to a Sentara Wound Healing Center, or you can self-refer. Call us or ask your doctor about visiting the Wound Healing Center if:
• You have a wound that hasn’t healed in 30 days (commonly experienced by people with diabetes)
• You have a sore with increased redness, swelling or pain; foul odor; or a change in color
• You have a surgical wound that has become infected
Sentara Martha Jefferson Wound Care Center
595 Martha Jefferson Drive, Suite 140
Sentara Wound Healing Center
2018 Health Campus Drive (in the main hospital)