Hyperbaric Oxygen in the Management of Pressure Sores in Patients with Injuries to the Spinal Cord

Abstract

The role of oxygen in wound healing is discussed, especially the healing of pressure sores, which are considered as ischemic ulcers. From the author's experience with 521 flap closures, 27 flaps had compromised circulation and 20 of these could be resuscitated almost totally by treatment with hyperbaric oxygen within 24 hours after surgery. The author emphasizes that this modality of treatment should be considered when a skin flap is in danger of ischemia during surgery for pressure sores.

Osteomyelitis in the spinal cord injured: a review and a preliminary report on the use of hyperbaric oxygen therapy

“…The most common predisposing factor is a pressure ulcer. In 88 per cent of our series, the infection spread from the infected pressure ulcer to the underlying bone (Eltorai, 1981). Pressure sores are the end result of tissue ischaemia due to pressure and/or shearing forces with consequent necrosis and bacterial invasion.…”

“…Of 2055 patients reviewed at the Spinal Cord Injury Service of the Veterans Administration Medical Centre at Long Beach, California, 90 patients had osteomyelitis; that is, an incidence of 4'3 per cent (Eltorai, 1981). The majority had the chronic variety.…”

“…In our centre, 75-80 per cent of patients who had died from renal failure and had had an autopsy showed amyloidosis from various causes, including osteomyelitis (Vaziri). In the last 10 years, four patients have been found to have malignant (cancerous) changes (Eltorai, 1981).…”

“…In the absence of ischaemia, HBO may be of little or no value, and may even have deleterious effects on osteogenesis and bone healing (Shaw and Bessett, 1967). Experiments and human studies show con clusively that HBO promotes wound healing when healing is delayed because of ischaemia and infection (Eltorai, 1981). 4.…”

“…Open fractures and the draining of bones were treated as inflammatory diseases using a pharmacopoea of plant and animal extracts, as well as by splinting. In spite of the antiquity of both spinal cord injury and osteomyelitis, the incidence of osteomyelitis in SCI patients has not been well documented, but according to Eltorai (1981) it occurs in about 5 per cent of such (SCI) patients. It most commonly affects the hips, the ischia, the sacrum and the calcaneous, in descending order of frequency.…”