The role of hyperbaric oxygen therapy in the treatment of sternal wound infection

Abstract

Sternal wound dehiscence and infection are major problems for patients and health care providers. A range of risk factors, including diabetes, obesity and internal thoracic artery harvest, has been implicated. Several pathophysiological mechanisms, which may account for the development of infection, have been proposed. There is a growing body of evidence which suggests that sternal ischaemia may play a significant role in the initiation of wound infection, and that this may be exacerbated by harvest of the internal thoracic artery. Current treatments for infection include wound debridement, irrigation and tissue flap reconstruction. In addition, several novel therapies such as negative pressure dressings have been shown to be safe and useful. Hyperbaric oxygen therapy - the administration of 100% oxygen at pressures greater than atmospheric pressure - is widely used in the treatment of various chronic wounds. The mechanism whereby hyperbaric oxygen exerts its effects is being elucidated and there is a growing body of clinical evidence that supports its use. It has been suggested that there may be a role for hyperbaric oxygen therapy in the treatment of sternal infection. The theoretical mechanisms would seem plausible, but at present there is only limited evidence to support its use. This review addresses the theory and evidence supporting the role of hyperbaric oxygen therapy in the treatment of sternal wound infection.

Theory, Instrumentation, and Applications of Electron Paramagnetic Resonance Oximetry

“…Extreme hyperoxia, on the other hand, can cause oxygen toxicity which can adversely affect the healing process. Oxygen therapy is commonly used in the wound clinics to treat wound hypoxia232. Schugart et al 233 developed a mathematical model for addressing the role of tissue oxygenation on cutaneous wound healing.…”

Hyperbaric oxygen therapy as an adjunctive treatment for sternal infection and osteomyelitis after sternotomy and cardiothoracic surgery

“…Ischemia and hypoxia are postulated as the mechanism resulting in development of sternal infection and osteomyelitis [3,4]; however, the current primary treatment only focuses on early debridement and antibiotic use [5]. …”

Wound angiogenesis as a function of tissue oxygen tension: A mathematical model

“…Interestingly, like hypoxia, hyperoxia also induces the expression of angiogenic factors and supports wound angiogenesis and healing (2,(15)(16)(17). Oxygen therapy is commonly used in the wound clinics to treat wound hypoxia (20)(21)(22)(23)(24). Extreme hyperoxia, on the other hand, can cause oxygen toxicity and derail tissue repair (16,17,19).…”