Transcutaneous oxygen measurements predict healing of leg wounds with hyperbaric therapy

Abstract

Twenty-six patients with chronic leg wounds had transcutaneous oxygen measurements taken from the peri-wound area and a chest reference site before undergoing hyperbaric oxygen therapy in order to evaluate the utility of transcutaneous oxygen measurements in predicting the response of wounds to hyperbaric therapy. Wound scores and wound areas were determined before treatment and after 10 hyperbaric exposures. Patients whose wounds averaged a 5% or greater reduction in wound score per treatment were designated "responders." Nine patients' wounds exhibited at least a 5% reduction in wound score per treatment. There were no differences observed between responders and the 17 nonresponders in age, duration of the wound, initial wound area, initial wound score, or in wound or reference transcutaneous oxygen measurements. Responders required significantly fewer treatments to achieve wound closure than did nonresponders. Peri-wound transcutaneous oxygen pressure when the patient was exposed to 2.4 atmospheres absolute correlated directly with the improvement in wound score per treatment (r = 0.64, p = 0.03). An inverse correlation was noted between surface peri-wound transcutaneous oxygen pressure and improvement in wound score per treatment (r = -0.74, p = 0.006). Elevated peri-wound transcutaneous oxygen measurements at 2.4 atmospheres absolute and reduced peri-wound oxygen measurements at 1 atmosphere absolute were associated with a more rapid response to hyperbaric oxygen treatments in patients with chronic leg wounds. The use of these measurements should allow this expensive and time-consuming therapy to be limited to those patients most likely to benefit.

Oxygen in acute and chronic wound healing

“…Usually, 10–30 treatments are performed. HBOT has turned out to be an effective tool to increase pO 2 values in wound tissue, and the effects of HBOT on chronic wound healing have been described by a mathematical model 108,109,111 . Sheikh et al.…”

Emerging topics in cutaneous wound repair

“…Normally, 10–30 treatments are necessary if the patient tolerates them. On the whole, HBOT improves the chance of healing and reduces the risk of amputation of the lower extremities 61–63 . However, even if there is practically no risk of chamber explosion, it is a costly therapy; 64 both tympanic membrane rupture and pneumothorax are common side effects, 65 and presently, there are conflicting data regarding the efficacy of this therapy 63,66,67 .…”

Hyperbaric oxygen therapy accelerates vascularization in keratinized oral mucosal surgical flaps

“…As HBO increases the amount of oxygen dissolved in blood plasma (pO 2 ), higher oxygen tensions can be obtained in injured tissues and in ischemic wounds . When a higher pO 2 is measured in tissue adjacent to an ischemic wound, an accelerated wound healing was observed . In vitro HBO experiments have been shown to accelerate enzymatic processes that, among others, improve cellular response and proliferation .…”