The Society of Hyperbaric and Underwater Medicine (Undersea and Hyperbaric Medical Society) has approved a series of indications for the use of Hyperbaric Oxygenation Treatment (HBOT) in medical practice, either as a coadjuvant treatment or absolute indication. Among those related to angiology we have: injuries and wounds with scarring problems, where the diabetic foot has a preponderant role; grafts and flaps of skin compromised by ischemia or infection, necrotizing soft tissue infections, acute traumatic ischemia, compartment syndromes and crush injuries.
In his article Hyperbaric Oxygenation in Angiology, Dr. José Álvarez explains the indications and the cost-benefit of this therapeutic modality in Angiology without going into details regarding the number of sessions, nor with the treatment pressures used:
1) Injuries with healing problems: HBOT promotes the following events that promote the healing and healing of ulcers and lesions: eliminate tissue hypoxia, anaerobic organisms can be directly inhibited, promotes the oxidative burst of polymorphonuclear cells with restoration of capacity to kill bacteria, increases the proliferation of fibroblasts and the formation of collagen, increases angiogenesis and reinforces the action of some. It also has a vasoconstrictor effect, which acts favorably on hypervascularization of the diabetic foot with neurovegetative disorders.
2) Ulcers due to arterial insufficiency: ulcers caused by chronic arterial insufficiency present difficulties for their healing due to local tissue hypoxia, especially if it is severe. The first is revascularization and, if the ulcer persists despite a good operation, the patient can be a candidate for treatment with HBOT. With hyperbaric oxygen as a coadjuvant treatment, it has been possible to improve or cure ulcers due to arterial insufficiency that are refractory to conventional treatment in 55% to 82% of patients. When arterial insufficiency is less severe and involves only the distal circulation, HBO provides adequate oxygenation for healing.
3) Venous stasis ulcers: a 35.7% reduction in ulcer size has been reported in non-diabetic patients who received OHB compared to 2.7% in patients who did not receive it.
4) Grafts and flaps: hyperbaric oxygen is generally used in compromised grafts and flaps. However, it can be considered for those patients in whom the existence of a local hypoxia and with a compromised physical state is known. HBOT has been very useful for those who have previously failed the graft and irradiated areas or vascular compromise. It has been used successfully in diabetic, venous ulcers and in the patient with arteriosclerosis obliterans with the objective of supporting the healing of the skin graft or flap.
5) Gas gangrene: in the centers that have hyperbaric oxygenation services, mortality has been reduced below 20% and a reduction in the amputation rate as well as its level in these patients is achieved.
6) Necrotizing soft tissue infections: a decrease in morbidity and mortality in these infections has been reported with the use of HBO. Mortality from these infections when HBO was not used varied from 33% to 67%, whereas after the use of this as a coadjuvant treatment it is reported from 12.5% to 25%.
7) Post-traumatic ischemia, compartment syndrome and crush injuries: HBOT causes a decrease in post-traumatic edema and compartmental pressures due to the vasoconstriction that occurs and, in addition, it increases tissue oxygenation tenfold, thus increasing the tissue viability. The greatest success occurs when it is used in the first hours after the accident, especially when the damage is severe.
Álvarez, J.2000. THE HYPERBARIC OXYGENATION IN ANGIOLOGY. Rev Cubana Angiol and Cir Vasc.
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