The Undersea and Hyperbaric Medicine Society along with most
third-party payors have concluded that hyperbaric oxygen therapy is
an approved and efficacious primary and/or adjunctive therapy for
the following conditions:
Air or gas embolism
Gas gangrene
Crush injury
Compartment syndrome
Acute peripheral ischemias
Decompression sickness
Enhanced healing in selected problem wounds
Exceptional blood loss anemia
Necrotizing soft tissue infections
Osteomyelitis
Delayed radiation injury (soft tissue and bony necrosis)
Compromised skin grafts and flaps
Carbon monoxide poisoning
Two indications that deserve special consideration
Radiation-induced tissue damage
Soft tissue radionecrosis (STRN) and osteoradionecrosis (ORN) are
delayed radiation injuries that occur in tissues and bones that have
been exposed to radiation, most commonly during a course of
radiation therapy for cancer treatment. The hallmark of these
conditions is a progressive destruction of small blood vessels
(endarteritis) that results in tissue hypoxia and fibrosis.
These tissues and bones are at risk for spontaneous breakdown and
tend to show poor healing after surgical or traumatic insult. These
conditions typically have a slow onset and symptoms may not present
for months to years after radiation exposure. Any tissue in the
irradiated field can be affected, including the mandible (osteoradionecrosis),
bladder (radiation cystitis), and bowel (radiation proctitis and
enteritis).
HBO encourages neovascularization (regrowth of new blood vessels) in
these tissues and can return oxygenation to near pre-radiation
levels. This enhances healing in tissues with clinically evident
disease and can even be used prophyactically to prepare compromised,
previously irradiated tissues for planned surgical procedures. This
is especially known in the case of mandible ORN where utilizing HBO
before, and after, tooth extraction has been shown to minimize the
incidence of post-operative jaw breakdown.
Diabetic foot wounds
Diabetic foot wounds are largely a result of impaired healing due to
tissue hypoxia in conjunction with other complications of the
underlying diabetes. HBO has been shown to enhance
neovascularization (regrowth of new blood vessels) and improve
tissue oxygenation, which allows the normal healing processes to
occur. In recognition of this, Medicare has recently approved the
use of HBO to treat diabetic foot wounds if they are at least a
Wagner's class III (involvement of deeper tissues-bone, tendon,
joint capsule-with abscess, osteomyelitsis, or tendonitis) and have
failed other therapies for greater than 30 days.
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