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A Journal on Physiopathology and Therapy of Chronic Cutaneous Ulcers
Official Journal of the Italian Association for Cutaneous Ulcers
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Acta Vulnologica 2003 August;1(1):21-32
Hyperbaric oxygen therapy in the management of pressure ulcers: a review
Longobardi P., Vernotico L., Baldini E., Baroni P., Sasselli A.
Centro Iperbarico, Ravenna
The discovery that oxygen is a pivotal nutritional ingredient of healing has stressed the importance of an adequate oxygen supply to the reparative tissue. Resistance to infection is extraordinarily dependent on local oxygen tension. Oxygen is important to immune mechanisms in wounds, because oxygen radicals derived from molecular oxygen are important agents in bacterial killing. The primary etiology of decubitus ulcers is pressure necrosis in poorly sensitive tissue. Smaller ulcers can be treated with bedside debridment, wound dressings, relief of pressure and frequent screening. The standard of care for larger ulcers with contaminated necrotic tissue is: surgical debridment followed by flap closure, antibiotic therapy and pressure relief methods. The usual decubitus ulcer occurs in non-ischemic areas, therefore, a physiological and clinical basis for using hyperbaric oxygen therapy (HBOT) is lacking. However, HBOT may have application as an adjunctive treatment for: 1) selected extremity decubitus ulcers complicated by ischemia, which fail to respond to pressure relief and usual wound care measures; 2) infected wounds or necrotizing soft tissue infections; 3) osteomye- litis; 4) compromised flaps. In patients with pressure sores, it has been showed that adjunctive HBOT suppress bacterial growth and stimulates granulation tissue before plastic surgery repair. It cannot be overemphasized that patients selection and the timing of HBOT are the keys to a successful outcome for the enhancement of healing in selected problem wounds, decubitus ulcers included.