Hyperbaric Oxygen Therapy

Wound healing is a subject of great interest and involvement for the surgeon. While much of the physiology of wound healing is understood, gaps still exist in our understanding of the phenomenon. The surgeon attempts to modify the wound milieu by various means at his disposal. One such method is hyperbaric oxygen therapy (HBOT).

HBOT is the use of 100% oxygen at pressures greater than atmospheric pressure. The patient breathes 100% oxygen intermittently while the pressure of the treatment chamber is increased to greater than 1 atmosphere absolute (ATA).[1] HBOT has had very exciting and interesting beginnings. In 1620, Drebbel developed a one-atmosphere diving bell.[2] Thereafter, a British clergyman named Henshaw built and ran the first well-known chamber called the domicilium that was used to treat a multitude of diseases. The idea of treating patients under increased pressure was continued by the French surgeon Fontaine, who built a pressurised, mobile operating room in 1879. Dr. Orville Cunningham, a professor of anaesthesia, ran what was known as the “Steel Ball Hospital.” The structure, erected in 1928, was six stories high and 64 feet in diameter and could reach 3 atmospheres pressure. The hospital was closed in 1930 because of the lack of scientific evidence indicating that such treatment alleviated disease and was broken down during World War II for scrap.[3,4] The modern age of hyperbaric medicine began in 1937, when Behnke and Shaw used a hyperbaric chamber to treat decompression sickness (DCS), but it was not until 1955 that HBOT was used for conditions other than DCS. That year, Churchill-Davidson began to use oxygen therapy in a hyperbaric chamber to treat radiotherapy-induced damage in cancer patients. In 1956, Boerema of Holland even performed the first reported heart surgery in a hyperbaric chamber.[2,4]

Hyperbaric oxygen therapy (HBOT) is the use of 100% oxygen at pressures greater than atmospheric pressure. Today several approved applications and indications exist for HBOT. HBOT has been successfully used as adjunctive therapy for wound healing. Non-healing wounds such as diabetic and vascular insufficiency ulcers have been one major area of study for hyperbaric physicians where use of HBOT as an adjunct has been approved for use by way of various studies and trials. HBOT is also indicated for infected wounds like clostridial myonecrosis, necrotising soft tissue infections, Fournier's gangrene, as also for traumatic wounds, crush injury, compartment syndrome, compromised skin grafts and flaps and thermal burns. Another major area of application of HBOT is radiation-induced wounds, specifically osteoradionecrosis of mandible, radiation cystitis and radiation proctitis. With the increase in availability of chambers across the country, and with increasing number of studies proving the benefits of adjunctive use for various kinds of wounds and other indications, HBOT should be considered in these situations as an essential part of the overall management strategy for the treating surgeon.

KEY WORDS: Air embolism, compartment syndrome, crush syndrome, decompression sickness, diabetes mellitus, diabetic foot, gas gangrene, hyperbaric medicine, hyperbaric oxygen therapy, hyperbaric, hyperbaric oxygenation, necrotising fasciitis, osteomyelitis, osteoradionecrosis, radiation injuries, radiation necrosis, reperfusion injury, soft tissue infections, surgical flaps, transcutaneous oximetry