Pearls for Practice: Hyperbaric Oxygen Therapy (HBOT) and Heel Ulcers

  Hyperbaric oxygen therapy (HBOT) increases the ability of the blood to carry and deliver oxygen to the tissues. Patients receiving HBOT breathe 100% oxygen while under increased atmospheric pressure, much like scuba diving. HBOT is provided in a pressurized (usually cylindrical) chamber that measures approximately 3 feet x 7 feet (or slightly wider) in a 100% oxygen environment. HBOT also may be provided in a room large enough to hold multiple people sitting in chairs; this multiperson chamber is pressurized with room air and each patient breathes 100% oxygen through a hood mask.

  The inhaled oxygen is absorbed into the tissues from the super-saturated plasma, greatly increasing the oxygen concentration delivered systemically to the cells throughout the body. The vasoconstrictive effects caused by super-oxygenation help reduce edema, subsequently decreasing tissue pressures and allowing for a freer-flowing blood supply.

  HBOT aids in wound healing because it increases capillary production, angiogenesis, and the supply of blood to the ulcer. Increased blood supply provides greater oxygen and nutrients to the wound site. Increased oxygenation can slow or halt infectious disease processes from anaerobes and improve the effectiveness of antibiotics. Bone is not highly vascular, so increasing the blood supply to an ulcer with osteomyelitis is vital.

  HBOT has been shown successful in the treatment of heel ulcers with bone infections that fail to heal or recur. The Centers for Medicare and Medicaid Services (CMS) guidelines approve the adjunctive use of HBOT in healing foot and heel ulcers when chronic refractory osteomyelitis is present. This modality is an important part of any wound healing or limb salvage program.