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Hyperbaric oxygen therapy in treatment of trophic ulcer and diabetic foot

1. HOW DOES THE WOUND HEALING PROCESS LOOK LIKE?

Wound healing is a very complex process, requiring coordination of phenomena which have a cellular, biochemical and physiological character. In order to repair the damaged tissues it is necessary to recreate their vascularity and improve their circulation.

A factor stimulating vascular proliferation is VEGF, i.e.  vascular endothelial growth factor produced by macrophages.

What contributes significantly to improving damaged skin are fibroblasts, which are responsible for production of collagen and elastin. Thanks to them the skin becomes firm and elastic.

2. WHY ARE SOME WOUNDS SO DIFFICULT TO HEAL?

After the skin breakdown there frequently occur superinfections of deep tissues. Deteriorated circulation is another risk factor here.

  • Reduction of tissues’ oxygen supply,
  • Increase in carbon dioxide pressure
  • Secondary weakening of the immune system

It exposes the patient to the spread of infection, which becomes a medical problem. Infection is intensified by a high level of glucose in blood, which is a natural breeding ground for bacteria

In the case of oxygen deficiency fibroblasts are not able to produce collagen, and in their cytoplasm there do not occur a range of enzymatic reactions, necessary for appropriate course of that process.

3. WHY IS HYPERBARIC OXYGEN THERAPY SO EFFECTIVE IN TREATMENT OF TROPHIC ULCER AND DIABETIC FOOT?

  • It increases the production of VEGF factor, which stimulates growth of blood vessels
  • It increases vascularity of diseased tissues and their oxygenation
  • It increases production of stem cells, responsible for regeneration of tissues.
  • It increases production of reactive oxygen species which have strong bactericidal properties.
  • It increases production of fibroblasts responsible for synthesis of collagen and elastin

4. HOW DOES TREAMENT OF TROPHIC ULCER AND DIABETIC FOOT IN HYPERBARIC CHAMBER LOOK LIKE?

Step 1.

Hyperbaric medicine specialist consultation– not every patient can be qualified for hyperbaric therapy!!! – Our experienced specialists, after consulting a medical practitioner specializing in therapy of trophic ulcer and diabetic foot,  careful collecting of medical history, and medical examination, will decide how many and what treatments you need.

Step 2.

Individual treatment programme  – hyperbaric oxygen treatment, dedicated for your disease. You’ll get the individual programme, which will include: a number and frequency of treatments (compressions), pressure which is adjusted to your health condition, and vascular, diabetic and surgical medicine specialist’s orders, if you’re not yet ready for hyperbaric chamber.

Step 3.

Before entering the chamber, the doctor will examine you once again, and the nurse will measure your blood pressure and blood sugar level, and will change the bandages on your wound. You’ll get special disposable clothes and your own disposable oxygen mask.

Step 4.

Compressions – in therapeutic shared hyperbaric chamber recommended by National Health Fund, besides patients there will be  the Attendant (doctor, nurse, paramedic), who will supervise you. That person will answer all your questions, will support you during the whole therapy. He/She will notice even the smallest deviations from the norm and will professionally react.

Compression lasts for 1.5 hours. The pressure in the chamber increases slowly and is also slowly decreased. You’ll inhale 100% oxygen.

Outside the chamber the chamber operator and the doctor will take care of your safety, and they will observe you on the monitors and will be in phone contact with the Attendant.

Step 5.

The end of a cycle of compressions. After you get out of the chamber and after you finish the cycle of compressions you’ll be examined by a hyperbaric medicine specialist.

Step 6.

Do not forget to sign the book of patients cured!!!

If our team comes up to your expectations – we hope you’ll write a few words of praise  – We work with passion for these words and for your smile.

Step 7.

Whenever you miss us, you can come back to our Centre in order to lift the spirits of other patients and take advantage of the benefits of oxygen, this time just improving your physical and mental condition and strengthening the effects of treatment.

5. IS TREATMENT OF TROPHIC ULCER AND DIABETIC FOOT IN HYPERBARIC CHAMBER A WELL-KNOWN MEDICAL THERAPY METHOD?

Hyperbaric oxygen therapy has been applied in treatment of various skin diseases, and especially ischemic and infectious etiology such as:

  • diabetic foot,
  • ulceration after irradiation therapy,
  • burn wounds,
  • skin grafting
  • bedsore.

During the 3-year clinical examination, conducted by Swedish scientists on patients with diabetic foot who were  treated my means of hyperbaric oxygen therapy, it was found that 75% of people were fully cured, comparing to 48% instances of curing in the group of patients treated without the use of hyperbaric chamber. At the same time, the percentage of amputations of limbs amounted to 12% and 33%, respectively.

Research conducted by other scientists have shown that a supply of 100% oxygen in hyperbaric conditions increases the ability of blood vessel lining cells to divide themselves and accelerates the process of creating epidermal basement membrane. A factor stimulating vascular proliferation is VEGF, i.e. vascular endothelial growth factor, produced by macrophages. During the oxygen therapy there increases the production of this factor, and it has also been proven that a level of stem cells, which are responsible for regeneration of tissues, increases eight times.

A high number of reactive oxygen species, produced in the conditions of hyperbaric oxygen therapy, have strong antibiotic properties.

Results of studies conducted by Knighton, MD and associates have proven that the tempo of healing of  an experimentally produced wound in the case of experimental animals was directly proportional to concentration of oxygen they inhaled.

The therapy is recommended by the National Health Fund.

Nowadays it is successfully used by almost all the leading centres of hyperbaric oxygen therapy in the whole world.

Some of them are partners of

HYPERBARIC RESEARCH AND DEVELOPMENT CENTRE IN LUBLIN.

Prof. Agnieszka Pedrycz-Wieczorska, PhD, MD

Małgorzata Skiba, MD