Hyperbaric Oxygen Therapy (HBOT) for Wound Healing

Chronic wounds are a financial burden on an individual in countries with no reimbursement for their treatment in national policy, such as in Australia. Whereas it poses a substantial economic burden on the healthcare system in the countries where the government bears expenses. In addition, wounds affect the quality of life, and the research suggests that people with chronic wounds spend poor life for a longer time. The prolonged healing followed by scar formation pushes the affected people into continuous distress and influences their performance. The types of wounds classified in the category of chronic wounds include:

• Thermal burns
• Skin flaps and grafts
• Soft tissue infections
• Diabetic wounds
• Radiation injuries
• Crush injuries
• Gangrene

Lack of oxygenation and infection are the main reasons that cause a delay in wound healing. If the partially injured cells at the wound site get sufficient oxygen then wound healing can be accelerated. HBOT is a non-invasive procedure that ensures the provision of a high concentration of oxygen (60 mL/L plasma oxygen level at 95% oxygen and 2 ATA pressure) to the damaged tissue site at elevated pressure. As a result, it is potent adjuvant therapy along with antibiotic treatment to promote wound healing, accelerate angiogenesis, remove toxins, trigger neovascularization, and upregulate the repair genes. Undersea and Hyperbaric Medicine Society (UHMS) is the universal organization to authorize this therapy for various medical conditions, and wound healing is one of those approved applications with proven efficacy and safety.

Mechanism of action of HBOT

HBOT primarily works for wound healing in two ways:

• Hyperoxygenation
• Decreasing the bubble size

Hyperoxygenation refers to the elevated plasma oxygen level and increased partial pressure. It is an application of Henry’s law. Hyperoxygenation is effective in managing crush injuries, flaps and grafts, compartment syndrome, and acute blood loss anemia.

Decreased bubble size is supported by Boyle’s law, in which bubble volume decreases due to high pressure. It works best for atrial gas embolism and decompression sickness.

Secondary mechanisms of wound healing involve:

• Angiogenesis: Although hypoxia stimulates angiogenesis, neovascularization, and formation of the capillary network depend on the level of oxygen our tissues get. Hyperbaric oxygen therapy made in HBOT chambers, facilitates blood vessel formation by increasing the gradient of oxygen between hypoxic tissues and blood plasma.
  
  
• Vasoconstriction: In normal cells, hyperoxia leads to vasoconstriction, lessening the chances of post-traumatic edema. Nevertheless, it does not cause hypoxia because HBOT provides a high concentration of blood plasma oxygen that compensates for the effect.
  
  
• Collagen formation: Oxygen is crucial for hydroxylation of proline and lysine residues in collagen synthesis. Wound healing needs crosslinking and maturation of collagen, and HBOT promotes it. Mature collagen deposition causes the wound to heal at a faster rate.
  
  
• WBCs oxidative killing: HBOT generates oxygen free radicals that oxidize membrane lipids and proteins, cause DNA damage, and impede bacterial metabolism. HBOT is principally effective against anaerobic bacteria that don’t have superoxide dismutase and stimulates the oxygen-dependent peroxidase through which WBCs kill bacteria. Furthermore, it triggers the oxygen radicals’ scavengers to eradicate the problematic molecules and continue the healing process.
  
  
• Fibroblast proliferation: Fibroblasts are critical in tissue repair from the late inflammatory stage until the final epithelization. HBOT mobilizes stem cells and upregulates repair factors to proliferate fibroblasts and improve cell migration for tissue regeneration.
  
  
• Detoxification: Hyperoxic conditions developed due to HBOT inhibit the toxin production by Clostridium, and encourage the transport of antibiotics through the bacterial cell membrane.
  
  
• Boost immunity: Skin is the physical barrier that protects the underlying tissues from the outside environment. Secondary infection is the major reason for chronic wound development. HBOT mobilizes stem cells and proliferates blood cells, and WBCs also increase in number. WBCs are the main cells for body defense (immunity). In this way, HBOT boosts immunity and helps the body fight against invading microbes through the injured site.
  

Types of Hyperbaric Oxygen Chambers

There are two types of chambers based on the capacity of people inside the chamber.

• Monoplace hyperbaric oxygen chambers: In these chambers, the user slips into the chamber and only one person can be accommodated inside it. The user faces pressurized oxygen at a high concentration within the chamber.
• Multiplace hyperbaric chambers: These are the chambers in which more than one person can enter. People inside can use masks to inhale pressurized high-concentration oxygen. In addition, the medical professional may also be present in the chamber to facilitate the users.
  
  

Duration of therapy

The therapy may last from 1.5 to 2 hours between one to three times daily, depending on the user’s medical history and the condition of the wound. Likewise, the number of sessions also depends on the healing progression and stage of injury.

How to select the hyperbaric chamber?

The choice of a hyperbaric oxygen chamber is important if someone considers independent therapy without the aid of a professional. However, medical professionals take care of everything if you choose therapeutic HBOT. Oxyhelp hyperbaric chambers are one of a kind when it comes to quality, easy operation, user-friendly interface, 100% efficiency, and effectiveness.

Safety measures

The most common issue associated with HBOT is middle ear trauma. So a person who has recently undergone ear surgery, flu, cold, fever, or has lung or sinus problems must not take HBOT unless prescribed by the doctor. Therapeutic HBOT must be taken after a health professional’s recommendation.

Conclusion

In a nutshell, the efficacy of HBOT in wound healing is FDA and UHMS-approved. Hyper oxygenation provides oxygen to the wound area, promotes vascularization, reduces inflammation, removes toxins, avoids secondary infections due to bactericidal and bacteriostatic effects, and stimulates angiogenesis. To date, there are multiple clinical reports where HBOT was used to treat chronic wounds, including burns, ulcers, diabetic wounds, gangrene, and others. Adjuvant therapy along with antibiotic treatment is found to heal wounds that are difficult to treat otherwise.