Wound Treatment Center

David Stanley, M.D.

Patients who have diabetes or severe peripheral vascular disease (PVD) are at particular risk for wounds related to an inadequate supply of oxygen to their limbs. The result can be amputation of arms, legs or feet, even when they receive aggressive traditional treatments.

Hyperbaric oxygen (HBO) technology at Methodist Medical Center of Oak Ridge is now allowing physicians in this area to successfully treat certain patients with chronic wounds that have not responded to traditional surgery or medical treatment. Non-healing ulcers on the legs or feet, chronic infection of surgery sites, or severe vascular disease may need the addition of hyperbaric oxygen. Adding HBO to wounds following radiation treatment for cancer, chronic bone infections, and failing skin grafts has also demonstrated to be very important. Treatment in a hyperbaric chamber also benefits certain patients who suffer from conditions including burns and radiation injury.

Click photo for larger version The hyperbaric chamber at Methodist Medical Center	Click photo for larger version Methodist’s Wound Treatment Center is located at 160A West Tennessee Ave., Oak Ridge

Ischemic ulcers may develop when affected tissues do not get an adequate supply of oxygen and are more frequent in diabetics. Foot wounds, in particular, often advance to infection, non-healing ulcers, gangrene (death of tissues), and amputation despite intensive treatment by family physicians; endocrinologists, who specialize in treating patients with diabetes; vascular surgeons and others. Traditional treatments may include bypass vascular surgery or angioplasty and stents intended to improve blood flow enough to save the threatened limb.

Carefully selected patients who are at risk for amputation because of non-healing wounds are treated at Methodist in hyperbaric chambers containing 100 percent pressurized oxygen at 2 to 2.5 atmospheres of pressure. The high oxygen level has been found to stimulate new artery growth which provides oxygen to ischemic feet and leg ulcers.

During hyperbaric treatment, a patient lying in a comfortable hyperbaric chamber breathes pure oxygen that is gradually pressurized. The procedure is virtually painless, although some people experience popping sensations in their ears. They can relieve this problem by yawning or swallowing to relieve changes in ear pressure.

During the 90 minutes that a patient is in the chamber, he or she is carefully monitored by a clinical staff trained in hyperbaric procedures. The staff records the patient's skin oxygen level before and after HBO treatment to evaluate the effectiveness of the hyperbaric oxygen in stimulating new blood vessel growth and wound healing.

By inhaling pure oxygen under pressure in the chamber, patients dissolve more oxygen in their red blood cells and plasma. This oxygen circulates throughout the body, reaching tissues that are not receiving enough oxygen under normal circumstances. The action promotes healing during and after the treatment. Patients should show signs of new artery growth and healing by 14 to 20 treatments.

High Risk Factors

Patients with diabetes are at higher risk than non-diabetics for high cholesterol, high blood pressure, heart disease, and neuropathy, which causes the loss of feeling in feet or toes. When diabetes is not properly controlled, tissue may die and non-healing infections and gangrene may develop.

Traditional treatments for diabetic vascular disease include dietary changes, medication to maintain healthy glucose levels, control of high blood pressure and cholesterol levels, and vascular surgery using stents to increase circulation.

Peripheral Vascular Disease (PVD)
PVD is a disease of the blood vessels characterized by narrowing and hardening of the arteries that supply blood to the legs and feet. It reduces the blood flow to these areas and can damage nerves and other tissues. As the disease progresses, the walls of the blood vessels become less able to open wider when tissues need more blood and oxygen, such as during exercise. Calcium deposits form on the blood vessel walls, causing even greater narrowing and stiffness.

PVD is a common problem in people with diabetes and also often affects men age 50 and older. Risk factors include a personal or family history of heart disease, stroke, kidney disease, or high blood pressure. Smoking also increases a person's risk of developing peripheral vascular disease. Complications of PVD include infections, ulcers, and open sores on the feet and legs, as well as gangrene.

Traditional treatment includes medications to thin the patient's blood, enlarge or dilate the affected arteries, and reduce pain. In severe cases, surgery may be performed to remove the lining of the artery or bypass the affected artery using a vein or synthetic graft.

Hyperbaric oxygen treatment at Methodist Medical Center is now giving many people with diabetic vascular disease and/or PVD another treatment option.