Pressure Sore – Decubitus Ulcer
source: http://www.spinal-injury.net/pressure-sores-sci.htm
Pressure and bed sores ordecubitus ulcers are common complication in people confined to bed rest or wheelchair. The wound is caused by continuous pressure on the skin over bony prominence due to prolonged immobilization in one position reducing the normal blood flow.
People with spinal cord injury are especially prone to develop pressure sores due decreased or absent normal sympathetic nerve activity that is causing normal muscular contractions which are pumping blood throughthe vascular network called “muscle pump”. The major symptom is pain usually complicated by infection and inflammation. When infection spreads in deeper layers, a bone infection (osteomyelitis) can develop which can be fatal like in case of famous actor Christopher Reeve.
Pressure on the skin impairs circulation leading to ulcer and enhances bacterial overgrowth as well as inhibiting leukocyte function to eliminate bacteria and slowing synthesis of collagen (protein needed for wound to close). Inflammation causes toxic substances (ammonia and lactate) to accumulate in the tissue leading to swelling, which is in turn further impairing blood supply and oxygen delivery. This is a vicious circle which further reduces oxygen supply and healing.
Hyperbaric oxygen directly affects the bacterial growth, improves white blood cell function, reduces swelling and inflammation and promotes collagen synthesis and fibroblast proliferation that are essential for new capillary growth and improved microcirculation (blood flow through capillaries).
Hyperbaric oxygen therapy for pressure sores is proven very successful and safe adjunctive treatment to daily wound dressing, administration of antibiotics and surgical debridment.
- HBO increases oxygen transport to wound area stopping further tissue damage
- HBO facilitates growth of new capillaries (angiogenesis) promoting the microcirculation
- HBO speeds up wound healing by reducing inflammation and swelling
- HBO relieves pain
- HBO reduces infection by eliminating bacteria directly and increasing capacity of white blood cell to fight infection
- HBO improves microcirculation and elimination of toxins in the blood
- HBO enhances the effect of some antibiotics
- HBO stimulates release of stem cells from the bone marrow
- HBO decreases blood viscosity and risk of thrombosis and stroke
- HBO improves lymphatic circulation
- HBO improves bone density and mineralization and speeds up bone healing
- HBO enhances peripheral nerve regeneration for improved sensitivity
- HBO prepares tissue and bone for grafting before surgery
- HBO speeds up healing after surgery and improves chances of graft survival
Electrical stimulation for treatment of pressure sores
Electrical stimulation is a non painful, non invasive effective therapy that uses electrical currents delivered through electrodes placed on the skin around the wound to promote the local blood flow and speed up wound healing and closure. At BaroMedical we use electrical stimulation in combination with hyperbaric oxygen therapy to achieve the best results in pain management, infection control and wound healing. Combined effect of two therapies used together is higher than each therapy used on its own. For your information we are attaching an extensive list of references and abstracts for use of electrical stimulation in wound healing.
Medical hyperbaric oxygen sessions are two hours long at depth of 2.4 to 2.8 ATA of pure oxygen pressure. At BaroMedical HBO sessions are given in mono-place chambers for better monitoring, comfort and safety. Number of HBO sessions needed depend on the seriousness of the condition and can be determined upon evaluation of the microcirculation. At BaroMedical, the screening of the clients and the progress of the therapy are monitored with most advanced equipment: Laser Doppler blood flow, tissue oxygen monitor and digital camera.
- Blessey A, Eubanks A: Hyperbaric oxygen is an important adjunct therapy. Crit Care Nurse; 16(3):14-5, Jun 1996
- Dimitrijevich SD, Paranjape S, Wilson JR, Gracy RW, Mills JG: Effect of hyperbaric oxygen on human skin cells in culture and in human dermal and skin equivalents. Wound Repair Regen; 7(1): 53-64, Jan-Feb 1999
- Fabian TS, Kaufman HJ, Lett ED, Thomas JB, Rawl DK, Lewis PL, Summitt JB, Merryman JI, Schaeffer TD, Sargent LA, Burns RP: The evaluation of subatmospheric pressure and hyperbaric oxygen in ischemic full-thickness wound healing. Am Surg; 66(12): 1136-43, Dec 2000
- Halm M, Zearley C.Assessment and follow-up of problem wounds in the hyperbaric oxygen setting. Ostomy Wound Manage; 37 : 51-9, Nov-Dec199
- Kivisaari J, Niinikoski J. Effects of hyperbaric oxygenation and prolonged hypoxia on the healing of open wounds. Acta Chir Scand; 141(1): 14-9, 1975
- LaVan FB, Hunt TK: Oxygen and wound healing. Clin Plast Surg; 17(3):463-72, Review, Jul 1990
- Moon RE: Use of hyperbaric oxygen in the management of selected wounds. Adv Wound Care; 11(7): 332-4, Review, Nov-Dec 1998
- Oriani G: Chronic Hyperbaric Oxygen Therapy Indications, Handbook on Hyperbaric Medicine Springer 110-124,1996
- Quirinia A, Viidik A: The impact of ischemia on wound healing is increased in old age but can be countered by hyperbaric oxygen therapy. Mech Ageing Dev. 25; 91(2): 131-44, Oct 1996
- Quirinia A, Viidik A:The effect of hyperbaric oxygen on different phases of healing of ischaemic flap wounds and incisional wounds in skin. Br J Plast Surg; 48(8):583-9, Dec 1995
- Roth RN, Weiss LD: Hyperbaric oxygen and wound healing. Clin Dermatol;12(1):141-56 Review, Jan-Mar 1994
- Shafer MR: Use of hyperbaric oxygen as adjunct therapy to surgical debridement of complicated wounds. Semin Perioper Nurs; 2 (4):256-62, Oct 1993
- Shulman AG, Krohn HL: Influence of hyperbaric oxygen and multiple skin allografts on the healing of skin wounds. Surgery; 62 (6): 1051-8, Dec 1967
- Stone A. Hyperbaric oxygen treatment for wounds. Plast Reconstr Surg.1998 May; 101(6): 1738-9. Medicine1999; 14:213 –241
- Uhl E, Sirsjo A, Haapaniemi T, Nilsson G, Nylander G: Hyperbaric oxygen improves wound healing in normal and ischemic skin tissue. Plast Reconstr Surg; 93(4): 835-41, Apr 1994
- Young T: Hyperbaric oxygen therapy in wound management. Br J Nurs. 9; 4(14): 796,798-803, Review, 27 Jul –Aug 1995
