HBOT is widely used to treat chronic wounds and ulcers caused by arterial insufficiency, as well as diabetic, venous, decubital, trophic and neuropathic ulcers.
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Diabetic ulcers usually affect feet, hence the name "diabetic foot". Pathological process on arteries persists even in patients with well-controlled glycaemia. As a result of that process, occlusive disease of large blood vessels and pathological changes on small blood vessels could develop. Additional problems include diabetic neuropathy and secondary wound infections. Standard treatment of the diabetic foot includes control of blood sugar, representative wound care and prevention and treatment of infection.
It has been well established that HBOT lessens number of amputations, necessity for insulin, and fights hypoxia and infection.
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Venous ulcers are one of manifestations of chronic wound insufficiency, which is defined as hypertension in superficial or deep veins of lower limbs. Trophic changes that lead to venous ulcers are caused by ischemia in microcirculation and by edema that exists due to increased capillary permeability and slow lymphatic drainage. The treatment of venous ulcers includes elevated position of the limb, compressive therapy, and careful wound dressing as well as local therapy of ulcers and surgical measures. HBOT stimulates healing of venous ulcers.
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Decubital or trophic ulcers occur due to pressure on skin that oppresses circulation in the area of contact. Such ulcers would occur after long immobility in one position. Usually could be found in sites with bone prominences, such as heel and sacrum. Ulcer is a consequence of damage of ischemic skin, bacterial invasion and infection.
HBOT lessens inflammatory reaction, stimulates granulation and epithelization.
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Ischemic ulcers develop as a consequence of insufficient peripheral arterial circulation caused by various diseases. They are mainly found on feet and/or hands. Primary treatment of persistent ischemic wounds on lower limbs is surgical revascularization and adequate wound care.
HBOT has manifested positive effects in cases when the wounds would not heal despite maximal previous surgical revascularization or when revascularization was not possible. HBOT enhances healing or helps preparing vascular bed for skin transplant.
Effects of HBOT in the treatment of chronic wounds:
- Stimulates activity of fibroblasts and deposition of collagen necessary in the wound healing process;
- Corrects tissue hypoxia, stopping vicious circle of hypoxia and enables better and faster wound healing;
- Stimulates neoangiogenesis in compromised circulation, especially in acute traumatic ischemia;
- Enables bactericidal and bacteriostatic oxygen effect in infected wounds;
- Lessens pain and edema in the surrounding tissue.