Arterial Ulcer Treatment in Hyperbaric Chambers

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ABSTRACT:

        In a study done by Heyboer et al^[1] on treatments that can promote and encourage healing in diabetic patients suffering from unhealing arterial ulcers, the use of hyperbaric oxygen treatments was examined. This was done in order to compare with that of wound care in patients who had previously undergone revascularization surgeries and had still experienced unhealing arterial ulcers, as well as patients who were deemed ineligible to receive revascularization surgeries and underwent only that of wound care interventions. The conduction of this study shows the benefits of hyperbaric oxygen treatments and proves that when tissue perfusion is increased, the patient experiences greater healing.

Arterial ulcers are ischemic tissue in which develop for a variety of reasons, following poor oxygen perfusion in especially that of the lower extremities such as the legs and feet.^[2] This is because the arteries are responsible for carrying oxygen to all parts of the body, including the peripheries of the body, and any interruption of this can result in decreased oxygen to the tissues, thus allowing for necrosis and breakdown of the effected tissues. Peripheral arterial disease (PAD) is in result of atherosclerosis – or the narrowing of the arteries due to a buildup of plaque – and results in tissue ischemia, which is insufficient blood to the areas in which are effected. This is the result of various factors and is the leading cause of arterial ulcers.^[3] Other diseases and pathologies that can worsen or cause this include renal failure, high blood pressure, limited joint mobility, trauma, peripheral vascular disease, and often the most detrimental of all; diabetes mellitus.

Arterial ulcers in the case of diabetes mellitus is unfortunately very common, as well as a very big health risk for the patient. This is because of the extremely poor oxygen perfusion to the extremities in patients with diabetes, which results in a greater chance of getting an arterial ulcer, as well as the impaired ability to heal. Because of this, the patient is not nearly as likely to heal on their own and many more complications may arise that may lead to amputation of the affected area, limb, and even death in some cases.

Current interventions and treatments that are being done in the attempt to heal these ulcers are procedures from as simple as wound care – involving debriding, cleaning, and covering of the wound, as well as the use of wound vaccs in larger wounds – to as invasive as bypass and angioplasty surgeries. Unfortunately, though wound care seems to prove to be not very effective in diabetes mellitus, it is very common that in the case of surgical intervention, the vascular surgeon may deem the patient ineligible for intervention. This leads to the question than is there another more effective way to treat arterial ulcers in diabetic patients? A series of studies were done in the case of arterial ulcers in patients with diabetes mellitus with three controlled groups. These groups included patients receiving wound care treatment that were deemed ineligible for surgical treatment, patients receiving surgical interventions, in addition to a group who was treated with hyperbaric oxygen because they were also deemed ineligible for surgical intervention. ^[4] This study was done with the very difficult cases of non-healing arterial ulcers.