Hyperbaric Oxygen Therapy for Diabetic Wounds
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Do you need the Wound Care Center?
The Diabetic Association reports that adding Hyperbaric Oxygen Therapy (HBOT) to a comprehensive treatment program can help avoid 85% of the potential amputations done each year due to non-healing diabetic wounds. Patients who have not responded to traditional treatment alone may benefit by adding Hyperbaric Oxygen Therapy to their comprehensive treatment program.
What is Hyperbaric oxygen therapy?
Hyperbaric Oxygen Therapy is a safe, comfortable, non-invasive treatment that speeds healing. Patients breath 100% oxygen while in the largest, FDA approved hyperbaric chambers in North Dallas. They receive 10 times the amount of oxygen and this results in improved healing, reduced swelling, and up to 8 times more stem cells, that are mobilized then to go where there is damaged tissue. Patients can watch a movie or sleep during the therapy.
Our experienced team of doctors and nurses are dedicated to treating wounds that have resisted healing after months and even years of traditional treatment.
Our Hyperbaric Oxygen Therapy Wound Care Center provides patients suffering with chronic or acute wounds and a variety of other conditions, with the most comprehensive, advanced therapy available. The Hyperbaric Oxygen Therapy Wound Care Center provides outpatient skilled care, and an individualized comprehensive treatment plan designed to provide you with the best possible healing outcomes. Our team of experienced experts offers technologically advanced outpatient care that is highly effective for individuals who have wounds that have been difficult to heal on their own or with standard wound treatment alone.
If you have a wound that hasn’t started to get significantly better after traditional treatment, call us, Dr. Graff can help!
These wounds include, but are not limited to:
- Diabetic ulcers
- Radiation tissue damage
- Bone infection
- Vascular disease
- Trauma wounds
- Failed grafts
- Spontaneous hearing loss
- Anaerobic Infections
Many of these conditions may be covered by your insurance.
HBOT FOR FAILED FLAPS AND SKIN GRAFTS
Preparation and preservation of compromised skin flaps and grafts utilizes hyperbaric oxygen therapy for graft or flap salvage in cases where hypoxia or decreased perfusion has compromised viability acutely. This indication is not for primary management of wounds, maintenance of split thickness skin grafts or bioengineered skin substitutes placed on wounds or operative sites (Mohs). Hyperbaric oxygen therapy may improve composite graft survival in the immediate postoperative period when viability appears threatened due to a technical complication. It is not indicated to correct the mechanical complication but may be adjunctive therapy once the technical problem has been corrected and the graft is jeopardized by a reperfusion effect.
hyperbaric oxygen therapy has not been found to be of significant benefit post 24 hours of warm ischemia or signs of compromise. Covered services require traditional construction of a pedicle or composite graft (flap) with confirmation of viability.
Bioengineered or allogeneic skin substitutes and traditional split thickness skin grafts placed for wound coverage do not meet CMS NCD 20.29 interpretation for coverage. HBO therapy is not considered reasonable and necessary for the initial preparation of the body site for a graft except as covered for other entities (radio necrosis, resistant osteomyelitis, neuropathic ulcers, etc.).
Treatments are given intensively initially for up to 72 hours followed by re-evaluation of the wound. It is not unusual to receive 2-3 treatments per day for up to 3 days post creation of the graft when viability appears threatened. When the graft appears stable, treatments are reduced to daily or discontinued. The number of sessions provided to enhance graft survival is not expected to exceed 20.
HBOT FOR GANGRENE
Clostridial Myositis and Myonecrosis (Gas Gangrene) is an acute, rapidly invasive infection of the muscle characterized by profound toxemia, extensive edema, massive death of tissue and variable degree of gas production. The diagnosis of gas gangrene is based on clinical data supported by the demonstration of Gram-positive rods from the fluids of the involved tissues as well as a virtual absence of leukocytes. Culture results are unpredictable while sialidase immunoassays may allow accurate identification of the Clostridium species. Tissue gas seen in a feather-like pattern radiologically, associated with crepitus, is an early and characteristic sign. An associated thin serosanguinous exudate with a sickly, sweet odor associated with disproportionate pain is essentially diagnostic. The onset of gangrene can occur one to six hours after injury and presents with severe and sudden pain at the infected area.
The goal of hyperbaric oxygen therapy is to stop alpha-toxin production, requiring tissue oxygen concentrations of 250 mm Hg, to inhibit further bacterial growth, at which point the body can use its own host defense mechanisms. Hyperbaric oxygen treatment starts as soon as the clinical picture presents and is supported by a positive Gram stain. The greatest reduction in mortality results from treatment utilizing HBOT, antibiotic therapy and surgery. Debridement of necrotic tissue can be performed between hyperbaric oxygen treatments when clear demarcation between dead and viable tissue is evident. The usual treatment consists of Oxygen administered at 3.0 ATA pressure for 90 minutes three times in the first 24 hours. Over the next four to five days, treatment sessions twice a day are usual, for up to 15 sessions. The actual decision for termination of therapy is dependent upon the patient’s response to hyperbaric oxygen therapy.