HyperbaRxs treats a variety of medical indications which are recommended by the Undersea and Hyperbaric Society as well as accepted by most insurance carriers, including Medicare. These guidelines are supported by scientific literature and are universally accepted. With each diagnosis the protocol and length of treatment will differ. Each protocol will be determined by the hyperbaric physician.
Routine Covered Indications
Portions of content in the following descriptions are provided courtesy of the Undersea & Hyperbaric Medical Society (UHMS) with their permission, and are copyright protected. The UNHS has provided a link to the accepted indications, please visit: www.uhms.org (leaving website).
Enhancement of Healing in Selected Problem Wounds (Arterial Insufficiencies)
Problem wounds are those which fail to respond to established medical and surgical management. Such wounds usually develop in compromised hosts with multiple local and systemic factors contributing to inhibition of tissue repair. These include diabetic feet, compromised amputation sites, nonhealing traumatic wounds, and vascular insufficiency ulcers (ulcers with poor circulation). All share the common problem of tissue hypoxia (low tissue oxygen level, usually related to impaired circulation). The elevation in tissue oxygen which occurs in the hyperbaric chamber induces significant changes in the wound repair process that promote healing. When hyperbaric treatment is used in conjunction with standard wound care, improved results have been demonstrated in the healing of difficult or limb threatening wounds as compared to routine wound care alone.
Skin Grafts & Flaps (Compromised)
Reconstructing complex wounds is accomplished by shifting or transferring tissues to the wound from a different part of the body. A “skin graft” is the transfer of a portion of the skin (without its blood supply) to a wound. A “flap” consists of one or more tissue component including skin, deeper tissues, muscle and bone. Flaps are transferred with either their own, original blood supply (pedicle flap) or with detached blood vessels which are attached at the site of the wound (free flap). Skin grafts survive as oxygen and nutrients diffuse into them from the underlying wound bed. Long-term survival depends on a new blood supply forming from the wound to the graft. When the wound bed does not have enough oxygen supplied to it, the skin graft will at least partially fail. Common causes for this are previous radiation to the wound area, diabetes mellitus, and certain infections. In these situations, the availability of oxygen in the wound bed can be increased with hyperbaric oxygen therapy in preparation for skin grafting. Additionally, hyperbaric oxygen therapy can be used after skin grafting to increase the amount of the graft that will survive in the compromised settings. Flaps also require oxygen and nutrients to survive. The outer, visible portion (usually skin) is furthest from the source of blood supply for the flap. This is the area most likely to be compromised by inadequate oxygen. Factors such as age, nutritional status, smoking, and previous radiation result in an unpredictable pattern of blood flow to the skin. If a flap is found to have less than adequate oxygen after it has been transferred, hyperbaric oxygen can help minimize the amount of tissue which does not survive and also reduces the need for repeat flap procedures. Hyperbaric oxygen can help by assisting in the preparation and salvage of skin grafts and compromised flaps.
Necrotizing Soft Tissue Infections
A number of types of infections of soft tissue may benefit from adjunct treatment with hyperbaric oxygen and are included in the category of “necrotizing soft tissue infections.” Names of such clinical syndromes include crepitant anaerobic cellulitis, progressive bacterial gangrene, necrotizing fasciitis, and nonclostridial myonecrosis. Gas gangrene (clostridial myositis and myonecrosis) is a separate entity. Necrotizing soft tissue infections themselves may induce conditions adverse to control of the infection by normal host defense mechanisms. The infections commonly lower tissue oxygen levels, impairing the ability of the white blood cells (neutrophils) to fight infection. Toxins produced by bacteria involved may also inhibit neutrophil activity. The primary treatments for necrotizing soft tissue infection are surgical excision of infected tissue and administration of appropriate antibiotics. Hyperbaric oxygen may be beneficial in several ways. Some of the bacteria involved in necrotizing soft tissue infections are “anaerobic,” growing most rapidly in a low oxygen environment. In the hyperbaric chamber, tissue oxygen levels may be raised sufficiently to inhibit bacterial growth. In addition, hyperbaric oxygen treatment may enhance the ability of neutrophils to kill bacteria, by a number of different mechanisms.
Abscess formation in the brain can be a devastating complication of sinus infections or bone infections (osteomyelitis) of the skull. Occasionally, abscesses are seeded from infection occurring in other parts of the body. Brain abscesses are frequently multiple. One of the problems in treatment of brain abscesses relates to the fact that surgical drainage of their contents is often required for cure. Unfortunately, normal brain tissue surrounding the abscess may be unavoidably damaged by such surgery. Fine needle aspiration of the abscesses is being performed with greater frequency to avoid this problem. Antibiotics may not penetrate well into the brain abscesses. Furthermore, white blood cells, which kill infecting bacteria, may not have enough oxygen to effectively eliminate the infection when functioning deep in the abscess at a distance from their normal blood supply. White blood cells require a minimum level of oxygen to kill bacteria. Most intracranial abscesses are caused by anaerobic bacteria (bacteria that function optimally in low oxygen concentrations). Hyperbaric oxygen raises the environmental oxygen level in the region of the abscess, exposing the bacteria to levels which may inhibit or kill them, as well as providing sufficient oxygen for white blood cells to exercise their killing power.