Is there a role for hyperbaric oxygen therapy in the treatment of refractory wounds of rare etiology?

Abstract

Introduction: Delayed wound healing indicates wounds that have failed to respond to more than 4-6 weeks of comprehensive wound care. Wounds with delayed healing are a major source of morbidity and a major cost to hospital and community healthcare providers. Hyperbaric oxygen therapy (HBOT) is a treatment designed to increase the supply of oxygen to wounds and has been applied to a variety of wound types. This article reviews the place of HBOT in the treatment of non-healing vasculitic, calcific uremic arteriolopathy (CUA), livedoid vasculopathy (LV), pyoderma gangrenosum (PG) ulcers.

Methods: We searched electronic databases for research and review studies focused on HBOT for the treatment of delayed healing ulcers with rare etiologies. We excluded HBOT for ulcers reviewed elsewhere.

Results: We included a total of three case series and four case reports including 63 participants. Most were related to severe, non-healing ulcers in patients with vasculitis, CUA, LV, and PG. There was some evidence that HBOT may improve the healing rate of wounds by increasing nitric oxide (NO) levels and the number of endothelial progenitor cells in the wounds. HBOT may also improve pain in these ulcers.

Conclusion: We recommend the establishment of comprehensive and detailed wound care registries to rapidly collect prospective data on the use of HBOT for these problem wounds. There is a strong case for appropriately powered, multi-centre randomized trials to establish the true efficacy and cost-effectiveness of HBOT especially for vasculitis ulcers that have not improved following immunosuppressive therapy.

Keywords: Calciphylaxis; Economics; Epidemiology; Hyperbaric medicine; Nitric oxide; Review article; Skin.

Figure 1

Flow diagram. Literature analysis, between January 2002 and March 2016, for Hyperbaric Oxygen Therapy in the treatment of refractory wounds of rare etiology. Seven publications have been included with different treatment of 63 individuals from three rare etiologies for chronic wounds: non-healing vasculitic ulcers that had not improved following immunosuppressive therapy, patients with calcific uremic arteriolopathy (CUA), livedoid vasculopathy (LV) and pyoderma gangrenosum (PG)