Roundtable Insights On Hyperbaric Oxygen Therapy

Volume 16 - Issue 7 - July 2003
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Weighing In On Topical HBO

Q: Is there any good proof that extremity HBO chambers are effective?

A: All of the panelists agree that this is a highly controversial subject and emphasize that HBO extremity chambers provide an entirely different type of therapy than the monoplace chambers that provide systemic HBO.

Dr. Kominsky says the buzz on extremity HBO chambers tends to be cyclical. He recalls that approximately 15 years ago, several companies touted the benefits and safety profile of extremity HBO chambers. Around the same time, Dr. Kominsky notes there were several published reports that said the units were ineffective because they could not provide the same amount of atmospheric pressure as the full body units. He also points out that the same reports said the units were dangerous and prone to exploding.

Several new companies are again promoting the benefits of employing extremity HBO chambers, but Dr. Kominsky says he doesn’t have any experience in using these devices.

Dr. Sage has used extremity HBO chambers on two occasions with successful healing in renal transplant patients who had stubborn ulcers but otherwise adequate vascular perfusion. However, he cautions that he’s not sure whether it was the topical HBO that made the difference or whether the extra care involved motivated the patients to offload more effectively and thus facilitated healing.

Dr. Armstrong has doubts about the extremity chambers. He says systemic HBO, theoretically, works by supersaturating hemoglobin and then plasma with oxygen at greater than one atmosphere absolute. “Unless one’s legs have evolved to the point where they have sprouted gills, that cannot be the mechanism of action of topical HBO,” maintains Dr. Armstrong.

Drs. Brill and Sage add that they aren’t aware of any definitive, controlled studies that demonstrate the efficacy of topical HBO.

Roundtable Insights On Hyperbaric Oxygen Therapy

Author(s):

Clinical Editor: Lawrence Karlock, DPM

Q: What complications have you seen in using systemic HBO?
A: Drs. Armstrong and Brill say claustrophobia is the most common sequela. Dr. Brill says claustrophobia cases can be resolved by providing adequate sedation for the patient. He notes that some patients have had trouble clearing their ears when the chamber is going to depth, but Dr. Brill says this can be alleviated with nasal decongestants or via a myringotomy in troublesome cases.
Dr. Armstrong adds that he has had patients who had perforated eardrums after undergoing HBO therapy, but says these incidents were his fault and that they could have been prevented with better evaluation along with his colleagues in ear, nose and throat and/or prophylaxis of the patients beforehand.
Certain ear problems, cardiac and pulmonary conditions may be affected by HBO treatment, notes Dr. Sage. Accordingly, he emphasizes that hyperbaric care should be supervised by a physician who is experienced in using this modality. Dr. Sage also recommends that DPMs continue to provide optimal wound care and monitor the progress of the wound during HBO therapy.
While Dr. Kominsky hasn’t see any complications per se, he has seen a few non-healing wounds. He says patients who have not benefited from HBO therapy have either had an underlying undiagnosed infection (usually osteomyelitis that wasn’t seen on X-ray) or were poorly perfused. Dr. Kominsky says this goes back to the importance of appropriate patient selection.
“I have learned through experience with a large patient pool that there must be some blood flow to the foot in order for (HBO) to be an effective tool,” notes Dr. Kominsky.

Dr. Armstrong is the Director of Research and Education within the Department of Surgery, Podiatry Section, within the Southern Arizona Veterans Affairs Medical Center in Tuscon, Ariz. He is a member of the National Board of Directors of the American Diabetes Association.

Dr. Brill practices at the Limb Salvage Centre at the BrillStone Building and is President of the BrillStone Corporation in Dallas. He is also a Consultant in wound care and reconstructive foot and ankle surgery at the Wound Care Clinic at Presbyterian Hospital in Dallas.

Dr. Kominsky is Residency Director and Director of Podiatric Medical Education at Washington Hospital Center in Washington, D.C. He is a Fellow of the American College of Foot and Ankle Surgeons and Diplomate of the American Board of Podiatric Surgery.

Dr. Sage is a Professor and Chief of the Section of Podiatry within the Department of Orthopaedic Surgery and Rehabilitation at the Stritch School of Medicine at Loyola University.

Dr. Karlock (pictured) is a Fellow of the American College of Foot and Ankle Surgeons, and practices in Austintown, Ohio. He is a member of the Editorial Advisory Board for WOUNDS, A Compendium of Clinical Research and Practice.