Supplementing Diabetic Wound Care With Hyperbaric Medicine
- Volume 24 - Issue 11 - November 2011
- 7693 reads
- 0 comments
Case Study: When A Patient With Diabetes Has An Involved Infection With Gas Gangrene
A 66-year-old male with type 2 diabetes mellitus had an involved infection with the presence of subcutaneous gas gangrene in the lateral foot. The patient subsequently had a wide margin excisional debridement and partial fifth ray resection. The resulting foot had an exposed bone of the fourth metatarsal shaft and the fifth metatarsal base as well as concerns of further tissue loss occurring due to local ischemia.
The patient immediately began treatments in the HBOT chamber due to his gas gangrene infection. The TcPO2 results showed a reading of 21 mmHg in the presence of room air with a significant improvement to 46 mmHg when the patient was breathing 100% O2 via a nasal cannula. Shortly after the initial debridement, the patient returned to the operating room for conversion to a transmetatarsal amputation of the foot due to the presence of exposed bone and advancing distal ischemia and necrosis of the foot.
The patient’s foot responded well after one month of treatment and healed completely after the completion of the 60 HBOT treatments.
Dr. Johnson is the Director of the Chronic Wound Clinic at the Hennepin County Medical Center in Minneapolis.
1. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005; 293(2):217-28.
2. Eggers PW, Gohdes D, Pugh J. Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population. Kidney Int. 1999; 56(4):1524-1533.
3. Henshaw IN, Simpson A. Compressed air as a therapeutic agent in the treatment of consumption, asthma, chronic bronchitis, and other diseases. Sutherland and Knox, Edinburgh, 1857.
4. Churchill-Davidson I, Sanger C, Thomlinson RH. High pressure oxygen and radiotherapy. Lancet. 1955; 268(6874):1091-1095.
5. Boerema I, Kroll JA, Meijne NG, Lokin E, Kroon B, Huiskes JW. High atmospheric pressure as an aid to cardiac surgery. Arch Chir Neerl. 1956; 8(3):193-211.
6. Brummelkamp WH, Hogendijk J, Boerema I. Treatment of anaerobic Infections (Clostridial myositis) by drenching the tissues with oxygen under high atmospheric pressure. Surgery. 1961; 49:299-302.
7. Smith G, Sharp GR. Treatment of coal gas poisoning with oxygen at two atmospheres pressure. Lancet. 1962; 1(7234):816-819.
8. Kindwall EP, Whelan HT. Hyperbaric Medicine Practice. 3rd Edition. Best Publishing Co. Flagstaff, AZ. 2008.
9. Hunt TK. The physiology of wound healing. Ann Emerg Med. 1988; 17(12):1265-1273.
10. Tompach PC, Lew D, Stoll JL. Cell response to hyperbaric oxygen treatment. Int J Oral Maxillofac Surg. 1997; 26(2):82-86.
11. Badway JA, Karnovsky ML. Active oxygen species and the functions of phagocytic leucocytes. Ann Rev Biochem. 1980; 49:695-726.
12. Centers for Medicare and Medical Services: National Coverage Determination for Hyperbaric Oxygen Therapy (20.29) Published number 100-3. Section 3 20.29. Version 3. 6/19/2006.
13. Pinzur MS, Sage R, Stuck R, Ketner L, Osterman H. Transcutaneous oxygen as a predictor of wound healing in amputation of the foot and ankle. Foot Ankle. 1992; 13(5):271-272.
14. Pinzur MS, Sage R, Stuck R, Osterman H. Transcutaneous tension in the dysvascular foot with infection. Foot Ankle. 1993; 14(5):254-256.
For further reading, see “A Guide To Hyperbaric Oxygen Therapy For Diabetic Foot Wounds” in the December 2007 issue of Podiatry Today.