northern nevada hyperbarics - oxygen therapy - powerpoint
DESCRIPTION
Overview of Hyperbaric Oxygen Therapy for non-healing wounds. NOTE: Some of the included medical images are graphic in nature due to visual appearance of non-healing wounds.TRANSCRIPT
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Northern Nevada Hyperbarics, Inc.Serving the Community for 8 Years
(775) 826-2084
1698 Meadowood Ln., #100
www.nevadahyperbarics.com
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What is HBO
• 100% oxygen in an enclosed chamber at higher-than-atmospheric pressure where oxygen dissolves in arterial plasma in increased amounts---up to 10 to 15 fold increase.
• Typical course consists of 30 or more treatments done daily for six weeks.
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Some Basics
• HBOT has been used in chronic wounds for about 40 years.
• 100% oxygen is delivered to a chamber under high pressure (2 to 2.4 ATA) for 90 minutes
• Typical HBOT treatment course consists of 30 or more treatments daily—M-F
• Administering oxygen to hypoxic tissue shown to activate fibroblast proliferation, down-regulate inflammatory responses, cytokines, up-regulate growth factors – all proxies for wound healing.
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Hyperbaric Chamber Designs
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Our Facility
2 Sechrist Monoplace Chambers
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Clinical Hyperbaric Oxygen Therapy
Clinical
Hyperbaric
Oxygen Therapy
Emergency Indications•Acute Traumatic Ischemia
Crush Injuries and
Compartment Syndrome
•Carbon Monoxide Poisoning
•Gas Gangrene
•Surgical Infections
•Failed Flaps and Grafts
•Diving Injuries
Scheduled Indications•Non-Healing Diabetic and problem Wounds
•Radiation soft tissue necrosis, cystitis, and proctitis.
•Osteoradionecrosis
•Osteomyelitis
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Primary Mechanisms
• Hyper---oxygenation
• Vasoconstriction—reduce inflammation
• Microbiological effects
• Activate fibroblast and collagen synthesis
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Secondary Mechanisms
• Angiogenesis
• Osteogenesis
• WBC Oxidative Killing
• Cell wall permeation
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Cumulative Effects
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Vascular Density in Response to Hyperbaric O2
Response to 20 x 1ATA 100% O2
Response to 20 x 2.4ATA 100% O28 x increase in vascular density
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Vascular Density Increase
No HBO Start HBO
18 Tx 24 Tx
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Diabetic Wound with Recalcitrant Osteomyelitis
78 Y.O Male/ 2 Wks Resection Bone / Continued Drainage
Pre-Hyperbaric Partial Wound Closure20 HBO2 TX---4 Weeks
Complication ResolvedFull Healing35 HBO2 TX7 Weeks
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Problem Wound w/Skin Graft Failure58 Y.O. Female/ Diabetic/ 6mo. Non-healing /one failed graft
u
After 25 Tx---5 Weeks---beefy, red, healthy granulation tissue
Split thickness graft placed---100% take
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Tissue Necrosis in Diabetic Foot69 Y.O. Diabetic Female/ w Exposed Tendon
After 15 Tx—2 Week
Granulation tissue
Required incision, drainage, and debridement
After 20 Tx---3 Week After 30 Tx---4 Week
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Non-Healing Post Amputation46 Y.O. Diabetic Male
Initial Visit After 10 Tx
After 16 Tx After 34 Tx
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Achilles Tendon repair Site
After 10 tx’s
After 25 tx’s
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Problem WoundNon healing Transmetatarsal Amputation
Non-healing suture line 3 months post
Healing after 25 HBO TX
Medial View
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Left Mandibular Osteoradionecrosis45 Y.O. Male/ Radical neck dissection/ radiation/ Exposed Bone
Initial Visit—Bone Exposed Tx 12—2 Weeks
Tx 25---5 Weeks Tx 39---8 WeeksNew skin over bone
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Radiation Soft Tissue Necrosis52 Y.O. Male/ Post Radical Neck Reconstruction/ Wound
Dehiscence and Flap Compromise
After 8 Tx—2 Weeks
After 36 Tx---7 WeeksAfter 18 Tx---4 Weeks
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Radiation necrosis with incision dehiscence
51 yo female/ neck dissection
12 TX 21 TX
36 TX Three weeks post tx
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Soft Tissue Radiation Necrosis40 Y.O. Male post T-cell Lymphoma—Rt. hand
Initial Visit Tx 7---1 Week
Tx 24---5 Weeks Tx 50---10 WeeksNo need for graft
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Graft Placement post Radiation Necrosis
2 months post-surgery After 20 HBO TX
10 days after spilt thickness graft
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Crush InjuryAvulsion of the Palmar Skin
• decreased perfusion or hypoxia
• » HBO at
11 Weeks after Surgery---Full Range of Motion
3 Tx in first 24hrs. Then total of 20 over a period of 4 weeks.
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Traumatic Ischemia—of a Replanted Leg4 Y.O. Mid-Calf Amputation from Lawnmower
Microvascular reattachment of nerves and arteries
3 days after surgery—and 6 Tx,Then 4 more Tx over 3 days
After 12 weeks, sensate leg---can walk and run with the
aid of brace.
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Healing Compromised Flap of Tibia Fracture54 Y.O. Male with Tibia Fracture and Internal Fixation
Necrosis and breakdown oftissue over plateand bone
After 10 Tx---1 Week---compromised portion of flap is now viable
After 20 Tx---3 Week—100% flap survival
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Failed Flap — Left Dorsal Foot50 Y.O. Female/ Degloving Accident
Tx 1
Tx 30---5 Weeks
Tx 18---3 WeeksTx 12---2 Weeks
Follow-Up3 Weeks
Final Follow-Up
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Healing Burns 23 YO Female w/facial burns from flaming gasoline
A
C
B
D
A-12 hrs after injury B-24 hrs and 2 HBO tx’sC-72 hrs later and 6 tx’s D-Shortly before discharge
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Failed Flap – Right Knee62 Y.O. Female/ Failed flap post total knee replacement
Tx 9—Two Weeks
Tx 16---3 Weeks
Initial Visit
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Lip Reimplantation10 Y.O. Female/ Full thickness lesion from dog bite
Re-attached. Wound looked ischemic and swollen. Patient started hyperbarics and antibiotics.
After 10Tx
Follow-up: Happy Smile
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Side Effects of HBO
• Claustrophobia/ Confinement anxiety• Barotrauma• Reversible myopia
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Contraindications
Absolute: • Untreated pneumothorax• Cis-Platin; Doxorubicin; Disulfiram• Emphysema w/air trapping
Relative:• Emphysema with CO2 retension• Pulmonary lesion in CXR• Uncontrolled high fever• Claustrophobia• Seizure disorder• Malignant disease
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InsuranceContracts/ agreements with:• HHP
• Senior Care Plus
• Blue Cross
• Aetna
• CIGNA
• Senior Dimensions
• Universal Health Network
• Principal Financial
• Nevada Preferred Professionals
• Humana
• Regence Blue Cross Blue Shield
• Wellcare
• Tri-Care
• Can treat secondary plans to Medicare
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How To Consult or Refer
Call us 24/7 at (775) 826-2084
We do most pre-authorizations for you!