This modality of treatment may be considered as adjunctive treatment in patients who fulfill the Medicare Guidelines of treatment for some conditions such as:
Radiation tissue or bone damage
Severe diabetic lower extremity wounds
Skin grafts or flaps
Enhancement of healing in selected problem wounds
Please do not smoke during your any of your treatments as nicotine will interfere with the blood flow to the wound. Also, for safety reasons, please come to the chamber clean without any of the following products on your body:
Perfume or aftershave
Hairsprays or oils
Nothing in your mouth such as gum, loose dentures or candy
Wigs or hairpieces
Nail polish that has been on less than 24 hours
Hyperbaric oxygen treatment therapy is a safe and evidence –based therapy proven to expedite the healing process of certain types of wounds. The clear chambers are equipped with televisions and comfortable bedding, so patients can watch their favorite television show, DVD or just take a nap.
In the clear chambers, the patient breathes 100% pressurized oxygen which quickly increases the concentration of oxygen in the blood. You may experience fullness in your ears as you would while flying in an airplane or scuba diving. There are maneuvers you may perform to help equalize your ear pressures. We may assist this with medications as well as treat you with medications to address any issues of claustrophobia. This hyperbaric oxygen therapy allows increased dissolved oxygen to nourish the wound facilitating its healing. It also stimulates the patient’s stem cells to activate, growth factors to be released, and new blood vessels to form. The increase oxygen in the blood assists the delivery system of antibiotics to the area and kills anaerobic bacteria. The total treatment time from Monday to Friday is about 120 minutes over a 4-6 week period of time. A physician is always on the premises during your treatment periods. Commitment to maintaining your appointments is important for this treatment to work along with your weekly wound care evaluations.
Transcutaneous Oxymetry Test (TcPO2)
TcPO2 stand for transcutaneous oxymetry test. This is a study that evaluates the circulation in the small blood vessels and the oxygen that the wound receives. Blocked or damaged blood vessels, if severe enough, can interfere with the healing process by decreasing the amount of oxygen that is available for the wound to heal.
During this study, you will lie flat and the sensors are placed around the wound. These sensors measure the oxygen that is getting to the wound. This process is painless and will take about 45 minutes to complete.
Peripheral arterial disease is a narrowing or blockage of your arteries that delivers blood to the legs. When the blood flow to your legs and feet is decreased, it affects the health of the skin and ulcers can develop. This poor circulation can be why an ulcer doesn’t heal. The tissues in the body need oxygen to stay healthy. People with PAD also have an increase risk of stroke and heart attack.
Venous insufficiency refers to veins in your legs that don’t work properly. This can cause leg swelling. When there is too much swelling, the skin can open up and ulcerate. Your skin tends to darken from the excess fluid in your legs. This swelling can also prevent wounds on your legs from healing.
Venous disease may cause:
Dark discoloration of your skin
Leg pain and increase swelling when your legs are down
Swollen legs and feet
Pain that goes away with elevation of the legs
Damaged veins are caused by:
Injury to the veins from trauma
The development of blood clots
Venous Leg Ulcer Treatment Options
Venous leg ulcer treatments are aimed at decreasing the swelling and the subsequent increased pressure that occurs causing the ulcers. These treatments will involve compression of your legs to decrease the swelling. You will be evaluated for the cause of your swelling and the treatments may involve skin substitute agents, skin grafting or other medications to aid in your healing. You will also be evaluated to see if surgery is an option to remove the damaged veins.
Veins have valves that will close to prevent blood from flowing backwards. When these valves cannot close properly, the blood will backflow and pool into your legs. When the pressure becomes great, it can leak out of the veins, pooling into the tissues, and ulcers can form.
Life style changes you can do:
Exercise: especially walking
By making these changes, you help us to help you. It is a team effort in getting your ulcers to heal.
Application of total contact cast
Neuropathy is caused by nerve damage. Over half of diabetics develop peripheral neuropathy and is the number one cause. Other causes include injuries, alcoholism, advanced age, certain medications, and diseases of the nervous system.
In people with diabetes, the elevated blood sugar can damage small blood vessels. This blood supply is needed to nourish the nerves. This decrease in blood supply causes the nerves to be damaged. This is mostly noted in the hands and feet.
The change in sensation, particularly in the feet, predisposes the patient to sustaining injuries. These injuries can easily be caused by excessive pressure or trauma to the feet. This decrease sensation is a loss of protection in knowing when there is a rock in your shoe or a blister forming. These wounds can become infected, become difficult to heal, and put the patient at great risk for possible amputation.
Dr. Najwa Javed and Christine, RN
The process of debridement is to remove dead and unhealthy tissue that is preventing your wound from healing. During this process we will evaluate for the presence of infection. Your weekly visits to the wound care center may involve numbing the wound to perform the debridements. When your wound is clean, we may use specialized products to promote healthy tissue to fill in the wound.
Diabetes is a disease where the body cannot process the sugar (glucose) in the blood. In type I diabetes, the pancreas does not produce any insulin. Insulin is required to move the glucose in the blood into the cells to be converted into energy. In type II diabetes, the body does not use the insulin properly. Over time, the pancreas can no longer produce enough insulin to keep the blood sugar within normal limits. Too much sugar will stay in the blood and can harm your body. Diabetes is a chronic problem that requires medical attention and management.
Signs and Symptoms of Diabetes:
High blood sugar
Sugar in the urine
Elevated blood sugars can delay your wound to heal or not heal at all. It is extremely important that you monitor and keep your blood sugars under control. This is one of the most important things you can do to assist in the healing of your wound.
Elevated blood sugars:
Affect your ability to fight infections
Cause nerve damage (peripheral neuropathy)
Contributes to severe infections that can lead to amputations
What you can do:
Following a diabetic diet
Exercise: 30-60 minutes everyday
Keep a log book of your blood sugars and keep them under control
Taking medications even when you are feeling well
Regular follow-up with your doctor
In addition you can:
Inspect your feet daily and keep them clean and dry
Do not walk barefooted and wear good fitting shoes
Trim your toenails straight across only (if your toenails are thick, see a podiatrist)
Avoid cutting on your ulcers or calluses (see a podiatrist or go to a wound care center)
What are the signs of wound or bone infection?
The following are some common signs of wound or bone infection:
Increasing redness or a red streak from the wound
Increased or persistent drainage
The wound persists or gets bigger
Fever or chills
The wound has dead tissue or blisters
The wound doesn’t heal
What we do at Wound Care Center:
In addition to debriding (cleaning) the wound on each visit, we may get:
Cultures of the wound and/or bone
A biopsy of the wound or bone
X-rays, MRI, or CAT scans
How can I avoid amputation?
Each year many patients with diabetes get a lower leg amputation. Sixty to 70% of Diabetics can develop peripheral neuropathy. Peripheral neuropathy is a common nerve problem that can cause pain, tingling, or no feeling at all. This decrease sensation can lead to injuries that can go un-noticed, fail to heal, lead to infections, and occasionally a limb that may need to be removed. Fifteen percent of all people with diabetes can develop a foot ulcer.
The American Diabetes Association states that amputation may be reduced in half if people:
Were tested for peripheral neuropathy
Inspect their feet every night and keep them clean and dry
Wear proper fitting shoes
It is very important that wounds be identified immediately and be treated appropriately. Our goal is to treat and teach patients about diabetic ulcers to prevent amputations. We are aggressive in our treatment plan to aid you in the most effective way to heal.
Why is it important for me to stop smoking?
It is important to stop smoking to help your wounds to heal. Tobacco contains nicotine which causes your arteries to narrow and spasm. This narrowing of the blood vessels decreases its ability to deliver oxygen and other nutrients to the wound. This decrease in oxygen and nutrients will slow or prevent the wound from healing.