IS HYPERBARIC-OXYGEN A USEFUL ADJUNCT IN THE MANAGEMENT OF PROBLEM LOWER-EXTREMITY WOUNDS

Hyperbaric oxygen (HBO) is currently being used in the treatment of no nhealing or ''problem'' wounds of the lower extremities. In an attempt to evaluate the efficacy of HBO in problem wounds, a retrospective st udy of the HBO experience at Orlando Regional Medical Center was condu cted. From 1989 to 1994, fifty-four patients with nonhealing lower ext remity wounds resulting from underlying peripheral vascular disease an d/or diabetes mellitus were treated with HBO. Wounds were grouped into the following five categories: (1) diabetic ulcers (n = 17 [31%]); (2 ) arterial insufficiency (n = 8 [15%]); (3) gangrenous lesions (n = 6 [11%]); (4) nonhealing amputation stumps (n = 13 [24%]); and (5) nonhe aling operative wounds (n = 10 [19%]). Each patient received an averag e of 30 treatments. Outcomes for all 54 patients treated with HBO in t his study were dismal. None of the patients experienced complete heali ng, six (11%) showed some improvement, 43 (30%) showed no improvement, and in five cases (9%) results were inconclusive because these patien ts underwent concomitant revascularization or amputation. Thirty-eight of the 43 patients who showed no improvement (88%) ultimately require d at least one surgical procedure to treat their wounds. Thirty-four p atients (63%) developed complications, most commonly barotrauma to the ears, which occurred in 23 patients (43%). The average cost of 30 HBO treatments was $14,000 excluding daily inpatient charges. Based on th e experience with HBO therapy at Orlando Regional Medical Center and t he paucity of good supporting literature, it is difficult to justify s uch an expensive, ineffective, complication-prone treatment modality f or problem extremity wounds.