Northern Nevada Hyperbarics - Oxygen Therapy - Powerpoint

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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.

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Northern Nevada Hyperbarics - Oxygen Therapy - Powerpoint

  1. 1. Northern Nevada Hyperbarics, Inc. Serving the Community for 8 Years <ul><li>(775) 826-2084 </li></ul><ul><li>1698 Meadowood Ln., #100 </li></ul><ul><li>www.nevadahyperbarics.com </li></ul>
  2. 2. What is HBO <ul><li>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. </li></ul><ul><li>Typical course consists of 30 or more treatments done daily for six weeks. </li></ul>
  3. 3. Some Basics <ul><li>HBOT has been used in chronic wounds for about 40 years. </li></ul><ul><li>100% oxygen is delivered to a chamber under high pressure (2 to 2.4 ATA) for 90 minutes </li></ul><ul><li>Typical HBOT treatment course consists of 30 or more treatments daily—M-F </li></ul><ul><li>Administering oxygen to hypoxic tissue shown to activate fibroblast proliferation, down-regulate inflammatory responses, cytokines, up-regulate growth factors – all proxies for wound healing. </li></ul>
  4. 4. Hyperbaric Chamber Designs
  5. 5. Our Facility <ul><li>2 Sechrist Monoplace Chambers </li></ul>
  6. 6. Clinical Hyperbaric Oxygen Therapy Clinical Hyperbaric Oxygen Therapy <ul><li>Emergency Indications </li></ul><ul><li>Acute Traumatic Ischemia </li></ul><ul><li>Crush Injuries and </li></ul><ul><li>Compartment Syndrome </li></ul><ul><li>Carbon Monoxide Poisoning </li></ul><ul><li>Gas Gangrene </li></ul><ul><li>Surgical Infections </li></ul><ul><li>Failed Flaps and Grafts </li></ul><ul><li>Diving Injuries </li></ul><ul><li>Scheduled Indications </li></ul><ul><li>Non-Healing Diabetic and problem Wounds </li></ul><ul><li>Radiation soft tissue necrosis, cystitis, and proctitis. </li></ul><ul><li>Osteoradionecrosis </li></ul><ul><li>Osteomyelitis </li></ul>
  7. 7. Primary Mechanisms <ul><li>Hyper---oxygenation </li></ul><ul><li>Vasoconstriction—reduce inflammation </li></ul><ul><li>Microbiological effects </li></ul><ul><li>Activate fibroblast and collagen synthesis </li></ul>
  8. 8. Secondary Mechanisms <ul><li>Angiogenesis </li></ul><ul><li>Osteogenesis </li></ul><ul><li>WBC Oxidative Killing </li></ul><ul><li>Cell wall permeation </li></ul>
  9. 9. Cumulative Effects
  10. 10. Vascular Density in Response to Hyperbaric O2 Response to 20 x 1ATA 100% O2 Response to 20 x 2.4ATA 100% O2 8 x increase in vascular density
  11. 11. Vascular Density Increase No HBO Start HBO 18 Tx 24 Tx
  12. 12. Diabetic Wound with Recalcitrant Osteomyelitis 78 Y.O Male/ 2 Wks Resection Bone / Continued Drainage <ul><ul><li>Pre-Hyperbaric </li></ul></ul><ul><ul><li>Partial Wound Closure </li></ul></ul><ul><ul><li>20 HBO2 TX---4 Weeks </li></ul></ul><ul><ul><li>Complication Resolved </li></ul></ul><ul><ul><li>Full Healing </li></ul></ul><ul><ul><li>35 HBO2 TX </li></ul></ul><ul><ul><li>7 Weeks </li></ul></ul>
  13. 13. Problem Wound w/Skin Graft Failure 58 Y.O. Female/ Diabetic/ 6mo. Non-healing /one failed graft <ul><li>u </li></ul>After 25 Tx---5 Weeks---beefy, red, healthy granulation tissue Split thickness graft placed--- 100% take
  14. 14. Tissue Necrosis in Diabetic Foot 69 Y.O. Diabetic Female/ w Exposed Tendon <ul><li>After 15 Tx—2 Week </li></ul><ul><li>Granulation tissue </li></ul>Required incision, drainage, and debridement After 20 Tx---3 Week After 30 Tx---4 Week
  15. 15. Non-Healing Post Amputation 46 Y.O. Diabetic Male Initial Visit After 10 Tx After 16 Tx After 34 Tx
  16. 16. Achilles Tendon repair Site After 10 tx’s After 25 tx’s
  17. 17. Problem Wound Non healing Transmetatarsal Amputation Non-healing suture line 3 months post Healing after 25 HBO TX Medial View
  18. 18. Left Mandibular Osteoradionecrosis 45 Y.O. Male/ Radical neck dissection/ radiation/ Exposed Bone Initial Visit—Bone Exposed Tx 12—2 Weeks Tx 25---5 Weeks Tx 39---8 Weeks New skin over bone
  19. 19. Radiation Soft Tissue Necrosis 52 Y.O. Male/ Post Radical Neck Reconstruction/ Wound Dehiscence and Flap Compromise After 8 Tx—2 Weeks After 36 Tx---7 Weeks After 18 Tx---4 Weeks
  20. 20. Radiation necrosis with incision dehiscence 51 yo female/ neck dissection 12 TX 21 TX 36 TX Three weeks post tx
  21. 21. Soft Tissue Radiation Necrosis 40 Y.O. Male post T-cell Lymphoma—Rt. hand Initial Visit Tx 7---1 Week Tx 24---5 Weeks Tx 50---10 Weeks No need for graft
  22. 22. Graft Placement post Radiation Necrosis 2 months post-surgery After 20 HBO TX 10 days after spilt thickness graft
  23. 23. Crush Injury Avulsion of the Palmar Skin <ul><li>decreased perfusion or hypoxia </li></ul><ul><li>» HBO at </li></ul>11 Weeks after Surgery---Full Range of Motion 3 Tx in first 24hrs. Then total of 20 over a period of 4 weeks.
  24. 24. Traumatic Ischemia—of a Replanted Leg 4 Y.O. Mid-Calf Amputation from Lawnmower <ul><li>Microvascular reattachment of nerves and arteries </li></ul>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.
  25. 25. Healing Compromised Flap of Tibia Fracture 54 Y.O. Male with Tibia Fracture and Internal Fixation <ul><li>Necrosis and </li></ul><ul><li>breakdown of </li></ul><ul><li>tissue over plate </li></ul><ul><li>and bone </li></ul>After 10 Tx--- 1 Week---compromised portion of flap is now viable After 20 Tx---3 Week— 100% flap survival
  26. 26. Failed Flap — Left Dorsal Foot 50 Y.O. Female/ Degloving Accident Tx 1 Tx 30---5 Weeks Tx 18---3 Weeks Tx 12---2 Weeks Follow-Up 3 Weeks Final Follow-Up
  27. 27. 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’s C-72 hrs later and 6 tx’s D-Shortly before discharge
  28. 28. Failed Flap – Right Knee 62 Y.O. Female/ Failed flap post total knee replacement Tx 9—Two Weeks Tx 16---3 Weeks Initial Visit
  29. 29. Lip Reimplantation 10 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
  30. 30. Side Effects of HBO <ul><ul><li>Claustrophobia/ Confinement anxiety </li></ul></ul><ul><ul><li>Barotrauma </li></ul></ul><ul><ul><li>Reversible myopia </li></ul></ul>
  31. 31. Contraindications <ul><li>Absolute: </li></ul><ul><li>Untreated pneumothorax </li></ul><ul><li>Cis-Platin; Doxorubicin; Disulfiram </li></ul><ul><li>Emphysema w/air trapping </li></ul><ul><li>Relative: </li></ul><ul><li>Emphysema with CO 2 retension </li></ul><ul><li>Pulmonary lesion in CXR </li></ul><ul><li>Uncontrolled high fever </li></ul><ul><li>Claustrophobia </li></ul><ul><li>Seizure disorder </li></ul><ul><li>Malignant disease </li></ul>
  32. 32. Insurance <ul><li>Contracts/ agreements with: </li></ul><ul><li>HHP </li></ul><ul><li>Senior Care Plus </li></ul><ul><li>Blue Cross </li></ul><ul><li>Aetna </li></ul><ul><li>CIGNA </li></ul><ul><li>Senior Dimensions </li></ul><ul><li>Universal Health Network </li></ul><ul><li>Principal Financial </li></ul><ul><li>Nevada Preferred Professionals </li></ul><ul><li>Humana </li></ul><ul><li>Regence Blue Cross Blue Shield </li></ul><ul><li>Wellcare </li></ul><ul><li>Tri-Care </li></ul><ul><li>Can treat secondary plans to Medicare </li></ul>
  33. 33. How To Consult or Refer <ul><li>Call us 24/7 at (775) 826-2084 </li></ul><ul><li>We do most pre-authorizations for you! </li></ul>

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