Northern Nevada Hyperbarics Presentation

Northern Nevada Hyperbarics, Inc. Serving the Community for over 10 Years
(775) 826-2084
Center for Advanced Medicine - B 1500 E. Second St., Ste. 104 www.nevadahyperbarics.com

What is HBOT?
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.

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.

Our State-of-the-Art Facility

5 Sechrist Monoplace Chambers Safe & Secure Oxygen Farm

Courteous & Professional Staff Janet Albright, MD, FACS Medical Director Richard Flyer, MS Clinic Director And Staff of Certified Hyperbaric Technologists

Clinical Hyperbaric Oxygen Therapy Clinical HyperbaricOxygen Therapy
Scheduled Indications
Non-Healing Diabetic and problem Wounds
Radiation soft tissue necrosis, cystitis, and proctitis.
Osteoradionecrosis
Osteomyelitis
Emergency Indications
Acute Traumatic Ischemia
Crush Injuries and
Compartment Syndrome
Carbon Monoxide Poisoning
Gas Gangrene
Surgical Infections
Failed Flaps and Grafts
Diving Injuries

Primary Mechanisms
Hyper---oxygenation
Vasoconstriction—reduce inflammation
Microbiological effects
Activate fibroblast and collagen synthesis

Secondary Mechanisms
Angiogenesis
Osteogenesis
WBC Oxidative Killing
Cell wall permeation

Cumulative Effects

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

Vascular Density Increase No HBO Start HBO 18 Tx 24 Tx

Diabetic Wound w/ Recalcitrant Osteomyelitis
Pre-Hyperbaric
Partial Wound Closure
20 HBO2 TX---4 Weeks
Complication Resolved
Full Healing
35 HBO2 TX
7 Weeks
78 Y.O Male/ 2 Wks Resection Bone / Continued Drainage

Problem Wound w/ Skin Graft Failure
u
After 25 Tx---5 Weeks---beefy, red, healthy granulation tissue Split thickness graft placed--- 100% take 58 Y.O. Female / Diabetic / 6mo. Non-healing / 1 Failed Graft

Tissue Necrosis in Diabetic Foot
After 15 Tx—2 Week
Granulation tissue
Required incision, drainage, and debridement After 20 Tx---3 Week After 30 Tx---4 Week 69 Y.O. Diabetic Female / with Exposed Tendon

Non-Healing Post Amputation Initial Visit After 10 Tx After 16 Tx After 34 Tx 46 Year-Old Diabetic Male

Achilles Tendon Repair Site After 10 tx’s After 25 tx’s

Problem Wound Non-healing suture line 3 months post Healing after 25 HBO TX Medial View Non Healing Transmetatarsal Amputation

Left Mandibular Osteoradionecrosis Initial Visit - Bone Exposed Tx 12 - 2 Weeks Tx 25 - 5 Weeks Tx 39 - 8 Weeks New skin over bone 45 Y.O. Male / Radical Neck Dissection / Radiation / Exposed Bone

Radiation Soft Tissue Necrosis After 8 Tx—2 Weeks After 36 Tx---7 Weeks After 18 Tx---4 Weeks 52 Year-Old Male w/ Post-Radical Neck Reconstruction Wound Dehiscence & Flap Compromise

Radiation Necrosis w/ Incision Dehiscence 12 TX 21 TX 36 TX Three weeks post tx 51 Year-Old Female w/ Neck Dissection

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

Graft Placement Post-Radiation Necrosis 2 Months Post-Surgery After 20x HBOTs 10 Days After Spilt Thickness Graft

Crush Injury
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. Avulsion of the Palmar Skin

Traumatic Ischemia of a Replanted Leg
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. 4 Year-Old Mid-Calf Amputation from Lawnmower

Healing Compromised Flap of Tibia Fracture
Necrosis and
breakdown of
tissue over plate
and bone
After 10 Tx--- 1 Week---compromised portion of flap is now viable After 20 Tx---3 Week— 100% flap survival 54 Year-Old Male w/ Tibia Fracture and Internal Fixation

Failed Flap - Left Dorsal Foot Tx 1 Tx 30---5 Weeks Tx 18---3 Weeks Tx 12---2 Weeks Follow-Up 3 Weeks Final Follow-Up 50 Year-Old Female w/ Degloving Accident

Healing Burns A C B D A) 12 hrs after injury B) 24 hrs & 2x HBOTs C) 24 hrs & 2x HBOTs D) Shortly before discharge 23 YO Female w/ Facial Burns From Flaming Gasoline

Failed Flap – Right Knee Tx 9—Two Weeks Tx 16---3 Weeks Initial Visit 62 Y.O. Female w/ Failed Flap Post Total Knee eplacement

Lip Reimplantation Re-attached wound looked ischemic and swollen. Patient started hyperbarics and antibiotics. After 10Tx Follow-up: Happy Smile 10 Year-Old Female w/ Full Thickness Lesion From a Dog Bite

Side Effects of HBOT
Claustrophobia / Confinement Anxiety
Barotrauma
Reversible Myopia

Contraindications
Absolute:
Untreated Pneumothorax
Cis-Platin; Doxorubicin; Disulfiram
Relative:
Emphysema with CO 2 Retension
Emphysema w/ Air Trapping
Pulmonary Lesion in CXR
Uncontrolled High Fever
Claustrophobia
Seizure Disorder
Malignant Disease

Insurance
Contracts / 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
Medicare and Medicaid (through our partnership with Renown Health)

How To Consult or Refer
Call us 24/7 at (775) 826-2084
or Visit Us at
www.NevadaHyperbarics.com
We do most pre-authorizations for you!

Northern Nevada Hyperbarics Presentation

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