FOR WOUND CARE
by Donna Medina, RN, BSN
Diabetes mellitus is a major health problem that
affects as many as 16 million Americans. One of its major
complications is non-healing foot wounds and infections.
Twenty percent of current diabetics either have a foot wound
or have had one within past years. Diabetics account for
60% of the non-traumatic amputations in the world.
Several factors influence the diabetic toward the
development of infected, non-healing wounds. Diabetics can
develop neuropathy, decreased level of sensation, in their
feet and legs, making wounds difficult to detect before they
become infected or septic. Also, diabetics can have
ischemia, poor circulation, in their feet. If a wound or
ulcer develops in the foot, healing is difficult, as the
impaired circulation delivers decreased levels of oxygen to
the wound. Diabetics can develop such poor lower extremity
circulation that spontaneous tissue breakdown can occur.
Because of these two factors, indetectability and poor
circulation, diabetic foot wounds are prone to infection.
Allowed to progress, such infection, with its increased
demands upon an already weakened circulatory system, and the
tissue damage from the resultant swelling, can lead to
further complications, such as osteomyelitis, bone
inflammation. Once such a major uncontrolled infection
occurs in a diabetic's foot wound, amputation of the limb
may be necessary.
Hyperbaric medicine is the therapeutic delivery of 100%
oxygen under atmospheric pressure greater than that found
at sea level. It is well known that hypoxia (oxygen
insufficiency) and infection are primary causes of problem
wounds, and hyperbaric medicine specifically addresses both
these factors. This has been verified by extensive research
and clinical experience.
Hyperbaric delivery of oxygen provides a major increase
in tissue oxygenation in an infected wound. It promotes
wound healing by assisting with the replication of
fibroblasts, formation of collagen, and creating new
capillary beds at the wound site, thus increasing endogenous
oxygen level. It also has a bactericidal effect by
increasing oxygen radicals.
Diabetics need to be aware that hyperbaric medicine may
be able to help heal their problem wound, and may help
prevent an amputation. Hyperbaric treatment for diabetic
wounds is approved by Medicare, Medicaid and most insurance
companies for payment.
Hyperbaric units have multiplied in the past few years,
but there are still only a limited number available. To
locate such a facility, please contact: The Undersea and
Hyperbaric Medical Society, 10531 Metropolitan Ave.,
Kensington, MD 20895; telephone: (301) 942-2980. They
offer a directory of hyperbaric facilities: "The Chamber
Directory; U.S. and Canada", which they will furnish for $25
(plus $5 shipping).