Hyperbaric Oxygen Therapy in Wound Care: Evidence that Demands a Verdict

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by Thomas E. Serena MD, FACS, FACHM, FAPWCA

I owe my humble thanks to GK Chesterton, the Christian apologist, for the title of this blog. In Chesterton’s book of the same title he observes that men have a strong tendency to cling to a deeply held belief despite overwhelming evidence to the contrary.This is true as it applies to the current thinking surrounding hyperbaric oxygen therapy.

Browsing through the brochures for this season’s wound care meetings, I was sure that Chesterton was speaking about the wound care community. There are numerous lectures extolling the effectiveness of alginates and antimicrobials, scaffolds, and ointments. However, the hyperbaric oxygen lectures tend to have titles that suggest that its effectiveness is in doubt (e.g. HBO effective or a hoax?).

In truth, the evidence for HBOT therapy is robust, while the evidence for most of our dressings and devices is based on poorly conducted trials, case studies, or simple opinion. HBOT for diabetic foot ulcers has been confirmed by four randomized controlled trials (RCTs) with more research underway. The evidence is stronger for tissues affected by the long term effects of radiation. More is known about the mechanism of action of oxygen under pressure than the majority of adjunct therapies.

The evidence indeed supports a verdict: HBO is an effective adjunctive therapy in the care of chronic wounds, and for approved indications, such as Wagner III diabetic ulcers, it is the standard of care.

Now, there is a dark side to the Hyperbaric Oxygen issue. Although it is incongruous to position Chesterton and Nietzsche on the same side of an argument, the latter’s observation that he often refused to abandon an argument, simply because his opponent’s position was so “insipid,” definitely has some purchase here. For the most part, the naysayers of Hyperbaric Medicine have constructed their quarrel not against hospital-based programs, but against the snake oil touts that set up HBO chambers in local shopping centers, charging cash for non-approved conditions such as Autism, stroke, MS, and other neurological disorders. There are more claims for miraculous healing here than at an Elmer Gantry tent meeting on a hot August night.

This practice is unfortunate and widespread—google HBOT and check it out. Such a practice, although appalling, is not grounds for an argument. It’s a straw man. As I indicated earlier, a hospital based HBO program addressing the thirteen approved conditions for the service, provides a great and needed service, especially for the diabetic population facing unnecessary limb amputation.

About The Author
Dr. Thomas Serena has published more than 75 peer-reviewed papers and has made in excess of 200 presentations worldwide. He has been elected to the Board of Directors of both The Wound Healing Society and the American College of Hyperbaric Medicine (ACHM), the leading academic society in the field of Hyperbaric Medicine. In 2013 Dr. Serena was elected vice president of the American Professional Wound Care Association (APWCA). Dr. Serena has opened and operates Wound Care and hyperbaric oxygen treatment clinics across the United States.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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Dr. Serena: Though my experience with HBOT has been somewhat dubious, I heartily agree with your assertion many wound care specialists' treatment algorithms are "Chestertonian" in nature. I pull my hair out when listening to the explanations of why clinicians use such things as H2O2; Domeboro solution; Betadine; full-strength Dakins; even DuoDerm; etc. to wounds. The responses are as silly as a kindergartner answering "Because" to everything. It is pathetic that in this era when everybody, including Wound Care Specialists, tout their certification as evidence of their superior knowledge, that so much wound care voodoo is tolerated. But when residents and nursing students are still being trained about wound care best practices with a mantra of simply "do as I do" without a hint of scientific explanation to go along with it (often because there is none), the subspecialty of wound care will continue to suffer with unpredictable and less than satisfactory outcomes.

As you correctly say, RCT and other evidence supports HBOT. Thus, it should remain a part of our wound treatment armamentarium.

John Baeke, MD
Plastic Surgery

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