By Lauren Lazarevski, RN, BSN, CWOCN
As summer begins to wind down and we look ahead to Halloween, let’s discuss some “creepy crawlies” we may encounter in wound care that may cause apprehension in even the most seasoned health care staff.
By Bruce E. Ruben MD
In order to understand the use of Hyperbaric Oxygen Therapy (HBOT) to heal burns, it is first important to understand the four burn classifications.
A first-degree or superficial burn affects only the epidermis or outer layer of skin. The burn site is red, painful, and dry with no blistering. A mild sunburn is one example of a first-degree burn. Long-term tissue damage is rare and usually consists of a lightening or a darkening in the skin color.
In a second-degree or partial-thickness burn, the epidermis and part of the dermis layer of skin are damaged. The burn site appears red, blistered, and may be swollen and painful.
With a third-degree or full-thickness burn, the epidermis and dermis are destroyed. Burns where there is also damage to the underlying tendon, muscle, and bone are considered to be fourth-degree burns. The burn site appears white or charred and no sensation is felt in the area because the nerve endings have been destroyed and worse, the blood vessels carrying needed oxygen have also been destroyed.
Therapeutic use of HBOT in burns is most often utilized for second and third degree burn cases. In third degree burns, the initial thermal injury occurs followed by circumferential, widening tissue loss. This means that the surrounding tissue of the burn also becomes damaged because the blood vessels have been destroyed as a consequence of the burn. When the blood vessels are destroyed, downstream blood flow from the burn site is arrested, propagating further tissue death due to a lack of oxygen.
When tissue death occurs, the body does not recognize that tissue as its own and perceives that it is a potentially harmful invader. This jeopardized tissue becomes a target for its own immune system and "attacks" the dying and surrounding tissues, resulting in more tissue death. This process is called ischemia reperfusion injury.
HBOT given within the first 48 to 72 hours following thermal injury increases the oxygen saturation to the body by up to 12 times that of breathing air at sea level. This can mitigate ischemia reperfusion injury and the possibility of advanced tissue destruction beyond the initial area of thermal injury by supplying the body with added oxygen that, in turn, can bring the damaged area "back to life." This signals the body that the tissue is no longer a foreign invader and consequently, normal wound-healing processes are able to take place.
Beyond 72 hours, HBOT helps by continuing to promote new tissue growth, which encourages healing by aiding in the manufacturing of new blood vessels, which, in turn, make fibroblasts that are responsible for collagen production. In addition, HBOT reduces the body's inflammation which otherwise would slow down the healing process. Finally, HBOT also offers infection control, as oxygen is the white blood cell's weapon to kill bacteria.
In short, serious thermal burns patient are great candidates for hyperbaric oxygen therapy due to the mitigation of ischemia reperfusion injury, the promotion of new blood vessels and tissue growth, and the control of infection.
About the Author
Dr. Bruce Ruben is the Founder and Medical Director of Encompass HealthCare, located in West Bloomfield, Michigan. Encompass Healthcare is an outpatient facility featuring advanced wound care, IV antibiotic therapies, hyperbaric oxygen treatment, nutritional assessment, and other treatment modalities. Dr. Ruben is board certified in Internal Medicine, Infectious Disease, and in Undersea and Hyperbaric Medicine. He is a member of the Medical and Scientific Advisory Committee and National Spinal Cord Injury Association (NSCIA) board.
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.