Hyperbaric oxygen therapy for ischemic wounds in Jordan
علاج الجروح ضعيفة التروية بالأكسجين المضغوط
Hyperbaric oxygen therapy for poorly perfused wounds means adding sessions of breathing high-concentration oxygen inside a pressurised chamber to the treatment of a wound that has not healed because the oxygen reaching its tissue falls short of what healing requires. Raised pressure dissolves much more oxygen into blood plasma, so oxygen reaches tissue that damaged capillaries can no longer supply, supporting new blood vessels, new tissue and resistance to infection. This is a medically accepted use, but it is accepted for selected wounds rather than for every wound that is slow to heal. The typical candidate is a chronic wound in which low tissue oxygen has been demonstrated, a wound in tissue previously exposed to radiotherapy, a surgical graft or flap failing because of poor perfusion, or an acute crush injury that has interrupted blood supply. Transcutaneous measurement of tissue oxygen is a useful tool for separating a wound that will benefit from one that will not. What the treatment does not do matters more than how it is marketed. Hyperbaric oxygen does not open a blocked artery; where the blockage can be treated, angioplasty or bypass surgery comes first and is not replaced by chamber sessions. It does not clear dead tissue, so surgical debridement remains necessary, and it does not cure bone infection on its own or remove the need for culture-directed antibiotics. It is also not a treatment for a venous leg ulcer, which needs compression and leg elevation, nor for a pressure sore, which needs pressure relief, nutrition and careful positioning. Treatment is a course of repeated sessions over weeks rather than a single visit, and its value is judged objectively: wound area and depth, the tissue in the wound bed, and advancing edges. If no meaningful improvement appears after a reasonable period, the right response is to review the diagnosis, the blood supply, any infection and the decision to continue, not to extend the course indefinitely. The chamber does not suit every patient. Untreated pneumothorax is an absolute barrier, active sinus or ear infection postpones the session, certain chemotherapy agents conflict with high-concentration oxygen, uncontrolled epilepsy must be controlled first, pregnancy is excluded except in carbon monoxide poisoning, and claustrophobia needs explanation and preparation before entry.
Procedure steps
- 1
Diagnosing why the wound is not healing
Sessions are not prescribed for a slow wound without an explanation. The cause is sought first: arterial blockage, venous congestion, continued pressure on the site, infection, bone infection, previously irradiated tissue, uncontrolled diabetes, poor nutrition, or a drug effect. The wound is photographed and measured to serve as a baseline. Eligibility is decided by this assessment, not by how long the wound has lasted.
- 2
Assessing perfusion and tissue oxygen
Blood flow is assessed with pulses, Doppler and pressure measurements, and tissue oxygen may be measured through the skin around the wound to establish whether the deficit is the type that responds to hyperbaric oxygen. If a treatable arterial blockage is found, revascularisation takes priority over sessions. This step is what prevents spending a long programme on a wound that cannot benefit.
- 3
Core wound care before and during sessions
Dead tissue is removed surgically, infection is treated with culture-directed antibiotics, an appropriate dressing is chosen, pressure is relieved from the site or compression applied according to the wound type, and blood sugar, nutrition and smoking cessation are addressed. Hyperbaric oxygen is added to this plan rather than replacing it, and without it no worthwhile effect should be expected.
- 4
Chamber preparation and the session
Your ears, sinuses and lungs are examined, your medications reviewed, and you are shown in practice how to equalise ear pressure. Fire-safety rules then apply: designated clothing and no oils, greasy ointments, perfumes, lighters, phones or electronic devices. Inside the chamber, pressure is raised gradually, oxygen is breathed for a set period, and pressure is then lowered. **Severe ear pain or bleeding from the ear stops the session.**
- 5
Measuring response and reviewing the decision
Sessions continue as a programme and the wound is measured at intervals: area, depth, the tissue in its bed and advancing edges, with tissue oxygen sometimes re-measured. Objective improvement is what justifies continuing. If progress stalls, perfusion, infection, the diagnosis and the value of the programme are all reconsidered, rather than extending it without limit on hope alone.
Before the procedure
Give the doctor the full history of the wound: when and how it started, and everything tried for it, including dressings, operations and antibiotics, whether you have had angioplasty or arterial surgery, and whether the area was previously treated with radiotherapy. Report all medications, including blood thinners, steroids and any chemotherapy, and any epilepsy or seizures, chronic lung disease, previous collapsed lung or ear surgery, and say if you are pregnant or might be. Contact the centre to postpone the session if you develop a cold, blocked nose, or an ear or sinus infection, because a blocked ear is the commonest source of pain inside a chamber, and learn and practise the equalisation technique before entry. Eat a light meal rather than arriving fasting, and check your blood sugar if you have diabetes. Do not smoke: smoking itself reduces the oxygen reaching your wound and works directly against the treatment. Wear no oil, greasy ointment, rich cream, perfume or deodorant, and take no lighter, phone or smart watch into the chamber, as this is a fire-safety rule. If closed spaces frighten you, say so in advance so preparation can be arranged.
After the procedure
Keep to the wound plan as prescribed: dressings on schedule, pressure relief or compression according to your wound type, any antibiotic course completed, blood-sugar control, adequate protein intake, and no smoking. Do not stop any treatment because sessions have started. Check your blood sugar after a session, as it can drop in some patients. Do not drive while dizzy or while vision is blurred, and if your vision shifts as the course progresses, that change is usually temporary and reverses after sessions end. Photograph the wound at intervals if asked, to make comparison easier. **Seek care immediately for fever or shivering; rapidly spreading redness and swelling; pus or a foul smell; unusually increasing pain; new blackening at the wound edges; a cold, pale or blue limb or loss of sensation in it; severe ear pain, bleeding from the ear or hearing loss; shortness of breath or chest pain; or a seizure or twitching.**
Expected duration
A single session usually lasts sixty to one hundred and twenty minutes, plus preparation and observation. Treatment is a programme rather than one visit: chronic wounds typically need about twenty to forty sessions at roughly one per weekday, while acute crush injuries may be treated with closely spaced sessions in the first days, and the programme is reviewed by measuring the wound at intervals.
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