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Hyperbaric Oxygen Therapy among most advanced techniques provided to patients

When Antonio Filipe, 67, showed up last May at the Emergency Department at Thomas Jefferson University Hospital in Philadelphia with an infected ankle, he was bracing for the worst. More than a decade earlier, surgeons at Jefferson had amputated the big toe on his left foot due to complications from diabetes. This time, surgeons operated on the ankle, leaving a deep wound open to the bone. He was told the ankle was too badly damaged and that his foot would need to be amputated.

R. Anthony Carabasi, M.D., told Mr. Filipe that he could help him. Dr. Carabasi, director of the Division of Vascular Surgery at Jefferson Medical College and Thomas Jefferson University Hospital had removed Mr. Filipe’s toe years before. He had Mr. Filipe came to the Jefferson Wound Care Center at Thomas Jefferson University Hospital for treatment for three months, and after 55 treatments in Jefferson’s hyperbaric oxygen chamber, the wound closed and he received a skin graft. Today, Mr. Filipe, who emigrated from Portugal a half-century ago and has owned a concrete and construction company near Yardley for the past 27 years, is back at work fulltime.

While not every case can be a success story, says Dr. Carabasi, who is the center’s medical director, the center treats patients with chronic wounds caused by diabetes, vascular diseases, or other conditions and patients with wounds that refuse to heal.

“There are certain criteria for being treated in the wound center,” Dr. Carabasi explains. The majority of patients, he says, are those with diabetes with chronic wounds who have healing difficulties because of poor circulation, those patients with chronic tissue damage from radiation therapy for head and neck cancer and individuals with certain types of infections that fail to respond to antibiotics.

The need for such wound care centers is rising. An estimated 6 million Americans develop chronic wounds. Approximately 1.5 million people with diabetes have poorly healing wounds, while some 2.5 million Americans have so-called pressure ulcers, resulting from conditions such as spinal cord injury, arthritis and others that require the patient to be bedridden.

While the center offers a number of different therapies, Hyperbaric Oxygen Therapy (HbOT) is arguably the most important. Whereas normal air is 21 percent oxygen, HbOT provides 100 percent pure oxygen in a pressurized chamber. Breathing pure oxygen under pressure increases its level in the body’s tissues, promoting wound healing by stimulating new blood vessel growth.

For some patients, HbOT is a normal part of the treatment protocol, says administrative director Christopher L. Barrett, D.P.M. For example, patients who have had radiation for head and neck cancer and need a tooth to be pulled typically have an extremely weakened jaw bone, or mandible. Studies have shown that HbOT – 20 treatments prior to the tooth extraction and 10 after – strengthens the mandible by resvascularizing the region and increasing the body’s ability to replace dead tissue and rebuild bone.

For others, it is the treatment of last resort. Dr. Barrett notes that HbOT is recommended for diabetic wound care involving severely ischemic (in some cases, considered a step away from developing gangrene) limbs in which amputation is considered likely. For such patients, the first line treatment is usually some sort of vascular bypass or graft to attempt to reestablish the blood supply.

The number of times a patient requires treatment varies. Emergency treatment, such as carbon monoxide poisoning, may require only one or two treatments while tissue damage from radiation might take 30 to 40 treatments.

A multidisciplinary approach to healing chronic wounds, particularly for diabetic patients, Dr. Barrett says, is often key. He notes that such teams typically include endocrinologists, diabetic educators, surgeons, and other specialists.

“Increasingly, physicians are recognizing that referring to a wound care center is a valuable option for their patients,” says Dr. Carabasi. “There’s been a resurgence of comprehensive, multidisciplinary wound care programs around the country.”

The Jefferson Wound Care Center offers another feature: outpatient pickup for up to 20 miles from the hospital – something crucial, says Dr. Carabasi, because often daily hyperbaric treatments are required.

Interested patients and referring physicians should call 1-800-JEFF-NOW.