Chronic

Non-Healing

Hyperbaric Oxygen Therapy

Wounds

"Treating the 14 conditions covered by OHIP"

Ontario HBOT

What are Chronic Non-Healing Wounds?

Including diabetic foot ulcers, venous & arterial insufficiency ulcers

Non-healing wounds are those which fail to heal within a reasonable time frame despite adequate management. Although multifactorial in aetiology, these wounds are typically hypoxic which is where HBOT becomes very effective. The rationale for treatment of chronic non-healing wounds with HBOT uses the known secondary mechanisms of action. HBOT leads to improved angiogenesis through a multifactorial mechanism. First, fibroblast proliferation and collagen synthesis are oxygen dependent, and collagen is the foundational matrix for angiogenesis.
 
In addition, HBOT likely stimulates growth factors, particularly vascular endothelial growth factor (VEGF), involving angiogenesis and other mediators of the wound healing process. Hyperbaric oxygen also has been shown to have direct and indirect antimicrobial activity; in particular, it increases intracellular leukocyte killing. Decreased oedema due to systemic vasoconstriction allows better diffusion of oxygen and nutrients through tissues while also relieving pressure on the surrounding vessels and structures
Wound Healing & Hyperbaric Oxygen Therapy
Non-healing wounds where HBOT has been successfully used include diabetic foot ulcers, venous and arterial insufficiency ulcers. Diabetic lower extremity ulcers have been the focus of most wound research in hyperbaric medicine, since the aetiology of these wounds is multifactorial, and HBOT can address many of these factors. Several randomised controlled clinical trials have proven the beneficial effects of HBOT for the treatment of diabetic lower extremity wounds, apart from many prospective, non-controlled clinical and retrospective studies.
Adjunctive Therapies

HBOT in non-healing wounds/ulcers including diabetic wounds, is used in conjunction with other wound management techniques including:

Each of these management techniques may be discussed with your wound-care physician/specialist.

1.

2.

3.

4.

5.

6.

Wound Debridement

Dressings

Pressure-relieving Strategies

Appropriate Glycaemic Control

Nutrition Management

Antibiotic Management

How do I Qualify for OHIP Coverage?

In order to qualify for OHIP covered hyperbaric oxygen therapy for a Chronic Non-Healing Wound, the individual must be in a wound-care program and/or regularly attending the office of a wound care specialist to monitor the wound and associative healing progress. A referral from a physician or specialist is preferred, however it is not absolutely necessary. Our medical director will look over all supporting documentation, and make the ultimate decision for qualification.

Additional Literature
The following documents are sourced from respected medical journals regarding Chronic Non-Healing Wounds, Diabetic Ulcers, Vascular & Arterial Ulcers, and Hyperbaric Oxygen Therapy (HBOT). 
Please click on the icon to open the PDF in your browser window. If you would like to download the PDF to your computer, right click on the icon and select "save linked file as". 
Annals of the American Thoracic Society
Volume 14, Issue 7, Pages 1216-1220
Published: July 2017
Journal of American Anestesiologists
Volume 93, Issue 4, Pages 1049–1052
Published: October 2000
Journal of the Undersea and Hyperbaric Medical Society
Volume 39, Issue 5, Pages 937-942
Published: May 2012