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hbomdmapai
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***REMINDER: In your initial HBO Consultation for APAl, history should include an ACUTE DETERIORATION in the wound
（~，2weeks）* *
This patient has hypoxic wounds consistent with arterial insufficiency. This can also be caused by fibrotic changes to the wound periphery, however, the response to oxygen suggests at least partial vascular reserve. This presentation is consistent with Type 2 acute arterial insufficiency.
Type 1 is acute thrombosis/insufficiency of a large vessel, while Type 2 is acute thrombosis/insufficiency of a small or micro vessel(s).
Either can be caused by spontaneous in situ thrombosis, embolization, or trauma, which results in direct injury to the vessel.
Type 3 is a mix of large and small vessel thrombosis/insufficiency, which at least in part can be chronic, but usually has an acute component, such as trauma, or change in symptoms.
Acute arterial insufficiency can require on average 30-40 treatments until they are capable of healing spontaneously, i.e. without additional Hyperbaric Oxygen. This wound is potentially limb threatening with the attendant risk of morbidity or mortality due to further tissue and/or limb loss.
The primary effects of HBO are through hyperoxygenation of plasma levels by delivery of oxygen at 2.0 atmospheres absolute (equivalent to 33 Feet of Sea Water) achieving 10-15 times that achievable at normal pressure (i.e. Sea level, or 1.0 Atmospheres absolute). This results in a reduction of edema (through a 30% reduction in blood flow due to prearteriolar sphincter constriction) as well as stimulation of fibroblasts and angiogenesis, and subsequent improved perfusion. Reperfusion injury is also blunted through inhibition of ICAM receptors on the PMNs.
In the case of compromised graft-flaps in the setting of APAl in particular, marginal perfusion at the flap edges is improved substantially, preserving marginally viable tissue and supporting healing. Often, these types of injuries can require a protracted course approaching 40 ), or several shorter courses, due to a need for repeated perioperative treatments that can help sustain tenuous gratts, flaps and pertusion.