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DOI: 10.4103/0970-0358.146574
Cutaneous wound healing: Current concepts and advances in wound care
Publication History
Publication Date:
26 August 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00042863/201403/lookinside/thumbnails/10-4103-0970-0358-146574_00303-1.jpg)
ABSTRACT
A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care.[1] It is a snapshot of a patient’s total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors.[2] The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT), as used at our institution (CAMC), and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society) may vary widely from country to country and payment system.[3] In the USA, CMS (Centers for Medicare and Medicaid Services) approved indications for HBOT vary from that of the UHMS for logistical reasons.[1] We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise.
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REFERENCES
- 1 Decision Memo for Hyperbaric Oxygen Therapy for Hypoxic Wounds and Diabetic Wounds of the Lower Extremities (CAG-00060N). Decision Memo for Hyperbaric Oxygen Therapy for Hypoxic Wounds and Diabetic Wounds of the Lower Extremities (CAG-00060N). http://www.cms.gov 2014 [Last accessed on 2014 August 16]
- 2 Feldmeier JJ, Matos LA. Hyperbaric Oxygen 2003. Indications and Results: The Hyperbaric Oxygen Therapy Committee Report. Kensington, Maryland: Undersea and Hyperbaric Medical Society; 2003
- 3 Undersea & Hyperbaric Medical Society. Indications for Hyperbaric Oxygen Therapy. 2014; 00: 00
- 4 Sheffield PJ, Sheffield JC. "Complication rates for hyperbaric oxygen therapy patients and their attendants: A 22-year analysis." Gas 6.25: 2003;139. http://hyperbaricinformation.com/HBO-Articles/HBO-Complications/4th-ICHM-2003-Complication-rates-in-HBO-Sheffield.pdf
- 5 Eskes AM, Ubbink DT, Lubbers MJ, Lucas C, Vermeulen H. Hyperbaric oxygen therapy: Solution for difficult to heal acute wounds? Systematic review. World J Surg 2011; 35: 535-42
- 6 Calhoun JH, Overgaard KA, Stevens CM, Dowling JP, Mader JT. Diabetic foot ulcers and infections: Current concepts. Adv Skin Wound Care 2002; 15: 31-45
- 7 Narayanamurthy VB. Personal Communication. 00: 00
- 8 Bansal C, Scott R, Stewart D, Cockerell CJ. Decubitus ulcers: A review of the literature. Int J Dermatol 2005; 44.10: 805-10
- 9 Hyperbaric Oxygen Therapy. Hyperbaric Oxygen Therapy 2014. http://www.emedicine.medscape.com/article/1464149-overview [Last accessed on 2014 August 16]
- 10 Löndahl M, Katzman P, Nilsson A, Hammarlund C. Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care 2010; 33: 998-1003
- 11 Saraf S, Parihar R. Sushruta: The first Plastic Surgeon in 600 B.C. Int J Plast Surg 2007; 4: 2 https://ispub.com/IJPS/4/2/8232
- 12 Bhutani S, Vishwanath G. Hyperbaric oxygen and wound healing. Indian J Plast Surg 2012; 45: 316-24
- 13 Gordillo GM, Sen CK. Revisiting the essential role of oxygen in wound healing. Am J Surg 2003; 186: 259-63
- 14 Kalani M, Jörneskog G, Naderi N, Lind F, Brismar K. Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers. Long-term follow-up. J Diabetes Complications 2002; 16: 153-8
- 15 Kessler L, Bilbault P, Ortega F, Grasso C, Passemard R, Stephan D. et al. Hyperbaric oxygenation accelerates the healing rate of nonischemic chronic diabetic foot ulcers: A prospective randomized study. Diabetes Care 2003; 26: 2378-82
- 16 David LA, Sàndor GK, Evans AW, Brown DH. Hyperbaric oxygen therapy and mandibular osteoradionecrosis: A retrospective study and analysis of treatment outcomes. J Can Dent Assoc 2001; 67: 384
- 17 Millar I. Middle ear barotraumas scoring. In: Barach P, Mueller PH, Pirone C. editors Patient Safety: Prevention and Treatment of Complications in Hyperbaric Medicine 52nd ed. Undersea and Hyperbaric Medical Society (UHMS) Workshop. Kensington, Maryland:: Undersea and Hyperbaric Medical Society; 2002: p. 101-6
- 18 Thom SR. Oxidative stress is fundamental to hyperbaric oxygen therapy. J Appl Physiol (1985) 2009; 106: 988-95
- 19 Beard T, Watson B, Barry R, Stewart D, Warriner R. Analysis of adverse events occurring in patients undergoing adjunctive hyperbaric oxygen treatment: 2009-2010. 2011; 00: 00
- 20 National Diabetes Fact Sheet, 2011. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. 2014; 00: 00
- 21 Lohr VL. Norvell HC Hyperbaric Nursing: Best Publishing Company; 2002
- 22 Uhlmeyer D, Warriner III RA, Pasceri P, Fife CE, Otto G. Pre and post hyperbaric oxygen therapy (HBOT) blood glucose levels. 2005; 00: 00
- 23 Pamidi S, Tasali E. Obstructive sleep apnea and type 2 diabetes: Is there a link? Front Neurol 2012;3:126. eCollection 2012; 00: 00
- 24 Weinstock TG, Redline S. Comparative effectiveness research in obstructive sleep apnea: Bridging gaps between efficacy studies and clinical practice. J Comp Eff Res 2012; 1: 83-105
- 25 Naeser MA, Martin PI, Lundgren K, Klein R, Kaplan J, Treglia E. et al. Improved language in a chronic nonfluent aphasia patient following treatment with CPAP and TMS. Cogn Behav Neurol 2010; 23: 29-38
- 26 Kasasbeh E, Chi DS, Krishnaswamy G. Inflammatory aspects of sleep apnea and their cardiovascular consequences. South Med J 2006; 99: 58-69 quiz 81
- 27 Davies RJ, Ali NJ, Stradling JR. Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. Thorax 1992; 47: 101-5
- 28 WHO. Diabetes. 2014. http://www.who.int/mediacentre/factsheets/fs312/en/ [Last accessed on 2014 August 16]
- 29 de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: A meta-analysis. Psychosom Med 2001; 63: 619-30
- 30 Centers for Disease Control and Prevention. Centers for Disease Control and Prevention 2014. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5345a2.htm./http://www.cdc.gov/diabetes/statistics/lea/table6.htm [Last accessed on 2014 August 16]
- 31 Adult Obesity Facts. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention 2013. http://www.cdc.gov/obesity/data/adult.html [Last accessed on 2014 Mar 17]
- 32 Calhoun JH, Cantrell J, Cobos J, Lacy J, Valdez RR, Hokanson J. et al. Treatment of diabetic foot infections: Wagner classification, therapy, and outcome. Foot Ankle 1988; 9: 101-6
- 33 Baba H, Wada M, Annen S, Azuchi M, Imura S, Tomita K. The tarsal tunnel syndrome: Evaluation of surgical results using multivariate analysis. Int Orthop 1997; 21: 67-71
- 34 Hotez PJ, Savioli L, Fenwick A. Neglected tropical diseases of the Middle East and North Africa: Review of their prevalence, distribution, and opportunities for control. PLoS Negl Trop Dis 2012; 6: e1475
- 35 Lasry-Levy E, Hietaharju A, Pai V, Ganapati R, Rice AS, Haanpää M. et al. Neuropathic pain and psychological morbidity in patients with treated leprosy: A cross-sectional prevalence study in Mumbai. PLoS Negl Trop Dis 2011; 5.3: e981
- 36 Centers for Disease Control and Prevention (CDC). Current depression among adults - United States, 2006 and 2008. MMWR Morb Mortal Wkly Rep 2010; 59: 1229-35
- 37 Goldney RD, Phillips PJ, Fisher LJ, Wilson DH. Diabetes, depression, and quality of life: A population study. Diabetes Care 2004; 27: 1066-70
- 38 Padberg Jr, Back TL, Thompson PN, Hobson 2nd RW. Transcutaneous Oxygen (TcPO2) Estimates Probability of Healing in the Ischemic Extremity. J Surg Res 1996; 60.2: 365-9
- 39 Faglia E, Favales F, Aldeghi A, Calia P, Quarantiello A, Oriani G. et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer: A randomized study. Diabetes Care 1996; 19: 1338-43
- 40 Mohler III ER, Mitchell E. Noninvasive Diagnosis of Arterial Disease. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. [Last accessed on 2014 April 5]
- 41 Katsamouris A, Brewster DC, Megerman J, Cina C, Darling RC, Abbott WM. Transcutaneous oxygen tension in selection of amputation level. Am J Surg 1984; 147.4: 510-7
- 42 Mueller PH. Review of screening procedures for elective hyperbaric admission. In: Barach P, Mueller PH, Pirone C. editors Patient Safety: Prevention and Treatment of Complications in Hyperbaric Medicine 52nd ed. Undersea and Hyperbaric Medical Society (UHMS) Workshop. Kensington, Maryland: Undersea and Hyperbaric Medical Society; 2002: 126-32
- 43 Bitterman N, Bitterman H. Oxygen toxicity. Chapter 3.7.2 In: Mathieu D. editor Handbook on Hyperbaric Medicine. Netherland: Springer; 2006: 731-65
- 44 Leach RM, Rees PJ, Wilmshurst P. Hyperbaric oxygen therapy. BMJ 1998; 317: 1140-3
- 45 Rudolph R. Plastic Surgery-epitomes of progress: Chronic skin ulceration after radiotherapy for cancer. West J Med 1982; 136: 525
- 46 Corman JM, McClure D, Pritchett R, Kozlowski P, Hampson NB. Treatment of radiation induced hemorrhagic cystitis with hyperbaric oxygen. J Urol 2003; 169: 2200-2
- 47 Charanya G, Patil KM, Narayanamurthy VB, Parivalavan R, Visvanathan K. Effect of foot sole hardness, thickness and footwear on foot pressure distribution parameters in diabetic neuropathy. Proc Inst Mech Eng H 2004; 218: 431-43
- 48 Liu Y, Petreaca M, Yao M, Martins-Green M. Cell and molecular mechanisms of keratinocyte function stimulated by insulin during wound healing. BMC Cell Biol 2009; 10: 1
- 49 Asai J, Takenaka H, Ii M, Asahi M, Kishimoto S, Katoh N. et al. Topical application of ex vivo expanded endothelial progenitor cells promotes vascularisation and wound healing in diabetic mice. Int Wound J 2013; 10: 527-33