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Wound Healing Disorder The diabetic foot syndrome

Diabetic Foot Syndrome - Wound Healing Disorder
The diabetic foot syndrome

Approx. 7% of all diabetes patients suffer from disorders of the feet: 

vascular disease
through a reduced oxygen supply
Nerve dysfunction
including, in particular, loss of pain sensation  
Even minimal injuries, i.e. a little cut whilst cutting toe nails or a small pressure ulcer, can then develop into a non-healing, chronic wound.
In Germany, 70% of foot or leg amputations, which are not caused by accidents, are the result of such chronic wounds. The timely use of HBOT in appropriate cases leads to an increased supply of oxygen, better blood circulation and the healing of chronic wounds, thus avoiding or limiting potential amputations.

How does Hyperbaric Oxygen Therapy work (HBOT)?
Under increased pressure (= hyperbaric atmosphere) patients inhale clinically pure oxygen (= Oxygenation). This is taken in through the lungs and enters into the blood stream.
In the pressure chamber a 20 times higher concentration of oxygen is physically dissolved in the blood plasma und is transported into the blood circulatory system to the whole body (i.e. skin and bones). The chamber is large enough to hold upto 12 people. 

Oxygen reduces inflammation because it improves the defence function of white blood cells and strengthens the role of certain enzyme systems responsible for destroying bacteria
Oxygen helps in wound healing because the tissue-forming cells (fibroblasts) are at their most active at elevated oxygen pressure
The connective tissue fibres are also at their most effective with an increased oxygen content in the wound area
New blood vessels can only be formed in the wound margin if the oxygen supply is sufficiently high
The maturation of the newly formed tissues and blood vessels is accelerated by the change from an oxygen deficiency to an over-oxygenation 
Monitoring the HBO treatment
By taking one or more adhesive samples from the wound environment, oxygen enrichment is ensured during treatment. The suitability of the wound for successful HBO treatment is also determined.

Treatment of non-healing wounds
What can the doctor do if there is a wound on the foot?
First, the wound is treated by the GP or surgeon and antibiotics may be prescribed. After surgical removal of already dead tissue, different wound dressings are used to support the wound healing process. In certain cases, specific growth factors are able to stimulate the cells involved in wound healing. Pressure-relieving orthopaedic appliances are indispensable in the treatment of these wounds.

What can HBOT do more?
If the measurement of oxygen partial pressure at the edge of the wound shows a sufficient increase in oxygen respiration, then there is a very good chance the wound will heal if the treatment is used in good time. Further complications including amputation are prevented or reduced. If a wound does not heal within 30 days, the possibility of treatment with HBO should be clarified by the partial pressure measurement, and the therapy should be started at short notice. If the wound is so far advanced that a cure without amputation is futile, at least the extent of the amputation can be limited.

Use of HBOT in diabetic foot syndrome
It is part of the S3 guidelines (= Treatment guidelines, which corresponds to the highest scientific standards)

HBO therapy is strongly recommended for the following conditions: 

Diabetic wound on foot or lower leg.
Severity level III or IV according to Wagner (= deep infection, possibly with involvement of the bone or the tendons).
If a standard wound treatment over a period of at least 30 days was not successful.
During the HBO treatment regular check ups and professional wound care are necessary.
Reimbursement of costs
Private health insurance companies and the benefits office make their decisions according to individual requirements of the insured person.  As a rule the costs are met. They are based on the statutory scale of medical fees for physicians (GOÄ).
Statutory health insurance companies will now pay for the treatment following a judgement by the Federal Court for Social Justice. (AZ B 1 KR 44/12 R). This is done according to the appropriate indication of the treating specialist or pressure chamber physician.


Wound healing disorders and problem wounds
Bone diseases
Inner ear diseases
Longterm radiation damage
Neurological deficits
Other indications
Emergencies

 

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