1. Oxygen therapy venous stasis ulcers and devitalised tissues in the lower limbs District Madeyski Hyperbaric Chamber 2003

2. Oxygen therapy We can say that oxygen therapy has been the evolution of Hyperbaric therapy used in the last 30 years to treat different pathologies related to deficiencies of circulation and infection. District Madeyski Hyperbaric Chamber 2003

3. Principles on which hyperbaric oxygen therapy is based The Oxygen works by contact and because dissolved in the blood ( a modest increase is linked to the haemoglobin but a considerable increase is dissolved in the plasma) District Madeyski Hyperbaric Chamber 2003

4. Principles on which hyperbaric oxygen therapy is based Remember that in the Hyperbaric Chamber the atmospheric pressure is increased while the partial pressure of the oxygen remains invariable District Madeyski Hyperbaric Chamber 2003

5. ULCERS AND DEVITALISED TISSUES IN THE LOWER LIMBS 1) Venous stasis ulcers 2) Arterial ulcers 3) Traumatic ulcers 4) Collagenopatic ulcers 5) Diabetic ulcers District Madeyski Hyperbaric Chamber 2003

6. THE THERAPIES 1) Medical therapy 2) Surgical therapy 3) Plastic surgery 4) Hyperbaric Chamber Therapy District Madeyski Hyperbaric Chamber 2003

7. AdvantagesDisadvantages increase oxygen dissolved in the plasma -Not for all people -Cardiac,vestibular or cochlear tract, psychological problems -Limited availably -Problems with travelling distances -No Availably of bed places -Social and public costs Hyperbaric Chamber District Madeyski Hyperbaric Chamber 2003

8. so called since resembling the Hyperbaric Chamber used by most important Medical Centres. The Madeyski District Hyperbaric Chamber District Normobaric Chamber District Madeyski Hyperbaric Chamber 2003

9. AdvantagesDisadvantages increased oxygen in contact with the lesion Minor increase by oxygen dissolved in the plasma Rilevant Advantage: No local or general contraindication. The Madeyski District Hyperbaric Chamber District Normobaric Chamber

10. Advantages: 1) Patient satisfaction 2) Simple use and appreciation by paramedic staff 3) The lack of general contraindications. 4) The lack of local contraindications 5) Its reduced dimensions and easiness of transport 6) Its agreeable shape 7) Easily availability 8) The low cost of the device and its maintenance 9) Staff's quick training 10) Documented effectiveness The Madeyski District Hyperbaric chamber District Normobaric Chamber

11. General hyperbaric chamber District hyperbaric chamber The Oxygen concentration reaches 22% The Oxygen concentration reaches 95% Oxygen dissolved in the plasma Vol 6 % Oxygen dissolved in the plasma Vol 2% DIFFERENCES BETWEEN THE HYPERBARIC CHAMBER AND THE DISTRICT HYPERBARIC CHAMBER District Madeyski Hyperbaric Chamber 2003

12. Differences between the hyperbaric chamber and the district hyperbaric chamber District Madeyski Hyperbaric Chamber 2003 Whilst in the hyperbaric chamber the treatment is through contact and dissolved oxygen in the plasma, in the district normobaric chamber the increase of dissolved oxygen in the plasma is lost This missing effect is compensated by the increased oxygen concentration in the district normobaric chamber The concentration, in fact, reaches 95% or a set value which therefore corresponds to 4 times the value found in the hyperbaric chamber.

13. Differences between the hyperbaric chamber and the district hyperbaric chamber District Madeyski Hyperbaric Chamber 2003 But if an associated breathing in an oxygen mask is performed, the dissolved oxygen quota in the plasma increases without reaching the values due to hyperbarism. 2% Vol against 6% Vol

14. Times of application of District hyperbaric chamber Are different according to the pathology and the local situation Similarly the number of days in which the therapy is applied is variable and linked to the pathology and to others contingent factors District Madeyski Hyperbaric Chamber 2003

15. Times of application of District hyperbaric chamber The average therapy is applied for the duration of one hour, twice a day Similarly the number of days in which the therapy is applied is variable and linked to the pathology and to others contingent factors District Madeyski Hyperbaric Chamber 2003

16. Past case histories 141 patients treated with chamber in an experimental period During this period the chamber was not the definitive one District Madeyski Hyperbaric Chamber 2003

17. Present experience 196 patients so divided: 1) 150 venous stasis ulcers 2) 12 Arterial ulcers 3) 5 Traumatic ulcers 4) 3 Collagenopatic ulcers 5) 22 Diabetic ulcers 6) 1 oncocarbide Ulcers 7) 13 patients with epidermic transplants District Madeyski Hyperbaric Chamber 2003

18. Results Considerations for a correct evaluation Since we are dealing with a chronic syndrome one can't reach a definitive recovery if the ethiology is not corrected identified. District Madeyski Hyperbaric chamber 2003

19. Results Considerations for a correct evaluation Sometimes,in subjects affected by peculiar pathology, a definitive recovery can not be reached. District Madeyski Hyperbaric cCamber 2003

20. Results 1) Decrease of the secretions 2) Improvement of subjective sinthomatolgy 3) Improvement of objective sinthomatology 4) Cleaning of the lesions 5) Reduction of the diameters 6) Evidence of the granulation tissues since the third day of application 7) A positive result of the transplants expecially if Reverdin method is used District Madeyski Hyperbaric Chamber 2003

21. The future … 1)Portable device of contained cost for the house therapy 2) Nebulising for introduction of drugs: -vaso dilatators – - healing - for diabetic ulcers 3) Platelets concentrated District Madeyski Hyperbaric Chamber 2003

22. Conclusions The use of the Hyperbaric Chamber with a partial increased oxygen pressure is a very useful tool, at a low-cost and without contraindications for a large number of subjects with a large amount of devitalised or not very vital tissues,due to local or general causes in the inferior limbs District Madeyski Hyperbaric Chamber 2003