1. Barcelona September 2013 Oxygen therapy in normobarism Trophic injuries of the lower limbs The reasoning for the therapy

2. Barcelona September 2013 Oxygen therapy in normobarism Trophic injuries of the lower limbs Epidemiology It is estimated that this pathology affects 1.5% of the population 5% of the population over 65 years

3. Barcelona September 2013 Oxygen therapy in normobarism Trophic injuries of the lower limbs Problem for the patient The sick person with such injuries, which by definiton are chronic, is often incapable, suffering, malodorous, depressed

4. Barcelona September 2013 Oxygen therapy in normobarism Trophic injuries of the lower limbs Problem for society. The costs Direct costs Treatment, material, departments Public services and within the national health service insurance

5. Barcelona September 2013 Oxygen therapy in normobarism Trophic injuries of the lower limbs Problem for society. The costs Indirect costs Working days lost both by the patient and by family members involved and eventual costs for insurance

6. Social health consequences of inadequate treatment For the Patient infections, gangrene, amputation and in any case complications of health and relationship. Oxygen therapy in normobarism Trophic injuries of the lower limbs Barcelona September 2013

7. Social health consequences of inadequate treatment For the family infections, gangrene, amputation and in any case complications of health and relationships. Oxygen therapy in normobarism Trophic injuries of the lower limbs Barcelona September 2013

8. Social health consequences of inadequate treatment Oxygen therapy in normobarism Trophic injuries of the lower limbs Barcelona September 2013 For the national health system greater costs for complications

9. Definition of ulcer Loss of substances linked to hemodynamic, hemorheologic and coagulative modifications: in its genesis the use of microcirculation and consequent impairment of tissue trophism is fundamental. It represents the epiphenomenon of various pathologies which have at their base an insufficient hematic supply with consequent hypoxia and infection (Bimonte). Madeyski’s Normobaric Chamber Barcelona September 2013

10. Classification 1) Ulcers of venous stasis 2) Arterial ulcers 3) Traumatic ulcers 4) Collagen ulcers 5) Diabetic ulcers (Diabetic foot) Madeyski’s Normobaric Chamber Barcelona September 2013

11. Physiopathology of the ulcer Transcutaneous oximetry has shown at the level of the vasculopathic injuries a pO2 of 5-10 mm of Hg. This value is incompatible with the life of the cells and impedes the proliferation and the action of the leukocytes which require values of pO2 of 30-40 mm of Hg: from this derives the danger of infection. Madeyski’s Normobaric Chamber Barcelona September 2013

12. Physiopathology of the ulcer Even the synthesis of the collagen starting from the fibroblasts cannot disregard the oxygen. In conditions of relative hypoxia an immature and not very stable collagen will be formed with inevitable healing problems Madeyski’s Normobaric Chamber Barcelona September 2013

13. For the re-epithelialization of the ulcera a)An optimal supply of oxygen b)Complete cleansing of the injury c)Good perfusion of blood Barcelona September 2013 Madeyski’s Normobaric Chamber

14. POSSIBLE THERAPIES Ulcer therapy concerns local and systemic factors. 1) Medical therapies 2) Surgical therapies 3)Therapy with hyperbaric chamber 4)Therapy with normobaric oxygen 5)Therapy with oxygen-ozone Barcelona September 2013

15. Reasoning for oxygen hyperbaric therapy R estores the distribution of O 2 from the capillaries to the cells where this is impeded or to reduce the hematic perfusion or for thickening of the means of transit (edema, pyogenic membrane, necrotic tissues ) Barcelona September 2013

16. Hyperbaric chamber Local chamber The concentration of oxygen reaches 22% The concentration of oxygen reaches 95% Oxygen dissolved in the blood equal to 6 cc % Oxygen dissolved in the blood equal to 2 cc % DIFFERENCES BETWEEN THE HYPERBARIC AND LOCAL CHAMBERS Barcelona September 2013

17. DIFFERENCES BETWEEN HYPERBARIC AND LOCAL CHAMBERS Substantially the hyperbaric chamber acts thanks to the increase in oxygen dissolved while the local chamber acts thanks to the high concen- tration of oxygen at the level of the trophic injuries Madeyski’s Normbaric Chamber Barcelona September 2013

18. AdvantagesDisadvantages Increase of O 2 dissolved Bactericidal action Anti-edema action Healing action -Not borne by many patients. -Cardiac,vestibular, psychological problems,etc. -Limited number of centres. -Transport problems. -High costs Hyperbaric Chamber Barcelona September 2013

19. So called for the “similarity” with the hyperbaric chamber. Madeyski’s Normobaric Chamber Barcelona September 2013

20. Madeyski’s Normobaric Chamber PORTABLE VERSION (HOME) Barcelona September 2013

21. AdvantagesDisadvantages High concentration of oxygen at the level of the injury Minor or no increase of oxygen dissolved in the plasma NO LOCAL OR SYSTEMIC SIDE EFFECTS Madeyski’s normobaric chamber Barcelona September 2013

22. CASE HISTORIES 2012 Casa di Cura Rizzola Patients treated : 156 Phlebostatic ulcers: 86 Diabetic ulcers: 42 Arterial ulcers: 11 Mixed ulcers: 07 Transplant ulcers 10 Barcelona September 2013

23. Methodology Patients underwent daily sittings of one or two hours. The number of sittings was variable with healing between 2 and 4 months on average. Self medication only took place with saline solution Barcelona September 2013

24. Subjective results 1) Reduction of secretion and cleansing of the injuries. 2) Improvement in the subjective symptomatology (pains, burns, itching,). Barcelona September 2013

25. Objective results 1) Precocious appearance of a good tissue of granulation. 2) Reduction of the diameter of the injury until complete closure in 70% of cases. 3) Effect favouring subsequent transplants taking root in 85% of the sick people. 4) Result null in 15% of cases Barcelona September 2013

26. Overview of ulcers treated Casa di Cura Rizzola 2012 Barcelona september 2013

27. Overview of ulcers treated Casa di Cura Rizzola 2012 Barcelona september 2013 before therapy After 1 month of therapy After 2 months of therapy After 3 months of therapy

28. Conclusion High compliance Effectiveness documented Low cost of purchase and of use Social cost Easy availability Absence of side effects Rapid training of personnel Barcelona September 2013