Plastic surgeons often have to deal with problematic
wounds. In reconstructive surgery, as well as in chronic
wounds, tissue
oxygen supply is often critically low. Similarly in the treatment of severely burned patients, perfusion and
oxygen supply to the areas beneath
burn wounds are often critical. This paper explains the mechanisms and impact of
oxygen for wound healing. It is important to mention that it has been shown that
oxygen even used at ambient pressure can improve wound healing. Whereas treatment with
oxygen under hyperbaric conditions is not everywhere available, at least normobaric
oxygen is cheap and ubiquitously available and should therefore be used routinely.
Oxygen treatment under hyperbaric conditions, especially in
critically ill patients, needs a special infrastructure and is quite more expensive. Therefore, it has to be evaluated whether the potential benefit for the patient meets the risk and costs of treatment. In 2006, at the Hyperbaric Centre of the Medical University of Vienna almost 2200 hyperbaric treatments including 330 in
critically ill patients have been performed. Beside 2 patients suffering from
Fournier's gangrene, 2 suffering from
gas gangrene and 4 patients with severe
carbon monoxide intoxications, all other
intensive-care patients were treated for severe
burns. Indications for less severely ill patients mainly included problem
wounds mostly of diabetic patients,
osteomyelitis of the mandible and less severe
carbon monoxide poisoning. Our experience with the use of
oxygen under hyperbaric conditions so far has been good enough to consider this kind of
therapy at least in our centre as an option in the adjunctive treatment for the so far used indications. However, it has to be mentioned that there is still lack of prospective randomised controlled studies to introduce this kind of
therapy as a level 1 indication in clinical routine.