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Hyperbaric oxygen therapy (HBO2T) is a useful adjunct modality for the treatment of complex, inadequately vascularized, and infected wounds, particularly in the context of ischemia reperfusion injury, severe infection, and refractory diabetic foot ulcers. During HBO2T a patient breathes 100% oxygen while inside a treatment chamber, usually at a pressure of 2-2.4 Atmospheres absolute (ATA) for 90 minutes a day for 20-60 treatments. The therapeutic mechanisms of HBO2T result from the pharmacologic effects of supraphysiologic tissue oxygen levels, which lead to generation of reactive oxygen and nitrogen species. These oxidants 1) induce wound growth factor synthesis and mobilization of bone marrow stromal precursor cells (i.e. are pro-inflammatory) , which increase neovascularization and 2) reduce neutrophil beta-2 integrin function and monocyte chemokine synthesis, and upregulate heat shock proteins and hypoxia-inducible factor-1 (i.e. are anti-inflammatory), which reduces edema and improves post-ischemic tissue survival.
Thom, SR. Hyperbaric oxygen: its mechanisms and efficacy. Plast Reconstr Surg. 2011;127 Suppl 1:131S-141S.
Weaver L, ed. Hyperbaric Oxygen Therapy Indications, 13th Edition. North Palm Beach, FL: Best Publishing Company, 2014. Access at https://www.uhms.org/resources/hbo-indications.html