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Northern Nevada Hyperbarics, Inc. Serving the Community for 8 Years (775) 826-2084 1698 Meadowood Ln., #100 www.nevadahyperbarics.com
What is HBO 100% oxygen in an enclosed chamber at higher-than-atmospheric pressure where oxygen dissolves in arterial plasma in increased amounts---up to 10 to 15 fold increase. Typical course consists of 30 or more treatments done daily for six weeks.
Some Basics HBOT has been used in chronic wounds for about 40 years. 100% oxygen is delivered to a chamber under high pressure (2 to 2.4 ATA) for 90 minutes Typical HBOT treatment course consists of 30 or more treatments dailyM-F Administering oxygen to hypoxic tissue shown to activate fibroblast proliferation, down-regulate inflammatory responses, cytokines, up-regulate growth factors  all proxies for wound healing.
Hyperbaric Chamber Designs
Our Facility 2 Sechrist Monoplace Chambers
Clinical Hyperbaric Oxygen Therapy Clinical Hyperbaric Oxygen Therapy Emergency Indications Acute Traumatic Ischemia Crush Injuries and  Compartment Syndrome Carbon Monoxide Poisoning Gas Gangrene  Surgical Infections Failed Flaps and Grafts Diving Injuries Scheduled Indications Non-Healing Diabetic and problem Wounds Radiation soft tissue necrosis, cystitis, and proctitis. Osteoradionecrosis Osteomyelitis
Primary Mechanisms Hyper---oxygenation Vasoconstrictionreduce inflammation Microbiological effects  Activate fibroblast and collagen synthesis
Secondary Mechanisms Angiogenesis Osteogenesis WBC Oxidative Killing Cell wall permeation
Cumulative Effects
Vascular Density in Response to Hyperbaric O2 Response to 20 x 1ATA 100% O2 Response to 20 x 2.4ATA 100% O2 8 x increase in vascular density
Vascular Density Increase No HBO Start HBO 18 Tx 24 Tx
Diabetic Wound with Recalcitrant Osteomyelitis 78 Y.O Male/ 2 Wks Resection Bone / Continued Drainage Pre-Hyperbaric Partial Wound Closure 20 HBO2 TX---4 Weeks Complication Resolved Full Healing 35 HBO2 TX 7 Weeks
Problem Wound w/Skin Graft Failure 58 Y.O. Female/ Diabetic/ 6mo. Non-healing /one failed graft u After 25 Tx---5  Weeks---beefy, red,  healthy granulation  tissue Split thickness  graft placed--- 100% take
Tissue Necrosis in Diabetic Foot 69 Y.O. Diabetic Female/ w Exposed Tendon After 15 Tx2 Week  Granulation tissue Required incision,  drainage, and debridement  After 20 Tx---3 Week After 30 Tx---4 Week
Non-Healing Post Amputation 46 Y.O. Diabetic Male Initial Visit After 10 Tx After 16 Tx After 34 Tx
Achilles Tendon repair Site After 10 txs After 25 txs
Problem Wound Non healing Transmetatarsal Amputation Non-healing suture line  3 months post Healing after 25 HBO TX Medial View
Left Mandibular Osteoradionecrosis 45 Y.O. Male/ Radical neck dissection/ radiation/ Exposed Bone Initial VisitBone Exposed Tx 122 Weeks Tx 25---5 Weeks Tx 39---8 Weeks New skin over bone
Radiation Soft Tissue Necrosis 52 Y.O. Male/ Post Radical Neck Reconstruction/ Wound Dehiscence and Flap Compromise After 8 Tx2 Weeks After 36 Tx---7 Weeks After 18 Tx---4 Weeks
Radiation necrosis with  incision dehiscence 51 yo female/ neck dissection 12 TX 21 TX 36 TX Three weeks post tx
Soft Tissue Radiation Necrosis 40 Y.O. Male post T-cell LymphomaRt. hand Initial Visit Tx 7---1 Week Tx 24---5 Weeks Tx 50---10 Weeks No need for graft
Graft Placement post Radiation Necrosis 2 months post-surgery After 20 HBO TX 10 days after spilt thickness graft
Crush Injury Avulsion of the Palmar Skin decreased perfusion or hypoxia 損 HBO at 11 Weeks after Surgery---Full Range of Motion 3 Tx in first 24hrs. Then total of 20 over a period of 4 weeks.
Traumatic Ischemiaof a Replanted Leg 4 Y.O. Mid-Calf Amputation from Lawnmower Microvascular reattachment of nerves and arteries 3 days after surgeryand 6 Tx, Then 4 more Tx over 3 days After 12 weeks, sensate leg--- can walk and run with the  aid of brace.
Healing Compromised Flap of Tibia Fracture 54 Y.O. Male with Tibia Fracture and Internal Fixation Necrosis and  breakdown of tissue over plate and bone After 10 Tx--- 1 Week---compromised portion of flap is now viable After 20 Tx---3 Week 100% flap survival
Failed Flap  Left Dorsal Foot 50 Y.O. Female/ Degloving Accident Tx 1 Tx 30---5 Weeks Tx 18---3 Weeks Tx 12---2 Weeks Follow-Up 3 Weeks Final Follow-Up
Healing Burns   23 YO Female w/facial burns from flaming gasoline  A C B D A-12 hrs after injury  B-24 hrs and 2 HBO txs C-72 hrs later and 6 txs   D-Shortly before discharge
Failed Flap  Right Knee 62 Y.O. Female/ Failed flap post total knee replacement Tx 9Two Weeks Tx 16---3 Weeks Initial Visit
Lip Reimplantation 10 Y.O. Female/ Full thickness lesion from dog bite Re-attached.  Wound looked ischemic and swollen. Patient started hyperbarics and antibiotics.  After 10Tx Follow-up: Happy Smile
Side Effects of HBO Claustrophobia/ Confinement anxiety Barotrauma Reversible myopia
Contraindications Absolute:   Untreated pneumothorax Cis-Platin; Doxorubicin; Disulfiram Emphysema w/air trapping Relative: Emphysema with CO 2  retension Pulmonary lesion in CXR Uncontrolled high fever Claustrophobia Seizure disorder Malignant disease
Insurance Contracts/ agreements with: HHP Senior Care Plus Blue Cross Aetna CIGNA Senior Dimensions Universal Health Network Principal Financial Nevada Preferred Professionals Humana Regence Blue Cross Blue Shield Wellcare Tri-Care Can treat secondary plans to Medicare
How To Consult or Refer Call us 24/7 at (775) 826-2084 We do most pre-authorizations for you!

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Northern Nevada Hyperbarics - Oxygen Therapy - Powerpoint

  • 1. Northern Nevada Hyperbarics, Inc. Serving the Community for 8 Years (775) 826-2084 1698 Meadowood Ln., #100 www.nevadahyperbarics.com
  • 2. What is HBO 100% oxygen in an enclosed chamber at higher-than-atmospheric pressure where oxygen dissolves in arterial plasma in increased amounts---up to 10 to 15 fold increase. Typical course consists of 30 or more treatments done daily for six weeks.
  • 3. Some Basics HBOT has been used in chronic wounds for about 40 years. 100% oxygen is delivered to a chamber under high pressure (2 to 2.4 ATA) for 90 minutes Typical HBOT treatment course consists of 30 or more treatments dailyM-F Administering oxygen to hypoxic tissue shown to activate fibroblast proliferation, down-regulate inflammatory responses, cytokines, up-regulate growth factors all proxies for wound healing.
  • 5. Our Facility 2 Sechrist Monoplace Chambers
  • 6. Clinical Hyperbaric Oxygen Therapy Clinical Hyperbaric Oxygen Therapy Emergency Indications Acute Traumatic Ischemia Crush Injuries and Compartment Syndrome Carbon Monoxide Poisoning Gas Gangrene Surgical Infections Failed Flaps and Grafts Diving Injuries Scheduled Indications Non-Healing Diabetic and problem Wounds Radiation soft tissue necrosis, cystitis, and proctitis. Osteoradionecrosis Osteomyelitis
  • 7. Primary Mechanisms Hyper---oxygenation Vasoconstrictionreduce inflammation Microbiological effects Activate fibroblast and collagen synthesis
  • 8. Secondary Mechanisms Angiogenesis Osteogenesis WBC Oxidative Killing Cell wall permeation
  • 10. Vascular Density in Response to Hyperbaric O2 Response to 20 x 1ATA 100% O2 Response to 20 x 2.4ATA 100% O2 8 x increase in vascular density
  • 11. Vascular Density Increase No HBO Start HBO 18 Tx 24 Tx
  • 12. Diabetic Wound with Recalcitrant Osteomyelitis 78 Y.O Male/ 2 Wks Resection Bone / Continued Drainage Pre-Hyperbaric Partial Wound Closure 20 HBO2 TX---4 Weeks Complication Resolved Full Healing 35 HBO2 TX 7 Weeks
  • 13. Problem Wound w/Skin Graft Failure 58 Y.O. Female/ Diabetic/ 6mo. Non-healing /one failed graft u After 25 Tx---5 Weeks---beefy, red, healthy granulation tissue Split thickness graft placed--- 100% take
  • 14. Tissue Necrosis in Diabetic Foot 69 Y.O. Diabetic Female/ w Exposed Tendon After 15 Tx2 Week Granulation tissue Required incision, drainage, and debridement After 20 Tx---3 Week After 30 Tx---4 Week
  • 15. Non-Healing Post Amputation 46 Y.O. Diabetic Male Initial Visit After 10 Tx After 16 Tx After 34 Tx
  • 16. Achilles Tendon repair Site After 10 txs After 25 txs
  • 17. Problem Wound Non healing Transmetatarsal Amputation Non-healing suture line 3 months post Healing after 25 HBO TX Medial View
  • 18. Left Mandibular Osteoradionecrosis 45 Y.O. Male/ Radical neck dissection/ radiation/ Exposed Bone Initial VisitBone Exposed Tx 122 Weeks Tx 25---5 Weeks Tx 39---8 Weeks New skin over bone
  • 19. Radiation Soft Tissue Necrosis 52 Y.O. Male/ Post Radical Neck Reconstruction/ Wound Dehiscence and Flap Compromise After 8 Tx2 Weeks After 36 Tx---7 Weeks After 18 Tx---4 Weeks
  • 20. Radiation necrosis with incision dehiscence 51 yo female/ neck dissection 12 TX 21 TX 36 TX Three weeks post tx
  • 21. Soft Tissue Radiation Necrosis 40 Y.O. Male post T-cell LymphomaRt. hand Initial Visit Tx 7---1 Week Tx 24---5 Weeks Tx 50---10 Weeks No need for graft
  • 22. Graft Placement post Radiation Necrosis 2 months post-surgery After 20 HBO TX 10 days after spilt thickness graft
  • 23. Crush Injury Avulsion of the Palmar Skin decreased perfusion or hypoxia 損 HBO at 11 Weeks after Surgery---Full Range of Motion 3 Tx in first 24hrs. Then total of 20 over a period of 4 weeks.
  • 24. Traumatic Ischemiaof a Replanted Leg 4 Y.O. Mid-Calf Amputation from Lawnmower Microvascular reattachment of nerves and arteries 3 days after surgeryand 6 Tx, Then 4 more Tx over 3 days After 12 weeks, sensate leg--- can walk and run with the aid of brace.
  • 25. Healing Compromised Flap of Tibia Fracture 54 Y.O. Male with Tibia Fracture and Internal Fixation Necrosis and breakdown of tissue over plate and bone After 10 Tx--- 1 Week---compromised portion of flap is now viable After 20 Tx---3 Week 100% flap survival
  • 26. Failed Flap Left Dorsal Foot 50 Y.O. Female/ Degloving Accident Tx 1 Tx 30---5 Weeks Tx 18---3 Weeks Tx 12---2 Weeks Follow-Up 3 Weeks Final Follow-Up
  • 27. Healing Burns 23 YO Female w/facial burns from flaming gasoline A C B D A-12 hrs after injury B-24 hrs and 2 HBO txs C-72 hrs later and 6 txs D-Shortly before discharge
  • 28. Failed Flap Right Knee 62 Y.O. Female/ Failed flap post total knee replacement Tx 9Two Weeks Tx 16---3 Weeks Initial Visit
  • 29. Lip Reimplantation 10 Y.O. Female/ Full thickness lesion from dog bite Re-attached. Wound looked ischemic and swollen. Patient started hyperbarics and antibiotics. After 10Tx Follow-up: Happy Smile
  • 30. Side Effects of HBO Claustrophobia/ Confinement anxiety Barotrauma Reversible myopia
  • 31. Contraindications Absolute: Untreated pneumothorax Cis-Platin; Doxorubicin; Disulfiram Emphysema w/air trapping Relative: Emphysema with CO 2 retension Pulmonary lesion in CXR Uncontrolled high fever Claustrophobia Seizure disorder Malignant disease
  • 32. Insurance Contracts/ agreements with: HHP Senior Care Plus Blue Cross Aetna CIGNA Senior Dimensions Universal Health Network Principal Financial Nevada Preferred Professionals Humana Regence Blue Cross Blue Shield Wellcare Tri-Care Can treat secondary plans to Medicare
  • 33. How To Consult or Refer Call us 24/7 at (775) 826-2084 We do most pre-authorizations for you!