Under Pressure: Hyperbaric Oxygen Therapy Explained

After Kelly Campbell had surgery in April 2015, she was recovering well and healing with no complications. Things changed suddenly three weeks after surgery, when she began to have debilitating symptoms. Ms. Campbell told her doctor about the high fever, extreme fatigue and intense pain she was experiencing, and was immediately referred to Richard Franklin, MD, a board-certified general surgeon at GBMC specializing in wound care and hyperbaric oxygen therapy (HBOT).

"I was so sick before I saw Dr. Franklin that I could hardly walk," says Ms. Campbell. "I had no energy whatsoever."

Dr. Franklin diagnosed Ms. Campbell with a compromised flap, a condition that can occur in procedures where a flap of skin is raised to close an incision and the body rejects the skin. Skin flaps are commonly used in ventral hernia repairs, skin cancer removal and plastic surgery procedures such as face lifts or, in Ms. Campbell's case, breast surgery.

"When the flap becomes compromised, tissue necrotizes, or dies, and is rapidly lost," Dr. Franklin explains, noting that for Ms. Campbell, this was impeding blood flow to the area, causing her fever and fatigue. "The goal was to work quickly to save the tissue and prevent further damage. I had Ms. Campbell start hyperbaric oxygen therapy that afternoon."

A compromised flap is often treated with HBOT, a type of treatment in which patients breathe 100 percent oxygen in an enclosed chamber at two to three times atmospheric pressure. Oxygen dissolves into the blood plasma causing an increase in tissue oxygenation, stimulating healing of tissues, forming new blood vessels, controlling infections and regenerating new, healthy tissues.

A session in the hyperbaric oxygen therapy chamber lasts about 90 minutes and a technician remains next to the chamber the entire time. It takes between 10-15 minutes to adjust the pressure at the beginning of the treatment and to return to normal pressure at the end, and every patient's level is different. "Our practice strictly follows the guidelines set forth by the Undersea and Hyperbaric Medical Society," explains Thomas Arwady, Wound Care Consultant, noting that the pressure in the chamber is similar to scuba diving.

If a patient expresses concerns about claustrophobia, sedation is available by consultation with the physician; however, the chamber is completely transparent, and flat-screen TVs are nearby for viewing the extensive movie collection. In addition to compromised flaps and grafts, the GBMC Hyperbaric Medicine Department is able to treat a number of other hyperbaric indications such as diabetic foot ulcers, necrotizing infections and osteomyelitis, osteoradionecrosis (bone damage caused by radiation therapy) and other soft tissue radiation injuries.

Ms. Campbell's treatment at the Wound Care Center involved 20 treatments in the hyperbaric chamber, followed by additional wound care techniques until she was fully healed four months into treatment.

"I started feeling better after two weeks. Once the progression of the necrosis stopped, I started to feel like myself again."

Dr. Franklin notes that Ms. Campbell could have required up to 12 months of routine wound care if she had not pursued hyperbaric therapy, adding that she also could have lost both breasts if she had not sought treatment right away.

"Dr. Franklin was absolutely wonderful," says Ms. Campbell. "If it wasn't for his support, along with the staff and nurses, I don't know if I would have had such a great experience going through such a hard time."