Wound Care

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If you're one of the more than five million Americans suffering from a non-healing wound, let us care for you!

Our specialists work together to provide individualized treatment and decrease the cost and time of your recovery.

If you are suffering with any of the following, please let the Center for Wound Healing and Hyperbaric Medicine help:

  • Diabetic foot ulcers
  • Chronic venous ulcers (leg ulcers)
  • Pressure ulcers (decubitus, bed sores)
  • Chronic osteomyelitis (bone infection)
  • Radiation-related tissue damage
  • Any ulcer/wound that persists for more than 30 days despite care
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Treatment Options

Wound Healing
When a wound fails to heal following 30 days of standard medical care, it is considered a "problem wound" and has the potential to benefit from the services offered by a wound healing center. The Center for Wound Healing and Hyperbaric Medicine at Hartford Hospital provides high quality, cost-effective treatment for individuals with problem wounds. 

Hyperbaric Medicine
When a wound fails to heal following 30 days of standard medical care, it is considered a "problem wound" and has the potential to benefit from the services offered by a wound healing center.

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Frequently Asked Questions

Q: What is Hyperbaric Oxygen Therapy (HBOT)?
A: Hyperbaric Oxygen Therapy (HBOT) is a medical treatment in which the patient is entirely enclosed in a pressure chamber breathing 100% pure oxygen (O2) at greater than one atmosphere pressure. Air contains nearly 21% oxygen, and approximately 78% nitrogen. In hyperbaric oxygen therapy (HBO), the oxygen percentage breathed by the patient is nearly or actually 100%, almost five times more than in air. The pressure of the oxygen breathed by the patient in a hyperbaric oxygen chamber is usually more than 1.5 times (and can be as much as 3 times) greater than atmospheric pressure. HBOT can deliver nearly 15 times as much oxygen as there is in air at normal pressure.

Q: What are the physiological mechanisms of action caused by HBOT that make it work?
A: Hyperoxygenation: HBOT physically dissolves extra oxygen into the blood plasma, which is then delivered to the tissues. Breathing pure oxygen at two to three times normal pressure delivers 10-15 times as much physically dissolved oxygen to tissues. This can increase the tissue oxygen in compromised tissues to greater-than-normal values. Hyperoxygenation has been demonstrated to induce formation of new capillaries in ischemic or poorly perfused wounds. Therefore, it is useful in the treatment of ischemic based compromised wounds, flaps and grafts. It is also helpful in some infections by allowing white cell (leukocytic) activity to resume function.

Mechanical Effect of Increased Pressure: Any gas in the body will decrease in volume as the pressure on it increases. With a threefold increase in pressure, a bubble trapped in the body is reduced by two-thirds. Thus, reduction in gas volume resolves air embolism and decompression illness when the diagnosis to treatment is done in a timely manner.

Vasoconstriction: High-pressure oxygen causes constriction of the blood vessels in normal tissues without creating hypoxia. It does not cause constriction in previously oxygen-deprived tissues. The vasoconstriction decreases edema which is helpful in the treatment of burns, crush injuries, compartment syndromes and other acute traumatic ischemias. Even though the blood flow that contributes to edema is reduced, oxygen delivery to the tissues is maintained through the hyperoxygenation effect.

Antimicrobial Activity: HBOT inhibits alpha toxin production as seen in anaerobic infections such as clostridium perfringens (gas gangrene). The most common cause of gas gangrene is clostridium perfringens; however, there are several gas producing organisms (aerobic and anaerobic) that require surgical debridement initially. It also enhances the white cell killing activity which provides an excellent adjuvant to I.V. antibiotic and local wound care.

Mass Action of Gases: The flooding of the body with any one gas tends to "wash out" others. This action occurs more rapidly under pressure than under ordinary conditions, and makes HBOT an indicated treatment for decompression sickness.

Reduction of Reperfusion Injury: Following an ischemic interval, indirect injury occurs, which is mediated by the inappropriate activation of leukocytes. HBOT prevents such activation. Adherence of white blood cells to capillary walls is markedly reduced, thus mitigating the "no reflow" phenomenon. This is why HBOT therapy is indicated in carbon monoxide poisoning and is considered the treatment of choice.

Q: What are the clinically accepted indications for HBOT?
A: HBOT has been proven effective for many medical conditions, and as a result the Undersea and Hyperbaric Medicine Society, one of the premier research institutes, has approved following indications:

  1. Air or Gas Embolism
  2. Carbon Monoxide Poisoning Carbon Monoxide Poisoning Complicated by Cyanide Poisoning
  3. Clostridal Myositis and Myonecrosis (Gas Gangrene)
  4. Crush Injury, Compartment Syndrome, and other Acute Traumatic Ischemias
  5. Decompression Sickness
  6. Enhancement of Healing in Selected Problem Wounds; Arterial Insufficiencies; Central Retinal Artery Occlusion
  7. Severe Anemia
  8. Intracranial Abscess
  9. Necrotizing Soft Tissue Infections
  10. Refractory Osteomyelitis
  11. Delayed Radiation Injury (Soft Tissue and Bony Necrosis)
  12. Compromised Skin Grafts & Flaps
  13. Acute Thermal Burn Injury

In addition, Medicare coverage determinations will reimburse in the U.S. for diabetic wounds of the lower extremities in patients who meet the following three criteria:

  • Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes;
  • Patient has a wound classified as Wagner grade III or higher; and
  • Patient has failed an adequate course of standard wound therapy.

Q: Is HBOT therapy reimbursed by insurance?
A: If therapy is performed within the accepted indications published by the Undersea & Hyperbaric Medicine Society and as viewed by the Health Care Financing Administration, therapy is normally reimbursed. Like all medical services provided, some private and all managed care providers require pre-authorization.

Q: What is it NOT used for?
A: Similar to all treatment modalities, HBOT is not used for diseases where there is no clinical evidence that it works. There have been claims that HBOT might help with problems like aging skin or to prolong normal healthy life. Those have not been documented nor accepted in the wider medical community.

Q: How is a hyperbaric treatment administered?
A: By definition, hyperbaric oxygen therapy is administered to a patient in a pressurized chamber. The hyperbaric chamber is a steel, aluminum or clear plastic room in which air can be compressed to a pressure that is greater than sea level.

The patient lies down on a stretcher which slides into the chamber. Typically the chamber is pressurized with 100% oxygen. The patient receives 100% oxygen by breathing the oxygen inside of the chamber. A mask or a hood is not needed. These chambers have the capability to be pressurized to 3 ATA. Other than decompression sickness and gas embolism, the UHMS protocols for hyperbaric therapy do not require greater than 3 ATA of pressure for treatment.

Q: How long is a hyperbaric treatment?
A: Except for decompression sickness and arterial gas embolism, the typical treatments are approximately two hours long. Treatments are administered on an in-patient or out-patient basis. In some acute cases, treatments may be administered every eight to twelve hours.

Q: How many treatments are needed?
A: A patient's clinical response and other factors often dictate the number of treatments required. Emergency cases, such as carbon monoxide poisoning, arterial gas embolism or decompression sickness, may only require one or two treatments. Non-healing wounds may call for as many as 20 to 30 treatments.

Q: What does a hyperbaric treatment feel like?
A: Generally, the patient will not feel differently. However, during certain parts of the treatment, the patient may experience a sensation of fullness in the ears, similar to the feeling experienced on an airplane. This is a result of the eardrum responding to pressures changes. Prior to treatment, the patient will be taught a few easy methods to "clear" his or her ears to avoid discomfort.

Q: How does a patient prepare for a hyperbaric treatment?
A: A patient must wear 100% cotton garments during a treatment. Personal items are not allowed in the hyperbaric chamber.

Q: What are the possible side effects?
A: The most common side-effects are not serious. These include:

  • Claustrophobia
  • Ear popping
  • Temporary myopia
  • Lung problems - in rare cases the lungs may become irritated by the oxygen, and the patient develops a dry cough that is resolved once the treatment is stopped.

In extremely small number of cases, some patients have developed non-life threatening issues. Overall, HBOT is a safe procedure.

Q: How does a physician prescribe HBOT?
A: All potential hyperbaric chamber patients must have a prescription from a referring physician in order to receive hyperbaric treatments.

Q: Is physician supervision required?
A: In order for HBOT to be covered under the Medicare program in the United States, the physician must be in constant attendance during the entire treatment.

Q: Are there standard HBOT protocols?
A: Treatment protocols are established by the attending physician. Safe treatment times, dose and pressure limits have been established for hyperbaric oxygen exposure and these limitations form the basis for all treatment protocols. While receiving therapy, the critically ill patient may be provided with mechanical ventilation, IV therapy and invasive and noninvasive physiological monitoring.

Q: How do I clean and disinfect chamber and gurney?
A: Wash then disinfect the chamber according to the type of cases being treated and as directed by the medical staff. Wash the chamber and all gurney, stretcher and mattress surfaces with an approved disinfectant or mild dish washing soap.

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Patient Resources

The management of chronic non-healing wounds is a complicated and time-consuming process in which the Center wishes to be the facilitator for the private physician and patient.

To this end, the Center functions in a collaborative fashion with the primary care provider and/or referring physician and will see patients for a onetime consultation or for ongoing care until wound healing occurs. The center provides ready access to services, expertise, and updated information regarding wound care to provide timely wound closure for both physician and patient alike. If need be, and with the consent of the referring physician, patients can be readily referred to the sub-disciplines supporting the Center, including Orthopedic Surgery, Infectious Disease, Podiatric Surgery, Plastic Surgery, Vascular Surgery and Rehabilitation Medicine. The Center also provides active resources for physician and patient education as well as on-going research designed to improve patient care.

American College of Hyperbaric Medicine
The American College of Hyperbaric Medicine was formed by a group of physicians practicing the developing specialty of hyperbaric medicine who noticed the need for a national professional organization dedicated to serving as a medical specialty society. The ACHM has worked to develop an image of hyperbaric oxygen therapy as a distinct medical specialty, often requiring full time practice.

Divers Alert Network (DAN)
Provides expert information and advice for the benefit of the diving public.

Undersea & Hyperbaric Medicine Society (UHMS)
The Undersea and Hyperbaric Medical Society (UHMS) is the primary source of information for diving and hyperbaric medicine physiology worldwide.

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Meet Our Wound Care Specialists:

Name Specialties Location
Bass, David Martin, MD
  • Plastic & Reconstructive Surgery
  • Hand Surgery
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  • Hartford
  • Avon
  • Glastonbury
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Case, Sara Ann, MD, FACS, CWSP
  • General Surgery
  • Hyperbaric Medicine
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  • Hartford
Nugent, James Fletcher, DPM
  • Podiatry
  • Plainville
  • Hartford
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Sarma, Akella S., MD
  • General Surgery
  • Hyperbaric Medicine
  • Vascular Surgery
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  • Hartford

Our Locations

Wound Care