Descargar - Úlceras.net

The Role of Hyperbaric Oxygen Therapyin the Treatment of Diabetic Foot UlcersISABEL CÁSSIO*, NELSON OLIVEIRA*, LISA BORGES* AND LUÍS CABRAL**.*Department of Angiology and Vascular Surgery, Hospital do Divino Espírito Santo-Ponta Delgada,Azores, Portugal.**Hyperbaric and Subaquatic Medicine Unit, Hospital do Divino Espírito Santo-Ponta Delgada,Azores, Portugal.DEFINITIONHyperbaric oxygen therapy (HBOT) consistson breathing oxygen at a higher pressurethan the local atmospheric pressure (1).Although generic, this definition associatesthe two most important concepts of thistherapy. Oxygen can only be administered byinhalation in a pressurized hyperbaric chamber.Subsequently, not all therapies thatinvolve oxygen or pressure are consideredHBOT. This restrictive definition is necessarybecause, throughout history, this concept hasbeen disrespected, and the term HBOT hasbeen misused, occasionally in mercenary wayswith lack of clinical results. Such difficulty inunderstanding the scientific basis of this me -dical therapy unfortunately led to a troubleddevelopment of HBOT.HYSTORICAL PERSPECTIVEThe physiologic concepts that allow thesafe administration of pressurized oxygenwere developed in the beginning of the 17 thcentury. The first investigations in this areafocused more on pressure variation as a the -rapeutical agent rather than on oxygen admi -nistration. In 1662, the British cleric Henshawcrowned his investigation with a publicationwhere he states that chronic pathologies be -nefitted from low atmospheric pressures andacute pathologies from a higher atmosphericFigure 1. Multiplace hyperbaric chamber installedin our Institution-outer view.pressure (2). Even after the discovery of oxygenin 1774, for decades, only pressure variationeffects were taken into account, whenstudying some pathophysiological processes.With the industrial development in the19 th century, more precisely in 1870, duringthe construction of the Brooklyn bridge foundation,Paul Bert gave hyperbaric medicine abreakthrough by describing the decompressiondisease on the constructors working inside aircompressed«caissons» (2). The attention ofnaval armed forces was drawn by his investigation,allowing the development of the vast va -riety of underwater exploration devices availablenowadays (3). In 1879, the French SurgeonFontaine described the connection betweenatmospheric pressure elevation and theincrease of the blood-dissolved oxygen frac-