Hyperbaric Oxygen Therapy and Chronic Osteomyelitis
Osteomyelitis represents a bacterial infection involving bone. The disease involves ischemia (inadequate blood supply) as well as infection, and it may be acute or chronic. The term “chronic osteomyelitis” refers to a failure to heal despite adequate surgical and antibiotic therapy. Staphylococci (staph) bacteria is a common bacteria that is often involved. Staphylococcus Epidermis and Pseudomonas Aeruginosa are also bacteria that can grow in the wound. The germs that cause osteomyelitis can enter the bone during an injury or travel to the bone through the blood. HBOT is an adjunctive therapy and should be used along with antibiotics and surgical debridement. Osteomyelitis can either be acute or chronic. All cases are initially acute. The signs of acute infection are pain, swelling, redness at the site of the infection or high fever and general malaise. Chronic osteomyelitis may follow the acute form or may develop over time, when it is not completely cured by initial treatment. Its symptoms include bone pain, tenderness and fever.
Long-term osteomyelitis may go on for years, with periods of worsening symptoms, in spite of treatment. HBOT provides oxygenation which helps fight this disease in three ways.
- Helps to strengthen the bone cells called osteoclasts that reabsorb dead bone, allowing the osteoclasts to remove bony debris more effectively.
- Enhances the function of the immune system’s white blood cells which depend on oxygen. For this reason, HBOT is especially effective when used with antibiotics as it supports the action of the antibiotics.
- Helps the body to create new blood vessels called capillaries. As a result of these three factors, the body is able to get rid of the diseased bone and replace it with healthy bone.
Oxygen is important in wound healing. When the environment of the fibroblast cell has an oxygen tension of less than 10mmHg, the cell can divide, but it can no longer make collagen. It also cannot migrate to where it is needed for healing. When the oxygen tension is increased, the fibroblast can again carry out these wound healing functions. The collagen produced by these cells forms a fibrous matrix, and new capillaries grow into this. Wound healing is a dynamic process and an adequate oxygen tension is mandatory for this process to proceed to healing. HBOT provides oxygen to promote collagen production, angiogenesis (new vessel growth) and wound healing in the ischemic or infected wound. Adequate supply of oxygen is key in the treatment of osteomyelitis