Hyperbaric oxygen therapy for nonhealing vasculitic ulcers

Background. Cutaneous nonhealing ulceration is a threatening manifestation ofvasculitis. Hyperbaric oxygen (HBO), frequently used as adjuvant therapy for patientswith ischaemic ulcers, exerts additional beneficial effects on the vascular inflammatoryresponse.Aim. To evaluate the effect of HBO on vasculitis-induced nonhealing skin ulcers.Methods. The study population comprised 35 patients aged ‡ 18 years with severe,nonhealing, vasculitis-induced ulcers that had not improved following immunosup pressive therapy. Baseline ulcer tissue oxygenation was evaluated at room air con centration (21% O2), at 1 atmosphere absolute (ATA) breathing 100% O2, and at 2ATA breathing 100% O2. The baseline treatment protocol consisted of a 4-week courseof 100% O2 for 90 min at 2 ATA, five times ⁄ week.Results. The mean baseline ulcer tissue oxygenation (3.1 ± 2.4 kPa at room airconcentration), was significantly increased to 13.9 ± 11.9 kPa at 1 ATA breathing100% O2 (P < 0.001), and subsequently increased further to 59.1 ± 29.8 kPa at 2ATA breathing 100% O2 (P < 0.001). At the end of the hyperbaric therapy, 28 pa tients (80%) demonstrated complete healing, 4 (11.4%) had partial healing and 3(8.6%) had no improvement. None of the patients had any side-effects related to theHBO therapy.Conclusion. HBO therapy may serve as an effective safe treatment for patients withvasculitis having nonhealing skin ulcers. Further studies are needed to evaluate its roleas primary therapy for this group of patients.