The Wesley Research Institute

Research Projects

Hyperbaric Medicine

Understanding the effects of hyperbaric medicine on chronic wounds

Clinical problem
Leg ulceration has been estimated at 1.1 per 1,000 of the Australian population and it particularly prevalent in diabetics. Leg ulcers are not only painful and difficult to heal, but often require hospitalisation and drastic intervention such as limb amputation.

The study
This project will determine whether hyperbaric oxygen therapy can aid the healing of ulcerated, non-healing wounds by increasing the level of oxygen delivered to soft tissue. It will also search for ‘biomarkers’ in wound fluid before, during and after hyperbaric oxygen treatment that can be used to enhance the prognosis and management of chronic wounds.

Ultimate aim
By understanding the components of the wound fluid before, during and after hyperbaric oxygen treatment, this project will improve treatment and therapies for chronic wounds.

Researchers
Dr Jos Malda, Research Fellow, Queensland University of Technology
Associate Professor Zee Upton, Queensland University of Technology
Dr Robert Long, Medical Director, Wesley Centre for Hyperbaric Medicine

Project sponsor
Xstrata

Project partners
Queensland University of Technology
Wesley Centre for Hyperbaric Medicine
Hyperbaric Oxygen Radiation Tissue Injury Study (HORTIS)

Researcher
Dr Bob Long, Medical Director, Wesley Centre for Hyperbaric Medicine

Project partners
Wesley Centre for Hyperbaric Medicine, International collaborators on HORTIS

Background
Radiation therapy is a key component of the control and eradication of malignant disease. Adequate tumorcidal doses may, however, result in damage to surrounding healthy tissue.

Hyperbaric oxygen has been used in the treatment of radiation tissue injury for several decades. Most of the supportive basic science and clinical
evidence stems from the management of mandibular osteoradionecrosis. More recently, the use of hyperbaric oxygen has been extended to other anatomic sites. This expanded use is based, in large part, on a presumed common underlying pathophysiology of late effects to normal tissue (LENT), regardless of its anatomic location.

Aim
This projects aims to more precisely determine the degree of benefit of hyperbaric oxygen therapy in the treatment of late radiation tissue injury. It has eight components. Seven involve evaluating established radionecrosis at varying anatomic sites, particularly urogenital organs such as the bladder and prostate. The eighth investigates the potential of hyperbaric oxygen therapy to prophylax against late radiation tissue injury. It will also generate more precise 'benchmarking' data as to the complications associated with hyperbaric exposure, including incidence and degree of morbidity.

Method
Patients were randomised to receive either oxygen at 2.0 ATA or air at 1.0 ATA. Both groups of patients underwent between 30 and 40 exposures.

Findings to date
An interim analysis of 68 patients into the proctitis arm of the study (HORTIS IV) has been undertaken. Both groups were compared for pre and post-exposure changes in both clinical findings and SOMA LENT scale. Of the 30 patients in the treatment group, 16 (53.3 per cent) were healed or had significant improvement; only 6 of 27 (22.2 per cent) who received placebo had these outcomes, none of whom were healed. Logistic regression indicates significance (p = .0146), with OR = 4.00 (1.25, 12.72). Change in LENT scale was also significant between the two groups (p = .0015), with a larger change in the treatment group than the placebo group (4.60 vs. 0.65).