HBOT AND REFRACTORY OSTEOMYLITIS

Osteomyelitis presents either with acute or chronic infection of bone and can be due
to bacteria, mycobacteria, fungi, or (very rarely) viruses. Chronic and unresponsive
bone infections are mainly caused by bacteria, which may remain dormant for years.
Combined with antibiotics, debridement and removal of foreign material, hyperbaric
oxygen therapy is recommended in localized and diffuse osteomyelitis, particularly
with vascular or immune compromise Hyperbaric oxygen therapy elevates
plasma-based oxygenation and provides the level of hyperoxia required for collagen
synthesis and angiogenesis, increasing vascularity and oxygenation. Leukocyte
bacterial killing is enhanced , as is the efficiency of certain antibiotics, by maximizing
oxygen dependent aminoglycoside transport across bacterial cell walls Hyperbaric
oxygen therapy eliminates anaerobes, promotes oxygen dependent osteoclastic
resorption of infected bone. Oedema, inflammation and pressure are significantly
reduced. Slack in 1965 was the first to use hyperbaric oxygen therapy in refractory
osteomyelitis. controlled animal studies confirmed its efficiency. Davis et al
reported the successful use of hyperbaric oxygen therapy in treating advanced
malignant otitis externa, a progressive and potentially fatal form of refractory
pseudomonal osteomyelitis of the ear canal and base of skull, usually affecting
elderly diabetic patients.