HBOT AND THERMAL BURNS

The skin is the largest organ in the body and major burns to it result in multi-organ
failure. Traditionally, the depth of a burn is classified as being either first, second or
third degree. First degree burns, involving only the epidermis, are clinically
manifested by localized erythema. Second degree burns extend into the underlying
dermis and are marked by blisters, which often erode leaving behind red, moist and
denuded skin. Because deeper elements of the dermis (the hair follicles and sweat
glands) still contain epidermal tissue, second degree burns usually are capable of
regenerating the epithelial layer, given enough time. Third degree burns are full
thickness injuries in which the entire dermal layer of skin has been destroyed. These
burns appear whitish and lack sensation. Re-epithelization is impossible and skin
grafts are needed to cover large areas. If a deep second degree burn becomes
infected or desiccated, it can convert to a third degree burn. Initially, the greatest
concerns in clinical management are hypovolaemia and the prevention of shock.
Following a burn, initial vasoconstriction rapidly gives way to vasodilatation and
stasis, the local capillaries become increasingly permeable, and plasma
extravasates into the burned areas. A second concern in clinical management is the
potential for infection. Most major burns are associated with a relative hypo immunity
state, characterized by decreased levels of immunoglobulin and ineffective
phagocytosis. Besides increasing local hypoxia, edema and changes in the
microcirculation inhibit the ability of normal humeral and cellular immune elements
from reaching the affected areas.
There is evidence that HBOT reduces polymorphonuclear killing ability The
hyperoxic environment results in vasoconstriction, decreases oedema, and
increases collagen formation and angiogenesis. Phagocytic bacterial killing can be
improved, and white cell endothelial adherence is inhibited, preventing capillary
damage. Hyperbaric oxygen therapy maintains the microvascular integrity, and
reduces infection. Hyperbaric oxygen therapy also decreases the healing time,
mortality and morbidity and hospitalization was reduced when compared to
controls. The need for grafting is likewise dramatically reduced .