Northern Nevada Hyperbarics, Inc.Serving the Community for 8 Years

(775) 826-2084

1698 Meadowood Ln., #100

www.nevadahyperbarics.com

What is HBO

• 100% oxygen in an enclosed chamber at higher-than-atmospheric pressure where oxygen dissolves in arterial plasma in increased amounts---up to 10 to 15 fold increase.

• Typical course consists of 30 or more treatments done daily for six weeks.

Some Basics

• HBOT has been used in chronic wounds for about 40 years.

• 100% oxygen is delivered to a chamber under high pressure (2 to 2.4 ATA) for 90 minutes

• Typical HBOT treatment course consists of 30 or more treatments daily—M-F

• Administering oxygen to hypoxic tissue shown to activate fibroblast proliferation, down-regulate inflammatory responses, cytokines, up-regulate growth factors – all proxies for wound healing.

Hyperbaric Chamber Designs

Our Facility

2 Sechrist Monoplace Chambers

Clinical Hyperbaric Oxygen Therapy

Clinical

Hyperbaric

Oxygen Therapy

Emergency Indications•Acute Traumatic Ischemia

Crush Injuries and

Compartment Syndrome

•Carbon Monoxide Poisoning

•Gas Gangrene

•Surgical Infections

•Failed Flaps and Grafts

•Diving Injuries

Scheduled Indications•Non-Healing Diabetic and problem Wounds

•Radiation soft tissue necrosis, cystitis, and proctitis.

•Osteoradionecrosis

•Osteomyelitis

Primary Mechanisms

• Hyper---oxygenation

• Vasoconstriction—reduce inflammation

• Microbiological effects

• Activate fibroblast and collagen synthesis

Secondary Mechanisms

• Angiogenesis

• Osteogenesis

• WBC Oxidative Killing

• Cell wall permeation

Cumulative Effects

Vascular Density in Response to Hyperbaric O2

Response to 20 x 1ATA 100% O2

Response to 20 x 2.4ATA 100% O28 x increase in vascular density

Vascular Density Increase

No HBO Start HBO

18 Tx 24 Tx

Diabetic Wound with Recalcitrant Osteomyelitis

78 Y.O Male/ 2 Wks Resection Bone / Continued Drainage

Pre-Hyperbaric Partial Wound Closure20 HBO2 TX---4 Weeks

Complication ResolvedFull Healing35 HBO2 TX7 Weeks

Problem Wound w/Skin Graft Failure58 Y.O. Female/ Diabetic/ 6mo. Non-healing /one failed graft

u

After 25 Tx---5 Weeks---beefy, red, healthy granulation tissue

Split thickness graft placed---100% take

Tissue Necrosis in Diabetic Foot69 Y.O. Diabetic Female/ w Exposed Tendon

After 15 Tx—2 Week

Granulation tissue

Required incision, drainage, and debridement

After 20 Tx---3 Week After 30 Tx---4 Week

Non-Healing Post Amputation46 Y.O. Diabetic Male

Initial Visit After 10 Tx

After 16 Tx After 34 Tx

Achilles Tendon repair Site

After 10 tx’s

After 25 tx’s

Problem WoundNon healing Transmetatarsal Amputation

Non-healing suture line 3 months post

Healing after 25 HBO TX

Medial View

Left Mandibular Osteoradionecrosis45 Y.O. Male/ Radical neck dissection/ radiation/ Exposed Bone

Initial Visit—Bone Exposed Tx 12—2 Weeks

Tx 25---5 Weeks Tx 39---8 WeeksNew skin over bone

Radiation Soft Tissue Necrosis52 Y.O. Male/ Post Radical Neck Reconstruction/ Wound

Dehiscence and Flap Compromise

After 8 Tx—2 Weeks

After 36 Tx---7 WeeksAfter 18 Tx---4 Weeks

Radiation necrosis with incision dehiscence

51 yo female/ neck dissection

12 TX 21 TX

36 TX Three weeks post tx

Soft Tissue Radiation Necrosis40 Y.O. Male post T-cell Lymphoma—Rt. hand

Initial Visit Tx 7---1 Week

Tx 24---5 Weeks Tx 50---10 WeeksNo need for graft

Graft Placement post Radiation Necrosis

2 months post-surgery After 20 HBO TX

10 days after spilt thickness graft

Crush InjuryAvulsion of the Palmar Skin

• decreased perfusion or hypoxia

• » HBO at

11 Weeks after Surgery---Full Range of Motion

3 Tx in first 24hrs. Then total of 20 over a period of 4 weeks.

Traumatic Ischemia—of a Replanted Leg4 Y.O. Mid-Calf Amputation from Lawnmower

Microvascular reattachment of nerves and arteries

3 days after surgery—and 6 Tx,Then 4 more Tx over 3 days

After 12 weeks, sensate leg---can walk and run with the

aid of brace.

Healing Compromised Flap of Tibia Fracture54 Y.O. Male with Tibia Fracture and Internal Fixation

Necrosis and breakdown oftissue over plateand bone

After 10 Tx---1 Week---compromised portion of flap is now viable

After 20 Tx---3 Week—100% flap survival

Failed Flap — Left Dorsal Foot50 Y.O. Female/ Degloving Accident

Tx 1

Tx 30---5 Weeks

Tx 18---3 WeeksTx 12---2 Weeks

Follow-Up3 Weeks

Final Follow-Up

Healing Burns 23 YO Female w/facial burns from flaming gasoline

A

C

B

D

A-12 hrs after injury B-24 hrs and 2 HBO tx’sC-72 hrs later and 6 tx’s D-Shortly before discharge

Failed Flap – Right Knee62 Y.O. Female/ Failed flap post total knee replacement

Tx 9—Two Weeks

Tx 16---3 Weeks

Initial Visit

Lip Reimplantation10 Y.O. Female/ Full thickness lesion from dog bite

Re-attached. Wound looked ischemic and swollen. Patient started hyperbarics and antibiotics.

After 10Tx

Follow-up: Happy Smile

Side Effects of HBO

• Claustrophobia/ Confinement anxiety• Barotrauma• Reversible myopia

Contraindications

Absolute: • Untreated pneumothorax• Cis-Platin; Doxorubicin; Disulfiram• Emphysema w/air trapping

Relative:• Emphysema with CO2 retension• Pulmonary lesion in CXR• Uncontrolled high fever• Claustrophobia• Seizure disorder• Malignant disease

InsuranceContracts/ agreements with:• HHP

• Senior Care Plus

• Blue Cross

• Aetna

• CIGNA

• Senior Dimensions

• Universal Health Network

• Principal Financial

• Nevada Preferred Professionals

• Humana

• Regence Blue Cross Blue Shield

• Wellcare

• Tri-Care

• Can treat secondary plans to Medicare

How To Consult or Refer

Call us 24/7 at (775) 826-2084

We do most pre-authorizations for you!