CHT CHT Wound Care & Hyperbaric Indications 1 — Questions and Answers
Question 1: Which diabetic foot wound classification qualifies for HBOT under UHMS-approved indications?
- Wagner Grade I superficial ulcer with no infection
- Wagner Grade II ulcer with adequate perfusion
- Wagner Grade III or higher wound with demonstrated tissue hypoxia (Correct answer)
- Any chronic diabetic wound regardless of perfusion
Correct answer: Wagner Grade III or higher wound with demonstrated tissue hypoxia
UHMS approves HBOT for Wagner Grade III or higher diabetic foot wounds with documented tissue hypoxia that has not responded to standard wound care.
Question 2: A transcutaneous oxygen measurement (TCOM/TcPO2) below what value indicates severe tissue hypoxia and poor healing potential?
- 40 mmHg
- 60 mmHg
- 25 mmHg (Correct answer)
- 80 mmHg
Correct answer: 25 mmHg
A periwound TCOM below 25 mmHg indicates severe tissue hypoxia and predicts poor wound healing without an oxygen-enhancing intervention such as HBOT.
Question 3: HBOT promotes wound healing primarily by:
- Mechanically destroying bacteria with high pressure
- Raising tissue oxygen tension to stimulate angiogenesis, fibroblast activity, and collagen synthesis (Correct answer)
- Cooling tissues to reduce inflammation
- Delivering topical antibiotics more efficiently
Correct answer: Raising tissue oxygen tension to stimulate angiogenesis, fibroblast activity, and collagen synthesis
HBOT elevates tissue PO2, which stimulates fibroblast proliferation, collagen deposition, and VEGF-driven angiogenesis — all critical steps in wound healing.
Question 4: Carbon monoxide poisoning is treated with HBOT because:
- High pressure physically destroys CO molecules
- Oxygen at high partial pressure competitively displaces CO from hemoglobin, reducing carboxyhemoglobin half-life from ~5 hours to ~20 minutes (Correct answer)
- HBOT prevents cerebral edema by reducing intracranial pressure
- Increased pressure forces CO out through the lungs faster
Correct answer: Oxygen at high partial pressure competitively displaces CO from hemoglobin, reducing carboxyhemoglobin half-life from ~5 hours to ~20 minutes
At 2.4–3 ATA, high PO2 competitively displaces CO from hemoglobin and myoglobin, dramatically accelerating CO elimination and reducing delayed neurological injury.
Question 5: Which type of radiation injury is an approved UHMS indication for HBOT?
- Acute radiation skin erythema within the first week
- Delayed radiation necrosis of soft tissue and bone (osteoradionecrosis) (Correct answer)
- Radiation-induced nausea and vomiting
- Radiation-induced alopecia
Correct answer: Delayed radiation necrosis of soft tissue and bone (osteoradionecrosis)
Delayed radiation necrosis (soft tissue radionecrosis and osteoradionecrosis) is UHMS-approved because radiation causes progressive vascular obliteration leading to chronic tissue hypoxia.
Question 6: Compromised skin grafts and flaps are treated with HBOT to:
- Sterilize the wound bed with high-pressure oxygen
- Enhance tissue oxygenation and neovascularization to improve graft and flap survival (Correct answer)
- Reduce post-operative surgical pain
- Accelerate absorbable suture breakdown
Correct answer: Enhance tissue oxygenation and neovascularization to improve graft and flap survival
HBOT enhances tissue PO2 and stimulates VEGF-driven neovascularization, improving perfusion to marginally viable grafts and flaps to prevent necrosis.
CHT CHT Wound Care & Hyperbaric Indications 1
Which diabetic foot wound classification qualifies for HBOT under UHMS-approved indications?