Hyperbaric Oxygen Therapy helps patients with major amputations

FREDERICK Foo, a 32-year old engineer based in Mauritius, was supervising a machine transfer on a typical day at work. Little did he realise that one of the machine parts that weighed a couple of hundred kilogrammes would suddenly slip from the forklift and crash onto his left foot.

Foo was immediately rushed to a local hospital that administered Hyperbaric Oxygen Therapy (HBOT), a therapy that boosts the blood system’s oxygen levels dramatically to accelerate wound recovery.

Oxygen therapy

Dr Soh Chai Rick, Director of the Hyperbaric and Diving Medicine Centre at SGH explained: “HBOT involves breathing pure oxygen at air pressure two to three times greater than normal, which forces more oxygen to be dissolved in the bloodstream.

“This heavy concentration of oxygen saturates every part of the body, stimulates blood vessel growth and enhances the immune system’s ability to fight infection.”

HBOT was initially developed to treat diving disorders that involved bubbles of gas in tissues, such as decompression sickness and gas embolism, which results from the quick ascension of divers to the water surface.

However, later studies found that HBOT could also help other conditions such as carbon monoxide poisoning, severe blood loss, poor healing wounds, thermal burns and radiation damaged tissues.

On the effectiveness of HBOT, Dr Soh said: “Patients with diabetes-related foot ulcers and those with delayed radiation injuries are most likely to respond well to HBOT. Several trials in diabetic patients have shown benefits. For example, a study has showed that only 8.6 per cent of patients who received HBOT required a major amputation compared to 33.3 per cent of patients who did not receive the therapy.”

Comfortable healing process

While undergoing treatment in Mauritius,  Foo experienced some discomfort. “As the HBOT chamber in Mauritius is mainly used to treat divers for decompression illness, it was difficult for me to fit into the relatively small chamber with my injured foot,” said  Foo.

In an attempt to save his foot, doctors advised him to seek further treatment at Singapore General Hospital (SGH). In Singapore,  Foo received surgical treatment, antibiotics, and went through 35 HBOT sessions of two hours each over a period of six weeks.  Foo who had difficulty sitting for long was able to lie down comfortably to receive treatment at the Hyperbaric and Diving Medicine Centre, which has a 41-foot-long and 40-tonne hyperbaric chamber.

“The chamber, with three compartments, can hold up to 14 patients. The main compartment can accommodate 10 patients, while a smaller one for four patients – the diver’s lock – is reserved for emergency cases. A third middle compartment allows doctors to enter the chamber in an emergency, without interrupting the session,” Dr Soh explained.

“My foot hurt the most during the first two weeks, and I had to be on painkillers. However after the first 20 sessions, I could already feel my foot healing,” said  Foo.

The intense therapy helped save Foo’s foot, although the tips of his toes had to be removed. “My foot, which had turned black from the lack of circulation, could have been amputated. With the advanced HBOT, my recovery took four months, which is half the time of the expected healing process,”  Foo shared.

Hyperbaric medicine

“At the Hyperbaric and Diving Medicine Centre, we are advancing the standards of diving and hyperbaric medicine to benefit patients. This year, we are participating in a three-year study involving 80 patients from SGH’s Burns Centre to assess the full benefits of hyperbaric treatment on patients suffering from thermal burns,” said Dr Soh.

To date, more than 50 patients suffering from diabetic wounds, injuries from radiation for cancer, and burns have been treated at the Hyperbaric and Diving Medicine Centre.

The Republic of Singapore Navy also collaborates with the Centre to provide recompression treatment for diving medical emergencies.