title: The Use of Hyperbaric Oxygen Therapy in the Treatment of Non-healing Ulcers Secondary to Graft-versus-host Disease.
abstract: We present the case of a 69 year-old gentleman with non-healing ulcers of the bilateral medial malleoli as a result of graft-versus-host disease (GvHD). The patient discussed was diagnosed with stage IV mantle cell lymphoma. Over the course of 4 years the patient was treated with autologous stem cell transplant, later reduced-intensity allogeneic stem cell transplant, and finally donor lymphocyte infusion due to recurrence. Following these therapies, the patient developed extensive GvHD that resulted in bilateral non-healing ulcers of the medial malleoli. The patient was seen in the wound care center, and his ulcers were treated with standard care that included off-loading, minor outpatient debridement, macrovascular assessment, and local moist wound healing. Despite this care, the ulcers failed to heal over a 6 month period. The patient underwent adjunctive hyperbaric oxygen therapy (HBO). He healed both ulcers within a month of completing HBO. It is our goal to discuss the pathophysiologic mechanism of non-healing wounds in the setting of GvHD and discuss the potential role of HBO in their treatment.
authors.affiliation: Department of Emergency Medicine, Division of Hyperbaric Medicine and Wound Care, SUNY Upstate Medical University, 550 East Genesee Street, Suite 103, Syracuse, NY 13202, USA.
authors.forename: Marvin
authors.initials: M
authors.lastname: Heyboer
authors.affiliation: SUNY Upstate Medical University, School of Medicine, Syracuse, NY, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Taylor
authors.affiliation: Department of Emergency Medicine, Division of Hyperbaric Medicine and Wound Care, SUNY Upstate Medical University, 550 East Genesee Street, Suite 103, Syracuse, NY 13202, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Morgan
authors.affiliation: Department of Emergency Medicine, Division of Hyperbaric Medicine and Wound Care, SUNY Upstate Medical University, 550 East Genesee Street, Suite 103, Syracuse, NY 13202, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Mariani
authors.affiliation: Department of Emergency Medicine, Division of Hyperbaric Medicine and Wound Care, SUNY Upstate Medical University, 550 East Genesee Street, Suite 103, Syracuse, NY 13202, USA.
authors.forename: Shane
authors.initials: S
authors.lastname: Jennings
keywords: Graft-versus-host disease; Hyperbaric; Wound healing