49 year old female with history of Lupus Vasculitis. Patient developed areas of necrosis of the skin and subcuaneous tissue at the lateral aspect lower leg as well as the lateral ankle. The patient required I.V. antibiotics and underwent an extensive debridement and split thickness skin graft. Angiograms done pregrafting revealed poor blood flow to the lower extremity with poor distal run off. If graft failed, the patient would be scheduled for a below knee amputation. Four months post grafting the patient was referred to the Hyperbaric Unit with a failed graft and nonhealing wound.

Assessment revealed an ulcerated area over and proximal to left lateral malleolus with areas of full thickness skin loss down to the malleolus and distal tibular shaft. Transcutaneous Oxygen mapping indicated areas adjacent to the wound site to be hypoxic with partial pressures below 30 mmHg. The wound would have a poor chance of healing in an ambient environment. HBOT was initiated, using 90 minute treatment protocol of 2.0 atmospheres absolute pressure five days per week for a total of 50 treatments. Moist wound care with IntraSite Gel® and Allevyn® were applied changed Q3D. Completion of 50 HBOT resulted in granulation tissue formation and epithelization over the malleolus and tibular shaft with salvage of the leg.