Bill ... another great case!

This is always a perplexing situation, and I'd value what Mike and others have to say.

While I agree with you that it seems HBOT is a tool for tissue salvage, you know that there is no proven benefit with adding HBOT to the mix of therapy for this difficult disease.

You parenthetically raised the possibility of osteo, but I wouldn't go there. CROM is a very specific story ... which this lady doesn't have.

So, the long story short, I would not go down the HBOT road here.

gene

Bill,

I too have had patients with scleroderma and/or Reynauds ask about HBO. If you look at it as a problem wound, then there have been HBO practioners who have used HBO for Reynauds with decent short term results, but the underlying problem is still present. As Gene said with respect to CROM, if would be difficult to make the diagnosis. With respect to making the diagnosis of chronic refractory osteomyelitis, we have to document how the patient was diagnosed with osteomylitis (biopy, bone culture, Radiographically), how was it treated (surgical, Antibiotics), and why is it now chronic refractory oteo and what is the next step in treatment. You may want to talk with the ID doc and revisit a bone biopsy with the hand surgeon if it is clinically appropriate. I think Gene pretty much nailed it on the head though.