Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers

Kalani, Majid; Jörneskog, Gun; Naderi, Nazanin; Lind, Folke; Brismar, Kerstin

doi:10.1016/s1056-8727(01)00182-9

Cited by 191 publications

(232 citation statements)

References 18 publications

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“…Most studies evaluating the effect of HBOT on diabetic foot ulcers do not report TBP. In our study TBP could not be used as a predictor for ulcer healing, which is in agreement with the study by Kalani et al, in which major amputation was performed in nine (of 38) patients, with TBP normal in four, moderately decreased in three and severely decreased in two [3]. In our study, basal TcPO 2 was significantly correlated with ulcer healing.…”

Section: Discussionsupporting

confidence: 89%

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Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure and ankle–brachial index in patients with diabetes and chronic foot ulcers

et al. 2010

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Aims/hypothesis The randomised, double-blind, placebocontrolled Hyperbaric Oxygen Therapy (HBOT) in Diabetic Patients with Chronic Foot Ulcers (HODFU) study showed beneficial effect of HBOT. As this treatment is expensive and time-consuming, being able to select patients for therapy would be very useful. The aim of this study was to evaluate whether circulatory variables could help in predicting outcome of HBOT. Methods All HODFU study participants who completed therapy, predefined as receiving at least 36 out of 40 scheduled HBOT/placebo sessions, were included in this study (n=75). Baseline transcutaneous oximetry (TcPO 2 ), toe blood pressure (TBP) and ankle-brachial index (ABI) were measured. Ulcer healing rate was registered at the 9-month follow-up visit. An ulcer was considered healed when it was completely epithelialised and remained so at the 12-month follow-up. ResultsIn the HBOT group TcPO 2 were significantly lower for patients whose ulcer did not heal as compared with those whose ulcers healed. A significantly increased healing frequency was seen with increasing TcPO 2 levels in the HBOT group (TcPO 2 /healing rate: <25 mmHg/0%; 26-50 mmHg/50%; 51-75 mmHg/73%; and >75 mmHg/ 100%). No statistically significant relation between the level of TBP or ABI and healing frequency was seen. Conclusions/interpretation Our results indicate that TcPO 2 in contrast to ABI and TBP correlates to ulcer healing following HBOT. We suggest HBOT as a feasible adjunctive treatment modality in diabetic patients with chronic non-healing foot ulcers when basal TcPO 2 at the dorsum of the foot is above 25 mmHg. Trial registration NCT00953186 Funding Mrs

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Section: Discussionsupporting

confidence: 89%

“…Systemic hyperbaric oxygen therapy (HBOT) has been suggested as a treatment for diabetic foot ulcers [1][2][3]. This Electronic supplementary material The online version of this article (doi:10.1007/s00125-010-1946-y) contains supplementary material, which is available to authorised users.…”

Section: Introductionmentioning

confidence: 99%

Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure and ankle–brachial index in patients with diabetes and chronic foot ulcers

et al. 2010

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“…These results are in contrast to several cohort (7,(26)(27)(28)) and open-label randomized trials (5,6,8,9) where no sham placebo was used. The study by Duzgun et al (8), one of the largest trials published, often is quoted as the justification for HBOT utility in treating diabetic wounds (29).…”

Section: Adverse Eventscontrasting

confidence: 84%

Hyperbaric Oxygen Therapy Does Not Reduce Indications for Amputation in Patients With Diabetes With Nonhealing Ulcers of the Lower Limb: A Prospective, Double-Blind, Randomized Controlled Clinical Trial

et al. 2016

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OBJECTIVEHyperbaric oxygen therapy (HBOT) is used for the treatment of chronic diabetic foot ulcers (DFUs). The controlled evidence for the efficacy of this treatment is limited. The goal of this study was to assess the efficacy of HBOT in reducing the need for major amputation and improving wound healing in patients with diabetes and chronic DFUs. RESEARCH DESIGN AND METHODSPatients with diabetes and foot lesions (Wagner grade 2-4) of at least 4 weeks' duration participated in this study. In addition to comprehensive wound care, participants were randomly assigned to receive 30 daily sessions of 90 min of HBOT (breathing oxygen at 244 kPa) or sham (breathing air at 125 kPa). Patients, physicians, and researchers were blinded to group assignment. At 12 weeks postrandomization, the primary outcome was freedom from meeting the criteria for amputation as assessed by a vascular surgeon. Secondary outcomes were measures of wound healing. RESULTSOne hundred fifty-seven patients were assessed for eligibility, with 107 randomly assigned and 103 available for end point adjudication. Criteria for major amputation were met in 13 of 54 patients in the sham group and 11 of 49 in the HBOT group (odds ratio 0.91 [95% CI 0.37, 2.28], P = 0.846). Twelve (22%) patients in the sham group and 10 (20%) in the HBOT group were healed (0.90 [0.35, 2.31], P = 0.823). All other indices of wound healing were also not statistically significantly different between groups. CONCLUSIONSHBOT does not offer an additional advantage to comprehensive wound care in reducing the indication for amputation or facilitating wound healing in patients with chronic DFUs.

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“…A retrospective study by David et al on HBOT outcomes in patients with osteoradionecrosis (ORN) showed that improvement occurred in 94.7% of patients [7], so there results are similar to ours. Kalani et al proved HBOT to be more effective compared with traditional treatment in patients with diabetic foot ulcers (respectively, 76% vs. 48% of completely healed patients) [8]. Despite very high short-term improvement resulting from HBOT intervention in patients with neuropathic ulcers, the aforementioned improvement may disappear at the 2-week follow-up [9].…”

Section: Discussionmentioning

confidence: 99%

Results of hyperbaric oxygenation in chronic wound healing – preliminary findings

Dzięgielewski¹,

Mikołajewska²,

Goch³

2016

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Introduction: Improved wound healing decreases the risk of complications, increases the possibilities of further treatment, rehabilitation, and care, and improves the quality of life for the patients. Aim of the research: The aim of this paper is to present the outcomes of a study of chronic wound healing using hyperbaric oxygenation therapy (HBOT). The indirect aim of the study was also to assess correlations, i.e. statistical relationships, between observed changes of pain assessment, wound length, wound width, and transcutaneous oximetry and establish prognostic signs. Material and methods: Inclusion criteria meet the medical records of thirty adult patients with chronic wounds treated with HBOT. Wound length, wound width, and transcutaneous oximetry were measured before and after treatment. The pain was evaluated using the numerical rating scale before and after treatment. Results: The response to HBOT varied from good to excellent. Favourable and statistically significant changes were observed in all measured areas: pain assessment, wound length, wound width, and transcutaneous oximetry. Conclusions: The HBOT in adult patients with chronic wounds is an effective method of treatment. Age above 60 years, sex (male), and lack of obesity, if confirmed by further studies, can be useful prognostic signs. However, there is still little evidence. There is a strong need for more research.

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Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers

Cited by 191 publications

References 18 publications

Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure and ankle–brachial index in patients with diabetes and chronic foot ulcers

Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure and ankle–brachial index in patients with diabetes and chronic foot ulcers

Hyperbaric Oxygen Therapy Does Not Reduce Indications for Amputation in Patients With Diabetes With Nonhealing Ulcers of the Lower Limb: A Prospective, Double-Blind, Randomized Controlled Clinical Trial

Results of hyperbaric oxygenation in chronic wound healing – preliminary findings

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