Hyperbaric oxygen therapy as an adjuvant to standard therapy in the treatment of diabetic foot ulcers

Abstract

Background and Aims: Chronic diabetic foot ulcers pose a major problem because of associated limb threatening complications. The aim of the present study was to evaluate the efficacy of hyperbaric oxygen therapy (HBOT) as an adjuvant to standard therapy for treatment of diabetic foot ulcers. Material and Methods: A total of 54 patients with diabetic foot ulcer of Wagner grade II–IV were recruited in this prospective, randomized, double blind study. Patients were randomized to receive HBOT along with standard therapy (group H; n = 28) or standard therapy alone (group S; n = 26). Patients were given 6 sessions per week for 6 weeks and followed up for 1 year. Outcomes were measured in terms of healing, and need for amputation, grafting or debridement. Parametric continuous variables were analyzed using Student unpaired t -test and categorical variables were analyzed using Chi square test. Results: The diabetic ulcers in 78% patients in Group H completely healed without any surgical intervention while no patient in group S healed without surgical intervention ( P = 0.001). 2 patients in group H required distal amputation while in Group S, three patients underwent proximal amputation. Conclusion: The present study shows that hyperbaric oxygen therapy is a useful adjuvant to standard therapy and is a better treatment modality if combined with standard treatment rather than standard treatment alone for management of diabetic foot ulcers.

Hyperbaric Oxygen Therapy for Diabetic Foot Ulcers Based on Wagner Grading: A Systematic Review and Meta-analysis

“…The same two trials 23,25 revealed significant decreases in minor/distal amputations based on Wagner grade (Fig. 9) overall for all subgroups.…”

“…No significant difference in the graft or flap closure requirement between the HBOT and control groups was found in the two applicable studies 23,25 (Fig. 13).…”

“…The overall effect for all subgroups of two trials, 23,25 with a total of 154 participants implied a significant increase in complete wound healing based on Wagner grade (Fig. 8).…”

“…39 Our analysis identified three trials that had reported outcomes based on the Wagner grading system. 12,23,25 Despite the limited study and participant numbers, a significant increase was found in complete wound healing for Wagner grades II, III, and IV in the HBOT group, while significant decreases were observed in minor/distal amputations for grade III, major/proximal amputations for grade IV, and the risk of operative debridement for grade II patients. The rates of nonhealing wounds, graft or flap closure requirements, and adverse side effects between the groups were not significantly different.…”

“…15,[17][18][19][20][21] Five studies did not provide a complete explanation of standard wound treatment. 12,[22][23][24][25] Three did not include details of the standard wound treatment provided, [26][27][28] and one used only normal saline and debridement. 29 The HBOT settings were generally consistent, with 100% oxygen and ATA pressures of 2.4-2.5, although some studies 23,24 used a pressure of 3 ATA.…”