Hyperbaric Oxygenation Accelerates the Healing Rate of Nonischemic Chronic Diabetic Foot Ulcers

Abstract

OBJECTIVE -To study the effect of systemic hyperbaric oxygenation (HBO) therapy on the healing course of nonischemic chronic diabetic foot ulcers. RESEARCH DESIGN AND METHODS-From 1999 to 2000, 28 patients (average age 60.2 Ϯ 9.7 years, diabetes duration 18.2 Ϯ 6.6 years), of whom 87% had type 2 diabetes, demonstrating chronic Wagner grades I-III foot ulcers without clinical symptoms of arteriopathy, were studied. They were randomized to undergo HBO because their ulcers did not improve over 3 months of full standard treatment. All the patients demonstrated signs of neuropathy. HBO was applied twice a day, 5 days a week for 2 weeks; each session lasted 90 min at 2.5 ATA (absolute temperature air). The main parameter studied was the size of the foot ulcer measured on tracing graphs with a computer. It was evaluated before HBO and at day 15 and 30 after the baseline.RESULTS -HBO was well tolerated in all but one patient (barotraumatic otitis). The transcutaneous oxygen pressure (TcPO 2 ) measured on the dorsum of the feet of the patients was 45.6 Ϯ 18.1 mmHg (room air). During HBO, the TcPO 2 measured around the ulcer increased significantly from 21.9 Ϯ 12.1 to 454.2 Ϯ 128.1 mmHg (P Ͻ 0.001). At day 15 (i.e., after completion of HBO), the size of ulcers decreased significantly in the HBO group (41.8 Ϯ 25.5 vs. 21.7 Ϯ 16.9% in the control group [P ϭ 0.037]). Such a difference could no longer be observed at day 30 (48.1 Ϯ 30.3 vs. 41.7 Ϯ 27.3%). Four weeks later, complete healing was observed in two patients having undergone HBO and none in the control group.CONCLUSIONS -In addition to standard multidisciplinary management, HBO doubles the mean healing rate of nonischemic chronic foot ulcers in selected diabetic patients. The time dependence of the effect of HBO warrants further investigations. Diabetes Care 26:2378 -2382, 2003L ower-extremity ulcers are responsible for 20% of the hospital admissions of diabetic patients; the incidence of amputation is 6 per 1,000(1). Foot ulcer represents one of the major causes of lower-extremity injuries in the 220 million people suffering from diabetes worldwide, 2.5% of whom will develop a foot ulcer each year (2). Moreover, duration of hospitalization attests to the high morbidity of this condition (3), which has been shown to require as long as ϳ26 weeks for full recovery (4) despite a multidisciplinary approach (associating glycemia control, daily local care, foot offloading antibiotic therapy, and surgical revascularization).The diabetic foot is characterized by sensory, motor, and autonomic neuropathies leading to alteration of pressure distribution, foot deformities, and ulcerations. Metabolic control and infection treatments are of primary importance to control the evolution of the diabetic foot. Hyperbaric oxygenation (HBO) has previously been proposed as an adjunctive treatment for the diabetic foot because it improves in vitro the complex processes underlying healing (5-7). It has also been reported that HBO reduces the incidence of major amputation in diabetic patient...

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

“…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).…”

“…Defining the most effective treatment strategies is essential to reducing the burden of this disease (1). Hyperbaric oxygen therapy (HBOT) has been used as an adjuvant treatment for difficult-to-heal chronic diabetic foot wounds; however, most evidence for its efficacy is based on observational cohort studies or open-label randomized trials (5)(6)(7)(8)(9). HBOT requires significant patient time and financial commitment compared with conventional wound care without HBOT.…”

New Technique of Applying Topical Oxygen Therapy as a Cost-Effective Procedure

“…Wound healing hyperbaric protocols involve daily treatments of 1.5 to 2 h for 20 to 40 days. Kessler et al in their randomized control study on hyperbaric oxygen therapy to heal nonischemic diabetic foot ulcers concluded that this hyperbaric oxygen therapy helps in wound healing by promoting neovascularisation, recruitment of stem cells, production of growth factors, and improved cell migration [1].…”

“…Hyperbaric oxygen therapy has been used for the healing of diabetic ulcers, chronic wounds, and post traumatic wounds [1]. As compared with hyperbaric oxygen therapy, several studies have been conducted in assessing the effectiveness of topical oxygen therapy [2,3].…”

Results of hyperbaric oxygenation in chronic wound healing – preliminary findings

“…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]. Similar positive results in HBOTbased therapy of non-healing ulcers were reported by Kaur et al [10].…”