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 (original) (raw)
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Diabetes Care, 2003
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.
Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers
Journal of Diabetes and its Complications, 2002
Background: The cause of diabetic foot ulcers is multifactorial, e.g., neuropathy and angiopathy, leading to functional disturbances in the macrocirculation and skin microcirculation. Adequate tissue oxygen tension is an essential factor in infection control and wound healing. Hyperbaric oxygen (HBO) therapy, daily sessions of oxygen breathing at 2.5-bar increased pressure in a hyperbaric chamber, has beneficial actions on wound healing including antimicrobial action, prevention of edema and stimulation of fibroblasts. The aim of the present study was to investigate the long-term effect of HBO in treatment of diabetic foot ulcers. Methods: Thirty-eight diabetic patients (30 males) with chronic foot ulcers were investigated in a prospective study. The mean age was 60 ± 13 years and the mean diabetes duration 27 ± 14 years. All patients were evaluated with measurements of transcutaneous oxygen tension (tcPO 2 ), peripheral blood pressure, and HbA 1c . All patients had a basal tcPO 2 value lower than 40 mmHg, which increased to 100 mmHg, or at least three times the basic value, during inhalation of pure oxygen. Seventeen patients underwent 40 -60 sessions of HBO therapy, while 21 patients were treated conventionally. The follow-up time was 3 years. Results: 76% of the patients treated with HBO (Group A) had healed with intact skin at a follow-up time of 3 years. The corresponding value for patients treated conventionally (Group B) was 48%. Seven patients (33%) in Group B compared to two patients (12%) in Group A went to amputation. Peripheral blood pressure, HbA 1c , diabetes duration, and basal values of tcPO 2 were similar in both groups. Conclusions: Adjunctive HBO therapy can be valuable for treating selected cases of hypoxic diabetic foot ulcers. It seems to accelerate the rate of healing, reduce the need for amputation, and increase the number of wounds that are completely healed on long-term follow-up. Additional studies are needed to further define the role of HBO, as part of a multidisciplinary program, to preserve a functional extremity, and reduce the short-and long-term costs of amputation and disability. D
Objective: To assess the efficacy and safety of hyperbaric oxygenation (HBO) therapy as adjunctive treatment for diabetic foot ulcers with a systematic review and meta-analysis of the literature. Methods: MEDLINE, EMBASE, and the Cochrane Library were searched to find relevant articles published up to April 20, 2012, without restriction as to language or publication status. All controlled trials that evaluated adjunctive treatment with HBO therapy compared with treatment without HBO for chronic diabetic foot ulcers were selected. A meta-analysis was performed to assess the efficacy and safety of hyperbaric oxygen in managing foot ulcers. Results: Thirteen trials (a total of 624 patients), including 7 prospective randomized trials, performed between January 1, 1966, and April 20, 2012, were identified as eligible for inclusion in the study. Pooling analysis revealed that, compared with treatment without HBO, adjunctive treatment with HBO resulted in a significantly higher proportion of healed diabetic ulcers (relative risk, 2.33; 95% CI, 1.51-3.60). The analysis also revealed that treatment with HBO was associated with a significant reduction in the risk of major amputations (relative risk, 0.29; 95% CI, 0.19-0.44); however, the rate of minor amputations was not affected (P¼.30). Adverse events associated with HBO treatment were rare and reversible and not more frequent than those occurring without HBO treatment (P¼.37).
Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society
The purpose of this study was to compare the effect of standard wound care with adjunctive hyperbaric oxygen therapy (HBOT) to standard wound care alone on wound healing, markers of inflammation, glycemic control, amputation rate, survival rate of tissue, and health-related quality of life in patients with diabetic foot ulcers (DFUs). Prospective, randomized, open-label, controlled study. The sample comprised 38 patients with nonhealing DFUs who were deemed poor candidates for vascular surgery. Subjects were randomly allocated to an experimental group (standard care plus HBOT, n = 20) or a control group (standard care alone, n = 18). The study setting was a medical center in Kaohsiung City, Taiwan. Hyperbaric oxygen therapy was administered in a hyperbaric chamber under 2.5 absolute atmospheric pressure for 120 minutes; subjects were treated 5 days a week for 4 consecutive weeks. Both groups received standard wound care including debridement of necrotic tissue, topical therapy for W...
Hyperbaric Oxygen Therapy in Ischaemic Foot Ulcers in Type 2 Diabetes: A Clinical Trial
The open cardiovascular medicine journal, 2018
Several treatment modalities and protocols for ischaemic foot ulcers are available. However, little consensus exists on optimal treatment. The aim of this study was to compare Standard Wound Care (SWC) alone SWC with adjunct hyperbaric oxygen therapy (HBOT) in the treatment of ischaemic Diabetic Foot Ulcers (DFUs). Twenty-six patients with Type 2 Diabetes Mellitus (T2DM) presenting with a newly diagnosed ischaemic foot ulcer were included. These were divided into group A (SWC with adjunct HBOT) and group B (SWC only). Participants were followed every week for 4 weeks and their ulcers were measured for their surface area and depth to assess any change in wound size. Both treatment arms succeeded in reducing ulcer area and depth (p<0.001). However, ulcer area (p<0.001) and depth (p<0.001) exhibited superior improvement in group A. Adjunctive HBOT appears to improve wound healing in ischaemic DFUs and merits further study.
Diabetes Care, 1999
R E S U LT S -Of the 13 patients who deteriorated, 11 had Tc PO 2 25 mmHg, while 34 of the 37 patients who improved had Tc PO 2 25 mmHg. The sensitivity and specificity for Tc PO 2 w e re 85 and 92%, re s p e c t i v e l y, when a cutoff level of 25 mmHg was used for determination of outcome of ulcer healing (healing or nonhealing). The corresponding values for TBP at 30 mmHg w e re 15 and 97%. Measurement of Tc PO 2 p rovided a higher positive predictive value (79%) than TBP (67%).
Diabetes mellitus (DM) is a metabolic disease in which the body has difficulty producing insulin which leads to high blood glucose levels. Consequently, people suffering from DM can have damage organs, blood vessels, and nerves which resulting in getting diabetic foot ulcer (DFU). Other therapeutic interventions are offered if the DFU does not heal with normal standard wound care. One of which is hyperbaric oxygen therapy (HBOT) that will increase the oxygen supply to wounds. However, the effectiveness of this therapy is not clearly known till present. Thus, the review of this paper aimed to report on the results of analysis of research that focuses on the effect HBOT on diabetic foot ulcer healing. Relevant literature was searched in Google Scholar and PubMed used keywords "hyperbaric oxygen therapy" "diabetic foot ulcer" "wound healing", and "chronic ulcer". Five articles that met the inclusion criteria based on the results of the analysis. Although there was some indication of a beneficial effect of wound healing process, it is currently unknown which patients are likely to benefit from HBOT and which patients are not. KEYWORD: hyperbaric oxygen therapy, diabetic foot ulcer, wound healing
2014
Peripheral Occlusive Vascular Disease impairs the healing process in diabetic foot ulcers. Ankle Brachial Index is the conventional method of assessing POVD and Transcutaneous Partial Pressure of Oxygen. It is a relatively new measure of assessing microvascular circulation. Our aim was to compare and contrast the utility of ABI and TcPO 2 in predicting wound healing in diabetic foot ulcers. The study included 118 diabetic foot ulcer patients who had their ABI and TcPO 2 measured. A handheld doppler device measured the ABI, and an electrochemical transducer measured the TcPO 2 . Wound outcome was classified as either healed or not healed. The mean ABI in the healed group was 0.96±0.24 and 0.61±0.27 (p<0.001) in the not healed group. The mean TcPO 2 in the healed group was 33.77±15.51 and 23.29±14.77 (p=0.002) in the not healed group. The agreement rate of ABI with TcPO 2 was 59.3%. More than 90% of ulcers with normal ABI and/or TcPO 2 healed. With aggressive management of POVD a g...
Effect of Hyperbaric Oxygen Therapy on Healing of Diabetic Foot Ulcers
Journal of Foot & Ankle Surgery, 2008
Hyperbaric oxygen therapy can be used as an adjunct to standard wound care in the treatment of diabetic patients with foot ulcers. We undertook a prospective, randomized investigation of the use of hyperbaric oxygen therapy versus standard therapy for the treatment of foot ulcers in diabetic patients. A number of demographic variables were analyzed in regard to wound healing. We noted that foot ulcers in patients in the hyperbaric oxygen therapy group were more likely to heal, and were more likely to undergo amputation distal to the metatarsophalangeal joint compared with those patients receiving standard therapy without hyperbaric oxygen. We feel that hyperbaric oxygen therapy should be considered a useful adjunct in the management of foot ulcers in diabetic patients.
2021
Background: Foot ulcer is one of the complications that causes major problems in the world for diabetics. If the wound on the foot is not treated immediately, it will lead to complications and the risk of amputation of the extremity. Thus, a strategy is needed in the prevention and treatment of diabetic foot ulcers. Hyperbaric oxygen therapy is hypothesized to affect the wound healing process, reduce exudate, lower inflammatory response, and the risk of amputation. This study aimed to systematically review the relevant research of hyperbaric oxygen therapy to accelerate the healing of diabetic foot ulcer. Subjects and Method: This was a systematic review using PRISMA Flow Diagram guidelines. The articles published in PubMed, Science Direct, ProQuest, and the Cochrane Library databases, from 2011 to 2021. The study population was patients with diabetic foot ulcer. Intervention was hyperbaric oxygen therapy. Comparison was non hyperbaric oxygen therapy. Outcome was endothelial growth factor serum. The inclusion criteria were randomized controlled trial and full-text in English. The eligible articles were assessed qualitatively. Results: A total of 7 randomized control trials from Egypt, Australia, Taiwan, India, Indonesia, and Malaysia was included in this study. Endothelial growth factor serum was high in the hyperbaric oxygen therapy group compared to the control group. Conclusion: Hyperbaric oxygen therapy has benefit on the wound healing process in patients with diabetic foot ulcer.