The effectiveness of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers.

Abstract

As the number of diabetes incidence is steadily increasing in our society, Diabetic Foot Ulcers (DFU) continues to be a major cause of complication in patients' care. Hospitalization and major amputation rates in DFU are a major concern relating to the patient's quality of life and a burden on our health care expenditure. Nevertheless, substantial progress has been registered in the treatment of the lower limbs. Over the years, medical research evaluated a great number of standard therapeutic treatments; revasculization; surgical debridement and Hyperbaric Oxygen Therapy (HBOT) is considered as an effective one of the other treatment modalities. The objective of the report is to evaluate the effectiveness of HBOT in increasing the healing rate and decreasing major amputation rate in DFU in addition to standard protocol therapy. This report met the research aims through an extensive study of relevant literature and the implementation of practical research. The latter was carried out through collection of various studies; prospective studies; blinded and double blinded randomised control trials; and also systematic reviews carried out between the years 1987-2011. In the studies participants had chronic diabetic ulcers, over 18 years and in most of the research studies patients were evaluated with measurements of TcP02 for tissue hypoxia and used Wagner scale for wound grading. Also the studies varied in method of control used; 2 studies used placebo therapy (air instead of oxygen); 7 studied used conventional/standard therapy and one study without any control. This research produced a number of key findings: recent ongoing studies confirm a significant increase in the benefit of HBOT; in fact all studies showed improvement in wound healing rate; decrease rate in major amputation and also increases the number of healed wounds on long term basis. On the other hand there was an increase in minor amputation rate. Major amputations were associated with Wagner scale 4-5 and TcP02 and the mostly affected were elderly patients. These studies also showed that HROT does not have effect on ulcers graded 1-1 on the Wagner scale and where the TcP02 less than 25mmHg. The studies showed a significant rate of healing in study group when compared with the control. Adjunctive HBOT is a valuable treatment for those suffering from chronic diabetic foot ulcer. This report provides sufficient evidence for the national administration to adopt HBOT as a standard practice and increase more awareness of the benefits that HBOT arise from it. Further studies are needed to further include HBOT as part of a multidisciplinary team to preserve functional extremities, reduce costs of long term treatments and the integrity of the patient.