Duzgun
Hyperbaric oxygen improved healing and reduced amputation rate in diabetic foot ulcers
Clinical bottom line:
1.HBOT improved the chance of healing in diabetic ulcers |
Citation:Duzgun AP, Satir HZ, Ozozan O, Saylam B, Kulah B, Coskun F. Effect of hyperbaric oxygen therapy on healing of diabetic foot ulcers. J of Foot & Ankle Surgery. 2008;47(6):515-9.
Lead author's name and fax:Arife Polat Duzgun. No email or fax supplied.
Three-part Clinical Question:Does adding Hyperbaric Oxygen Therapy to Standard Treatment in adult diabetics with foot ulcers result in greater healing with less surgical intervention?
Search Terms:Diabetes, diabetic foot ulcers, foot ulcers
The Study:Non-blinded randomised controlled trial with intention-to-treat.
The Study Patients:Adult patients with diabetes and an infected foot wound that had not responded to 'appropriate' local and systemic wound care for 4 weeks.
Control group(N = 50; 50 analysed): Standard treatment of wounds including dressing changes and debridement as clinically dictated.
Experimental group(N = 50; 50 analysed): As above with HBOT at 2-3 ATA for 90 min, twice daily then once daily on alternate days for between 20-30 days
The Evidence:
Outcome |
Time to Outcome |
Control group |
HBOT group |
Relative risk reduction |
Absolute risk reduction |
NNT |
Healed with minor bedside debridement |
92 weeks |
0 |
0.66 |
INF |
0.66 |
2 |
95% CIs: |
0.53 to 0.79 |
1 to 2 | ||||
Graft or Flap required |
92 weeks |
0 |
0.08 |
INF |
0.08 |
13 |
95% CIs: |
0.01 to 0.16 |
6 to 208 | ||||
Minor amputation |
92 weeks |
0.48 |
0.08 |
83% |
0.40 |
3 |
95% CIs: |
51% to 100% |
0.24 to 0.56 |
2 to 4 | |||
Major amputation |
92 weeks |
0.34 |
0 |
INF |
0.34 |
3 |
95% CIs: |
51% to 100% |
0.24 to 0.56 |
2 to 4 |
Comments:
1. Study not blinded and and therefore at some risk of bias.
2. There were more men, obese patients and smokers in the HBO group.
3. No differentiation between neuropathic vs pure ischaemic ulcers.
4. Exact HBOT protocol is unclear and not the same for all patients.
Appraised by:Dr Glen Hawkins Hyperbaric Health, Suite 3 Ground Floor, 46-50 Kent Rd, Mascot NSW 2020 Fax: +61282125987; January 2018
Email: glen.hawkins@unsw.edu.au
Kill or Update By:July 2022