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
**2. HBOT also reduced the chance of amputations and significant surgical interventions in these patients.
    • Citation/s: 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 0.66 INF 0.66 2
^ 95% CIs: 0.53 to 0.79 1 to 2
Graft or Flap 92 weeks 0.0 0.08 INF 0.08 13
^ 95% CIs: 0.005 to 0.16 6 to 208
Minor amputation 92 weeks 0.480 0.080 83% 0.40 3
^ 95% CIs: 51% to 100% 0.24 to 0.56 2 to 4
Major amputation 92 weeks 0.34 0.0 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. 5. Mean follow up was 92 ± 12 weeks.

    • Appraised by: Dr Glen Hawkins Hyperbaric Health, Suite 3 Ground Floor, 46-50 Kent Rd, Mascot NSW 2020 Fax: +61282125987; 18 January 2018

Email: glen.hawkins@unsw.edu.au

    • Kill or Update By: July 2021
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