The addition of hyperbaric oxygen to standard care improved healing of diabetic foot ulcers.

    • Clinical Bottom line:

1.Hyperbaric oxygen in addition to standard wound care resulted in a reduction of wound size for diabetic foot ulcers on the completion of 20 sessions over 2 weeks of treatment.

Clinical Scenario: Patient with diabetic foot ulcer. Three-part question: In patients with diabetic foot ulcers, does hyperbaric treatment, when added to standard care, improve wound healing.

Search terms: diabetic foot ulcer, radical oxygen species, oxidative stress

The study: Non-blinded, prospective, randomised control trial of patients with chronic diabetic foot ulcers (Wagner grade 3 or less). Control group:(n=18, 18 analysed) Standard treatment: custom footwear, non-weight bearing, strict glycaemic control and daily dressings. No sham treatment Experimental group:(n=18, 18 analysed) As above, plus 100% oxygen at 2.5ATA for 90 minutes twice daily for 10 days (20 sessions total) over two weeks.

    • The Evidence
Outcome Control Group HBO Group Difference 95% CI
^ Mean SD Mean SD ^ ^
Ulcer size reduction (%) at 14 days 18.1 6.5 42.4 20 24.3 14.2 to 34.4
Transcutaneous oxygen at wound margin 14 days (mmHg) 35.1 4.9 501 138 466 400 to 532
    • Comments:

1. Very large and unusual differences in transcutaneous oxygen pressures between groups suggests readings at pressure on 100% in the HBO group were used – not a meaningful comparison 1. Reported elevated levels of superoxide dismutase, catalase and glutathione peroxidase in wound tissue biopsies 2. Unblinded study so any differential participation effect lost in control group 3. Very short-term outcome with unclear clinical significance 4. Small samples size with low power.

    • Reference:

1. Ma L, Li P, She Z, Hou T, Chen X and Du J. A Prospective, Randomised Controlled Study of Hyperbaric Oxygen Therapy: Effects on Healing and Oxidative stress of Hyperbaric Oxygen Therapy: Effects on Healing and Oxidative stress of Ulcer Tissue in Patients with a Diabetic Foot Ulcer. Ostomy Wound Management. 2013; 59 (3): 18 – 24.