Hyperbaric oxygen may improve transcutaneous oxygen tension in chronic diabetic foot ulcers.

Clinical bottom line:

  1. No clinical outcome was assessed
  2. Hyperbaric resulted in improvement in transcutaneous oxygen tension

Citation/s:1. Wadee AN, Aref MH, Nassar AA, Aboughaleb IH, Fahmy SM. The influence of low-intensity laser irradiation versus hyperbaric oxygen therapy on transcutaneous oxygen tension in chronic diabetic foot ulcers: a controlled randomised trial. Journal of Diabetes & Metabolic Disorders. 2021 Sep 3:1-9.

Lead author’s name and fax:Amir N. Wadee : anazih@cu.edu.eg

Three-part Clinical Question:For patients with chronic diabetic foot ulcers, does treatment with hyperbaric oxygen or low-intensity laser irradiation in comparison with standard wound care lead to improvement in wound healing as assessed by transcutaneous oxygen tension?

Search Terms:Transcutaneous oxygen tension, diode laser irradiation, chronic diabetic foot ulcer

The Study:Non-blinded concealed randomised controlled trial with intention-to-treat.

The Study Patients:Adult patients with type 2 diabetes mellitus and chronic diabetic foot ulcers (Wagner Grade 2) present for less than 6 weeks. Patients with a history of underlying respiratory, cardiac or ENT conditions or disorders predisposing to ulcer formation (other than diabetes) were excluded.

Control group(N = 25; 25 analysed): Conventional wound care (saline wash and dressing) twice daily for 6 weeks.

Experimental group(N = 25; 25 analysed): Conventional wound care and HBOT 100% O2 at 2.5 ATA for 90 minutes 5 days per week for 6 weeks for a total of 30 sessions.

The Evidence:


Control Group

HBOT Group


95% CI





Transcutaneous oxygen tension






-38.7 to 99.1


  1. No clinical outcome was assessed.
  2. The authors analysed intragroup differences before and after treatment rather than the values between groups after treatment. We have calculated the between group differences for the wound care and wound care plus hyperbaric groups and cannot conclude there is high confidence around the estimate of improved PtcO2 with HBOT.
  3. The authors described blinding and allocation concealment but as there was no sham treatment described, it is unlikely the study was actually blinded. No mention if the person measuring the transcutaneous oxygen was blinded.
  4. Conventional wound care in this study consisted of saline wash and dressing changes which is no longer common practice.
  5. The authors describe a sample size calculation, but it is not clear what the minimum difference between groups was set at.
  6. The authors included a third treatment arm which assessed low intensity laser irradiation. This performed better than the control but was not as effective as hyperbaric.

Appraised by:Hannah Rubinstein h.rubinstein@student.unsw.edu.au; Tuesday, 23 November 2021

Kill or Update By:November 2023