M.bennett at 06:23, 24 February 2022

2022-02-24T06:23:35Z

Gordoben: Imported from Wikispaces

2018-01-20T23:21:46Z

Imported from Wikispaces

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==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

[[File:sumhorsa.gif|center]]

'''[[Non-healing wounds | BACK]]'''

Duzgun - Revision history

M.bennett at 06:23, 24 February 2022

Gordoben: Imported from Wikispaces