Diabetic foot wounds are a major complication of diabetes resulting in substantial morbidity and mortality. Fifty percent of all lower extremity amputations in the United States are due to diabetes, affecting 42/10000 patients with this disease. One mode of therapy that is frequently employed but is controversial is hyperbaric oxygen therapy (HBO). This therapy is designed to increase oxygen delivery to local ischemic tissue by having a patient breathe 100% oxygen at greater than normal sea level atmospheric pressure. To test the hypothesis that a defined course of intermittent increased tissue concentrations of oxygen will result in a reduction in amputation rates, we performed a retrospective analysis of 469 consecutive patients with diabetes treated at a referral wound care center over a 33 month period. Eighty-seven patients received an average of 19±13 HBO treatments while 382 received "standard care" only, including revascularization, debridement, glycemic control, antibiotics, offloading, dietary modification, smoking cessation, and autologous platelet derived growth factors. Patients referred for HBO (X ± SE) had larger wounds (2533 ± 987 vs. 1199 ± 61 mm3), more wounds per patient (3.8 vs. 2.4), and a greater percentage recommended for amputation (31% vs. 19% p=0.002). Despite having the more serious wounds, the limb salvage rate was greater in the HBO patients (72% vs. 53% p<0.002). This study suggests that HBO may be a useful adjunctive clinical treatment for diabetic foot wounds. However, a study with objective blinded assessment, randomization, and prospective placebo controlled design is required for definitive conclusions. The Role of Hyperbaric Oxygen in the Treatment of Diabetic Foot Wounds.
JEFF A. STONE, RONALD G. SCOTT, LEON R. BRILL, BENJAMIN D. LEVINE,
Diabetes, May 1995 vol. 44, supp 1
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