SLR - August 2014 - Rajnish Rammohan
Reference: Londahl M. Hyperbaric Oxygen Therapy as Adjunctive Treatment for Diabetic Foot Ulcers. The International Journal of Lower Extremity Wounds. 2013 12 (2): 152-157.
Scientific Literature Review
Reviewed By: Rajnish Rammohan, DPM
Residency Program: Southern Arizona VA Health Care System
Podiatric Relevance: Patients with Diabetic Foot Ulcers are a common problem encountered by podiatrists. It is often important to enhance the healing of these patients using a multimodal approach. Hyperbaric Oxygen Therapy can be used as a safe and effective additional modality in helping heal these patients. Although only a few randomized control studies exist supporting the use of Hyperbaric Oxygen Therapy, understanding the rationale for use as well as potential complications of Hyperbaric Oxygen Therapy will help physicians incorporate Hyperbaric Oxygen Therapy in their treatment plans, appropriately.
Methods: Hyperbaric Oxygen Therapy is conducted by placing the patient inside a chamber where the patient breathes 100 percent oxygen at an increased pressure of 2 to 2.5 atm. The sessions can last anywhere between 90-120 minutes. Usually the patient is treated with multiple sessions. Usually five to 15 minutes are required for compression and decompression. This therapy is conducted along with standard wound care practices as well as using advanced biologics if needed. Basis of the therapy is increasing oxygen tension at the wound site and stimulating several phases of wound healing.
Results: The first prospective controlled study was by Baroni et al; 18 patients with Diabetic Foot Ulcers were treated with HBOT, 16 patients healed and two underwent amputation as compared with one healing and four amputations in control group. Six randomized control studies show lower amputation rates and/or increased ulcer reduction area in patients who received Hyperbaric Oxygen Therapy as compared to patients who did not receive Hyperbaric Oxygen Therapy.
Conclusions: Hyperbaric Oxygen Therapy has evidence to support its use, although this evidence is not optimal due to various drawbacks with the studies. It does, however, provide data to substantiate the use. It certainly should be considered as a tool which can be used to heal Diabetic Foot Ulcers. This article makes a convincing argument to utilize Hyperbaric Oxygen Therapy as part of a multimodal approach in the treatment of difficult to heal Diabetic Foot Ulcers.