Adjuvant Hyperbaric Oxygen Therapy Enhances Healing of Nonischemic Diabetic Foot Ulcers Compared With Standard Wound Care Alone

Abstract

Recent systematic reviews and meta-analyses have produced conflicting results about the efficacy of hyperbaric oxygen therapy (HBOT) in improving the healing rate for chronic diabetic foot wounds. This study aimed to assess the efficacy of systemic HBOT in healing of chronic nonischemic diabetic foot ulcer. Thirty adult patients having Wagner's grade 2 or 3 chronic diabetic foot ulcers, in whom the response to 30 days of standard wound care was not favorable, were prospectively randomized to have either HBOT (20-40 sessions) plus conventional treatment (n = 15) or conventional treatment alone (n = 15). Ischemic wounds and patients with contraindications to systemic HBOT were excluded. The primary end point was complete healing of the target ulcer. Secondary endpoints included the following: rate of ulcer healing at the end of treatment period and at 4 and 8 weeks thereafter as well as rate of amputation. A significantly greater percentage of HBOT-treated wounds (33.3%, 5/15) achieved complete closure than conventional therapy-treated wounds (0%, 0/15; P = .014) at the end of treatment. This significant difference was maintained throughout the 8 weeks of follow-up. Complications frequency was nonsignificantly different between both groups. Our study showed that HBOT plus conventional therapy appears as safe as and probably more effective than conventional therapy alone for the healing of chronic nonischemic diabetic foot wounds. Larger studies are required to confirm its specific indications.

Keywords: HBOT; diabetic foot; hyperbaric oxygen; ulcers.