Post Surgery and Diabetic Ulcer Healing
Hyperbaric oxygen is a powerful treatment for acute and chronic wounds, acting on injured and healing tissues in a number of ways. Hypoxic tissue, reperfusion injury, compartment syndrome, crush injury, failing flaps, chronic wounds, burns and necritizing infections have been shown to respond favourably to HBOT.
Chronic wounds of the lower limb are a cause of severe morbidity in diabetic patients. Low oxygen tension around the wound is one of the several critical factors, which mutually enhance the progression of a chronic ulcer. Hyper baric oxygen is believed to improve wound healing by enhancing oxygen tension around the wound.
Factors influencing the outcome of lower-extremity diabetic ulcers treated with hyperbaric oxygen therapy
Wound Repair Regen. 2007 May-Jun;15(3):322-31. Links
Fife CE, Buyukcakir C, Otto G, Sheffield P, Love T, Warriner R
Department of Anesthesiology, The University of Texas Medical School at Houston, Texas, USA.
The objectives of this study were to report outcomes of a large number of patients receiving hyperbaric oxygen therapy for diabetic lower-extremity ulcers, and to identify likely outcome predictors. Five hyperbaric facilities supplied data on 1006 patients. A sixth clinic served as a validation sample for the regression-based prediction model, and later additional data from another facility was added. The severity of lower extremity lesions was assessed upon initiation of HBOT using the modified Wagner scale, and the outcome described as healed, partially healed, not improved, amputated or died.
Overall, 73.8% of patients improved (granulated or healed). Factors significantly related to outcome included renal failure, pack year smoking history, transcutaneous oximetry, number of HBOT treatments, and interruption of treatment regimen. Number of treatments per week and treatment pressure (2.0 vs 2.4 atmospheres absolute) were not significant factors in outcome. A multiple regression model was fitted to the data that can be used to predict the outcome of diabetic patients undergoing HBOT.
Given the high cost of amputation and rehabilitation, these data suggest that hyperbaric oxygen treatment should be an important adjunctive therapy to heal lower-extremity lesions, especially those with a Wagner grade 3 or higher.