Factors influencing the outcome of lower‐extremity diabetic ulcers treated with hyperbaric oxygen therapy

Abstract

The objectives of this study were to report outcomes of a large number of patients receiving hyperbaric oxygen therapy (HBO(2)T) for diabetic lower-extremity ulcers, and to identify likely outcome predictors. Five hyperbaric facilities supplied data on 1,006 patients. A sixth clinic served as a validation sample for the regression-based prediction model, and later additional data from Memorial Hermann Hospital were added. The severity of lower-extremity lesions was assessed upon initiation of HBO(2)T 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 HBO(2)T 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. Concomitant administration of autologous growth factor gel did not improve outcome. A multiple regression model was fitted to the data that can be used to predict the outcome of diabetic patients undergoing HBO(2)T. 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 of 3 or higher.

Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure and ankle–brachial index in patients with diabetes and chronic foot ulcers

“…In our diabetic patients no correlation between foot ulcer healing and ABI was seen. Similarly, ABI was not reported as a factor influencing outcome of lower-extremity diabetic ulcers in a retrospective study including 1,006 patients from five hyperbaric facilities in the USA [8]. However, an absolute ABI value reduction of 0.1 was associated with a 1.7 times increased risk of major amputation in a randomised study by Faglia et al [1].…”

Safety and efficacy of hyperbaric oxygen therapy in chronic wound management: current evidence

“…Fife et al highlighted that the main objectives of partial healing and stimulation of granulation and epithelialization are not always taken into consideration when the treatment outcome of HBOT is evaluated, even though the treatment is addressing chronic wounds that have shown no improvement for a significant time, with amputation being a realistic alternative option. 59 In their study, only 79 of 136 patients (58%) with renal failure improved compared with 638 of 835 (76%) without renal failure. Due to the difference in outcome with and without renal failure, the authors removed renal failure patients from the statistical analyses to avoid confounding the results.…”

“…58 Fife et al investigated outcomes for 971 patients with diabetic lower extremity ulcers who received HBOT. 59 They reported that 717 (73.8%) patients had improved healing with 34 HBOT treatments. Patients who demonstrated no improvement received an average of 24 therapies.…”

Correction of Hypoxia, a Critical Element for Wound Bed Preparation Guidelines: TIMEO2 Principle of Wound Bed Preparation

“…57,[69][70][71][72][73][74] I propose the timely use of HBO therapy in wound bed preparation for wounds that have a poor prognosis and wounds that have not shown significant signs of healing in the first 4 weeks of standard wound care. 6,75,76 …”

“…[35][36][37][38] Originally, the technique was 29,30,53,55,56,69,76 developed for use in neonatology, 39 but it is now commonly used in pediatric intensive care units, 40 plastic surgery, 41 vascular surgery, 42 anesthesiology, 43 orthopedics, 44 and hyperbaric medicine. 45 Tissue oxygenation and perfusion data are collected to identify the presence of tissue hypoxia, responders to hyperoxia, and adequacy of perfusion.…”