Hyperbaric Oxygen Therapy for Venous Leg Ulcers: A 6 Year Retrospective Study of Results of a Single Center

Abstract

Background: Venous leg ulcers (VLUs) are common and have a large impact on healthcare budgets worldwide. Hyperbaric oxygen therapy (HBOT) may improve healing of these ulcers.Methods: Retrospective, single-center cohort study between 2013 and 2019. All patients with a VLU from an outpatient clinic providing HBOT and wound care were included. The primary outcome measure was wound healing, determined at discharge from the center. Other outcome measures were improvement in patient related outcome measures (PROMs), as assessed by the EQ-5D-3L questionnaire and including quality of life (QoL) and pain score.Results: Fifty patients were included, 53% female, with a mean age of 73.4 (±12.2). Most wounds (83%) had existed longer than 3 months before starting treatment. Patients received an average of 43 (±20) sessions of HBOT. After treatment, 37 patients (63%) achieved complete or near-complete wound healing. Wound size decreased from a median of 14 cm2 [interquartile range (IQR) 32 cm2] to 0.5 cm2 (IQR 5.3 cm2), a median decrease of 7.5 (IQR 16.2 cm2) in cm2 (94%). Patients mostly reported improvement for all health aspects on the questionnaire. Pain score decreased from 5.7 (±2.5) to 2.1 (±2.2) (p < 0.0001) and health score increased from 57.2 (±15.6) to 69.9 (±18.9) (p = 0.02).Conclusions: Patients with non-healing VLUs may benefit from HBOT to achieve complete or substantial wound healing. We recommend a well-designed randomized clinical trial with a number of patients allowing enough statistical power, and of a reasonable duration, to establish the potential of additional HBOT on hard-to-heal venous ulcers.

Hyperbaric Oxygen Therapy for Nonhealing Wounds—A Long-term Retrospective Cohort Study

“…Having a lower number of sessions or severe signs of PAOD was associated with worse outcomes in the current study. This finding corroborates earlier research, which indicated that undergoing 30 or more HBOT sessions is associated with a successful outcome in chronic wounds 29,31 . The presence of severe PAOD is an important independent risk factor for lower extremity amputations 32 .…”

“…This finding corroborates earlier research, which indicated that undergoing 30 or more HBOT sessions is associated with a successful outcome in chronic wounds. 29,31 The presence of severe PAOD is an important independent risk factor for lower extremity amputations. 32 The present findings therefore seem to reflect clinical practice.…”

“…Venous leg ulcers are an important example because these wounds are highly prevalent in the general population 28 . However, studies suggest a positive effect of HBOT on VLUs when these wounds do not heal with standard care 29,30 . All chronic wounds share common etiologic factors 10,11 that respond positively to HBOT, so it follows logically that all chronic wounds, regardless of underlying pathology, may benefit from the therapy.…”

Effects of exercise in treating patients with venous leg ulcers: An umbrella review

“…In United States, the annual expenditure for VLUs care amounts to approximately $15 billion 4 . Recent studies have indicated an increasing incidence of VLUs, adding to the burden faced by healthcare systems 5,6 . These ulcers are notorious for their prolonged healing times, frequent recurrence, and substantial impact on patients' quality of life 4,7 …”

“…4 Recent studies have indicated an increasing incidence of VLUs, adding to the burden faced by healthcare systems. 5,6 These ulcers are notorious for their prolonged healing times, frequent recurrence, and substantial impact on patients' quality of life. 4,7 The development of VLUs is intricately linked to the pathophysiology of chronic venous insufficiency, characterized primarily by venous hypertension and small vessel damage.…”