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

Abstract

Aims/hypothesis The randomised, double-blind, placebocontrolled Hyperbaric Oxygen Therapy (HBOT) in Diabetic Patients with Chronic Foot Ulcers (HODFU) study showed beneficial effect of HBOT. As this treatment is expensive and time-consuming, being able to select patients for therapy would be very useful. The aim of this study was to evaluate whether circulatory variables could help in predicting outcome of HBOT. Methods All HODFU study participants who completed therapy, predefined as receiving at least 36 out of 40 scheduled HBOT/placebo sessions, were included in this study (n=75). Baseline transcutaneous oximetry (TcPO 2 ), toe blood pressure (TBP) and ankle-brachial index (ABI) were measured. Ulcer healing rate was registered at the 9-month follow-up visit. An ulcer was considered healed when it was completely epithelialised and remained so at the 12-month follow-up. ResultsIn the HBOT group TcPO 2 were significantly lower for patients whose ulcer did not heal as compared with those whose ulcers healed. A significantly increased healing frequency was seen with increasing TcPO 2 levels in the HBOT group (TcPO 2 /healing rate: <25 mmHg/0%; 26-50 mmHg/50%; 51-75 mmHg/73%; and >75 mmHg/ 100%). No statistically significant relation between the level of TBP or ABI and healing frequency was seen. Conclusions/interpretation Our results indicate that TcPO 2 in contrast to ABI and TBP correlates to ulcer healing following HBOT. We suggest HBOT as a feasible adjunctive treatment modality in diabetic patients with chronic non-healing foot ulcers when basal TcPO 2 at the dorsum of the foot is above 25 mmHg. Trial registration NCT00953186 Funding Mrs

What is the Role of Hyperbaric Oxygen in the Management of Diabetic Foot Disease?

“…In this study no ulcer healed at TcPO 2 levels below 25 mm and all ulcers healed at TcPO 2 levels greater than 75 mm Hg. In patients with TcPO 2 between 26 and 50 mm Hg and 51 to 75 mm Hg, healing rates were 50% and 73%, respectively [44]. Similar results have been reported by others.…”

“…The inclusion criteria in these studies must be recognized (ie, only patients without a need for or a possibility of vascular surgical intervention were included in the Swedish study). Some evidence indicates that microvascular parameters such as TcPO 2 could be useful in predicting which patients will benefit from therapy [43,44].…”

New Treatment Strategies in Diabetic Neuropathy

“…It has long been known that diabetes may itself play an active part in the causation of perforating foot ulcers (Londahl et al, 2010). Foot ulcers are common in diabetic patients and associated with high morbidity and mortality.…”

“…It is generally accepted that the majority of amputations in diabetes are preceded by foot ulcers on the same leg with a lifetime risk of a foot ulcer estimated to reach 15-25%, where the majority of the ulcers are located to the toes. The main cause of diabetic foot ulcers are neuropathy and macro-and microvascular disease, but also other factors may increase the risk for an ulceration (Londahl et al, 2010). Patients with loss of sensation in the foot seem to have a sevenfold increased risk of developing foot ulcers as compared to diabetic patients without neuropathy (Young & Harris, 1994).…”

“…It may be an exiting approach in the future to refine detection of neuropathy. Interestingly, adjunct hyperbaric oxygen therapy, used in a multidisciplinary setting, can improve healing of chronic diabetic foot ulcers (Londahl et al, 2010); a therapy that may also beneficial in nerve regeneration after injury.…”