Treatment of diabetic foot complications with hyperbaric oxygen therapy: A retrospective experience

BackgroundThe aim of this study is to evaluate the role of hyperbaric oxygen in the treatment of diabetic foot ulcers.MethodsWe performed a retrospective observational study of all patients with diabetic foot ulcers treated at the Institution's hyperbaric chamber between January 2010 and August 2012. Patient data was obtained upon patient hospital visit and prospective clinical record consultation.ResultsTwenty-six foot lesions including 13 foot ulcers Wagner grade 2 or greater and 13 amputation stump ulcers were submitted to hyperbaric oxygen therapy between January 2010 and August 2012 in our Institution. Of these, 23 foot lesions completed treatment and complete epithelialization of the primary lesion was achieved in 15 (65%). The mean healing period since the first hyperbaric oxygen therapy session was 16 weeks. Above-ankle amputations were performed in 3 limbs and transmetatarsal amputations in 2 limbs.ConclusionHyperbaric oxygen may be associated with ulcer healing in selected diabetic foot ulcers with impaired cicatrization.     

The role of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers and refractory osteomyelitis

The use of hyperbaric oxygen therapy in the care of the diabetic patient with nonhealing ulcers, refractory osteomyelitis, or both of the lower extremity can be a valuable adjunct in their overall treatment. Adequate tissue oxygenation to promote wound healing and stimulate cellular defenses can be achieved in a hyperbaric environment. Several clinical studies have supported its use in select patients.     

A prospective study: hyperbaric oxygen therapy in diabetics with chronic foot ulcers

Research suggests that hyperbaric oxygen therapy may have beneficial effects on ulcer healing and amputation rates in diabetic patients. This paper describes the design of a study that is evaluating its effects on chronic diabetic foot ulcers.     

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

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.     

The use of adjuvant hyperbaric oxygen in treatment of the diabetic foot

Hypoxia in the relatively ischemic diabetic foot impairs leukocyte bacterial killing and fibroblast-collagen support for capillary angiogenesis. Infection in even the relatively young, "warm-foot" diabetic with microangiopathy, neuropathy, and infection leads to hypoxia due to local high oxygen consumption. The 1100 to 1300 mm Hg arterial PO2 achievable with hyperbaric oxygen results in elevation of wound PO2. Periodic correction of wound hypoxia improves leukocyte bacterial killing and support for capillary angiogenesis. Hyperbaric oxygen is usually futile in the elderly diabetic with significant and generalized large-vessel occlusion.     

负压创面治疗联合高压氧治疗糖尿病足的临床疗效

目的 探讨负压创面治疗联合高压氧治疗糖尿病足的临床疗效.方法 采用回顾性病例对照研究分析江苏大学附属人民医院整形烧伤科自2013年2月至2017年12月收治的46例糖尿病足患者的临床资料,根据治疗方法分为对照组(24例)和联合治疗组(22例).糖尿病足创面按Wagner分级为3～5级;共46足.对照组采用控制血糖、抗感...     

Lower extremity bypass in patients with diabetic foot ulcers

The assessment and management of ischemia for the diabetic patient must be a part of an evidence-based treatment algorithm for wound healing. In 1999, the American Diabetes Association published a consensus position to provide guidance to health care professionals who manage foot wounds in patients with diabetes. The consensus panel recognized six approaches that are supported by clinical trials or well-established principles of wound healing: off-loading, debridement, dressings, antibiotics, vascular reconstruction, and amputation or reconstructive foot surgery when necessary. Adjunctive medical therapies include normalization of blood glucose, treatment of comorbid conditions, control of edema, nutritional repletion, and physical and emotional therapy. Education and prevention of recurrence are essential in any treatment algorithm. Box 1 and Box 2 are algorithms developed by the author and used in clinical management of diabetic lower extremity wounds. The author's multidisciplinary team approach is evidenced based with documented healing and a reduction in amputation at every level. For the patient, it best allows a return to function and well-being. Focusing on quality maximizes the cost/benefit ratio.     

糖尿病足患者的循证护理实践

目的描述糖尿病足的循证护理证据。方法以中文检索关键词"糖尿病足、护理",英文检索关键词"diabetes foot,care ormanagement"检索该领域2000～2010发表的相关临床实践指南、系统评价等循证资源。结果共检索到RNAO(Registered Nur-ses Association of Ontario)临床实践指南2篇、JBI(Joanna Briggs Institute)的系统评价1篇、Cochrane的系统评价3篇。循证推荐建议包括:进行糖尿病足危险因素评估,对所有糖尿病患者进行预防足溃疡的健康教育,当患者处于足溃疡和/或截肢(趾)高危时提供适合的护理干预和社会支持。结论目前尚未发现糖尿病足护理的最佳实践信息,主要是由于缺乏高质量的原始研究,迫切需要进行大样本、高质量的关于糖尿病足护理的实验性研究。     

Assessment of infection in diabetic foot ulcers

Typical signs of infection in diabetic foot ulcers are often absent or late. This literature review outlines the factors practitioners must take into account when assessing for and managing such infections.     

Antibiotic treatment of infected diabetic foot ulcers

Antimicrobial treatment can be effective in diabetic foot ulcers. However, choosing the appropriate regimen depends on the clinical and microbial presentation. This review describes the factors practitioners need to consider.     

糖尿病足溃疡的诊断与治疗

在我国糖尿病发病率正呈逐渐增加趋势，约12％～25％的糖尿病人在病程进展中可并发足部溃疡。糖尿病足高发病率与致残率已成为一个重要的问题。目前国内尚缺乏专业足病治疗师，对糖尿病足溃疡临床特点认识不够，许多足部溃疡未得到充分治疗，失去了挽救肢体的时机。本文综合有关糖尿病足溃疡诊治的文献资料．就目前比较成熟的观点和方法简要归纳，以供借鉴。     

Hyperbaric oxygen therapy of diabetic foot ulcers, transcutaneous oxymetry in clinical decision making

The foot ulcer is one of most common and devastating complications of diabetes and is associated with considerable morbidity and mortality. The major causes of these ulcers are ischemia/hypoxia, neuropathy, and infection, and they often coexist. Despite conventional therapy including revascularization procedures when appropriate, three situations lead frequently to amputation: persistent critical limb ischemia, soft tissue infection, and impaired wound healing from osteomyelitis. In these conditions, hyperbaric oxygen therapy may be used as an adjunctive treatment and is associated with a better outcome. Randomized, prospective, controlled trails have shown the benefit of hyperbaric oxygen therapy in diabetic ulcers of the lower extremity. Transcutaneous oxygen measurement performed under hyperbaric oxygen therapy has a prognostic significance when used to select patients who are the most likely to benefit from therapy. Hyperbaric oxygen should be added to conventional treatment if the transcutaneous oxygen tension close to the trophic lesion in 2.5 ATA hyperbaric oxygen is over 200 mmHg. Peri-wound transcutaneous oxygen tensions over 400 mmHg in 2.5 ATA hyperbaric oxygen or over 50 mmHg in normobaric pure oxygen predict healing success with adjuncted hyperbaric oxygen therapy with high accuracy.     

Treatment of radiation-induced cystitis with hyperbaric oxygen

The effects of hyperbaric oxygen on radiation cystitis have been documented in 3 patients with radiation-induced hemorrhagic cystitis refractory to conventional therapy. Cessation of gross hematuria and reversal of cystoscopic bladder changes were seen in response to a series of hyperbaric oxygen treatments of 2 atmosphere absolute pressure for 2 hours. To our knowledge this is the first report of cystoscopically documented healing of radiation-induced bladder injury.     

Metatarsal head resection for diabetic foot ulcers

Twenty-five diabetic patients underwent 34 metatarsal head resections for chronic neuropathic ulceration. All ulcers were located on the plantar surface beneath the metatarsophalangeal joints. The ulcers had been present for a mean of 9.0 +/- 7.8 months before operation, yet they healed in a mean of 2.4 +/- 1.6 months postoperatively. None recurred during the mean follow-up time of 13.8 +/- 11.0 months. Moderate peripheral vascular disease, impaired renal function, and retinopathy did not affect the time required for ulcer healing. There were two complications: one wound infection and one hematoma. No extremities were lost, and none of the patients suffered any long-term sequelae. We recommend metatarsal head resection to achieve the healing of chronic diabetic foot ulcers under the metatarsophalangeal joints.     

Wound-related pain is underestimated in patients with diabetic foot ulcers

Few studies have assessed pain in neuropathic and neuroischaemic foot ulcers. This pilot study found that patients with these ulcers do experience pain, and that the intensity and nature of the pain was similar in both types of ulcer.