Does hyperbaric oxygen therapy (HBOT) improve wound healing in patients with diabetic foot ulcers (DFU) and peripheral arterial disease (PAD) with low transcutaneous oxygen measurement (TcOM)?

From the Guidelines

Hyperbaric oxygen therapy (HBOT) should not be routinely used as an adjunctive treatment for wound healing in patients with diabetic foot ulcers complicated by peripheral vascular disease and low transcutaneous oxygen measurements (TCOM), due to the lack of strong evidence supporting its effectiveness in improving wound healing outcomes 1. However, according to the most recent guidelines, HBOT may be considered as an adjunct therapy in neuro-ischaemic or ischaemic diabetes-related foot ulcers where standard of care alone has failed and resources exist to support this intervention 1. The decision to use HBOT should be made on a case-by-case basis, taking into account the individual patient's circumstances and the availability of resources. Some key points to consider when deciding whether to use HBOT include:

• The patient's overall health status and ability to tolerate the treatment
• The severity of the wound and the presence of any underlying conditions that may affect healing
• The availability of resources and expertise to support the use of HBOT
• The potential benefits and risks of HBOT, including the risk of side effects such as ear barotrauma and oxygen toxicity seizures. It is essential to note that HBOT should only be used as an adjunct to standard wound care, and not as a replacement for comprehensive diabetic foot care, including glycemic control, appropriate debridement, infection management, offloading, and vascular assessment 1.

From the Research

Hyperbaric Oxygen Therapy for Diabetic Foot Ulcers

• Hyperbaric oxygen therapy (HBOT) has been investigated as a treatment for diabetic foot ulcers (DFUs) with peripheral vascular disease and low transcutaneous oxygen measurement (TcOM) 2, 3, 4, 5.
• A systematic review and meta-analysis found that adjuvant HBOT improves major amputation rate, but not wound healing, in patients with DFUs and peripheral arterial occlusive disease (PAOD) 2.
• A randomized controlled trial found that adjunctive HBOT improved wound healing and reduced the risk of amputation in patients with DFUs 3.
• A literature review found that HBOT shows theoretical promise and has been successfully used in the treatment of individual DFUs, but there remains a lack of strong clinical evidence to encourage its wider use 4.
• Another study found that HBOT can be employed to improve wound healing and correct the pathophysiological factors for chronic wounds, and is internationally recognized as a treatment option for non-healing DFUs 5.

Patient Selection Criteria

• Patient selection criteria for HBOT treatment include glycaemic control, possible contraindications and complications associated with treatment, ulcer severity, and resistance to first and second line treatments 4.
• Further high-quality clinical research is needed to improve the evidence base and determine which patients with DFUs and PAOD benefit most from HBOT as standard adjunctive treatment 2, 4.

Wound Healing and Amputation Rate

• HBOT has been shown to improve wound healing and reduce the risk of amputation in patients with DFUs 3, 5.
• A systematic review and meta-analysis found that HBOT significantly reduced the major amputation rate in patients with DFUs and PAOD, but did not improve wound healing 2.
• Another study found that HBOT improved wound healing in persons with DFU and reduced the risk of amputation of the affected limb 3.