Role of hyperbaric oxygen therapy in the treatment of chronic ulcers of the foot in patients with type II diabetes mellitus

Authors

  • Said El Mallah Department of General and Vascular Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
  • Abd El Moniem Fareed Department of General and Vascular Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
  • Omar M. Abd Al-Halim Ghaly Nasser Institute for Search and Treatment, Cairo, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20194398

Keywords:

Chronic ulcers, Hyperbaric oxygen therapy, Type II diabetes mellitus

Abstract

Background: The aim of this study is to evaluate the effect of hyperbaric oxygen therapy (HBOT) in healing of chronic foot ulcers in patients with type II diabetes mellitus.

Methods: A case control study included 40 type II diabetic patients with chronic foot ulcers not healing for more than 4 weeks. It has been conducted at Naser Institute for Research and Treatment and Menoufia University Hospital during the period between April 2017 and September 2018. Patients with non-healing diabetic foot ulcers were referred by physicians and were also identified through a number of wound care clinics in various hospitals.

Results: Most ulcers were observed in the sole and heel in both groups A and B (n=14 and 9 respectively), while the rest of ulcers were distributed in other areas of the foot, namely the medial and lateral malleoli, dorsum and toes. On comparing the wound related complications developing during the treatment period, no statistically significant difference was found between both groups (p=0.147). As regards Wagner's grade, 7 patients (17.5%) had grade 4 ulcers, 18 patients (45%) had grade 3 ulcers and 15 patients (37.5%) had grade 2 ulcers, showing no statistically significant difference between both groups before treatment (p=0.259).

Conclusions: HBOT is a useful adjunct in the treatment of non-healing diabetic foot ulcers, and that the cost of HBOT itself will be reduced as it becomes more widely available in the clinical setting, and as further knowledge of its other advantages, such as limited side effects and relative safety, become more widely appreciated. 

References

The Canadian National Institute of Health. Hyperbaric oxygen therapy for non-healing ulcers in Diabetes Mellitus; Ontario Health Technology Assessment Series. 2005;5:11.

Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.

Gregg EW, Sorlie P, Paulose-Ram R. Prevalence of lower-extremity disease in the US adult population >40 years of age with and without diabetes: 1999-2000 national health and nutrition examination survey. Diabetes Care. 2004;27:1591-7.

Faglia E, Mantero M, Caminiti M, Caravaggi C, De GR, Pritelli C, et al. Extensive use of peripheral angioplasty, particularly infrapopliteal, in the treatment of ischaemic diabetic foot ulcers: clinical results of a multicentric study of 221 consecutive diabetic subjects. J Intern Med. 2002;252(3):225-32.

Moss SE, Klein R, Klein BE. Long-term incidence of lower-extremity amputations in a diabetic population. Arch Fam Med. 1996;5(7):391-8.

Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Armstrong DG, Harkless LB, Boulton AJ: The effects of ulcer size and site, patient's age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers. Diabet Med. 2001;18:133-8.

Healthcare Cost and Utilization Project (HCUP): Nationwide Inpatient Sample, 2001, 2002. Available at: http://www.hcup-us.ahrq.gov. Accessed on 3 June 2019.

Prompers L, Huijberts M, Apelqvist J, Jude E, Piaggesi A, Bakker K, et al. High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe: baseline results from the Eurodiale study. Diabetologia. 2007;50:18-25.

Ramsey SD, Newton K, Blough D. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care. 2009;22:382-7.

Kalani M, Jorneskog G, Naderi N, Lind F, Brismar K. Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers. Long-term follow-up. J Diabetes Compl. 2002;16(2):153-8.

Faglia E, Favales F, Aldeghi A, Calia P, Quarantiello A, Barbano P, et al. Change in major amputation rate in a center dedicated to diabetic foot care during the 1980s: prognostic determinants for major amputation. J Diabetes Compl. 1998;12(2):96-102.

Valensi P, Girod I, Baron F, Moreau-Defarges T, Guillon P. Quality of life and clinical correlates in patients with diabetic foot ulcers. Diabetes Metab. 2005;31:263-71.

Pandya S, Doctor N, Supe A. Hyperbaric oxygen therapy in diabetic foot. J Postgraduate Med. 1992;38:112-4.

Gill AL, Bell CAN. Hyperbaric oxygen: its uses, mechanisms of action and outcomes. QJ Med. 2004;97:385-95.

Cimsit M, Uzun G, Yildiz S. Hyperbaric oxygen therapy as an anti-infective agent. Expert Rev Anti Infect Ther. 2009;7:1015-26.

Abidia A, Laden G, Kuhan G, Johnson BF, Wilkinson AR, Renwick PM, et al. The role of hyperbaric oxygen therapy in ischaemic diabetic lower extremity ulcers: a double-blind randomized controlled trial. Eur J Vascular Endovascular Surg. 2003;25(6):513-8.

Wagner FW. The diabetic foot. Orthopedics. 1987;10:163-72.

Borun Center for Gerontological Research. Pressure Ulcer Prevention Training Module. Anna and Harry Borun Center for Gerontological Research, 2004. Available at: http://borun.medsch.ucla.edu/ modules/Pressure_ulcer_prevention/pumod.pdf. Accessed on 2 June 2019.

Duzgun AP, Satir HZ, Ozozan O, Saylam B, Kulah B, Coskun F. Effect of hyperbaric oxygen therapy on healing of diabetic foot ulcers. J Foot Ankle Surg. 2008;47:515-9.

Lindahl E, Gilje F, Norberg A, Soderberg A. Nurses’ ethical reflections on caring for people with malodorous exuding ulcers Nursing Ethics. 2010;17(6):777-90.

Viswanathan V, Jasmine JJ, Snehalatha C, Ramachandran A. Prevalence of pathogens in diabetic foot infection in South Indian type 2 diabetic patients. J Assoc Physicians India. 2002;50:1013-6.

Markova A, Mostow EN. US skin disease assessment: ulcer and wound care. Dermatol Clin. 2012;30(1):107-11.

Kessler L, Bilbault P, Ortéga F, Grasso C, Passemard R, Stephan D, et al. Hyperbaric oxygenation accelerates the healing rate of non-ischemic chronic diabetic foot ulcers: a prospective randomized study. Diabetes Care. 2003;26:2378-82.

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Published

2019-09-26

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Original Research Articles