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Hyperbaric Oxygenation Accelerates the Healing Rate of Nonischemic Chronic Diabetic Foot Ulcers

A prospective randomized study

¹ Department of Endocrinology and Diabetology, University Hospital, Strasbourg, France
² Medical Intensive Care and Regional Hyperbaric Oxygenation Center, University Hospital, Strasbourg, France
³ Department of Cardiovascular Disease, University Hospital, Strasbourg, France

Address correspondence and reprint requests to Dr L. Kessler, Service d’Endocrinologie et de Diabétologie, Hôpitaux Universitaires 1, Place de l’Hôpital, 67091 Strausbourg Cedex, France. E-mail: laurence.kessler{at}medecine.u-strasbg.fr

OBJECTIVE—To study the effect of systemic hyperbaric oxygenation (HBO) therapy on the healing course of nonischemic chronic diabetic foot ulcers.

RESEARCH DESIGN AND METHODS—From 1999 to 2000, 28 patients (average age 60.2 ± 9.7 years, diabetes duration 18.2 ± 6.6 years), of whom 87% had type 2 diabetes, demonstrating chronic Wagner grades I–III foot ulcers without clinical symptoms of arteriopathy, were studied. They were randomized to undergo HBO because their ulcers did not improve over 3 months of full standard treatment. All the patients demonstrated signs of neuropathy. HBO was applied twice a day, 5 days a week for 2 weeks; each session lasted 90 min at 2.5 ATA (absolute temperature air). The main parameter studied was the size of the foot ulcer measured on tracing graphs with a computer. It was evaluated before HBO and at day 15 and 30 after the baseline.

RESULTS—HBO was well tolerated in all but one patient (barotraumatic otitis). The transcutaneous oxygen pressure (TcPO₂) measured on the dorsum of the feet of the patients was 45.6 ± 18.1 mmHg (room air). During HBO, the TcPO₂ measured around the ulcer increased significantly from 21.9 ± 12.1 to 454.2 ± 128.1 mmHg (P < 0.001). At day 15 (i.e., after completion of HBO), the size of ulcers decreased significantly in the HBO group (41.8 ± 25.5 vs. 21.7 ± 16.9% in the control group [P = 0.037]). Such a difference could no longer be observed at day 30 (48.1 ± 30.3 vs. 41.7 ± 27.3%). Four weeks later, complete healing was observed in two patients having undergone HBO and none in the control group.

CONCLUSIONS—In addition to standard multidisciplinary management, HBO doubles the mean healing rate of nonischemic chronic foot ulcers in selected diabetic patients. The time dependence of the effect of HBO warrants further investigations.

Abbreviations: HBO, hyperbaric oxygenation • TcPo₂, transcutaneous oxygen tension

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