Hyperbaric oxygen

In a debate on whether hyperbaric oxygen is beneficial in the healing of diabetic foot wounds, Anthony Berendt (Nutfield, U.K.) suggested it not to be appropriate, while Harriet Hopf (Salt Lake City, UT) argued that it is an evidence-based appropriate approach for treating certain people with severe diabetic foot wounds. As discussed in last month's column, the diabetic foot is an important problem. In a series of 449 patients with diabetic foot wounds, 352 were superficial and 134 of these were neither ischemic nor infected. A total of 183 ulcers were clinically infected, and 216 patients had arterial insufficiency. At 6 and 12 months, 247 and 295 of the ulcers had healed without amputation, with median time to healing 78 days; 6 and 8% required amputation and an additional 6 and 11% of the patients had died at the two time points, suggesting high morbidity and mortality associated with diabetic foot wounds (1). Using a Medicare database, the average expenditure for a diabetic person with a lower-extremity ulcer in 1995–1996 was over $15,000, approximatley three times that for a diabetic person without ulceration (2).

Berendt referred to the …