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Hyperbaric Oxygen Therapy in the Treatment of Diabetic Foot Ulcers

Updated: Nov 26, 2023




Diabetic foot ulcers (DFU) are one of the most common phenomena for individuals with type II diabetes, diabetes mellitus (DM). More than 60% of non-traumatic amputations are a result of diabetes mellitus. The condition which affects the weight-bearing part of the foot could result in hospitalization, amputation, or death, depending on the severity of the wound. Infections of the wound have dire consequences and are attributed to most of the fatalities for individuals with this condition. There are high chances that once one loses their lower limb from amputation, as a result of diabetes mellitus, they are likely to lose their other limb as well. The mortality rate for such individuals is quite high as well. DFU is famously resistant to other forms of treatment/therapy. However, with HBOT the results have been impressive. For most patients, DFU is treated using 20-30 sessions of 1.5 hours daily in the hyperbaric oxygen chamber.

Hyperbaric oxygen therapy reduces the likelihood of amputations or further amputations that result from DFU. It also prompts proper re-epithelialization. Also, in case one has had surgeries earlier on, they can recuperate faster. Hyperbaric oxygen (HBO) reduces inflammation associated with DFU by reducing the proportion of inflammatory cytokines. Increased tissue oxygenation also leads to tissue proliferation since the cell metabolism conditions are viable for new tissue growth. Also, there is increased vascularization around the wounded part. HBOT increases the body’s immunity thus protecting the wounds against infections. The antimicrobial effect results as a result of increased oxygen supply to the oxygen-deprived foot muscles. Boosting immunity enhances the protective capabilities of neutrophils on both aerobic and anaerobic microorganisms. Pure oxygen also prompts collagen synthesis and the growth of new cells as the healing process continues. Boosting fibroblast activity and the growth of new connective tissue reduces protein leakage through the wounds. Edema and swelling are reduced by increased tissue oxygenation as well. Regions of limited perfusion can receive ample oxygen which is essential for healing and regeneration of tissues. The energy demand is quite high for wounds such as DFUs.

HBOT complements different forms of wound care. Also, it can prompt the proper wound-healing sequence. Chronic wounds such as DFU do not follow the regular healing sequence thus leading to minimal recovery. The wound remains at the inflammation stage. HBOT leads to proper wound healing by prompting the inclusion of all the states of healing: inflammation, granulation, angiogenesis, re-epithelialization, and tissue rebuilding. HBOT is cost-effective in comparison to limb amputation plus rehabilitation costs. Overall, HBOT increases the quality of life and life expectancy of those suffering from DFU.

References

Bajuri, M. Y., Ayesyah, A., Ab, N., & Hassan, M. R. (2017). The Physiological, Biochemical and Quality of Life Changes in Chronic Diabetic Foot Ulcer after Hyperbaric Oxygen Therapy. Medicine and Health, 12(2), 210–219. https://doi.org/10.17576/mh.2017.1202.06

Daly, M. C., Faul, J., & Steinberg, J. S. (2010). Hyperbaric oxygen therapy as an adjunctive treatment for diabetic foot wounds: a comprehensive review with case studies. PubMed, 22(1), 1–11. https://pubmed.ncbi.nlm.nih.gov/25901456



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