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[Long-term evaluation of chronic diabetic foot ulcers, non-healed after hyperbaric oxygen therapy].

AIM OF THE STUDY
To assess the effect of systemic hyperbaric oxygen therapy in chronic diabetic lower limb lesions, non-healed after this adjunctive treatment, a retrospective controlled study was undertaken.


RESEARCH DESIGN AND METHODS
From 1990 to 2003, 96 patients demonstrating chronic Wagner grades II-IV lower limb ulcers, with no improvement over a 6 month average period (range 1-48 m) of full standard treatment, were studied. 55 patients received HBOT (study group); Hyperbaric oxygen (HBO) was applied in a multiplace hyperbaric oxygen chamber, at 2.5 absolute atmospheres, during 90 minutes, once a day, 5 days a week; The average number of HBO sessions per patient was 54 (range 20-151). 41 patients refused HBOT or left the Hyperbaric Medical Center after first consultation. So, they did not receive HBOT (control group). HBO and control patients did not differ in their baseline characteristics (i.e., age, sex, type and duration of diabetes, type and duration of lower limb ulcers).


RESULTS
78% of the control group were followed over a mean period of 55 months; 61.8% of the HBO group patients were evaluated over a mean period of 45 months; The patients were assessed for wound healing and need for amputation. The mean healing rate of chronic ulcers was significantly higher in the HBO group; The need for amputation was significantly less in the HBO group; The mean rate of major amputation was less (about one half) in the HBO group, but it was statistically no significant; The need for minor amputation was less (about two thirds) in the HBO group, but it was statistically no significant.


CONCLUSIONS
This retrospective study provides evidence that HBOT increased significantly (13 times more) the mean healing rate of chronic lower limb ulcers in diabetic patients, over a mean follow-up period of 45 months. It also provides evidence that this adjunctive therapy decreased significantly (2 times less) the need for amputation in these patients, over the same period of time. The need for major amputation was also less (about two times) in the HBO group, but statistically no significant; The mean time required for amputation was higher in the HBO group, but statistically no significant. The long-standing beneficial effects of HBOT may be explained by the sustained improvement of fibroblast collagen production and of the microvascular supply inside the leg ulcers, enhanced by this adjunctive therapy.