Diabetic foot ulcer, a rising concern in the modern world, can occur from a number of factors like atherosclerotic peripheral disease, sudden mechanical changes in the creation of the bony structure of the foot, peripheral neuropathy etc. Frequent and severe diabetic attack can trigger all of these situations.
What’s the Statistics Saying?
According to a study, diabetes is the main reason behind the nontraumatic lower extremity amputations in the United States. In 5% cases, diabetes leads to diabetic foot ulcers. Of these patients, 15-20% require amputation within 5 years of the ulcer onset.
Nowadays, hyperbaric medicine is coming to the forefront for its number of benefits. Now, let’s discuss how hyperbaric oxygen therapy or HBOT can treat diabetic foot ulcers.
HBOT indulges in an intermittent administration of 100% oxygen inhaled at a greater atmospheric pressure than the pressure at sea level.
How Does HBOT work?
HBOT increases the amount of oxygen dissolved into the tissue to improve the oxygenation of these tissues. Oxygenation plays a vital role in wound healing. In the United States, Hyperbaric medicine is applied with the pressures of 2.0-3.0 atmosphere absolute along with partial pressures of arterial oxygen of 1,200 mm Hg. In such a situation, hemoglobin gets fully saturated which indicates an increased amount of dissolved oxygen in the plasma. Oxygen is suffused into the tissues and the end arterioles. This action results in healing. Other benefits of HBOT in wound healing are:
- Increased periwound tissue oxygenation
- Decreased edema
- Enhanced oxidative killing of harmful bacteria
- Increased cellular energy production
- Antibiotic potentiation
- Neoangiogenesis promotion
- Improved epithelial migration
- Increased collagen production
HBOT can be used for some specific kinds of wounds including sufficiently perfused lower extremity diabetic ulcers. According to the guidelines, patients having type 1 or 2 diabetes with a lower extremity diabetic ulcer are allowed to take hyperbaric medicine.
In this article, I have come up with a bundle of instances where patients got a positive result from hyperbaric oxygen therapy. Let’s have a quick glance at those case studies.
Case # 1
A 56-year-old person was suffering from a nonhealing diabetic ulcer. He had other complications including diabetes mellitus type 2, methicillin-resistant Staphylococcus aureus (MRSA), neuropathy, chronic obstructive pulmonary disease, pedal edema, and stroke. He was a smoker as well. The severity of his ulcer was 6.2 cm* 4.6 cm, 0.7 cm deep. He was provided hyperbaric oxygen therapy. After going through 26 sessions over 52 days, he reached nearer to recovery. This case is a remarkable one to justify the potential of HBOT in wound healing.
Case # 2
A 79-year-old male was suffering from type 2 diabetes mellitus with Wagner grade 3 diabetic ulcer. His other complications were peripheral sensory neuropathy along with colon cancer. His ulcer was measured as 0.7*1.0 cm and 0.3 cm deep. He underwent 5 debridements during the HBOT sessions and he received recovery once the treatment was over.
Case # 3
In the third case, a 50-year-old female was detected having a Wagner grade 3 diabetic foot ulcer with abscess on her left foot. She was affected by diabetes mellitus type 2, MRSA infection, motor and peripheral neuropathy. Her medical history shows two episodes of diabetic foot ulcers. Both of these two episodes were resolved successfully. She underwent 31 HBOT treatments, and then doctors found signs of progress.
Types of Hyperbaric Chamber
Systematic HBOT is effective in reducing needs of amputation since it avails sufficient oxygen to the vascularized connective tissue compartment beside the wound. It also helps to improve local host immune response and fight the infection. HBOT is offered in a hyperbaric chamber. There are two types of hyperbaric chambers - monoplace hyperbaric chamber, and multiplace hyperbaric chamber. Both of these two types of chambers serve the same purpose only with one difference. The previous one is designed for use by a single person while the latter one can be used by multiple people at the same time.
A Final Takeaway
HBOT is nothing new in the medical world. It has a long history, and in its initial days, it was used to treat decompression only. Now, the periphery of its applications has been expanding greatly. Every day, the hold of diabetes is getting stronger. With this upsurge, diabetic foot ulcer is no doubt going to take worst forms in the near future. Hyperbaric medicine or hyperbaric oxygen therapy is showing a promising prospect to deal with this problem.
Do you have any experience of HBOT? If yes, please do share with us!