Few topics in diabetic wound management generate as much “heated” discussion as
hyperbaric oxygen (HBO). Hyperbaric oxygen is an intermittent inhalation therapy in which
the patient breathes oxygen at greater than 1 atm of pressure. This requires placement of
the patient into a sealed vessel (chamber) which is capable of withstanding
pressurization. This article discusses the role of HBO as an adjunct to the management of
diabetic problem foot wounds from evidenced-based, approved (by Medicare) indications and
cost-effectiveness perspectives.
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diabetic, lower-extremity ulcers: a double-blind randomized control
trialEur. J. Vasc. Endovasc. Surg.25:513–518,
2003.
2.
BaroniGPorroTFagliaE: Hyperbaric oxygen in diabetic gangrene
treatmentDiabetes Care10:81–86,
1987.
3.
BrittonJPBarrieWW: Amputation in the diabetic: ten years experience
in a district general hospitalAnn. R. Coll. Surg.69:127–129,
1987.
4.
CianciPPetroneGDragerS: Salvage of problem wound and potential
amputation with wound care and adjunctive hyperbaric oxygen therapy: An economic
analysisJ. Hyperbaric Med.3:127–141,
1988.
5.
DavisJC: The use of adjuvant hyperbaric oxygen in the
treatment of the diabetic footClin. Podiatr. Med. Surg.4:429–437,
1987.
6.
FagliaEFavalesFAldeghiA: Adjunctive systemic hyperbaric oxygen
therapy in treatment of severe prevalently ischemic diabetic foot ulcerDiabetes Care19:1338–1343,
1996.
7.
HohnDC: Oxygen and leucocyte microbial
killing In: DavisJCHuntTK, eds, Hyperbaric Oxygen Therapy,
Bethesda, MD, Undersea Medical
Society, 1997, pp.
101–110.
8.
HuntTKZederfeldtBGoldstickTK: Oxygen and healingAm. J. Surg.118:521–525,
1969.
9.
Hyperbaric Oxygen (HBO) Therapy: Medicare Bulletin
424, May 11, 1999, and supplement April 2003, Center for Medicare/Medicaid
Services. Available at: http://www.cms.gov.
10.
MackeyWMcCulloughJConlonT: The costs of surgery for limb-threatening
ischemiaSurgery99:26–35,
1986.
11.
OrianiGMeazzaDFavalesF: Hyperbaric therapy in diabetic
gangreneJ. Hyperbaric Med.5:171–175,
1990.
12.
StoneJAScottRBrillLRLevineBD: Role of hyperbaric oxygen in the treatment of
diabetic foot wounds (abstract)Diabetes44(suppl):71A,
1995.
13.
StraussMB: Diabetic foot and leg wounds: principles,
management preventionPrimary Care Rep.7:187–198,
2001.
14.
StraussMBBryantBJHartGB: Transcutaneous oxygen measurements under
hyperbaric conditions as a predictor for healing of problem woundsFoot Ankle Int.23:935–937,
2001.
15.
StraussMBVillaviciencioPHartGBBengeC: Salvaging the difficult wound through a combined
management program In: KindwallE, ed, Proceedings of the Eighth International Congress on
Hyperbaric Medicine, San Pedro, CA,
Best Publishing, 1984, p.
207.
16.
ThangLCRamiahRSengLCRajooV: Adjunctive hyperbaric in diabetic foot ulcers. A
preliminary report. Proceedings of the Malaysian Orthopaedic Association
Meeting, April 2001.
17.
WattelFMathieuDCogetJMBillardV: Hyperbaric oxygen therapy in chronic vascular
wound managementAngiology42:159–165,
1990.
18.
WirjosemitoSA: Results of combined therapy including HBO in
salvaging diabetic limbs (abstract)Aviat. Space Environ. Med.63:440, 1992.
