The diabetic foot and hyperbaric oxygen therapy

Overview

Hyperbaric oxygen therapy is an important aid in the treatment of “problematic wounds” which are under a chronic oxygen deficit, and in which the local oxygen tension is below the optimum necessary for healing the defect.

The author presents the principles of hyperbaric oxygen (HBO) therapy in the treatment of defects and gangrene in diabetic foot. She explains the effect – mechanism of the method, the positive capacity of 100% oxygen under overpressure based not only on hyperoxygenation. Presented is also a review of important factors influencing the healing of diabetic foot ulcerations. Pointed out are the conditions that participate in the success of therapy in this affection, the necessity of complex treatment, and the significant share of HBO therapy in successful treatment. Likewise, undoubted is the importance of transcutaneous assessment of oxygen (TCpO₂) at site of defect and the increase of its value in the course of exposure to HBO.

TCpO₂ values can be applied not only in the determination of the amputation line at times of necessity of such a surgical intervention, but also in the selection of patients for HBO therapy. In diabetic patients with a chronic defect in the leg, TCpO₂ should, in the vicinity of the defect, reach about 30 mm Hg in normobaric ambient air; in normobaric 100% oxygen that should be around 50 mm Hg; and 400 mm Hg in an absolute pressure of 2.5 atmospheres in the hyperbaric chamber – so that there be a high probability for the defect to be healed.

The presentation is documented by a number of renouned studies conducted by recognized institutions abroad. There is also presented a review of the types of hyperbaric chambers and the most frequent reasons of unsuccessful treatment due to extraneous causes.

Key words:
hyperbaric oxygen therapy (HBO) – diabetic foot – transcutaneous assessment of oxygen (TCpO₂).