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Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes.
Open accessAbstract
OBJECTIVE: Chronic diabetic foot ulcers are a source of major concern for both patients and health care systems. The aim of this study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) in the management of chronic diabetic foot ulcers. RESEARCH DESIGN AND METHODS: The Hyperbaric Oxygen Therapy in Diabetics with Chronic Foot Ulcers (HODFU) study was a randomized, single-center, double-blinded, placebo-controlled clinical trial. The outcomes for the group receiving HBOT were compared with those of the group receiving treatment with hyperbaric air. Treatments were given in a multi-place hyperbaric chamber for 85-min daily (session duration 95 min), five days a week for eight weeks (40 treatment sessions). The study was performed in an ambulatory setting. RESULTS: Ninety-four patients with Wagner grade 2, 3, or 4 ulcers, which had been present for >3 months, were studied. In the intention-to-treat analysis, complete healing of the index ulcer was achieved in 37 patients at 1-year of follow-up: 25/48 (52%) in the HBOT group and 12/42 (29%) in the placebo group (P = 0.03). In a sub-analysis of those patients completing >35 HBOT sessions, healing of the index ulcer occurred in 23/38 (61%) in the HBOT group and 10/37 (27%) in the placebo group (P = 0.009). The frequency of adverse events was low. CONCLUSIONS: The HODFU study showed that adjunctive treatment with HBOT facilitates healing of chronic foot ulcers in selected patients with diabetes.
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In the citing paper
“Dressing selection Based on wound characteristics, ie, location, inflammation, and amount of exudate Promote a moist environment conducive to tissue growth and epithelial migration.63,64”
From Diabetic Foot Ulcers: A Review (2023) · cites this paper as [63]
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Citations
Cites
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“Two of these ulcers were classified as Wagner grade 4 and two were classified as grade 3 ulcers (20).”
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“D iabetic foot ulcers are a common and serious complication of diabetes (1,2).”
BackgroundHyperbaric oxygen therapy for chronic wounds
Kranke, P., Bennett, M. H., James, M. M., Schnabel, A., Debus, S. E., & Weibel, S. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004123.pub4 · Cited by 705
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“In contrast to our findings, some studies have shown the beneficial effect of HBOT in preventing amputations (8,21,23).”
BackgroundResultAbidia, A., Laden, G., Kuhan, G., Johnson, B., Wilkinson, A. R., Renwick, P., Masson, E. A., & McCollum, P. T. (2003) · European Journal of Vascular and Endovascular Surgery · doi:10.1053/ejvs.2002.1911 · Cited by 367 · cited 1×
“(17) in 2003 suggested the benefit of HBOT, but the study was small and included only patients with Wagner grade 1 and 2 ulcers.”
BackgroundOyibo, S. O., Jude, E. B., Tarawneh, I., Nguyen, H. C., Armstrong, D. G., Harkless, L. B., & Boulton, A. J. M. (2001) · Diabetic Medicine · doi:10.1046/j.1464-5491.2001.00422.x · Cited by 339
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“Furthermore, loss of mobility poses a great burden on the patient and the health care system (3).”
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“D iabetic foot ulcers are a common and serious complication of diabetes (1,2).”
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“The implications of these interventions on study outcome have been debated (24).”
BackgroundHyperbaric Oxygenation Accelerates the Healing Rate of Nonischemic Chronic Diabetic Foot Ulcers
Kessler, L., Bilbault, P., Ortéga, F., Grasso, C., Passemard, R., Stéphan, D., Pinget, M., & Schneider, F. (2003) · Diabetes Care · doi:10.2337/diacare.26.8.2378 · Cited by 257 · cited 4×
“Our findings are in agreement with those reported in previous randomized studies focused on ulcer healing by Abidia et al. (17), Duzgun et al. (21), Kessler et al.(22), and Kalani et al. (23).”
BackgroundMethodInfluentialHyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers
Kalani, M., Jörneskog, G., Naderi, N., Lind, F., & Brismar, K. (2002) · Journal of Diabetes and its Complications · doi:10.1016/s1056-8727(01)00182-9 · Cited by 214 · cited 2×
“In contrast to our findings, some studies have shown the beneficial effect of HBOT in preventing amputations (8,21,23).”
MethodResultHyperbaric oxygen reduced size of chronic leg ulcers: a randomized double-blind study.
Hammarlund, C., & Sundberg, T. (1994) · PubMed · Cited by 173
Hyperbaric oxygen therapy in diabetic foot.
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Effect of Hyperbaric Oxygen Therapy on Healing of Diabetic Foot Ulcers
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“In contrast to our findings, some studies have shown the beneficial effect of HBOT in preventing amputations (8,21,23).”
MethodResultHyperbaric oxygen therapy for chronic wounds
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“Patients from both groups could be treated in the same session as study gases were administered by masks and air or 100% oxygen entered the chamber through separate double-blinded pipes (19).”
MethodDose‐dependent hyperbaric oxygen stimulation of human fibroblast proliferation
Hehenberger, K., Brismar, K., Lind, F., & Kratz, G. (1997) · Wound Repair and Regeneration · doi:10.1046/j.1524-475x.1997.50206.x · Cited by 80 · cited 1×
“This enhances neutrophil killing ability, stimulates angiogenesis, and enhances fibroblast activity and collagen synthesis (9,11,12).”
BackgroundCounterpoint: Hyperbaric Oxygen for Diabetic Foot Wounds Is Not Effective
Berendt, A. R. (2006) · Clinical Infectious Diseases · doi:10.1086/505223 · Cited by 76
Point: Hyperbaric Oxygen Is Beneficial for Diabetic Foot Wounds
Barnes, R. C. (2006) · Clinical Infectious Diseases · doi:10.1086/505207 · Cited by 72
A prospective study: hyperbaric oxygen therapy in diabetics with chronic foot ulcers
Löndahl, M., Katzman, P., Nilsson, A., Hammarlund, C., Sellman, A., Wykman, A., Hugo-Persson, M., & Apelqvist, J. (2006) · Journal of Wound Care · doi:10.12968/jowc.2006.15.10.26970 · Cited by 26 · cited 2×
“The study design and rationale were reported in detail previously (18).”
BackgroundMethodEffects of hyperbaric oxygen upon S. aureus, Ps. aeruginosa and C. albicans.
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Voza, F. A., Liu, Z., & Velazquez, O. C. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-13820-1.00019-0 · Cited by 5
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Challenges in the Treatment of Chronic Wounds
Frykberg, R. G., & Banks, J. (2015) · Advances in Wound Care · doi:10.1089/wound.2015.0635 · Cited by 2,703
“03).(69) Unfortunately, the heterogeneity of the patients and time to reported outcomes (9 months or 1 year) make comparisons with other DFU trials difficult.”
BackgroundResultChronic Wound Healing: A Review of Current Management and Treatments
Han, G., & Ceilley, R. I. (2017) · Advances in Therapy · doi:10.1007/s12325-017-0478-y · Cited by 2,184
“This was in some ways underlined in a recent randomized controlled trial where hyperbaric oxygen as an adjunct did help wound healing but even the authors qualified their findings to be applicable only to ‘‘selected patients with diabetes’’ [61].”
ResultGlobal Vascular Guidelines on the management of chronic limb-threatening ischemia.
Conte, M. S., Bradbury, A. W., Kolh, P., White, J. V., Dick, F., Fitridge, R., Mills, J. L., Ricco, J.-B., Suresh, K. R., Murad, M. H., et al. (2019) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2019.02.016 · Cited by 2,015
Diabetic Foot Ulcers: A Review
Armstrong, D. G., Tan, T.-W., Boulton, A. J. M., & Bus, S. A. (2023) · JAMA · doi:10.1001/jama.2023.10578 · Cited by 1,928
Global vascular guidelines on the management of chronic limb-threatening ischemia
Conte, M. S., Bradbury, A. W., Kolh, P., White, J. V., Dick, F., Fitridge, R., Mills, J. L., Ricco, J.-B., Suresh, K. R., Murad, M. H., et al. (2019) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2019.05.006 · Cited by 1,582
Metadata
- Authors
- Löndahl, M., Katzman, P., Nilsson, A., & Hammarlund, C.
- Affiliations
- Lund University (SE)
- Department of Internal Medicine, Ängelholm Hospital, Ängelholm, Sweden;
- Helsingborgs lasarett (SE)
- Corresponding author
- Löndahl, Magnus
- ORCID
- Löndahl, Magnus
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2010-05-01
- Volume
- 33
- Issue
- 5
- Pages
- 998-1003
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2858204
- OpenAlex
- W2143723758
- Cited by
- 441
- References
- 28
- Citations by year
- 2026: 22 · 2025: 28 · 2024: 25 · 2023: 20 · 2022: 16 · 2021: 31 · 2020: 33 · 2019: 25 · 2018: 31 · 2017: 26 · 2016: 26 · 2015: 28 · 2014: 22 · 2013: 45 · 2012: 29
- FWCI
- 25.69
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Surgery › Wound Healing and Treatments
- Health Sciences › Medicine › Dermatology › Skin Diseases and Diabetes
- Keywords
- hyperbaric oxygen therapy, chronic diabetic foot ulcers, wound healing, hyperbaric air, Wagner grade, adjunctive therapy, diabetes mellitus, adverse events
- MeSH terms
- Adult, Aged, Aged, 80 and over, Air, Amputation, Surgical, Chronic Disease, Female, Follow-Up Studies, Humans, Hyperbaric Oxygenation, Male, Middle Aged, Placebos, Wound Healing, Treatment Outcome, Diabetic Foot
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