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hyperbaric and diabetes foot

Vickie R Driver, Alexander Reyzelman, Jill Kawalec, Michael French
Worldwide, diabetic foot ulcers (DFUs) continue to exact a major burden on patients and health care providers. Although hyperbaric oxygen therapy is well-known as an adjunct option, less is known about the efficacy of transdermal continuous oxygen therapy (TCOT). A prospective, randomized, blinded, multicenter, parallel study was conducted from October 2009 to November 2012 to evaluate healing time and the proportion of DFUs healed after 12 weeks of moist wound therapy (MWT) with or without TCOT. Study participants (persons with type 1 or type 2 diabetes and a nonhealing [>1-month but <1-year duration], 1 cm² to 10 cm² in area, infection-free DFU) were randomized to TCOT or a sham device (control) in addition to receiving MWT...
April 2017: Ostomy/wound Management
Mehmet Orçun Akkurt, Ismail Demirkale, Ali Öznur
Objective: The treatment of diabetic hindfoot ulcers is a challenging problem. In addition to serial surgical debridements, hyperbaric oxygen therapy and local wound care play important roles in the surgeon's armamentarium, for both superficial infection and gangrene of the soft tissue, often complicated by osteomyelitis of the calcaneus. The purpose of this study was to evaluate the results of an aggressive approach from diagnosis to treatment of calcaneal osteomyelitis in foot-threatening diabetic calcaneal ulcers...
2017: Diabetic Foot & Ankle
Mesut Mutluoglu, Gunalp Uzun, Michael Bennett, Peter Germonpré, David Smart, Daniel Mathieu
Diabetic foot ulcers (DFUs) are one of the most common indications for hyperbaric oxygen treatment (HBOT). The role of HBOT in DFUs is often debated. Recent evidence based guidelines, while recommending its use, urge further studies to identify the patient subgroups most likely to benefit from HBOT. A recent study in Diabetes Care aimed to assess the efficacy of HBOT in reducing the need for major amputation and improving wound healing in patients with chronic DFUs. In this study, patients with Wagner grade 2-4 diabetic foot lesions were randomly assigned to have HBOT (30 sessions/90 min/244 kPa) or sham treatment (30 sessions/90 min/air/125 kPa)...
September 2016: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
Howard M Kimmel, Anthony Grant, James Ditata
Oxygen must be tightly governed in all phases of wound healing to produce viable granulation tissue. This idea of tight regulation has yet to be disputed; however, the role of oxygen at the cellular and molecular levels still is not fully understood as it pertains to its place in healing wounds. In an attempt to better understand the dynamics of oxygen on living tissue and its potential role as a therapy in wound healing, a substantial literature review of the role of oxygen in wound healing was performed and the following key points were extrapolated: 1) During energy metabolism, oxygen is needed for mitochondrial cytochrome oxidase as it produces high-energy phosphates that are needed for many cellular functions, 2) oxygen is also involved in the hydroxylation of proline and lysine into procollagen, which leads to collagen maturation, 3) in angiogenesis, hypoxia is required to start the process of wound healing, but it has been shown that if oxygen is administered it can accelerate and sustain vessel growth, 4) the antimicrobial action of oxygen occurs when nicotinamide adenine dinucleotide phosphate (NADPH)-linked oxygenase acts as a catalyst for the production of reactive oxygen species (ROS), a superoxide ion which kills bacteria, and 5) the level of evidence is moderate for the use of hyperbaric oxygen therapy (HBOT) for diabetic foot ulcers, crush injuries, and soft-tissue infections...
August 2016: Wounds: a Compendium of Clinical Research and Practice
Joseph A Molnar, Lucian G Vlad, Tuna Gumus
There is increasing awareness that chronic wound healing is very dependent on the patient's nutritional status, but there are no clearly established and accepted assessment protocols or interventions in clinical practice. Much of the data used as guidelines for chronic wound patients are extrapolated from acutely wounded trauma patients, but the 2 groups are very different patient populations. While most trauma patients are young, healthy, and well-nourished before injury, the chronic wound patient is usually old, with comorbidities and frequently malnourished...
September 2016: Plastic and Reconstructive Surgery
Sabrina Meireles de Andrade, Isabel Cristina Ramos Vieira Santos
OBJECTIVE: To describe the most common types of wounds indicated for hyperbaric oxygen therapy and the results. METHOD: Cross-sectional study at a Hyperbaric Centre in the city of Salvador, Bahia, Brazil. The medical records of 200 patients treated with hyperbaric oxygen were reviewed from January to November 2013. The variables of the persons, clinical, indications, number of sessions and wound care were analysed by means of descriptive statistics and the chi-square test of association incorporating Yates's correction with a level of 5%...
June 2016: Revista Gaúcha de Enfermagem
David Balaz, Andrea Komornikova, Peter Sabaka, Elena Leichenbergova, Kristina Leichenbergova, Matej Novy, Darina Kralikova, Ludovit Gaspar, Andrej Dukat
OBJECTIVES: To investigate vasomotion in diabetic patients who underwent sessions of hyperbaric oxygen (HBO2) therapy. MATERIALS AND METHODS: Seventy-one patients with diabetes Type 2 and lower-extremity neuropathy were enrolled in a prospective matched case-control study. A total of 39 patients underwent 15 sessions of HBO2 therapy consisting of 90 minutes of breathing 100% oxygen at 2.5 atmospheres; 32 were included in the control group without exposure to hyperbaric oxygen...
March 2016: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
Şamil Aktaş, Selçuk Baktıroğlu, Levent Demir, Önder Kılıçoğlu, Murat Topalan, Erdem Güven, Bengüsu Mirasoğlu, Fatih Yanar
OBJECTIVE: The intralesional injection of recombinant human epidermal growth factor (EGF-IL), a new therapy, has been claimed to prevent major amputations in advanced diabetic foot lesions. In this study, the efficacy of EGF-IL on advanced diabetic foot ulcers (DFU) was reviewed. METHODS: Intralesional 75 µg EGF application (Heberprot-P® 75, Heber Biotec, Havana, Cuba) to 12 diabetic foot lesions in 11 patients (8 males, 3 females; mean age: 62.2±10.6 years) was evaluated...
2016: Acta Orthopaedica et Traumatologica Turcica
J V Eggert, E R Worth, C C Van Gils
We obtained costs and mortality data in two retrospective cohorts totaling 159 patients who have diabetes mellitus and onset of a diabetic foot ulcer (DFU). Data were collected from 2005 to 2013, with a follow-up period through September 30, 2014. A total of 106 patients entered an evidence-based limb salvage protocol (LSP) for Wagner Grade 3 or 4 (WG3/4) DFU and intention-to-treat adjunctive hyperbaric oxygen (HBO₂) therapy. A second cohort of 53 patients had a primary lower extremity amputation (LEA), either below the knee (BKA) or above the knee (AKA) and were not part of the LSP...
January 2016: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
Benjamin R Johnston, Austin Y Ha, Bielinsky Brea, Paul Y Liu
Non-healing wounds are a growing public health concern, and more than $25 billion per year in the US are spent caring for patients with chronic wounds. Many of these patients are referred to specialized wound centers, where hyperbaric oxygen therapy (HBO2T) has become a mainstay in healing wounds, especially diabetic foot ulcers (DFU). However, it is costly, with a typical course of therapy running into the tens of thousands of dollars. Presently, as many as 30-40% of DFU patients with Wagner's Grade 3 and 4 ulcers treated with HBO2T fail to heal by 24 weeks...
February 1, 2016: Rhode Island Medical Journal
David E Katz, N Deborah Friedman, Evgenia Ostrovski, Dor Ravid, Nadav Amrami, Dori Avivi, Bethlehem Mengesha, Ronit Zaidenstein, Tsilia Lazarovitch, Mor Dadon, Dror Marchaim
BACKGROUND: Acute infections of the diabetic foot (DFI) are a common and complex condition. Patients are generally managed in the ambulatory setting and epidemiological data pertaining to hospitalized patients is lacking. The aim of this study was to analyze the epidemiology, microbiology and outcomes of hospitalized patients with DFI, who are managed at a referral center equipped with hyperbaric oxygen (HBO) therapy. METHODS: A retrospective cohort study of adult patients admitted to a tertiary referral center with DFI over a six-month period in 2013 was undertaken...
March 2016: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Tarig Elraiyah, Apostolos Tsapas, Gabriela Prutsky, Juan Pablo Domecq, Rim Hasan, Belal Firwana, Mohammed Nabhan, Larry Prokop, Anil Hingorani, Paul L Claus, Lawrence W Steinkraus, Mohammad Hassan Murad
BACKGROUND: Multiple adjunctive therapies have been proposed to accelerate wound healing in patients with diabetes and foot ulcers. The aim of this systematic review is to summarize the best available evidence supporting the use of hyperbaric oxygen therapy (HBOT), arterial pump devices, and pharmacologic agents (pentoxifylline, cilostazol, and iloprost) in this setting. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2011...
February 2016: Journal of Vascular Surgery
Ludwik Fedorko, James M Bowen, Wilhelmine Jones, George Oreopoulos, Ron Goeree, Robert B Hopkins, Daria J O'Reilly
OBJECTIVE: Hyperbaric oxygen therapy (HBOT) is used for the treatment of chronic diabetic foot ulcers (DFUs). The controlled evidence for the efficacy of this treatment is limited. The goal of this study was to assess the efficacy of HBOT in reducing the need for major amputation and improving wound healing in patients with diabetes and chronic DFUs. RESEARCH DESIGN AND METHODS: Patients with diabetes and foot lesions (Wagner grade 2-4) of at least 4 weeks' duration participated in this study...
March 2016: Diabetes Care
Trientje B Santema, Robert M Stoekenbroek, Koen C van Steekelenburg, Rob A van Hulst, Mark Jw Koelemay, Dirk T Ubbink
INTRODUCTION: Hyperbaric oxygen treatment (HBOT) is used to treat acute and chronic wounds. This systematic review was conducted to summarise and evaluate existing evidence on the costs associated with HBOT in the treatment of wounds. METHODS: We searched multiple electronic databases in March 2015 for cohort studies and randomised clinical trials (RCTs) that reported on the clinical effectiveness and treatment costs of HBOT in the treatment of acute or chronic wounds...
December 2015: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
Gerard Laden
Increased access to any treatment sensibly follows the clinical and cost benefit being established. For many treatments this requires multiple, high-quality clinical trials and supporting cost analysis. Cost analysis may be applied to a single treatment or used to compare two or more treatments. Clinical efficacy and cost benefit are best scrutinised and validated by publication in the peer-reviewed literature. True peer review is most effectively achieved 'after publication' by the wider scientific community, i...
December 2015: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
David Balaz, Andrea Komornikova, Peter Sabaka, Matej Bendzala, Elena Leichenbergova, Kristina Leichenbergova, Matej Novy, Ludovit Gaspar, Andrej Dukat
OBJECTIVES: Favorable metabolic changes have been observed in many in vitro and animal studies after application of hyperbaric oxygen (HBO2). Metabolic changes after hyperbaric oxygen therapy, especially focused on lipoprotein subfractions, have not been described in humans. Our aim was to investigate possible alteration in concentration of lipoprotein subfractions in diabetic patients after hyperbaric oxygen therapy. METHODS: 58 Type 2 diabetic patients were enrolled in a prospective matched case-control study...
September 2015: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
K Markakis, F L Bowling, A J M Boulton
In 2015, it can be said that the diabetic foot is no longer the Cinderella of diabetic complications. Thirty years ago there was little evidence-based research taking place on the diabetic foot, and there were no international meetings addressing this topic. Since then, the biennial Malvern Diabetic Foot meetings started in 1986, the American Diabetes Association founded their Foot Council in 1987, and the European Association for the Study of Diabetes established a Foot Study Group in 1998. The first International Symposium on the Diabetic Foot in The Netherlands was convened in 1991, and this was soon followed by the establishment of the International Working Group on the Diabetic Foot that has produced useful guidelines in several areas of investigation and the management of diabetic foot problems...
January 2016: Diabetes/metabolism Research and Reviews
E J Peters, B A Lipsky, J Aragón-Sánchez, E J Boyko, M Diggle, J M Embil, S Kono, L A Lavery, E Senneville, V Urbančič-Rovan, S A Van Asten, W J Jeffcoate
The expert panel on diabetic foot infection (DFI) of the International Working Group on the Diabetic Foot conducted a systematic review seeking all published reports relating to any type of treatment for infection of the foot in persons with diabetes published as of 30 June 2014. This review, conducted with both PubMed and EMBASE, was used to update an earlier one undertaken on 30 June 2010 using the same search string. Eligible publications included those that had outcome measures reported for both a treated and a control population that were managed either at the same time, or as part of a before-and-after case design...
January 2016: Diabetes/metabolism Research and Reviews
Katarina Fagher, Per Katzman, Magnus Löndahl
AIMS: Heart rate corrected QT (QTc) interval prolongation is a risk factor associated with increased mortality. Hyperbaric oxygen therapy (HBO) has previously been shown to have acute beneficial effects on QTc dispersion. The aim of this study was to evaluate long-term effects of HBO on QTc time in diabetic patients with hard-to-heal foot ulcers. METHODS: In a prospective, double-blinded placebo-controlled study, patients were randomized to 40 treatment sessions with either HBO or air (placebo), at 2...
November 2015: Journal of Diabetes and its Complications
A W Nur Hilda Hanina, N S Intan, A N Syafinaz, A Zalinah, M N Lailatul Akmar, A S Devnani
INTRODUCTION: Patients suffering from diabetes mellitus (DM) frequently present with infected diabetic foot ulcers (DFU). This study was done to record the anatomical site and the grade of ulcers according to Wagner's classification and to culture the microorganisms from the ulcers and determine their antibiotic sensitivity. MATERIALS AND METHODS: Prospective study was conducted on 77 diabetic patients who were admitted with DFU from June until December 2011. Patients with end stage renal failure, those who had previous vascular surgery on the involved limb, or hyperbaric oxygen or maggot therapy for the ulcers, or had unrelated skin diseases around the involved foot were excluded from the study...
June 2015: Medical Journal of Malaysia
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