Diabetes is the main cause of non-traumatic lower limb amputation. Worldwide, each year, more than 1 million amputations are performed as a result of this pathology. Hyperbaric Oxygen Therapy (OTH) has been proposed as a medical treatment for diabetic foot ulcers. The therapy consists of subjecting the patient to a treatment with 100% oxygen and an internal pressure greater than 1.4 absolute ATA.
Hyperbaric treatment has been shown to have an antimicrobial effect and increases oxygenation in hypoxic injury tissues, in addition to stimulating the capacity of neutrophils, angiogenesis increases the activity of fibroblasts and the synthesis of collagen.
To report the results obtained in our service with the hyperbaric treatment as adjuvant therapy in ulcers of lower limbs of diabetic patients.
Material and methods
During the period between November 2010 and July 2014, 50 patients aged between 53 and 77 years, with Wagner grade 3 and 4 ulcers, received an average of 50 OTH sessions of 60 minutes duration at 2.5 ATA. This group of patients presented a 55.2% severe infrapatellar peripheral arteriopathy, 34.5%, and 10% did not present significant obstructions.
Twenty-eight patients (56%) had complete resolution of ulcers, 17 patients (34%) received a minor amputation, this refers to digital amputations, metatarsal and/or transmetatarsal amputations, which in the long term are functional, with orthopedic prostheses and 5 patients (10%) required major amputation of the affected lower limb, 4 of them at the suprapatellar level and one infrapatellar.
Hypoxia influences all the factors that prevent proper healing and OTH can reverse them. In our series of cases, the addition of OTH has improved the clinical results obtained. This clinical improvement is represented by the complete healing of the lesions observed in the majority of our patients, as well as by a significant reduction rate of major amputations (supra or infrapatellar) that in our series only corresponds to 10%.
Source: Experience in a Public Hospital: High Complexity Hospital “Presidente Juan D. Perón” (Formosa)
Authors: Romero E., Estrada E., Esperanza M., Di Tomaso M, Arguello M., Fisher F., Gamarra D., Salinas Y., Nicora E.