Insight on Hyperbaric Oxygen Therapy as an Adjunctive Treatmentin Diabetic Foot Ulcer: A Review

Diabetic foot ulcers (DFU) are a source of major concern for both patients and health care systems. DFU is the most expensive and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime. That can lead to infection, gangrene, amputation, and even death if necessary care is not provided. On the other hand, once DFU has developed, there is an increased risk of ulcer progression that may ultimately lead to amputation. Overall, the rate of lower limb amputation in patients with diabetes mellitus is 15 times higher than patients without diabetes. Hyperbaric oxygen therapy (HBOT) can be defined as a mode of medical treatment in which the patient is entirely enclosed in a pressure chamber and breathes 100% oxygen at a pressure greater than 1 atmosphere absolute (ATA). HBOT can be used as an adjunct to standard wound care in the treatment of diabetic patients with foot ulcers. HBOT has been demonstrated to have an antimicrobial effect and to increase oxygenation of hypoxic wound tissues. This enhances neutrophil killing ability, stimulates angiogenesis, and enhances fibroblast activity, collagen synthesis and alter vascular activity. Thus, theoretically, HBOT could improve the healing of ischemic foot ulcers in patients with diabetes. This review focuses on providing an up-to-date summary of the currently available evidence-based data on HBOT in DFU, as well as elaborating its use in the management of diabetic injuries both ischemic and non-ischemic ulcers.