What You Should Know About Using HBO In Diabetic Wounds

By Robert A. Warriner, III, MD, and Caroline E. Fife, MD
A low baseline TcPO2 confirms that spontaneous healing will probably not occur. You should then proceed to revascularization if possible. If TcPO2 still remains low, then you should check the in-chamber TcPO2. If that value is greater than 200 mmHg, the likelihood of benefit from HBO is high and a course of HBO may be appropriate, assuming other criteria have been met. You must regularly re-evaluate patients undergoing HBO for evidence of benefit. One should evaluate patients for functional outcome. You should remove necrotic toes or other material prior to initiating HBO. In many cases, a transmetatarsal amputation is an acceptable outcome. HBO cannot be used to “resurrect” necrotic material. When HBO is used adjunctively in a setting of multidisciplinary wound care, it has the potential to significantly improve diabetic foot ulcer outcome and limb salvage in this challenging group of patients. Dr. Warriner is the Medical Director of the Southeast Texas Center for Wound Care and Hyperbaric Medicine at the Conroe Regional Medical Center Hospital in Conroe, Tx. He is a Fellow of the American College of Hyperbaric Medicine, is a Certified Wound Specialist and is certified by the American Board of Anesthesiology. Dr. Fife is the Medical Director of the Memorial Hermann Center for Wound Healing and Hyperbaric Medicine in Houston, Tx. She is a Clinical Associate Professor within the Department of Anesthesiology at the University of Texas Health Science Center. Dr. Steinberg (pictured) is an Assistant Professor in the Department of Orthopaedics/Podiatry Service at the University of Texas Health Science Center.



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