Point-Counterpoint: HBOT: Is It Worthwhile For DFUs?

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Enoch T. Huang, MD, MPH&TM, FACEP, FUHMS, FACCWS, and Javier La Fontaine, DPM, MS, FACFAS, FASPS

   Five trials, including four RCTs, provided data on minor amputations distal to the ankle joint with outcome assessment for up to 55 months. Pooled analysis of these data resulted in a relative risk of 1.24, revealing identical minor amputation rates between HBOT and conventional therapy, and no evidence to suggest statistical heterogeneity.7 Pooling analysis revealed that, in comparison to treatment without HBOT, adjunctive treatment with HBOT resulted in a significantly higher proportion of healed diabetic ulcers. The analysis also revealed that treatment with HBOT was associated with a significant reduction in the risk of major amputations but had no effect on the rate of minor amputations. The authors concluded that treatment with HBOT improved the rate of healing and reduced the risk of major amputations in patients with diabetic foot ulcers.

In Conclusion

After evaluating the medical literature supporting HBOT as an adjunctive treatment for diabetic foot wounds, I can conclude that additional research is needed to define the specific indications and benefits of this treatment modality. Unfortunately, the literature on the efficacy of HBOT is still not clear. There have been no studies of the effectiveness of this therapy. The importance of effectiveness studies on therapies for the treatment of diabetic foot ulcers is critical.

   Therapies such as skin substitutes, acellular dermal matrices and offloading modalities have had extensive study with a high level of well-designed studies. The true RCT that compared HBOT treatment with a sham showed positive results at one year. The two meta-analyses still showed conflicting results. Therefore, long-term studies with the sham control are still needed to show the effectiveness of HBOT.

   Dr. La Fontaine is the Associate Professor of the Department of Plastic Surgery at the University of Texas Southwestern Medical Center in Dallas. He is a Fellow of the American College of Foot and Ankle Surgeons, and the American Society of Podiatric Surgeons.

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