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Acta Vulnologica 2015 June;13(2):91-113

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English, Italian

Hyperbaric oxygen therapy in the diabetic foot: history, mode of action, indications, contraindications

Iacopi E., Coppelli A., Goretti C., Piaggesi A.

Section of Diabetic Foot, Medical Area Department, Pisa University Hospital, Pisa, Italy

Hyperbaric oxygen therapy (HBOT) is defined as administration of 100% oxygen to a patient inside environments in which it has been created a pressure greater than one atmosphere at sea level.
In human bodies, oxygen is essential for production of ATP and maintenance of life. In hypo-perfusion states, it can be observed a reduction in the amount of oxygen carried to metabolically active cells. This is even more important in diabetic patients, in which there is frequently a reduction of blood flow. The direct consequence is the creation of chronically hypoxic tissue areas within which lesions may be locked in the inflammatory phase and then become chronic ulcers. HBOT, by increasing the partial oxygen pressure at level of all arterial vessels enhances oxygen release capability to tissues, improving the availability of oxygen for metabolic requirements. Therefore the treatment is capable of exercise a stimulus to restore a more physiological evolution towards re-epithelialization phases. According to the scientific evidence, the societies of hyperbaric medicine recognize about twenty different therapeutic indications for the use of HBOT. In particular, in diabetic foot, it holds a role in four different clinical conditions: ulcer, refractory osteomyelitis, gas gangrene and application of dermo-epidermal grafts. The effectiveness of HBOT to treat foot wounds in diabetic patients continues to be controversial: published recommendations are based on small, underpowered studies and composition of patients’ groups is often very heterogeneous. Even today thus, considering the low quality of current evidence and the high costs of HBOT, there are insufficient evidences to support the routine use of this therapy in addiction to standard treatments in diabetic patients with foot lesions.