Hyperbaric oxygenation in prevention of amputations of diabetic foot

Abstract

Background/Aim. Diabetic foot is the term for the pathological changes on foot in patients with diabetes. It is caused by diabetic angiopathy, polyneuropathy and osteoarthropathy. The treatment is complex and long-term and often leads to the loss of the extremity. The appliance of hyperbaric oxygen therapy (HBOT) has a lot more important place in adjuvant treatment of this disease. The aim of this study was to determine the influence of HBOT on the wound healing in comparison with the conventional treatment, the possibility of shortening the time of the treatment in patients with diabetic foot. Methods. In a fiveyear period a retrospective-prospective multicentric study, involving 60 patients with diabetic foot divided into two groups, was performed. The first group (group A) consisted of 30 patients treated by combined therapy (with medications, surgical therapy and HBOT). All the patients were receiving HBOT in the Special Hospital for Hyperbaric Medicine, CHM Hollywell-Neopren in Belgrade. The control group (group B) also consisted of 30 patients treated with medications and surgical therapy, but without HBOT. Results. The demographic data, the types of diabetes, as well as the Wagner classification stage of diabetic ulcers and radiography scans of changes in bones were equal in both groups. The median healing time of the Wagner grade III ulcer in the group A was 37.36 days [mean ± standard deviation (SD) = 65.6 ± 45.8 days], and in the group B 99.78 days (mean ± SD = 134.8 ± 105.96 days) and it was statistically significant (p = 0.074). The median time of recovery in patients of the group A with the Wagner grade IV was 48.18 days (mean ± SD = 49.7 ± 33.8 days), and in the group B 85.05 days (mean ± SD = 86.7 ± 71.6 days) and that was statistically significant (p = 0.121). The foot amputations were performed in both groups in 3 (10%) patients. In the group A there were no high amputations, whereas in the group B there were 4 (13.33%) below-knee amputations and 4 (13.33%) above-knee amputations which was highly statistically significant (p < 0.0001). Conclusion. In this study, HBOT definitely showed positive adjuvant role in the treatment of diabetic foot. For the good treatment result it is essential the timely and successful surgical treatment of the ulcer and the use of bandage with the healing dressings. In case of the clear signs of local infection, the antibiotic therapy according to the antibiogram is necessary.

Uvod/Cilj. Dijabetičnim stopalom nazivamo patološke promene na stopalu kod bolesnika koji boluju od šećerne bolesti, a uzrokovane su dijabetičkom angiopatijom, polineuropatijom i osteoartropatijom. Lečenje je kompleksno i dugotrajno i često dovodi do gubitka esktremiteta. Primena hiperbarične oksigene terapije (HBOT) ima sve značajnije mesto u adjuvantnom lečenju ovog oboljenja. Cilj ovog rada bio je utvrđivanje uticaja HBOT na efikasnije zarastanje rane u poređenju sa konvencionalnim lečenjem i mogućnost skraćenja vremena lečenja bolesnika sa dijabetičkim stopalom. Metode. U petogodišnjem periodu urađena je retrospektivno-prospektivna multicentrična studija, koja je obuhvatila 60 bolesnika podeljenih u dve grupe. Prva grupa (grupa A) od 30 bolesnika lečena je kombinovanom terapijom (medikamentoznom, hirurškom i HBOT). Svi bolesnici dobijali su HBOT u Specijalnoj bolnici za hiperbaričnu medicinu, CHM Hollywell-Neopren u Beogradu. Kontrolna grupa (grupa B), takođe od 30 bolesnika sa dijabetičkim stopalom, lečena je medikamentozno i hirurški, ali bez HBOT. Rezultati. Demografski podaci, tip dijabetesa, stadijum dijabetičkih rana prema Wagner-u i nalazi radiografskih promena na kostima bili su jednaki u obe grupe. Medijana vremena za sanaciju rane III stadijuma po Wagner-u u grupi A iznosila je 37,36 dana [srednja vrednost ± standardna devijacija (SD) = 65,6 ± 45,8 dana], a u grupi B 99,78 dana (srednja vrednost ± SD = 134,8 ± 105,96 dana) (p = 0,074). Bolesnici u IV stadijumu po Wagner-u u grupi A imali su medijanu vremena za sanaciju rane od 48,18 dana (srednja vrednost ± SD = 49,7 ± 33,8 dana), a u grupi B 85,05 (srednja vrednost ± SD =86,7 ± 71,6 dana) (p = 0,121). Amputacije stopala bile su izvršene u obe grupe kod tri (10%) bolesnika. U grupi A nije bilo ni jedne visoke amputacije, a u grupi B su bile izvršene četiri (13,33%) potkolene i četiri (13,33%) natkolene amputacije, što je bilo visoko statistički značajno (p < 0,0001). Zaključak. HBOT u ovoj studiji kao i kod većine drugih autora definitivno je pokazala pozitivnu adjuvantnu ulogu u lečenju dijabetičkog stopala. Za dobar rezultat lečenja potrebna je pravovremena i sukcesivna hirurška obrada rane i zavoj lekovitim oblogama. U slučaju pojave jasnih znakova lokalne infekcije potrebna je antibiotska terapija prema antibiogramu.