Diabetic foot ulcers represent a severe complication of diabetes mellitus, characterized by lesions that can progress to serious infections and, in extreme cases, lead to amputation.

Hyperbaric oxygen therapy (HBOT) has emerged as an effective adjunctive intervention in the management of these ulcers, offering significant benefits in wound healing and prevention of complications.

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Mechanisms of action of hyperbaric oxygen therapy in diabetic foot ulcers

OHTB consists of the inhalation of pure oxygen at 100% in an environment with a pressure above atmospheric pressure, which increases the amount of dissolved oxygen in the blood plasma. This increase in the availability of oxygen facilitates its diffusion towards the ischemic and injured tissues of the diabetic foot, promoting several therapeutic effects:

  • Improved tissue oxygenation: The high partial pressure of oxygen in the blood improves the oxygenation of compromised tissues, promoting cell regeneration and the healing of ulcers.
  • Stimulation of angiogenesis: OHTB promotes the formation of new blood vessels, improving perfusion in affected areas and facilitating the delivery of essential nutrients for tissue repair.
  • Antimicrobial effect: The hyperbaric environment inhibits the growth of anaerobic bacteria and enhances the effectiveness of leukocytes in eliminating pathogens, reducing the risk of infections.
  • Reduction of edema and inflammationHBO-induced vasoconstriction decreases fluid accumulation in injured tissues, relieving pressure and improving perfusion.

Clinical evidence and benefits of HBO in the treatment of diabetic foot

Clinical studies have shown that OHTB can speed up the healing of diabetic foot ulcers and reduce the rate of amputations. Research published in Diabetes Care indicated that HBOT decreases amputation rates in patients with diabetic ischemic foot ulcers.

In addition, OHTB complements antibiotic treatment, improving its effectiveness and reducing the need for invasive surgical procedures.

Treatment protocol and clinical considerations

The OHTB protocol for diabetic foot ulcers typically involves daily sessions of 60 to 90 minutes, with a pressure of between 2.0 and 2.5 atmospheres absolute (ATA). The total number of sessions varies depending on ulcer severity and individual patient response. It is critical that OHTB be integrated into a multidisciplinary approach that includes glycemic control, wound debridement, infection management, and podiatric care.

Hyperbaric oxygen therapy represents a valuable therapeutic tool in the management of diabetic foot ulcers, offering multiple benefits that contribute to healing and prevention of complications.

Its integration into a comprehensive treatment plan can significantly improve clinical outcomes and quality of life for patients with diabetes.

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