Amputation predictors in diabetic foot ulcers treated with hyperbaric oxygen.

Area of Science:

• Diabetology
• Vascular Surgery
• Wound Healing

Background:

• Diabetic foot ulcers (DFUs) represent a significant complication of diabetes mellitus, often leading to severe morbidity and amputation.
• The efficacy of hyperbaric oxygen therapy (HBOT) in managing DFUs remains a subject of ongoing clinical debate.
• Identifying reliable predictors for DFU-related amputations is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate the effectiveness of hyperbaric oxygen therapy (HBOT) as an adjunct to standard care for chronic diabetic foot ulcers (DFUs).
• To identify clinical and biochemical factors that predict the need for amputation in patients with DFUs.

Main Methods:

• A cohort of 146 patients with chronic DFUs (Wagner grade 2-5) received HBOT (100% oxygen, 2.4 ATA for 120 minutes) alongside standard treatment.
• Patients were monitored for a minimum of 3 years, or until ulcer healing or amputation occurred.
• Statistical analysis, including multiple regression, was used to identify predictors of amputation.

Main Results:

• Overall, 87.5% of patients achieved complete healing (69.6%) or significant improvement (17.9%).
• Amputation occurred in 23.2% of cases (minor: 15.0%; major: 8.2%).
• Significant predictors of amputation included duration of diabetes, new wound formation, C-reactive protein levels, and Wagner grade. Mortality was higher in the amputation group.

Conclusions:

• The integration of HBOT with standard care and a multidisciplinary approach may improve outcomes for DFU patients.
• Wagner grade and wound infection emerged as the most critical predictors of amputation.
• Further evidence from multicentre, prospective, randomised controlled trials is warranted to solidify these findings.