Diabetic Foot Treatment
Foot treatment options have been quite limited. It has been estimated that 25 percent of all Americans with diabetes will eventually develop foot problems. And as one of the most common complications of a diabetic patient, foot wounds require immediate attention. Diabetic foot wounds produce serious infections that can very quickly lead to hospitalization and eventual amputation. These procedures are extremely costly and may not offer long-term results.
Amputation has become a common diabetic foot treatment option. Approximately 50 percent of all amputations performed each year are related to diabetic foot wounds. Long hospital stays and extensive rehabilitation make this option nearly impossible for many patients. After an amputation, many other health risks become increasingly prevalent, significantly lowering the success rate of these procedures.
Diabetic foot ulcers are a very serious concern and early detection plays a crucial role in preventing complications. If left untreated, diabetic foot wounds open up a breeding ground for harmful, if not fatal, bacteria and infections. Quickly and aggressively treating foot ulcers provides the first line of defense and greatly reduces the risk of lower extremity amputations. Alternative diabetic foot treatment options can offer a solution before amputation even becomes an option.
Therapy has been used for over 20 years as a diabetic foot treatment option. This therapy provides an enhanced flow of oxygen, which helps to promote healthy generation of tissue. It also targets and kills microorganisms, greatly reducing infections in diabetic wounds. The ability to enhance the effects of antimicrobials also provides tremendous healing to diabetic patients with various foot ulcers.
A significantly higher rate of healing has been associated with the use of treatments as compared to traditional treatment options. Many diabetic patients have been able to avoid amputation altogether, seeing a significant reduction in wound size. Long-term healing of chronic diabetic foot wounds is also a part of this treatment option.
Studies have shown an amazing 70 to 90 percent success rate in which diabetic patients have completely healed as a direct result of treatments.
Hyperbaric Oxygen Therapy for Diabetic Foot Wounds Has hope hurdled hype?
Benjamin A. Lipsky, MD, FACP, FIDSA, FRCP1 and Anthony R. Berendt, BM, BCH, FRCP2
+ Author Affiliations
1University of Washington, VA Puget Sound, Seattle, Washington
Bone Infection Unit, Nuffield Orthopaedic Centre NHS Trust, Oxford, U.K.
American College of Hyperbaric Medicine
Numerous retrospective studies have shown the efficacy of HBO. Davis reviewed a clinical series of 168 patients with compromised refractory diabetic foot wounds treated over a seven-year period. Utilizing the parameter of limb salvage, a success rate of 70 percent was obtained. In 1988, Cianci treated 19 patients with diabetes in a subset of 39 lower extremity lesions, with a salvage rate of 89 percent. Salvage was defined as: bipedal ambulation, if two limbs were originally present; and intact wound coverage remaining for at least one year. HBO costs were $12,668 and were reflected in total hospital charges of $34,370, with an average length of stay of 35 days.
More recently, data on another series of 41 patients with diabetes, who averaged 63 years in age, was analyzed. Thirty-nine patients (97 percent) were suffering limb-threatening lesions. Thirty-one patients (78 percent) experienced successful salvage of their lower extremities. HBO charges in this series were $15,900, total hospital charges were $32,000, and the average length of stay was 27 days. These figures compare favorably with the cost of primary amputation and the hospitalization required. Avoiding rehabilitation costs and the additional savings involved in preventing re-amputation or stump revision was an additional benefit. The follow-up of these patients over one to six years (average of 30 months) has shown a 92 percent durability. That is, patients were able to ambulate without further lesions or problems.
Observations have been corroborated by clinical studies by Batoni, et al., and Hart, Strauss, Perrins, and Barr. Baroni, et al., performed a prospective, double-blinded, randomized, controlled clinical trial of inpatients with diabetic foot infections and partial foot gangrene. That study showed the wounds of 16 of 18 patients treated with HBOT healed, compared with one of the 10 control patients. HBOT produced wound healing in 89 percent of patients, while the wound of only one control healed, 10 percent.
The Role of Hyperbaric Oxygen in the Treatment of Diabetic Foot Wounds JEFF A. STONE, RONALD G. SCOTT, LEON R. BRILL, BENJAMIN D. LEVINE Diabetes, May 1995 vol. 44, supp 1
Hyperbaric oxygen therapy (HBO) is designed to increase oxygen delivery to local ischemic tissue by having a patient breathe 100% oxygen at greater than normal sea level atmospheric pressure. To test the hypothesis that a defined course of intermittent increased tissue concentrations of oxygen will result in a reduction in amputation rates, we performed a retrospective analysis of 469 consecutive patients with diabetes treated at a referral wound care center over a 33 month period. Eighty-seven patients received an average of 19±13 HBO treatments while 382 received "standard care" only, including revascularization, debridement, glycemic control, antibiotics, offloading, dietary modification, smoking cessation, and autologous platelet derived growth factors. Patients referred for HBO (X ± SE) had larger wounds (2533 ± 987 vs. 1199 ± 61 mm3), more wounds per patient (3.8 vs. 2.4), and a greater percentage recommended for amputation (31% vs. 19% p=0.002). Despite having the more serious wounds, the limb salvage rate was greater in the HBO patients (72% vs. 53% p<0.002).