Hyperbaric Oxygen Therapy Program - Diabetic Foot Ulcers

Hyperbaric oxygen therapy program – Diabetic foot ulcers

Diabetes is one of the most common non-communicable diseases in Hong Kong, with approximately 700,000 diabetic patients. Of these, 6% develop multiple diabetic complications, including diabetic foot. Diabetes ranks fifth among the top ten causes of death, and its incidence is increasing annually. Statistics show that 25% of diabetic patients seek medical attention for foot problems, and 15% will develop foot ulcers in their lifetime. Foot problems are also the most common reason for hospitalization among diabetic patients. Furthermore, approximately 45-70% of amputation cases are related to diabetes, demonstrating the profound impact of the disease's complications on patients.

The relationship between diabetic feet and diabetes

Diabetic foot is a complication of diabetes, usually caused by long-term high blood sugar leading to damage to blood vessels and nerves, which in turn affects blood circulation and sensory function in the feet.

Diabetic feet can be divided into 2 types：

  • Neuropathic Ulcers
  • Ischemic Ulcers

Causes of diabetic foot disease

The causes of diabetic foot disease can be mainly summarized into two categories: neurological disorders and foot ischemia.

Nervous system lesions

Neurological disorders can cause loss of normal sensation in the feet, which can lead to toe deformities and dry skin, making the toes more susceptible to injury.

Foot ischemia

Diabetes can also cause structural degeneration of blood vessels, disrupting blood circulation in the feet, which can hinder the healing process of foot injuries and increase the risk of bacterial infections.

Diabetic complications typically progress slowly, and patients often cannot detect any abnormalities in the early stages, only experiencing decreased or heightened sensation in the skin of their feet, especially in the toes. As the disease progresses, numbness and pain may gradually appear. The nature of the pain varies, including tingling, burning, a biting sensation, and a feeling like scalding water running through the skin, which may also be accompanied by a crawling sensation. Due to the loss of normal sensory function, patients' feet are easily injured or struck without their knowledge.

Treatment methods for patients with diabetic feet

The treatment principles for diabetic foot ulcers mainly include three parts:

1. Drug control

  • Medications such as antibiotics are used to control infection, manage blood sugar, and promote wound healing, ensuring a stable condition.
  • Maintaining stable blood sugar levels and taking prescription antibiotics can control bacterial infections, such as cellulitis.

2. Wound control

  • Ulcers on the skin surface can be treated by washing, applying medication, and bandaging.
  • Deeper and chronic ulcers are difficult to heal and require surgical debridement and restoration of local blood flow to improve blood supply to the foot. If poor blood supply to the tissue persists or the infection is not controlled, amputation may eventually be necessary to prevent more serious complications.

3. Hyperbaric oxygen therapy

  • Hyperbaric oxygen therapy, as an effective adjunctive therapy, can reduce the risk of amputation, increase the chance of wound healing, and shorten the course of treatment.

What is hyperbaric oxygen therapy?

Hyperbaric oxygen therapy involves placing the patient in a completely sealed pressure chamber and inhaling pure oxygen at a pressure higher than normal (above 1.3 atmospheres absolute). The main purpose of hyperbaric oxygen therapy is to increase blood oxygen concentration, promote oxygen dissolution in the blood, and increase tissue oxygen content, thereby accelerating the body's self-repair and enhancing tissue oxygenation. It also utilizes physical principles to increase the oxygen dissolved in blood plasma.

As of July 2021, the FDA has approved the use of hyperbaric oxygen therapy to treat and improve non-healing wounds, such as diabetic foot ulcers.13 indications.

 

The effect of hyperbaric oxygen therapy on diabetic foot ulcers

Hyperbaric oxygen therapy can rapidly increase the body's oxygen concentration, promote angiogenesis, and activate hypoxic tissues, thus aiding in ulcer healing. Depending on the wound's condition, a course of treatment is recommended to be approximately 10 to 20 sessions; however, the specific number of sessions needs to be determined by a healthcare professional who understands the patient's condition and requirements.

A previous study randomly assigned 38 patients with non-healing diabetic foot ulcers (DFU) who were deemed unsuitable for vascular surgery to two groups: one group received regular hyperbaric oxygen therapy (HBOT). The results showed that 25% of the patients achieved complete closure of the DFU; the amputation rate in the HBOT group was 5%, significantly lower than in the general population who did not undergo HBOT (11%, χ² = 15.204, P = .010). Furthermore, their inflammation indices, blood flow, and health-related quality of life all showed significant improvements.

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FAQ

Q: Does hyperbaric oxygen therapy promote the growth of cancer cells?
A: Current clinical experience in Hong Kong shows that the standard treatment for radiation-induced injury has not been observed to promote tumor growth, but a comprehensive evaluation is required before treatment.

Q: Is the treatment process uncomfortable?
A: Most patients only feel a slight pressure in their ears (similar to an airplane taking off or landing), and medical staff will guide them on pressure adjustment techniques.

Q: When is HBOT not suitable for cancer patients?
A: Active central nervous system metastases, uncontrolled pneumothorax, and the use of certain chemotherapy drugs (such as cisplatin) require careful evaluation.