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One of the most common complications of DM is nonhealing wounds and gas gangrene. Many of synergistic factors predispose diabetics of developing wounds that can become secondarily infected.

• Changing in blood vessels (microangiopathy) - leading to tissue hypoxia, which cause spontaneous skin breakdown, nonhealing ulceration and infection.
• Nerves damages (neuropathy)–in lower extremities causing “glove and stocking” sensation, diminish pain perception allows the unperceived development of traumatic wounds

Case file  : Non smoker, diabetic for 25 years, insuline dependent for 13 years.
 Left foot partial amputation 3 months earlier.  Right foot presenting 3 open ulcers and low tissue oxygen values.

The greatest benefit of hyperbaric oxygen is achieved in situation where the oxygen supply to the tissue is disrupted by infection, local injury (poor circulation) or generally in (immunocompromised) people such as diabetics.
 HBO elevates wound oxygen tension that helps;

• HBO relieves pain by increasing oxygen transport to ischemic tissue and improving blood supply and circulation
• HBO speeds up wound healing by promoting growth of new, healthy tissue (new capillaries formation - angiogenesis)
• HBO reduces infection by killing bacteria directly and increasing capacity of white blood cell to fight infection and eliminate wasted products of bacterial invasion
• HBO enhances the effect of some antibiotics providing the environment that is toxins free and supplied with enough oxygen
• HBO reduces swelling which develops as a consequences of the infection, poor circulation and injury
• HBO speeds up bone growth by osteogenesis and in bone infection such as osteomyelitis, improves osteoclastic activity (removing necrotic bone)
• HBO prevents infection in generally by strengthening immune system.

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