Diabetic foot ulcer.
One of the most common and devastating complications of poor
circulation in diabetes is the foot
ulcer. About 25% of those ulcers do not respond to standard wound care
and
could develop a gangrene ending with amputation in 85% cases (ref Can
Diab
Assoc).
Hyperbaric oxygen therapy provides sufficient oxygen for the damaged
circulation to start budding new tiny blood vessels - capillaries. The
blood flow through those newly established capillaries is called
microcirculation. This process can take up to 20 days with daily oxygen
therapy and can be followed with Laser Doppler blood flowmeter
(micro-circulation assessment). Improved microcircuation will speed up
the wound healing, reduce pain and prevent the infection.
At BaroMedical we combine oxygen therapy with daily wound care
using cutting edge products to reduce pain, odor, infection, while
promoting comfort and healing.
Diabetic clients who received oxygen therapy at BaroMedical
for chronic wounds are reporting more stable blood sugar levels
and improvement with other complications
associated with diabetes. The natural improvement in microcirculation
with oxygen throughout the body and better blood sugar control reflects
in: improved kidney and bladder function, better skin, gums, vision,
memory,
sexual drive, better intestinal function and blood pressure control and
overall improved energy and better quality of life.
Warning signs
Symptoms
of tingling, numbness
and
pain can quickly escalate to poor and prolonged healing of small cuts
and nicks, larger chronic wounds, deeper gangrene and eventually
amputation.
Diagnosis of poor circulation and oxygen supply is important
and can be done with a
micro-circulation assessment.
Prevention
Regular screening of circulation in your legs and feet (microvascular
assessment) can uncover the deteriorating circulation before the onset
of first signs: pain, cramping and numbness. With
timely preventive oxygen therapy wound development and other
complications associated with diabetes can be prevented. Diabetic
clients who have received preventive oxygen therapy at BaroMedical are
maintaining good health years after the diagnosis.
Cost / benefits analysis
Studies show that 70 to 90% of diabetes related amputations can be
avoided with timely hyperbaric oxygen therapy (
ref).
It has
furthermore been documented to be cost effective therapy compared to
traditional options (
ref,
ref).
Human and
hospital cost are devastating: 25% of all medicare cost goes to about
6% of population with diabetes (reference).
text
Benefit
of hyperbaric oxygen therapy (HBO) in diabetic foot ulcers
Unmanaged
toe
ulcer can lead to chronic wounds and gangrene
Diabetic
foot
ulcers are
the leading cause of lower limb amputations.
Case file: Diabetic foot ulcer
- PDF version
Male
55 years, diabetic for 25 years, insuline dependent for 13
years. Non
smoker.
Right foot
presenting 3 open ulcers and poor circulation with low tissue oxygen
values. Loss of sensitivity in the whole foot and up to the knee.
Wounds did not respond to wound care and antibiotis therapy and
amputation of the right foot was pending.
Left foot had partial amputation 3 month earlier.
Treatment protocol
Micro-circulation assessment on the left foot relieved pO
2
of 34 mm Hg which is 40% of normal tissue oxygen tension and 30 % of
the
normal blood flow. Following the assessment, 9
hyperbaric session in oxygen compressed monoplace chamber were given on
consecutive days and combined with daily wound dressing.
Treatment pressure was above 2.2 ATA. Each session was 90 min long.
Treatment outcome
After 5 sessions the pain subsided and sensitivity returned in the
right foot and up to the mid calf. After 9th session tissue oxygen
tension in the left foot dorsum close
to the toes increased to
51
mmHg. Also
blood
flow measured with the Laser Doppler showed 32% increase from
the
pre-therapy value. Both values were on
the lower end
of the normal value and hyperbaric oxygen therapy was safely
discontinued. The ulcer on the right heel (not visible on the picture)
closed, and other two below the toes showed new granulation.
Client was advised to visit the podiatrist for debridement of the rough
skin around the ulcer which can create another pressure point and
receive proper off-loading shoe. When reported for check up
after
three months all wounds were closed. See right picture below.
Initial
evaluation:
After
9 hyperbaric session over 2 weeks.
Follow
up at 3 months
Comments
Positive
treatment result was obtained relatively quickly due to timely
intervention. Foot ulcers with infection and necrosis
(gangrene) usually require more than 20
sessions to
heal, but in this case therapy was discontinued as soon as the oxygen
tension around the wound was high enough to prevent the area from
reentering a state of hypoxia. Oxygen tension was measured
with
transcutaneous oxymetry, and blood flow with Laser Doppler flowmetry.
