Hyperbaric oxygen therapy for chronic wounds (Review)

BackgroundChronic wounds are common and present a health problem with significant effect on quality of life. Various pathologies may causetissue breakdown, including poor blood supply resulting in inadequate oxygenation of the wound bed. Hyperbaric oxygen therapy(HBOT) has been suggested to improve oxygen supply to wounds and therefore improve their healing.ObjectivesTo assess the benefits and harms of adjunctive HBOT for treating chronic ulcers of the lower limb.Randomised controlled trials (RCTs) comparing the effect on chronic wound healing of therapeutic regimens which include HBOTwith those that exclude HBOT (with or without sham therapy).Data collection and analysisThree review authors independently evaluated the risk of bias of the relevant trials using the Cochrane methodology and extracted thedata from the included trials. We resolved any disagreement by discussion.Main results We included twelve trials (577 participants). Ten trials (531 participants) enrolled people with a diabetic foot ulcer: pooled data of five trials with 205 participants showed an increase in the rate of ulcer healing (risk ratio (RR) 2.35, 95% confidence interval (CI)1.19 to 4.62; P = 0.01) with HBOT at six weeks but this benefit was not evident at longer-term follow-up at one year. There was no statistically significant difference in major amputation rate (pooled data of five trials with 312 participants, RR 0.36, 95% CI 0.11 to1.18). One trial (16 participants) considered venous ulcers and reported data at six weeks (wound size reduction) and 18 weeks (woundsize reduction and number of ulcers healed) and suggested a significant benefit of HBOT in terms of reduction in ulcer area only at sixweeks (mean difference (MD) 33.00%, 95% CI 18.97 to 47.03, P < 0.00001). We identified one trial (30 participants) which enrolled patients with non-healing diabetic ulcers as well as venous ulcers (“mixed ulcers types”) and patients were treated for 30 days. For this“mixed ulcers” there was a significant benefit of HBOT in terms of reduction in ulcer area at the end of treatment (30 days) (MD 61.88%, 95% CI 41.91 to 81.85, P < 0.00001). We did not identify any trials that considered arterial and pressure ulcers.