Clinical Question: Does hyperbaric oxygen improve outcomes in patients with chronic wounds?

Setting: Various (meta-analysis)

Study Design: Systematic review

Synopsis: The four main varieties of chronic wounds, listed here in descending prevalence, are diabetic foot ulcers, venous leg ulcers, arterial leg ulcers, and pressure ulcers. Hyperbaric oxygen therapy has been proposed as an adjunct to improve wound healing. Investigators systematically reviewed all randomized controlled trials that compared the effect of adjunctive hyperbaric oxygen therapy with no hyperbaric oxygen therapy or sham therapy for chronic wound healing. They searched several databases, relevant textbooks, and conference proceedings, and contacted experts in the field. Next, the investigators independently identified studies that met inclusion criteria, extracted the data, and assessed the quality of the studies. Disagreements were settled by consensus. Finally, if data were missing, the investigators contacted the author.

Only six studies with a total of 191 patients were included. Five studies evaluated patients with diabetic foot ulcers and one study included patients with venous ulcers. Only two of the studies of diabetic foot ulcers and the one study on venous ulcers were of good quality. The most important finding of this meta-analysis was that fewer major amputations occurred in patients with diabetes who received hyperbaric oxygen therapy for up to one year (number needed to treat = four; 95 percent confidence interval, 3.0 to 11.0). The rate of minor amputations was unaffected.

Bottom Line: In patients with diabetic foot ulcers, hyperbaric oxygen therapy reduces the number of major amputations for up to one year. These data, however, are based on fewer than 200 patients among all six studies in the literature. (Level of Evidence: 1a–)