Volume 198 - Issue 5
Australian Diabetes Foot Network: management of diabetes-related foot ulceration — a clinical update
Authors: Glen C Hawkins, Michael H Bennett and David R Smart
Med J Aust 2013; 198 (5): 259-260. || doi: 10.5694/mja12.11486
Published online: 18 March 2013
Published online: 18 March 2013
To the Editor: We commend the clinical update of Bergin and colleagues on the management of diabetes-related foot ulceration.1 We agree that a multidisciplinary approach is the best way to manage these complex wounds. However, we believe that the use of hyperbaric oxygen treatment (HBOT) for ulcers which have failed to respond to 3 months’ standard treatment justifies more prominent consideration.
The actions of HBOT are diverse, ...
To the Editor: We commend the clinical update of Bergin and colleagues on the management of diabetes-related foot ulceration.1 We agree that a multidisciplinary approach is the best way to manage these complex wounds. However, we believe that the use of hyperbaric oxygen treatment (HBOT) for ulcers which have failed to respond to 3 months’ standard treatment justifies more prominent consideration.
The actions of HBOT are diverse, including support of oxygen-dependent healing processes and, more importantly, cell-signalling effects that accelerate these processes for many hours beyond the HBOT exposure. There is now favourable clinical evidence from high-quality randomised studies. HBOT has been shown to be efficacious for wounds that fail to heal after 8 weeks of thorough multidisciplinary foot care,2,3 and beneficial for a range of chronic ulcers, particularly diabetic ulcers.4 A systematic review is also supportive of the use of HBOT.5
Contrary to the suggestion that they are difficult to access, hyperbaric facilities are located in all states and territories except the Australian Capital Territory, and have procedures to support and treat patients referred from regional centres. Diabetes-related foot ulceration is an approved indication for HBOT under Medicare and other health-funding agencies around the world.
HBOT is indicated and effective for ulcers in patients with diabetes when good wound care has failed to produce healing, or when there is reason to believe that the more drastic step of amputation can be avoided.
Competing interests
No relevant disclosures.
References
- Bergin SM, Gurr JM, Allard BP, et al. Australian Diabetes Foot Network: management of diabetes-related foot ulceration — a clinical update. Med J Aust 2012; 197: 226-229. 0_CHDEIGEF
- Löndahl M, Fagher K, Katzman P. What is the role of hyperbaric oxygen in the management of diabetic foot disease? Curr Diab Rep 2011; 11: 285-293. 0_CBBJEICG
- Löndahl M, Katzman P, Nilsson A, Hammarlund C. Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care 2010; 33: 998-1003. 0_i1142873
- Hawkins GC, Bennett MH, van der Hulst AE. The outcome of chronic wounds following hyperbaric oxygen therapy: a prospective cohort study — the first year interim report. Diving Hyperb Med 2006; 36: 94-98. 0_i1142875
- Goldman RJ. Hyperbaric oxygen therapy for wound healing and limb salvage: a systematic review. PM R 2009; 1: 471-489. 0_i1142877