Topical Oxygen Therapy Results in Complete Wound Healing in Diabetic Foot Ulcers

Atypical or refractory diabetic foot ulcers (DFUs) are still a major health problem. Maggot debridement therapy (MDT) by larva of Lucilia sericata is an ancient and a modern option for wound healing. It works by debridement, stimulation of wound healing, and disinfection. In this study, we aimed to evaluate the efficacy of MDT for healing atypical and refractory DFUs. Patients with atypical DFUs were selected and further evaluated for some predefined differential diagnoses like atypical fungal, parasitic, or bacterial infections, malignancy, trauma, and so on. Multiple MDT sessions were carried out. Ulcer size was measured before every MDT session. Complete wound healing, time to heal, and adverse effects were recorded as well. Forty-two DFU patients (26 men, 16 women) with 42 nonhealing atypical ulcers participated in this study. Complete wound healing was achieved in 35 patients (83.3%) by MDT. Complete debridement and then healing of the wounds happened in less than 1.79 ± 0.8 months. Four ulcers persisted, and 3 (7.1%) were eventually amputated. MDT may be considered as an effective treatment for atypical DFUs, which are unresponsive to conventional therapies.

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33-LB: Nuclear Factor Erythroid 2 Related Factor 2 (Nrf2) Increases with Hyperbaric Oxygen Therapy and Promotes Wound Healing in Diabetic Foot Ulcers

Diabetes ◽

10.2337/db19-33-lb ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 33-LB

Author(s):

DHAMODHARAN UMAPATHY ◽

POOJA VIKRAMAN ◽

VAISHNAVI ALLADI ◽

SOMASUNDAR ARUMUGAM ◽

SIREESH DORNADULA ◽

...

Keyword(s):

Wound Healing ◽

Hyperbaric Oxygen ◽

Diabetic Foot ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Foot Ulcers ◽

Related Factor ◽

Nuclear Factor ◽

Diabetic Foot Ulcers

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Prospective exploration of the effect of adiposity and associated microbial factors on healing and progression of diabetic foot ulcers in Tanzania: study protocol of a longitudinal cohort study

BMJ Open ◽

10.1136/bmjopen-2019-031896 ◽

2019 ◽

Vol 9 (12) ◽

pp. e031896

Author(s):

Fredirick Mashili ◽

Agricola Joachim ◽

Said Aboud ◽

Mabulla Mchembe ◽

Faraja Chiwanga ◽

...

Keyword(s):

Type 2 Diabetes ◽

Wound Healing ◽

Diabetic Foot ◽

Medical Centre ◽

Foot Ulcers ◽

High Morbidity ◽

Diabetic Foot Ulcers ◽

Academic Medical Centre ◽

Complete Wound Healing

BackgroundDiabetic foot ulcers (DFUs) are associated with high morbidity and mortality in low-income countries. This coexists with an increasing prevalence of obesity which has been reported to alter antimicrobial susceptibility and potentially affect the outcome of infected foot ulcers. This study aims to determine whether adiposity and local microbial factors affect the progression and healing of foot ulcers in people with type 2 diabetes in hospital settings in Tanzania.Methods and analysisA prospective cohort of 300 individuals with type 2 diabetes presenting with DFUs at an outpatient clinic will be enrolled into the study. At baseline, participants will be stratified into normal and high adiposity groups (150 per group) as measured by bioelectrical impedance analysis (BIA). Both groups will receive DFU management according to locally appropriate standards of care and will be followed up for 24 weeks or until complete wound healing, whichever occurs first. The primary end point is complete wound healing at 24 weeks while secondary end points are ulcer progression (worsening or improving), amputation and death. Enrolling 150 participants per group will have a minimum power of 80% to detect a 20% difference in cumulative incidence of complete ulcer healing (at the 5% level of statistical significance) between the normal and high adiposity groups.Ethical considerations and dissemination of resultsThis study will be conducted in compliance with the independent institutional review boards (IRBs), informed consent guidelines, the declaration of Helsinki and International Conference on Harmonisation, Good Clinical Practice Guidelines. Ethical clearance has been granted by the Muhimbili University of Health and Allied Sciences ethical review board (MUHAS Ref. No. DA.282/298/01 .C/). Permissions to conduct the study have been granted by the Abbas Medical Centre and the Muhimbili Academic Medical Centre (MAMC).Progress and results emanating from this work will be communicated to the scientific community through conference presentations, short communications (using journal letters and interesting case reports) and peer-reviewed publications. When necessary, through proper channels, popular means of communication (newspapers, magazines and online communications) will be used to inform policy and the public.Trial registration numberNCT03960255; Pre-results.

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Topical Wound Oxygen Therapy in the Treatment of Chronic Diabetic Foot Ulcers

Medicina ◽

10.3390/medicina57090917 ◽

2021 ◽

Vol 57 (9) ◽

pp. 917

Author(s):

Robert G. Frykberg

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Clinical Studies ◽

Oxygen Therapy ◽

Chronic Wounds ◽

Supplemental Oxygen ◽

Foot Ulcers ◽

Critical Threshold ◽

Diabetic Foot Ulcers

Oxygen is a critical component of many biological processes and is essential for wound healing. Chronic wounds are typically characterized as being hypoxic in that the partial pressure of oxygen (pO2) in the center of the wound is often below a critical threshold necessary to fully support those enzymatic processes necessary for tissue repair. Providing supplemental oxygen can effectively raise pO2 levels to better optimize functioning of these essential enzymes. While hyperbaric oxygen therapy has been well studied in this regard, comparative clinical studies have fallen short of providing clear evidence in support of this modality for healing chronic diabetic foot ulcers (DFU). Topical oxygen therapy (TOT) has been in clinical use for over 50 years with encouraging pre-clinical and clinical studies that have shown improved healing rates when compared to standard care. Nonetheless, TOT has heretofore been discounted as an unproven wound healing modality without theoretical or clinical evidence to support its use. This review shall provide a brief summary of the role of oxygen in wound healing and, specifically, discuss the different types of topical oxygen devices and associated studies that have convincingly shown their efficacy in healing chronic DFUs. The time has come for topical oxygen therapy to be embraced as a proven adjunctive modality in this regard.

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IGF-1 Increases with Hyperbaric Oxygen Therapy and Promotes Wound Healing in Diabetic Foot Ulcers

Journal of Diabetes Research ◽

10.1155/2013/567834 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 14

Author(s):

Figen Aydin ◽

Ahmet Kaya ◽

Levent Karapinar ◽

Mert Kumbaraci ◽

Ahmet Imerci ◽

...

Keyword(s):

Wound Healing ◽

Hyperbaric Oxygen ◽

Diabetic Foot ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Significant Difference ◽

The Mean ◽

Design And Methods

Objectives. To investigate insulin-like growth factor I (IGF-1) levels in response to hyperbaric oxygen therapy (HBOT) for diabetic foot ulcers and to determine whether IGF-1 is a predictive indicator of wound healing in patients with diabetic foot ulcers.Design and Methods. We treated 48 consecutive patients with diabetic foot ulcers with HBOT. Alterations of IGF-1 levels in patients whose wound healed with HBOT were compared with those in patients who did not benefit from HBOT.Results. There was no significant difference in initial IGF-1 levels between the two groups(P=0.399). The mean IGF-1 level increased with HBOT(P<0.05). In the healed group, the mean IGF-1 increase and the final values were significantly higher(P<0.05). In the nonhealed group, the mean IGF-1 increase was minus and the final values were not significantly different(P<0.05). The increase in IGF-1 level with HBOT was significantly higher in the healed group(P<0.001).Conclusions. IGF-1 increased significantly in the healed group. We believe that HBOT is effective in the treatment of diabetic foot ulcers, with an elevation of IGF-1. This alteration seems to be a predictive factor for wound healing in diabetic foot ulcers treated with HBOT.

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Molecular Biomarkers of Oxygen Therapy in Patients with Diabetic Foot Ulcers

Biomolecules ◽

10.3390/biom11070925 ◽

2021 ◽

Vol 11 (7) ◽

pp. 925

Author(s):

Alisha R. Oropallo ◽

Thomas E. Serena ◽

David G. Armstrong ◽

Mark Q. Niederauer

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Oxygen Therapy ◽

Molecular Biomarkers ◽

Pure Oxygen ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Physiological Basis ◽

Collagen Formation ◽

The Impact

Hyperbaric oxygen therapy (HBOT) and topical oxygen therapy (TOT) including continuous diffuse oxygen therapy (CDOT) are often utilized to enhance wound healing in patients with diabetic foot ulcerations. High pressure pure oxygen assists in the oxygenation of hypoxic wounds to increase perfusion. Although oxygen therapy provides wound healing benefits to some patients with diabetic foot ulcers, it is currently performed from clinical examination and imaging. Data suggest that oxygen therapy promotes wound healing via angiogenesis, the creation of new blood vessels. Molecular biomarkers relating to tissue inflammation, repair, and healing have been identified. Predictive biomarkers can be used to identify patients who will most likely benefit from this specialized treatment. In diabetic foot ulcerations, specifically, certain biomarkers have been linked to factors involving angiogenesis and inflammation, two crucial aspects of wound healing. In this review, the mechanism of how oxygen works in wound healing on a physiological basis, such as cell metabolism and growth factor signaling transduction is detailed. Additionally, observable clinical outcomes such as collagen formation, angiogenesis, respiratory burst and cell proliferation are described. The scientific evidence for the impact of oxygen on biomolecular pathways and its relationship to the outcomes in clinical research is discussed in this narrative review.

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