The main pathological condition in patients with impaired wound
healing is diabetes mellitus. These patients have significantly low
circulating nitric oxide (NO) levels because the stimulatory action
of insulin on NO synthesis is absent. Additionally, asymmetric
dimethylarginine (ADMA), an inhibitor of NO synthase, is
increased owing to the generation of oxidative stress. NO was
thought to contribute to wound healing. Hyperbaric oxygen
(HBO) treatment is generally used in order to accelerate the
healing of wounds. The aim of this study was to determine the
changes in plasma procollagen type I and III N-terminal peptides
(PINP and PIIINP), total nitrite/nitrate (NOx) and ADMA levels;
and to evaluate their relation to healing during the HBO
treatment of foot ulcers. Data obtained from 18 diabetic patients
before and after the HBO therapy were compared statistically by
the Wilcoxon test. NOx was increased in 11 and ADMA was
decreased in 12 patients following HBO treatment. Both PINP
(32.6±29.4 μg/l vs 44.3±33.4 μg/l) and PIIINP (6.97±3.01 μg/l
vs 7.92±2.49 μg/l) were significantly increased (p<0.05).
Progressive reductions were observed in wound areas, as
assessed by the digital wound imaging. In 12 patients, wounds
healed by 50 % or higher; whereas only two subjects had
minimal improvements (15 % or less healing). The duration of
diabetes correlated negatively with wound healing (r = -498,
p<0.05). This study suggests that increased collagen synthesis is
associated with wound healing during hyperbaric oxygen therapy.
Nitric oxide generation may also contribute to the healing
process.
Assessment of Fraction Exhaled Nitric Oxide in Patients Undergoing Hyperbaric Oxygen Therapy