Effectiveness of most common adjuvant wound treatments (skin substitutes, negative pressure wound therapy, hyperbaric oxygen therapy, platelet-rich plasma/fibrin, and growth factors) for the management of hard-to-heal diabetic foot ulcers: a meta-analysis of randomized controlled trials for the development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome

What Researchers Did

Italian researchers performed a meta-analysis of 51 randomized controlled trials to compare five wound treatments for hard-to-heal diabetic foot ulcers, including HBOT, skin substitutes, platelet-rich plasma, growth factors, and negative pressure wound therapy.

What They Found

All five treatments significantly improved ulcer healing compared to standard care, with healing odds ratios ranging from 2.17 to 4.18. HBOT and platelet-rich plasma/fibrin were the only two therapies that also significantly reduced the risk of major amputation. HBOT cut amputation risk by 72% (MH-OR: 0.28, 95% CI: 0.10-0.79, p=0.02), though it was also linked to a higher rate of serious adverse events.

What This Means for Canadian Patients

For Canadians with diabetic foot ulcers not healing with standard care, HBOT is one of only two treatments shown to reduce the risk of losing a limb. Given that amputation rates in diabetic Canadians remain high, this finding warrants discussion with an endocrinologist or wound care specialist.

Canadian Relevance

Diabetic foot ulcers are an OHIP-covered indication for HBOT in Ontario. Patients with non-healing diabetic foot wounds should ask about eligibility for covered HBOT treatment.

Study Limitations

The higher rate of serious adverse events associated with HBOT needs to be weighed carefully against the amputation-prevention benefit in individual patient discussions.