Tarig Elraiyah1, Apostolos Tsapas2, Gabriela Prutsky3, Juan Pablo Domecq3, Rim Hasan4, Belal Firwana4, Mohammed Nabhan1, Larry Prokop5, Anil Hingorani6, Paul L Claus7, Lawrence W Steinkraus7, Mohammad Hassan Murad8. 1. Evidence-based Practice Center, Mayo Clinic, Rochester, Minn. 2. Second Medical Department, Aristotle University, Thessaloniki, Greece. 3. Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru. 4. Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Department of Internal Medicine, University of Missouri, Columbia, Mo. 5. Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn. 6. Department of Surgery, Lutheran Medical Center, Brooklyn, NY. 7. Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn. 8. Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu.
Abstract
BACKGROUND: Multiple adjunctive therapies have been proposed to accelerate wound healing in patients with diabetes and foot ulcers. The aim of this systematic review is to summarize the best available evidence supporting the use of hyperbaric oxygen therapy (HBOT), arterial pump devices, and pharmacologic agents (pentoxifylline, cilostazol, and iloprost) in this setting. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2011. Pairs of independent reviewers selected studies and extracted data. Predefined outcomes of interest were complete wound healing and amputation. RESULTS: We identified 18 interventional studies; of which 9 were randomized, enrolling 1526 patients. The risk of bias in the included studies was moderate. In multiple randomized trials, the addition of HBOT to conventional therapy (wound care and offloading) was associated with increased healing rate (Peto odds ratio, 14.25; 95% confidence interval, 7.08-28.68) and reduced major amputation rate (odds ratio, 0.30; 95% confidence interval, 0.10-0.89), compared with conventional therapy alone. In one small trial, arterial pump devices had a favorable effect on complete healing compared with HBOT and in another small trial compared with placebo devices. Neither iloprost nor pentoxifylline had a significant effect on amputation rate compared with conventional therapy. No comparative studies were identified for cilostazol in diabetic foot ulcers. CONCLUSIONS: There is low- to moderate-quality evidence supporting the use of HBOT as an adjunctive therapy to enhance diabetic foot ulcer healing and potentially prevent amputation. However, there are only sparse data regarding the efficacy of arterial pump devices and pharmacologic interventions.
BACKGROUND: Multiple adjunctive therapies have been proposed to accelerate wound healing in patients with diabetes and foot ulcers. The aim of this systematic review is to summarize the best available evidence supporting the use of hyperbaric oxygen therapy (HBOT), arterial pump devices, and pharmacologic agents (pentoxifylline, cilostazol, and iloprost) in this setting. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2011. Pairs of independent reviewers selected studies and extracted data. Predefined outcomes of interest were complete wound healing and amputation. RESULTS: We identified 18 interventional studies; of which 9 were randomized, enrolling 1526 patients. The risk of bias in the included studies was moderate. In multiple randomized trials, the addition of HBOT to conventional therapy (wound care and offloading) was associated with increased healing rate (Peto odds ratio, 14.25; 95% confidence interval, 7.08-28.68) and reduced major amputation rate (odds ratio, 0.30; 95% confidence interval, 0.10-0.89), compared with conventional therapy alone. In one small trial, arterial pump devices had a favorable effect on complete healing compared with HBOT and in another small trial compared with placebo devices. Neither iloprost nor pentoxifylline had a significant effect on amputation rate compared with conventional therapy. No comparative studies were identified for cilostazol in diabetic foot ulcers. CONCLUSIONS: There is low- to moderate-quality evidence supporting the use of HBOT as an adjunctive therapy to enhance diabetic foot ulcer healing and potentially prevent amputation. However, there are only sparse data regarding the efficacy of arterial pump devices and pharmacologic interventions.
Authors: Ketan Dhatariya; Stephen C Bain; John B Buse; Richard Simpson; Lise Tarnow; Margit Staum Kaltoft; Michael Stellfeld; Karen Tornøe; Richard E Pratley Journal: Diabetes Care Date: 2018-08-02 Impact factor: 19.112
Authors: Morten Hedetoft; Niels V Olsen; Isabel G Smidt-Nielsen; Anna M Wahl; Anita Bergström; Anders Juul; Ole Hyldegaard Journal: Diving Hyperb Med Date: 2020-03-31 Impact factor: 0.887
Authors: J Růžička; M Grajciarová; L Vištejnová; P Klein; F Tichánek; Z Tonar; J Dejmek; J Beneš; L Bolek; R Bajgar; J Kuncová Journal: Physiol Res Date: 2021-09-10 Impact factor: 1.881
Authors: Thomas S Nørlinger; Per Mose Nielsen; Haiyun Qi; Emmeli Mikkelsen; Kasper Hansen; Nikolaj H Schmidt; Michael Pedersen; Peter Agger; Fredrik Palm; Christoffer Laustsen Journal: Physiol Rep Date: 2017-03