Amputation Avoidance = Limb Preservation Clinic
Diabetes is a metabolic disease in which the body has difficulty producing insulin. This leads to high blood glucose levels, which can damage organs, blood vessels, and nerves. Diabetes affects 10.2% of the Ontario population.
For several reasons, people with diabetes are especially susceptible to lower limb and foot wounds that do not heal. People with diabetes may experience nerve damage, which can lead to weakness and numbness in the foot in addition to pain.3 This numbness can predispose patients to foot injuries, either through trauma or by continuing to walk on a severe blister or callus without feeling any pain.4 Additionally, diabetes can cause the skin to become very dry and prone to cracking, increasing the risk for infection.4 People with diabetes may also experience peripheral artery disease, which can cause a hardening and obstruction of blood vessels in the lower leg and foot. This condition results in poor circulation, which can make fighting infection more difficult and make patients more susceptible to ulcers. Other factors that may contribute to complications with wound healing include poor tissue perfusion (spread of oxygen in the body), bacterial infection, malnutrition, and poor control of blood glucose levels.
It is estimated that about 15% to 25% of people with diabetes develop a foot ulcer in their lifetime. These wounds are often resistant to treatment and difficult to heal; therefore, people with diabetes experience lower limb amputation at about 20 times the rate of people without diabetes.
If an ulcer does not heal with standard wound care, other therapeutic interventions are offered, one of which is hyperbaric oxygen therapy (HBOT) (1)
In a review published online in May of 2017 Ontario Health Quality conducted an assessment of he safety, clinical effectiveness, and cost-effectiveness of standard wound care plus HBOT versus standard wound care alone for the treatment of diabetic foot ulcers. The preferences and perspectives of people with diabetic foot ulcers through lived experience were also investigated.
What Were the Results of the Assessments?
Comparing standard wound care plus HBOT with standard wound care alone, results were mixed for major amputation rates (GRADE quality of evidence: low), and a significant difference in favour of standard wound care plus HBOT on ulcers healed (GRADE quality of evidence: low),
Patients feel that HBOT is an effective treatment and reported that they were satisfied with how their ulcers healed and that this improved their quality of life.