title: Systematic review of the effectiveness of hyperbaric oxygenation therapy in the management of chronic diabetic foot ulcers.
abstract: OBJECTIVE
  To assess the efficacy and safety of hyperbaric oxygenation (HBO) therapy as adjunctive treatment for diabetic foot ulcers with a systematic review and meta-analysis of the literature.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Library were searched to find relevant articles published up to April 20, 2012, without restriction as to language or publication status. All controlled trials that evaluated adjunctive treatment with HBO therapy compared with treatment without HBO for chronic diabetic foot ulcers were selected. A meta-analysis was performed to assess the efficacy and safety of hyperbaric oxygen in managing foot ulcers.
  
  
  RESULTS
  Thirteen trials (a total of 624 patients), including 7 prospective randomized trials, performed between January 1, 1966, and April 20, 2012, were identified as eligible for inclusion in the study. Pooling analysis revealed that, compared with treatment without HBO, adjunctive treatment with HBO resulted in a significantly higher proportion of healed diabetic ulcers (relative risk, 2.33; 95% CI, 1.51-3.60). The analysis also revealed that treatment with HBO was associated with a significant reduction in the risk of major amputations (relative risk, 0.29; 95% CI, 0.19-0.44); however, the rate of minor amputations was not affected (P=.30). Adverse events associated with HBO treatment were rare and reversible and not more frequent than those occurring without HBO treatment (P=.37).
  
  
  CONCLUSIONS
  This meta-analysis reveals that treatment with HBO improved the rate of healing and reduced the risk of major amputations in patients with diabetic foot ulcers. On the basis of these effects, we believe that quality of life could be improved in selected patients treated with HBO.
authors: Department of Endocrinology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
authors: Rui
authors: R
authors: Liu
authors: Ling
authors: L
authors: Li
authors: Mengliu
authors: M
authors: Yang
authors: Guenther
authors: G
authors: Boden
authors: Gangyi
authors: G
authors: Yang
mesh_terms: D016022:Case-Control Studies; D002908:Chronic Disease / Q000628:therapy*; D017719:Diabetic Foot / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D015201:Meta-Analysis as Topic; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014945:Wound Healing