Hyperbaric oxygen therapy for treating non-diabetic chronic wounds

The addition of hyperbaric oxygen to the treatment of chronic, non-diabetic leg ulcers resulted in a reduction in wound area.

Clinical Results:
  1. The addition of hyperbaric oxygen was associated with a significant reduction in the area of chronic wounds.
  2. No wounds were completely healed at the end of the six week treatment period, but there was a trend to eventual healing in the hyperbaric group.
Clinical Scenario:

An adult with chronic, non-diabetic leg ulcer in the absence of major arterial/venous vessel disease.

Three-part Question:

In adult patients with chronic, non-diabetic leg ulcers, does the adjunctive use of hyperbaric oxygenation compared to standard wound care alone, result in any improvement in ulcer size or other signs of healing.

The Study:

Double-blinded concealed randomised controlled trial with intention-to-treat.

Leg ulcer present for one year or longer, no major vascular disorder, non-smoking, non-diabetic.

Control group (N = 8): All treatment prescribed at enrollment was continued. Placebo treatment breathing air at 2.5 ATA for 90 minutes daily, 5 days each week to a total of 30 sessions.

Experimental group (N = 8): As above plus addition of hyperbaric oxygenation at 2.5 ATA on the same regime as control group.

The Evidence:
Outcome Time to Outcome Control Hyperbaric Relative risk reduction Absolute risk reduction Number needed to treat
Wound healed 18 weeks 0 0.333 INF 0.333 3
95% CI         0.71 to 0.04 NNT= 23 to INF

NNH= 1 to INF

Wound area decrease (%) Air group HBO group P-value
Week 2 2.8 6.6 n/s
Week 4 3.7 22.0 <0.05
Week 6 2.8 35.7 <0.001