Oley MH, Oley MC, Kepel BJ, Faruk M, Wagiu AMJ, Sukarno I, Tulong MT, Sukarno V, et al.
Plastic and reconstructive surgery. Global open. Date of publication 2024 Mar 25;volume 12(3):e5692.
1. Plast Reconstr Surg Glob Open. 2024 Mar 25;12(3):e5692. doi:
10.1097/GOX.0000000000005692. eCollection 2024 Mar.
Hyperbaric Oxygen Therapy for Diabetic Foot Ulcers Based on Wagner Grading: A
Systematic Review and Meta-analysis.
Oley MH(1)(2)(3), Oley MC(3)(4)(5), Kepel BJ(6), Faruk M(7), Wagiu AMJ(8),
Sukarno I(8), Tulong MT(3), Sukarno V(9).
Author information:
(1)From the Plastic Reconstructive and Aesthetic Surgery Division, Department of
Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia.
(2)Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery,
Kandou Hospital, Manado, Indonesia.
(3)Hyperbaric Centre Siloam Hospital, Manado, Indonesia.
(4)Neurosurgery Division, Department of Surgery, Faculty of Medicine, Sam
Ratulangi University, Manado, Indonesia.
(5)Neurosurgery Division, Department of Surgery, Kandou Hospital, Manado,
Indonesia.
(6)Department of Chemistry, Faculty of Medicine, Sam Ratulangi University,
Manado, Indonesia.
(7)Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar,
Indonesia.
(8)Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado,
Indonesia.
(9)Bangli General Hospital, Bangli, Indonesia.
BACKGROUND: Diabetic foot ulcers (DFUs) are common complications of uncontrolled
diabetes mellitus that can result in infection and amputation of the lower
extremities. This study compared the benefits and risks of hyperbaric oxygen
therapy with those of other DFU treatments, based on the Wagner grading system.
METHODS: Systematic searches for randomly controlled trials using hyperbaric
oxygen therapy for DFUs were performed using PubMed, the Cochrane Library, and
Embase. Data regarding demographics, wound healing, minor and major amputations,
operative debridement, nonhealing wounds, and adverse effects were analyzed
based on Wagner grades, using RevMan 5.4.1 and Microsoft Excel.
RESULTS: Hyperbaric oxygen therapy was significantly superior to other
treatments for wound healing rates 8 or more weeks after the final treatment (RR
= 2.39; 1.87-3.05; P < 0.00001) minor/distal amputations (RR = 0.58; 0.43-0.80;
P < 0.007), and major/proximal amputations (RR = 0.31; 0.18-0.52; P < 0.00001)
for the 14 studies analyzed. In addition, this therapy increased the rate of
complete wound healing for Wagner grades II (RR = 21.11; 3.05-146.03; P =
0.002), III (RR = 19.58; 2.82-135.94, P = 0.003), and IV (RR = 17.53;
2.45-125.44; P = 0.004); decreased the minor/distal amputation rate for grade
III (RR = 0.06; 0.01-0.29; P = 0.0004) and the major/proximal amputation rate on
for grade IV (RR = 0.08; 0.03-0.25; P < 0.0001); and decreased the operative
debridement rate for Wagner grade II (RR = 0.09; 0.01-0.60; P = 0.01).
CONCLUSIONS: Moderate-quality evidence revealed that adjunctive hyperbaric
oxygen therapy improved DFU wound healing for Wagner grades II, III, and IV;
prevented minor and major amputations for grades III and IV, respectively; and
prevented operative debridement in grade II wounds.
Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf
of The American Society of Plastic Surgeons.
DOI: 10.1097/GOX.0000000000005692
PMCID: PMC10962882
PMID: 38528847
Conflict of interest statement: The authors have no financial interest to
declare in relation to the content of this article.
