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July 5, 2000

Adjunctive Therapies for Wound Healing—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;284(1):40-41. doi:10.1001/jama.284.1.39

In Reply: We agree with Drs Bozzuto and Fife that in vitro and animal model data support the positive effects of oxygenation on wound healing. Interestingly, some data also suggest that hypoxia may play a role in wound healing.1 While there are a large number of anecdotal reports pertaining to hyperbaric oxygen and wound healing, there is a dearth of prospective, randomized, double-blind, placebo-controlled studies.

We agree with the statement of the Consensus Development Conference on Diabetic Foot Wound Care2 that "there are no randomized controlled trials supporting the use of hyperbaric oxygen therapy to treat neuropathic diabetic foot wounds. Given the limited evidence of positive results in select groups of patients with severe wounds, additional randomized clinical trials are warranted. It is reasonable, however, to use this costly modality to treat severe and limb- or life-threatening wounds that have not responded to other treatments, particularly if ischemia that cannot be corrected by vascular procedures is present."2

A randomized placebo-controlled study on "nonarterial, nondiabetic ulcers" (presumably venous) did show a faster rate of healing in the group treated with hyperbaric oxygen.3 However, compression (the standard treatment for venous ulcers) was not mentioned, and the wounds were not followed to complete healing.

A randomized non–placebo-controlled study reported that systemic hyperbaric oxygen decreased major amputations in diabetic patients with severe ischemic foot ulcers.4 A recent randomized controlled trial supported the use of perioperative supplemental oxygen administration as a practical method of reducing the incidence of surgical wound infections.5

We do not disagree that systemic hyperbaric oxygen may have a role in the treatment of appropriately selected wounds, but we feel that more randomized controlled trials are needed and, to date, there are insufficient quality data to recommend routine use of this modality in chronic wound care.

Dr Graham describes his experience with vacuum-assisted devices. Indeed, topical negative pressure therapy shows promise in numerous case studies and anecdotal reports, including an uncontrolled series of 300 patients.6 Randomized controlled trials evaluating the therapy are in progress, and the data from such trials will allow a more complete evaluation of this therapy.

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