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Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor
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
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.
Fontanarosa PB, Bello YM, Phillips TJ. Adjunctive Therapies for Wound Healing—Reply. JAMA. 2000;284(1):40–41. doi:10.1001/jama.284.1.39
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