[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
Purchase Options:
[Skip to Content Landing]
Letters
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.

References
1.
Tokuda  YCrane  SYamaguchi  YZhou  LFalanga  V The levels and kinetics of oxygen tension detectable at the surface of human dermal fibroblast cultures.  J Cell Physiol. 2000;182:414-420.Google Scholar
2.
American Diabetes Association, Consensus Development Conference on Diabetic Foot Wound Care: 7-8 April 1999, Boston, Massachusetts.  Diabetes Care. 1999;22:1354-1360.Google Scholar
3.
Hammarlund  CSundberg  T Hyperbaric oxygen reduced size of chronic leg ulcers: a randomized double-blind study.  Plast Reconstr Surg. 1994;93:829-833.Google Scholar
4.
Faglia  EFavales  FAldeghi  A  et al.  Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer: a randomized study.  Diabetes Care. 1996;19:1338-1343.Google Scholar
5.
Greif  RAkca  OHorn  EPKurz  ASessler  DI Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection.  N Engl J Med. 2000;342:161-167.Google Scholar
6.
Argenta  LCMorykwas  MJ Vacuum-assisted closure: a new method for wound control and treatment: clinical experience.  Ann Plast Surg. 1997;38:563-577.Google Scholar
×