Hello friends of #StemSocial, today I want to talk about one of the most treated pathologies in my medical specialty.
As expressed in the title, the use of Hyperbaric Oxygenation in a pressurized chamber, in people suffering from Diabetes Mellitus with ulcerative lesions in their feet, is one of the best therapies you can receive.

When we talk about diabetic foot, we refer to certain pathological conditions in the foot of patients, often associated with an ulcerative lesion generally in the plantar area, caused by a combination of different factors: vascular, neuropathic and infectious.

Diabetics suffer from delayed healing processes and this leads to the chronicity of their wounds. If the wound remains open for more than 4 weeks, it can lead to a worse prognosis.

Clinical Aspects

It is important to classify the depth of the ulcer in the foot, and for this we use the Wagner Classification that goes from 0 to 5 degrees, and another that allows us to classify in a practical way, which I detail below: where it is observed whether or not there is danger of amputation or if there is a threat to the patient's life when associated with sepsis and shock, in addition to the real danger of amputation.

Without danger of amputation:

• Superficial ulcers
• Lymphangitis or cellulitis of less than 2 cm
• No joint repercussions, presence of abscesses or fasciitis.
• No systemic toxicity
• Equivalent to a Wagner grade 1
• No significant ischemia

With amputation risk:

• Deep ulcers
• Cellulitis of more than 2 to 3 cm
• With involvement of deep structures
• There may be systemic toxicity and metabolic dysregulation.
• Equivalent to a Wagner grade 2 to 5
• With ischemia or gangrene

Apart from ulceration, we may find:

• Osteomyelitis
• Cellulitis
• Abscesses
• Gangrene
• Ischemic necrosis

Treatment

We must consider several aspects when managing the diabetic foot, which are key pillars for the achievement of the best results:

• Of great importance is to control the infection with the use of appropriate antibiotics.
• Metabolic control and control of modifiable risk factors are cornerstones in the prevention of complications.
• Surgical debridement is appropriate to remove non-viable parts of the lesion and necrotic tissue. This removes the local pressure and then covers with dressing or draping.
• Vascular reconstruction if necessary and amputation only in cases that require it.

Diabetic foot injuries go through processes: hypoxia caused by microvascular damage, which leads to neurological damage, metabolic imbalance and infections.

Benefits of using Hyperbaric Oxygenation

Corrects Hypoxia:

By increasing the availability of tissue oxygen during treatment sessions and hours after, where its diffusion is increased 4 to 6 times and partial pressures of oxygen from 100 to 200 mmHg, which can be measured through transcutaneous tensions.

Promotes collagen synthesis:

At tissue oxygen pressures between 40 to 60 mmHg, we achieve hydroxylation of procollagen to collagen, which aids the healing process.

Stimulates angiogenesis:

By the formation of new functional capillary vessels.

Improved response to infections:

By increasing the leukocyte bactericidal capacity against aerobic and anaerobic bacteria; in turn, it improves the phagocytic activity of polymorphonuclear cells and the oxidation-reduction potential.

Improves metabolic control:

• We achieve a hypoglycemic effect by the activation of enzymes, recovery of insulin receptors, better utilization of glucose at tissue level and activation of certain pancreatic functions through peptide influence.
• Decrease in lactate levels and tissue necrosis.
• Normalization of enzymes, catecholamine secretion, excretion and glycemia.
• Improved oxygen transport function in the erythrocyte.

What is the treatment protocol when using the Hyperbaric Chamber for this injury?

• Frequency: One session per day of Hyperbaric Oxygenation is used.
• Pressure: 2.2 ATA of absolute pressure.
• Time: 50 minutes of isopressure.
• Number of sessions: minimum 20 sessions, until complete healing of the ulcers, and that the comprehensive assessment of the case is adequate.

Well friends, these are the most important aspects that you should know. The use of Hyperbaric Oxygenation is very useful in these injuries suffered by a diabetic patient, but the most important thing is to take care of them, to avoid ulceration of their feet.

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Bibliografía consultada/Bibliography consulted:

Duzgun A.P., Satir H.Z, Ozozan O. Effect of hyperbaric oxygen therapy on healing of diabetic foot ulcers; 2008. Available online at: Academic Search Premier.

Barnes R. Point: Hyperbaric Oxygen is Beneficial for Diabetic Foot Wounds. Clinical Infectious Diseases; 2006. Available online at: Academic Search Premier.

Fife C., Buyukcakir C., Otto G., Sheffield P., Warriner R., Mader J., et al. The predictive value of transcutaneous oxygen tension measurement in diabetic lower extremity ulcers treated with hyperbaric oxygen therapy: a retrospective analysis of 1144 patients. Wound Repair & Regeneration; 2002. Available online at: Academic Search Premier.

Lipsky B.A, Berendt A.R, Deery H.G, Embil J.M, Joseph W.S, Karchmer A.W, et al. Diagnosis and Treatment of Diabetic Foot Infections. Clin Infect Dis; USA; 2004.