Rüttermann et al. were able to determine “the efficacy” from whole-body hyperbaric oxygen therapy (HBOT) on the basis of “good evidence”, demanding an unequivocal recommendation (at least grade B) for its use. In support they cite a meta-analysis by Kränke et al. from 2004 (1).

In 2012 however, Kränke et al. had updated their meta-analysis, reaching a notably different conclusion: “In people with foot ulcers due to diabetes, HBOT significantly improved the ulcers healed in the short term but not thelong term and the trials had various flaws in design and/or reporting that means we are not confident in the results” (2).

While Rüttermann et al. refer to “valid data in support of hyperbaric oxygen,” Kränke et al. (2) felt compelled to comment that the relevance of hyperbaric oxygen therapy for persons with chronic wounds, after all, needs proper evaluation by studies adequately powered and designed to minimize all kinds of biases.

In the US, hyperbaric oxygen therapy completely failed in 6259 diabetes patients with foot ulcers and sufficient arterial perfusion, as was shown in the most recent—and by far most comprehensive—publication on the subject (3).

DOI: 10.3238/arz9tebl.2013.0372a

em. Prof. Dr. med. Ernst A. Chantelau
Bremen

chantelau@gmx.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Kränke P, Bennett MH: Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews. Reviews 2004, Issue 1. MEDLINE
2.
Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE: Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD004123. DOI: 10.1002/14651858.CD004123.pub3 CrossRef MEDLINE
3.
Margolis DJ, Gupta J, Hoffstad O, Papdopoulos M, Glick HA, Thom SR, Mitra N: Lack of effectiveness of hyperbaric oxygen therapy for the treatment of diabetic foot ulcer and prevention of amputation: a cohort study. Diabetes Care 2013, February 19 [ahead of print]. CrossRef MEDLINE
4.
Rüttermann M, Maier-Hasselmann A, Nink-Grebe B, Burckhardt M: Local treatment of chronic wounds in patients with peripheral vascular disease, chronic venous insufficiency and diabetes. Dtsch Arztebl Int 2013; 110(3): 25–31. VOLLTEXT
1.Kränke P, Bennett MH: Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews. Reviews 2004, Issue 1. MEDLINE
2.Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE: Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD004123. DOI: 10.1002/14651858.CD004123.pub3 CrossRef MEDLINE
3.Margolis DJ, Gupta J, Hoffstad O, Papdopoulos M, Glick HA, Thom SR, Mitra N: Lack of effectiveness of hyperbaric oxygen therapy for the treatment of diabetic foot ulcer and prevention of amputation: a cohort study. Diabetes Care 2013, February 19 [ahead of print]. CrossRef MEDLINE
4.Rüttermann M, Maier-Hasselmann A, Nink-Grebe B, Burckhardt M: Local treatment of chronic wounds in patients with peripheral vascular disease, chronic venous insufficiency and diabetes. Dtsch Arztebl Int 2013; 110(3): 25–31. VOLLTEXT

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