HBO Nuggets of the Week

A forum to discuss interesting aspects of hyperbaric medicine.

Monday, October 21, 2013

HBO Nugget 8

One of the more common uses of hyperbaric oxygen therapy is in the treatment of diabetic foot ulcers (DFUs). Diabetic foot ulcers are one of the feared complications of diabetes. They occur in about 15% of persons with diabetes, and an article by Brem and Tomic-Canic1 stated that approximately 84% of lower extremity amputations are preceded by them.

The Centers for Medicare & Medicaid Services requirements for treatment of DFUs include the following 3 criteria:

Patient has type 1 or type 2 diabetes and has a lower extremity wound that is a result of having diabetes

Patient has a wound classified as Wagner grade III or higher

Patient has failed an adequate course of standard wound therapy for at least 30 days (including debridement, revascularization if indicated, offloading, and so on)

The Wagner’s classification of diabetic foot ulcers is as follows. Although not a perfect grading system (doesn’t take into account vascular status or superficial ulcers), it is the grading system that is used to determine candidacy for HBOT at the present time:

Grade      Lesion

 0              No open lesions: may have deformity or cellulitis

 1             Superficial ulcer

 2             Deep ulcer to tendon or joint capsule

 3             Deep ulcer with abscess, osteomyelitis, or joint sepsis

 4             Local gangrene – forefoot or heel

 5             Gangrene of entire foot

Treatment is typically 30 dives at 2.0 ATA and if improvement is shown, the number of dives may be increased.


1. Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. J Clin Invest 2007;117:1219-22.