Abstract:
In 2002 Fife and Strauss (Fife, et al. Wound Rep Reg, 10:198-207; Strauss, et al. Foot Ankle Intl, 23:933-937) studied the predictability of transcutaneous oxygen measurements (TCOMs) for healing diabetic foot ulcers (DFUs). This paper analyzes the validity of the two studies and combines their information to predict which DFU will heal with adjunctive hyperbaric oxygen (HBO₂) treatments. A statistical review of the Fife and Strauss papers was performed. The numbers presented in the papers were subjected to analyses to compare like by like data as well as test for p-values and odds ratios for predicting healing of DFUs with HBO₂. In the Strauss paper 143 subjects were studied in retrospective and prospective series. In those TCOMs which exceed 200 mmHg with HBO₂ healing occurred in 87.5% even if the room air TCOM was ⟨ 30 mmHg (p ⟨ 0.001). The Fife paper studied retrospectively a subset of 221 patients who had TCOMs with HBO₂. Failure rates for healing decreased progressively from 35.7% to 14.3%, with TCOMs grouped in 100-mmHg increments from 200 mmHg to 699 mmHg. This resulted in absence of statistical significance for any 100-mmHg range over 200 mmHg with HBO₂ due to the small number of subjects for each 100-mmHg grouping. Although differences exist between the study designs, each complements the other. If TCOMs exceed 200 mmHg with HBO₂, both authors observed that almost 90% of DFUs healed regardless of the room air readings when HBO₂ was used as an adjunct to management.
Moon H, Strauss MB, La SS, Miller SS. The validity of transcutaneous oxygen measurements in predicting healing of diabetic foot ulcers. Undersea Hyperb Med. 2016 Sept-Oct;43(6):641-648. PMID: 28768391. https://www.ncbi.nlm.nih.gov/pubmed/28768391