Increasing tissue oxygenation for diabetic wound healing

초록

Adequate tissue oxygenation is an essential factor during wound healing. Diabetic foot ulcers almost always accompany vascular insufficiency. Unfortunately, recovery of vascular insufficiency is difficult in diabetic patients because of both macro- and micro-circulations. This article presents the author’s methods or innovations developed to increase tissue oxygenation for diabetic wound healing. Normobaric hyperoxic (NBO) therapy, which requires increasing the fractional inspired oxygen to almost 100% at normobaric pressure, is a potentially attractive alternative to hyperbaric oxygen therapy because of its high availability, good patient compliance, cost-effectiveness, decreased complications, and few technical requirements. NBO significantly increases tissue oxygenation level of diabetic feet. The foot lowering, rather than elevation, also significantly augments tissue oxygenation level of diabetic foot ulcers. Based on experience of the author’s group, percutaneous transluminal angioplasty (PTA) is efficient enough to increase tissue oxygenation even in severely ischemic feet. The most severely ischemic group shows the most dramatic increase of tissue oxygenation after PTA. Monochromatic infrared energy, ultrasound, and pain scrambler therapy can also be used as adjunctive to improve tissue oxygen level in diabetic foot ulcers.

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