Transcutaneous Oximetry Optimizes Clinical Management and Cost-Effectiveness of Diabetic Foot Ulcers Treated with Hyperbaric Oxygen: A Review of Point of Care Vascular Screening Options

Transcutaneous Oximetry Optimizes Clinical Management and Cost-Effectiveness of Diabetic Foot Ulcers Treated with Hyperbaric Oxygen: A Review of Point of Care Vascular Screening Options 

Richard E. Clarke, CHT-ADMIN 

National Baromedical Services, Columbia, South Carolina, USA

CORRESPONDING AUTHOR: dickclarke@baromedical.com

ABSTRACT 

Hyperbaric oxygen therapy has been employed to treat diabetic foot ulcers for more than four decades. While supported by some high-quality evidence, sufficient conflicting data makes its use open to criticism. Even systematic and other reviews favorably disposed to this treatment adjunct invariably plead  for better patient selection. Common among several causes of non-healing ulcers is persistent hypoxia. Transcutaneous oximetry uniquely measures tissue oxygen tension. Combination air and oxygen testing provide an evidence-based approach to hyperbaric patient selection by demonstrating locally reversible hypoxia. Transcutaneous oximetry differentiates hyperbaric responders from non-responders early in their treatment course by detecting neo-angiogenesis, thereby providing the basis for continued hyperbaric dosing only in those benefiting. Finally, such testing guides therapeutic endpoint determination, namely normalized peri-ulcer oxygen tensions. This contrasts with continuing medically unnecessary and costly hyperbaric treatments until wound closure. Measurements of blood pressure and blood flow represent imperfect oxygen delivery surrogates and imperfect ones. Recently introduced near-infrared spectroscopy and long-wave infrared thermography provide insights into tissue oxygen saturation and changes in micro-vascular density, respectively. Neither, however, guide clinically efficacious and cost-effective hyperbaric oxygenation in the manner afforded by transcutaneous oximetry. This paper describes evidence-based guidance for hyperbaric oxygen dosing of diabetic foot ulcers, reviews point-of-care screening options, and argues the continued superiority of transcutaneous oximetry in the current era. 

Keywords: ankle-brachial index; Doppler ultrasound; laser Doppler flowmetry; long wave infrared thermography; near-infrared spectroscopy; skin perfusion pressure; toe-brachial index.