METHOD: This is a retrospective observational study. Patients who were admitted to the Orthopaedic ward of Hospital Segamat (HS), Johor, Malaysia from January 2016 to December 2018 and required surgical intervention were included in the study. Data was collected from the computer system of HS and medical notes of patients.
RESULTS: 35.6% of the total orthopaedic emergency surgeries performed were for patients with diabetic foot infection, 25% of the surgical procedures performed were major amputations of lower limb and 40% of the patients with diabetic foot infection required more than one surgical operation.
DISCUSSION: The demographics of the patients is consistent with the demographics of Malaysia where majority of them are Malays followed by Chinese, Indians and others. Despite being only 10% of total admission to the department, this group of patients contributed to 35.6% of the total emergency surgeries performed. The amputation rate in the centre is comparable to the other local studies. The average length of stay in hospital was found to be shorter compared to overseas due to different rehabilitation protocols.
METHODS: Fifty-eight diabetic patients with ulcers at Wagner Grade 2 and above involved in this study after presented at two study centres of tertiary teaching hospitals. The assigned patients received conventional wound care with additional HBOT given at 2.4 ATA for 90 minutes. Patients in the control group who received conventional wound care only were treated and observed for 30 days. The progress of wound healing was observed and measured at day 0, 10, 20 and 30 of study. The data collected were analysed using SPSS software (ver. 22) to study the association of HBOT towards healing of the diabetic foot ulcers.
RESULTS: Repeated Measures ANOVA analysis with Greenhouse-Geisser correction indicated that the means of wound size over time points (Day 0, 10, 20 and 30) among patients under HBOT group were statistically significantly different [F(1,61)=30.86, p<0.001)] compared to conventional therapy group. Multiple logistic regression analysis showed that HBOT group has nearly 44 times higher odds to achieve at least 30% wound size reduction within the study period (95%CI: 7.18, 268.97, p<0.001).
CONCLUSION: The results obtained in this study indicated that as an adjunctive therapy to conventional wound care, HBOT affected the rate of healing in diabetic foot ulcers significantly in terms of wound size reduction when compared to administering the conventional wound care alone.