Hyperbaric Oxygen as an Adjunct in the Treatment of Venous Ulcers: A Systematic Review.

BACKGROUND: The use of Hyperbaric Oxygen Therapy (HBOT) in diabetic wounds has been studied extensively. Even though venous insufficiency is the most common cause of lower limb ulceration, there is comparatively little evidence regarding the use of HBOT for Venous Leg Ulcers (VLU). We performed a systematic-review to evaluate and synthesise available evidence, to evaluate whether patients with VLU, when treated with HBOT, had greater rates of (i) complete VLU healing or (ii) reduction in VLU area, than controls. METHODS: In keeping with PRISMA guidelines, database searches of PubMed, Scopus and Embase was performed. After removal of duplicates, titles were screened for relevance by two authors, then abstracts, and in turn full text manuscripts. Data were extracted from relevant sources including one published abstract. Included studies were assessed for risk of bias using the Risk of Bias 2 (RoB-2) and Risk Of Bias In Nonrandomized Studies (ROBINS-I) tools. RESULTS: Six studies were included. There was significant heterogeneity across the studies, with no standard control intervention, method of outcome reporting, or duration of follow up. Two studies reported 12 week follow up results and pooled analysis of complete ulcer healing showed no statistically significant difference between HBOT and controls for the outcome of complete ulcer healing OR 1.54 (95%CI = .50-4.75) P = .4478. A similar non-signifiacnt result was seen in four studies reporting 5-6 week follow up; OR 5.39 (95%CI = .57-259.57) P = .1136. Change in VLU area was reported in all studies, and pooled standardised mean difference was 1.70 (95%CI = .60 to 2.79) P = .0024, indicating a statistically significant benefit of HBOT in reducing ulcer area. CONCLUSION: Existing evidence suggests that HBOT does not significantly affect complete healing of VLU. There is a statistically significant benefit in terms of reducing ulcer size, though in the absence of ulcer healing the clinical significance of this is not established. Current evidence does not justify widespread use of HBOT for VLU.

Dorsalis pedis artery aneurysm.

Aneurysm of the pedal arteries is uncommon. Dorsalis pedis aneurysms are a clinically rare phenomenon. We present a case of traumatic fusiform aneurysm of the dorsalis pedis artery in an otherwise well 53-year-old Caucasian man. Initial history was suggestive of micro-embolic disease to the medial toes of the left foot and on examination pulses were palpable throughout the lower limbs with a strong, palpable dorasalis pedis pulse. Ankle brachial pressure indexes were normal but reduced toe pressures to the left toes. Colour flow duplex imaging revealed aneurysmal dilation, involving all layers of artery wall, with irregular intraluminal thrombus across a 16-mm segment. Subsequent CTA run-off revealed all vessels were patent in the left lower limb. Due to concerns over further embolisation, our patient underwent successful ligation of the his dorsalis pedis. He had an uneventful post-operative recovery.