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Australian Diabetes Foot Network: management of diabetes-related foot ulceration — a clinical update

To the Editor: We commend the clinical update of Bergin and colleagues on the management of diabetes-related foot ulceration.1 We agree that a multidisciplinary approach is the best way to manage these complex wounds. However, we believe that the use of hyperbaric oxygen treatment (HBOT) for ulcers which have failed to respond to 3 months’ standard treatment justifies more prominent consideration.

The actions of HBOT are diverse, including support of oxygen-dependent healing processes and, more importantly, cell-signalling effects that accelerate these processes for many hours beyond the HBOT exposure. There is now favourable clinical evidence from high-quality randomised studies. HBOT has been shown to be efficacious for wounds that fail to heal after 8 weeks of thorough multidisciplinary foot care,2,3 and beneficial for a range of chronic ulcers, particularly diabetic ulcers.4 A systematic review is also supportive of the use of HBOT.5

Contrary to the suggestion that they are difficult to access, hyperbaric facilities…