Failure to heal is a very common frustrating problem. In many cases excellent wound care management and brilliant diabetes controls fails to produce the expected results. In fact fairly well known data suggest that in these conditions only about 25% of diabetic foot ulcers will be healed after 20 weeks. Advanced wound care now contributes to significantly raising this rather poor percentage. Combined with modern radiology such as MRI, PET CT and white cell scans to detect and treat the dreaded bone infection called osteomyelitis, our ability to save limbs from the need for amputation has never been better in better shape.

Despite the optimism there are still wounds that are reluctant to heal and basically they need help or they will not heal. In this regard there is now emerging evidence that additional therapies can also be considered. There are several recently published clinical trials which show the positive healing properties of Negative Pressure Wound Therapy (NPWT) in healing diabetic foot ulcers.

There is interest too in the role of oxygen therapy. This is fast becoming a frequent player in the multi factorial range of treatment possibilities. Wounds are known to be notoriously low in oxygen, this is made worse by the surrounding oedema and it has been known for a long time that hyperbaric oxygen treatment can decrease wound related oedema and increase oxygen delivery to the tissues within the wound. The main reasons for non healing are foot deformities, wound infection and tissue hypoxia which means low oxygen content. It makes theoretical sense to consider attacking this problem. There are clinical studies supporting the use of hyperbaric oxygen in chronic diabetic foot ulcers but there are also those who doubt its significance to the overall management plan.

Where the evidence is not so strong at the moment is topical oxygen therapy. Although there are machines and practitioners doing this work in chronic wounds the evidence from randomised clinical trials needs to be further evaluated because the evidence is sparse and patchy.