***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract The possibility of obtaining increased survival of split skin grafts by the use of hyperbaric oxygen was investigated in a controlled clinical trial . This showed that a significant improvement can be obtained . In this series an increase in survival of 29 % of the surface area of the grafts was achieved . A high proportion of complete " takes " occurred ; 64 % of the treated cases as opposed to 17 % of the controls . The results suggest that the method is valuable when extensive raw areas have to be covered , or when good cosmetic results are important OBJECTIVE To evaluate the effectiveness of systemic hyperbaric oxygen therapy ( s HBOT ) in addition to a comprehensive protocol in decreasing major amputation rate in diabetic patients hospitalized for severe foot ulcer . RESEARCH DESIGN AND METHODS From August 1993 to August 1995 , 70 diabetic subjects were consecutively admitted into our diabetologic unit for foot ulcers . All the subjects underwent our diagnostic-therapeutic protocol and were r and omized to undergo s-HBOT . Two subjects , one in the arm of the treated group and one in the arm of nontreated group , did not complete the protocol and were therefore excluded from the analysis of the results . Finally , 35 subjects received s-HBOT and another 33 did not . RESULTS Of the treated group ( mean session = 38.8 ± 8) , three subjects ( 8.6 % ) underwent major amputation : two below the knee and one above the knee . In the nontreated group , 11 subjects ( 33.3 % ) underwent major amputation : 7 below the knee and 4 above the knee . The difference is statistically significant ( P = 0.016 ) . The relative risk for the treated group was 0.26 ( 95 % CI 0.08–0.84 ) . The transcutaneous oxygen tension measured on the dorsum of the foot significantly increased in subjects treated with hyperbaric oxygen therapy : 14.0 ± 11.8 mmHg in treated group , 5.0 ± 5.4 mmHg in nontreated group ( P = 0.0002 ) . Multivariate analysis of major amputation on all the considered variables confirmed the protective role of s-HBOT ( odds ratio 0.084 , P = 0.033 , 95 % CI 0.008–0.821 ) and indicated as negative prognostic determinants low ankle-brachial index values ( odds ratio 1.715 , P = 0.013 , 95 % CI 1.121–2.626 ) and high Wagner grade ( odds ratio 11.199 , P = 0.022 , 95 % CI 1.406–89.146 ) . CONCLUSIONS s-HBOT , in conjunction with an aggressive multidisciplinary therapeutic protocol , is effective in decreasing major amputations in diabetic patients with severe prevalently ischemic foot ulcers BACKGROUND The cause of diabetic foot ulcers is multifactorial , e.g. , neuropathy and angiopathy , leading to functional disturbances in the macrocirculation and skin microcirculation . Adequate tissue oxygen tension is an essential factor in infection control and wound healing . Hyperbaric oxygen ( HBO ) therapy , daily sessions of oxygen breathing at 2.5-bar increased pressure in a hyperbaric chamber , has beneficial actions on wound healing including antimicrobial action , prevention of edema and stimulation of fibroblasts . The aim of the present study was to investigate the long-term effect of HBO in treatment of diabetic foot ulcers . METHODS Thirty-eight diabetic patients ( 30 males ) with chronic foot ulcers were investigated in a prospect i ve study . The mean age was 60+/-13 years and the mean diabetes duration 27+/-14 years . All patients were evaluated with measurements of transcutaneous oxygen tension ( tcPO(2 ) ) , peripheral blood pressure , and HbA(1c ) . All patients had a basal tcPO(2 ) value lower than 40 mmHg , which increased to > /=100 mmHg , or at least three times the basic value , during inhalation of pure oxygen . Seventeen patients underwent 40 - 60 sessions of HBO therapy , while 21 patients were treated conventionally . The follow-up time was 3 years . RESULTS 76 % of the patients treated with HBO ( Group A ) had healed with intact skin at a follow-up time of 3 years . The corresponding value for patients treated conventionally ( Group B ) was 48 % . Seven patients ( 33 % ) in Group B compared to two patients ( 12 % ) in Group A went to amputation . Peripheral blood pressure , HbA(1c ) , diabetes duration , and basal values of tcPO(2 ) were similar in both groups . CONCLUSIONS Adjunctive HBO therapy can be valuable for treating selected cases of hypoxic diabetic foot ulcers .  It seems to accelerate the rate of healing , reduce the need for amputation , and increase the number of wounds that are completely healed on long-term follow-up . Additional studies are needed to further define the role of HBO , as part of a multidisciplinary program , to preserve a functional extremity , and reduce the short- and long-term costs of amputation and disability OBJECTIVE To study the effect of systemic hyperbaric oxygenation ( HBO ) therapy on the healing course of nonischemic chronic diabetic foot ulcers .  RESEARCH DESIGN AND METHODS From 1999 to 2000 , 28 patients ( average age 60.2 + /- 9.7 years , diabetes duration 18.2 + /- 6.6 years ) , of whom 87 % had type 2 diabetes , demonstrating chronic Wagner grade s I-III foot ulcers without clinical symptoms of arteriopathy , were studied . They were r and omized to undergo HBO because their ulcers did not improve over 3 months of full st and ard treatment . All the patients demonstrated signs of neuropathy .  HBO was applied twice a day , 5 days a week for 2 weeks ; each session lasted 90 min at 2.5 ATA ( absolute temperature air ) . The main parameter studied was the size of the foot ulcer measured on tracing graphs with a computer . It was evaluated before HBO and at day 15 and 30 after the baseline . RESULTS HBO was well tolerated in all but one patient ( barotraumatic otitis ) . The transcutaneous oxygen pressure ( TcPO(2 ) ) measured on the dorsum of the feet of the patients was 45.6 + /- 18.1 mmHg ( room air ) . During HBO , the TcPO(2 ) measured around the ulcer increased significantly from 21.9 + /- 12.1 to 454.2 + /- 128.1 mmHg ( P < 0.001 ) . At day 15 ( i.e. , after completion of HBO ) , the size of ulcers decreased significantly in the HBO group ( 41.8 + /- 25.5 vs. 21.7 + /- 16.9 % in the control group [ P = 0.037 ] ) . Such a difference could no longer be observed at day 30 ( 48.1 + /- 30.3 vs. 41.7 + /- 27.3 % ) . Four weeks later , complete healing was observed in two patients having undergone HBO and none in the control group . CONCLUSIONS In addition to st and ard multidisciplinary management , HBO doubles the mean healing rate of nonischemic chronic foot ulcers in selected diabetic patients . The time dependence of the effect of HBO warrants further investigations OBJECTIVE ischaemic lower-extremity ulcers in the diabetic population are a source of major concern because of the associated high risk of limb-threatening complications . The aim of this study was to evaluate the role of hyperbaric oxygen in the management of these ulcers . METHOD eighteen diabetic patients with ischaemic , non-healing lower-extremity ulcers were recruited in a double-blind study . Patients were r and omly assigned either to receive 100 % oxygen ( treatment group ) or air ( control group ) , at 2.4 atmospheres of absolute pressure for 90 min daily ( total of 30 treatments ) . RESULTS healing with complete epithelialisation was achieved in five out of eight ulcers in the treatment group compared to one out of eight ulcers in the control group . The median decrease of the wound areas in the treatment group was 100 % and in the control group was 52 % ( p=0.027 ) . Cost-effectiveness analysis has shown that despite the extra cost involved in using hyperbaric oxygen , there was a potential saving in the total cost of treatment for each patient during the study . CONCLUSION hyperbaric oxygen enhanced the healing of ischaemic , non-healing diabetic leg ulcers and may be used as a valuable adjunct to conventional therapy when reconstructive surgery is not possible Summary Foot ulceration results in substantial morbidity amongst diabetic patients . We have studied prospect ively the relationship between high foot pressures and foot ulceration using an optical pedobarograph . A series of 86 diabetic patients , mean age 53.3 ( range 17–77 ) years , mean duration of diabetes 17.1 ( range 1–36 ) years , were followed-up for a mean period of 30 ( range 15–34 ) months . Clinical neuropathy was present in 58 ( 67 % ) patients at baseline examination . Mean peak foot pressure was higher at the follow-up compared to baseline ( 13.5 kg·cm−2±7.1 SD vs 11.2±5.4 , p<0.001 ) with abnormally high foot pressures ( > 12.3 ) being present in 55 patients at follow-up and 43 at the baseline visit ( p = NS ) . Plantar foot ulcers developed in 21 feet of 15 patients ( 17 % ) , all of whom had abnormally high pressures at baseline ; neuropathy was present in 14 patients at baseline . Non-plantar ulcers occurred in 8 ( 9 % ) patients . Thus , plantar ulceration occurred in 35 % of diabetic patients with high foot pressures but in none of those with normal pressures . We have shown for the first time in a prospect i ve study that high plantar foot pressures in diabetic patients are strongly predictive of subsequent plantar ulceration , especially in the presence of neuropathy Necrotic/gangrenous wounds lack adequate blood supply and develop further vascular damage from either reperfusion injury or oxygen toxicity when exposed to oxygen at the wrong pressures . A prospect i ve r and omized study was performed to confirm the efficacy of topical hyperbaric oxygen at 1.004 to 1.013 atmospheres ( THOT ) in stimulating angiogenesis and healing of necrotic/gangrenous wounds . Participants included 40 in patients ( 79 ulcers ) recruited over 12 months who were assigned to treatment by either THOT or st and ard wound care ( SWC ) . The results showed that 90 % of the wounds healed in the THOT group compared to 22 % in the SWC controls . Repeated measures ANOVA on log ( ulcer size at 4 weeks ) showed a significant group by time interaction , F(1,55 ) = 68.2 , P < 0.0001 . The size of ulcers ( at 4 weeks ) was significantly smaller with THOT , but larger with SWC . Capillary density/hpf ( high power field ) was significantly higher in THOT wounds than in SWC wounds ( P < 0.001 ) . It was concluded that THOT is effective in stimulating angiogenesis with enhanced healing of necrotic wounds To evaluate the effect of hyperbaric oxygen therapy on chronic wound healing , 16 otherwise healthy patients who had nondiabetic , chronic leg ulcers with no large vessel disease were included in a double-blind study . Patients were grouped according to age and then r and omly assigned to two groups breathing either air or oxygen at 2.5 atmospheres of absolute pressure for 90 minutes 5 days per week for a total of 30 treatments . The wound area was copied onto transparent film covering the wound and then measured using only one matching wound from each patient . The mean decrease of the wound areas at weeks 2 , 4 , and 6 in the oxygen group were 6 percent ( SD + /- 14 ) , 22 percent ( SD + /- 13 ) , and 35.7 percent ( SD + /- 17 ) , respectively , and in the air group , 2.8 percent ( SD + /- 11 ) , 3.7 percent ( SD + /- 11 ) , and 2.7 percent ( SD + /- 11 ) , respectively , giving a p value less than 0.05 at week 4 , and a p value less than 0.001 at week 6 between the groups using the Mann-Whitney U test . These data indicate that hyperbaric oxygen therapy may be used as a valuable adjunct to conventional therapies when nondiabetic wounds do not heal A modified technique for administering hyperbaric oxygen with the use of disposable polyethylene bags was evaluated for the treatment of arterial leg ulcers . The potential advantages of the method include fairly low expense , lack of cross-infection , and simplicity in the administration of oxygen . Six men with 27 chronic arterial ulcers were treated with this technique , and five men ( ten ulcers ) served as controls . In the treated group , 18 of 27 ulcers ( 5/6 patients ) were healed within six to 21 days , with 50 % to 90 % reduction in size 
    Output:
    
REVIEW ERS ' CONCLUSIONS In people with foot ulcers due to diabetes , HBOT significantly reduced the risk of major amputation and may improve the chance of healing at 1 year .