| Summary: | ABSTRACT INTRODUCTION: HBOT is consistently being introduced into the treatment of several pathologies and conditions, as DFU, yet evidence is still scarce regarding its beneficial effects. The present systematic review aims to analyse the role of HBOT in the prevention of limb amputation and in the improvement of ulcer healing in patients with lower limbs DFU. EVIDENCE ACQUISITION: Three databases were searched: PubMed, Scopus, and ISI Web of Knowledge. The search was enrolled during October 2020. Both titles and abstracts were independently examined. Only randomized controlled trials (RCTs) reporting a comparison between standard DFU treatment and standard treatment associated with HBOT were included. In all studies eligibility was assessed and data regarding studies characteristics, methods and considered outcomes was obtained. Odds ratio (OR) was used to evaluate amputation and complete ulcer healing rates. Percentage of ulcer reduction at two weeks was evaluated using the inverse variance method, and the values were compared using mean difference values. Meta-analysis was done using a fixed-effect model if I2 values were under 50%, and a random-effects model if not. EVIDENCE SYNTHESIS: In total, 11 RCTs were included, with a total of 668 patients studied. Meta-analysis results have revealed significantly fewer major amputations (OR 0.53 95% CI 0.32-0.90, I2=31%) and significantly higher completely healing rates (OR 4,00 95% CI 1.54-10.44, I2=70%) in HBOT group. It has also shown higher percentage of ulcer area reduction after two weeks of treatment in the HBOT group (mean difference 23.19%; 95% CI 14.86-31.52; I2=0%). No difference was found in minor amputations (OR 0.89 95% CI 0.35-2.24, I2=69%). CONCLUSIONS: The present review offers evidence that adjuvant HBOT improves major amputation and wound healing when combined to standard treatment in the management of DFU. These inferences may be generalized with prudence, contemplating included studies' inherent methodological limitations.
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