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THE ROLE OF HYPERBARIC OXYGEN THERAPY IN THE TREATMENT OF DIABETIC FOOT ULCERS ■ 125fibrosis is the hallmark of this entity, andresults from prolonged exposure to oxygen.This effect is avoided by respecting expositiontables that limit the number of hours of expositionaccording to the administered FiO 2.HYPERBARIC TREATMENT DOSAGEA hyperbaric chamber is defined as a pressurizablecontainer that has the capacity toaccommodate one or several individuals inorder to submit them to a medical treatment.Therefore, multiple types of chambers exist,from monoplace chambers (oxygen pressurized)to multiplace chambers (air pressurized)according to the number of patients they mayaccommodate. Any one of the alternatives hasadvantages and disadvantages, but securityand versatility lead to the increased numberof multiplace chambers.Treatment protocols take into accountthe toxic effect and exposition time to oxygenof the patient and the assistants. AllFigure 4. A patient currently on HBOT in ourInstitution-after 20 sessions.patients, independently of their pathology, aretreated according to the same table, excludingdiving accident patients who have a specifictreatment protocol. The United States ofAmerica Navy’s tables are the most commonlyused, and among these, the most appropriatefor non urgent indications is the US9 3 . Onthis protocol, patients are submitted daily to3 periods of 30 minutes breathing 100% oxygenat 2.4 ATA. The number of sessions variesaccording to the illness treated, but usuallymore than 20 and less than 80 are recommended.Oxygen is given by inhalation throughfacial masks or head tents after pressurizationof the chamber to the treatment depth.Modern hyperbaric chambers have air conditioningand entertainment systems in orderto offer the best possible comfort to patients.DIABETIC FOOT –A PUBLIC–HEALTH ISSUEMultiple etiopathogenic factors contributeto the development of diabetic foot ulcers,such as autonomic, motor and sensory neuropathy,peripheral microvascular andmacrovascular disease, structural foot deformities(Charcot arthropathy), abnormal footmechanics, which lead to increased load ofpressure, and predispose to foot trauma (20,21, 22). Diabetic ulcer-related complicationsare the most frequent cause of hospitaladmissions in the diabetic population (about25% of all admissions) (20, 21). They are estimatedto affect 15% of all diabetics in anymoment throughout their lives (21) and tohave a 5-year cumulative recurrence rate of66 to 70% (20, 22).Non-healing diabetic foot ulcers with over30 days of evolution are associated with apoor outcome as these are often complicatedwith infection, osteomyelitis, and gangrene,which in turn may lead to amputation.Diabetic ulcer-related complications accountalone for more than two thirds of all nontraumaticamputations (20) and 85% of all diabeticlower limb amputations are preceded by