(CR-011) Optimising Split-Thickness Skin Graft Uptake in Diabetic Foot Ulcers: Comparative Efficacy of Hyperbaric Oxygen Therapy and Negative Pressure Wound Therapy

Friday, April 10, 2026

Akshay Kapoor, MS,MCh; Bhairavi Jha, MS,MCh

Introduction: Split-thickness skin grafting (STSG) remains a cornerstone in the surgical management of diabetic foot ulcers following adequate debridement. However, impaired vascularity, persistent inflammation, and high microbial load frequently compromise graft integration. Adjunctive modalities such as Hyperbaric Oxygen Therapy (HBOT) and Negative Pressure Wound Therapy (NPWT) have demonstrated potential to optimize wound-bed physiology and improve graft uptake, though robust comparative evidence is limited. This study aimed to directly compare the efficacy of HBOT and NPWT in enhancing STSG uptake in diabetic foot ulcers through a randomized controlled trial design.

Methods:

In this single-centre, prospective, randomized controlled trial, 80 patients were enrolled and randomized to NPWT (Group A, n=44) or HBOT (Group B, n=46). All patients underwent standardized surgical debridement followed by STSG. NPWT was applied at continuous subatmospheric pressure for 5 postoperative days, while HBOT was administered as 10 standardized sessions. Graft uptake was assessed using the grid-square method on postoperative days (POD) 5 and 14. Preoperative wound cultures, graft loss patterns, and adverse events were documented. Statistical analyses included Student’s t-test and chi-square test, with significance set at p< 0.05.

Results:

On POD 5, mean graft uptake was identical in both groups (NPWT: 86% ± 8.4%; HBOT: 86% ± 7.9%; p=0.94). By POD 14, uptake declined comparably—67% ± 12.1% in NPWT versus 66% ± 11.7% in HBOT (p=0.81). Partial graft loss occurred in 27.3% of NPWT and 28.2% of HBOT patients (p=0.89), while complete graft failure remained low (4.5% vs 4.3%; p=0.97). Microbial culture profiles showed no significant difference between groups (p=0.76), with Pseudomonas aeruginosa (38%) and polymicrobial colonization (42%) predominating. Minor adverse events—transient discomfort, mild periwound maceration, serous ooze—occurred at similar rates (p=0.67), and no patient required discontinuation of assigned therapy.

Discussion:

HBOT and NPWT demonstrate equivalent efficacy in supporting STSG uptake, with no statistically significant differences observed in graft integration, graft loss, or microbiological patterns. Given these comparable outcomes, therapy selection may be individualized based on patient characteristics, cost considerations, availability of resources, and clinician judgment. This randomized trial provides Level I evidence supporting flexible, patient-centred use of adjunctive modalities in complex DFU wound reconstruction.