Objective. This post hoc analysis evaluates the association between the frequency of diabetic foot ulcer (DFU) debridement and the proportion of ulcers treated with active continuous diffusion of oxygen (CDO) that heal in a 12-week evaluation period. Materials and Methods. There were 146 patients with DFUs (77% men; average age, 56.3 ± 12.4 years) enrolled in a double-blind, placebo-controlled, randomized study to receive either active CDO or an otherwise fully operational placebo device. Patients were followed for 12 weeks or until wound closure. All patients received identical offloading, dressings, and follow-up. Ulcer debridement was left to the discretion of the treating physician and recorded from physician self-report as a dichotomous variable. Results. A significantly higher proportion (204%) of ulcers healed in the CDO group compared with the placebo (46.2% vs. 22.6%, respectively; P = .016). The relative performance of active CDO over placebo became greater when frequent debridement was used (51.2% vs. 21.3%, respectively; P = .006). Conclusions. A significantly greater percentage of healing was recorded in patients receiving active CDO therapy than those receiving a placebo device in addition to standard wound care with identical dressings, debridement recommendations, and offloading. The relative performance of CDO appears to increase with the use of frequent debridement. 

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; EO2 Concepts, San Antonio, TX; University of Arizona, Tucson, AZ; and Department of Surgery, Southwestern Academic Limb Salvage Alliance (SALSA) Keck School of Medicine of USC, Los Angeles, CA