Key Findings:
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Graft uptake was identical for both therapies: Mean graft uptake of 86% at post-op day 5 for both groups.
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Comparable Long-Term Graft Integration: At day 14 post-op, graft uptake remained similar between groups (67% for NPWT vs. 66% for HBOT).
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Low Failure Rates: Complete graft failure was remarkably low and nearly identical in both cohorts (4.5% for NPWT vs. 4.3% for HBOT).
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Microbiological profiles were similar: No significant differences were found in microbial colonization, with Pseudomonas aeruginosa and polymicrobial profiles being predominant in both groups.
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Level I Evidence: The study provides robust data supporting the flexible, individualized use of adjunctive therapies in complex wound reconstruction.
Charlotte, NC (April 9, 2026) — Surgeons and wound care specialists now have expanded flexibility in treating complex diabetic foot ulcers (DFUs) following the revelation of groundbreaking clinical data comparing Hyperbaric Oxygen Therapy (HBOT) and Negative Pressure Wound Therapy (NPWT). The findings, shared today as a First-to-Podium presentation at the 2026 Symposium on Advanced Wound Care (SAWC) Spring | WHS, reveal that both therapies offer equivalent clinical efficacy.
Clinicians can select the most appropriate therapy based on individual patient needs, logistical considerations, and resource availability without compromising surgical outcomes. The study led by Debarati Chattopadhyay, MS, MCh, Professor at All India Institute of Medical Sciences (AIIMS), Rishikesh addressed the frequent compromise of graft integration due to impaired vascularity and persistent inflammation, a critical challenge in diabetic limb salvage.
Level I Comparative Evidence
While STSG is a cornerstone of surgical management, adjunctive therapies are often required to optimize wound-bed physiology and improve graft uptake. This trial is among the first to provide Level I comparative evidence between HBOT and NPWT in this specific clinical context.
The research team enrolled 90 patients, randomizing them into two groups: Group A (n=44), receiving NPWT at continuous subatmospheric pressure for five postoperative days; and Group B (n=46), receiving 10 standardized sessions of HBOT. All patients underwent standardized surgical debridement followed by STSG.
The results showed no statistically significant differences in primary outcomes. On postoperative day (POD) 5, mean graft uptake was identical at 86% for both groups (p=0.94). By POD 14, uptake declined comparably to 67% in the NPWT group and 66% in the HBOT group (p=0.81).
The rates of partial graft loss (27.3% vs. 28.2%) and complete graft failure were nearly indistinguishable between the two therapies. Minor adverse events such as transient discomfort, mild periwound maceration, and serous ooze occurred at similar rates (p=0.67), and no patient required discontinuation of assigned therapy.
Skin Graft Integration in Complex Diabetic Foot Ulcers
The data demonstrates that HBOT and NPWT are equally effective in supporting skin graft integration in complex diabetic foot ulcers. As a result of the clinical outcomes being so closely matched, the researchers suggest that the choice of therapy can be individualized based on the specific needs of the patient, the availability of local resources, and cost considerations.
In facilities where a hyperbaric chamber may not be accessible, NPWT serves as a robust and equal alternative. Conversely, for patients who may not tolerate the lack of mobility due to the tethering of a negative pressure pump, HBOT provides a comparable biological boost to graft healing.
Research Takeaways
Ultimately, this research highlights the continued evolution in the clinical management of diabetic foot ulcers. Having multiple, equally effective tools allows for a more patient-centered approach to wound healing.
Whether utilizing the mechanical benefits of NPWT or the distinct physiological and systemic advantages of HBOT, the goal of successful graft uptake and the prevention of limb loss remain the same.