Abstract
Oxygen is a critical component of many biological processes and is essential for wound healing. Chronic wounds are typically characterized as being hypoxic in that the partial pressure of oxygen (pO2) in the center of the wound is often below a critical threshold necessary to fully support those enzymatic processes necessary for tissue repair. Providing supplemental oxygen can effectively raise pO2 levels to better optimize functioning of these essential enzymes. While hyperbaric oxygen therapy has been well studied in this regard, comparative clinical studies have fallen short of providing clear evidence in support of this modality for healing chronic diabetic foot ulcers (DFU). Topical oxygen therapy (TOT) has been in clinical use for over 50 years with encouraging pre-clinical and clinical studies that have shown improved healing rates when compared to standard care. Nonetheless, TOT has heretofore been discounted as an unproven wound healing modality without theoretical or clinical evidence to support its use. This review shall provide a brief summary of the role of oxygen in wound healing and, specifically, discuss the different types of topical oxygen devices and associated studies that have convincingly shown their efficacy in healing chronic DFUs. The time has come for topical oxygen therapy to be embraced as a proven adjunctive modality in this regard.
Highlights
While many clinicians might consider topical oxygen therapy (TOT) to be an unproven or controversial wound healing modality, it has been in clinical use for over fifty years
This review aims to briefly explore the role of oxygen in the healing wound and, to address the evidence supporting the benefits and clinical efficacy of Topical oxygen therapy (TOT) for healing chronic diabetic foot ulcers
Using a group sequential design with a priori stopping points and optimal standard of care (SOC) throughout, the active TWO2 arm was found to be superior to the sham arm, with a closure rate of 41.7% at 12 weeks compared with 13.5% (p = 0.007), respectively
Summary
While many clinicians might consider topical oxygen therapy (TOT) to be an unproven or controversial wound healing modality, it has been in clinical use for over fifty years In his 1969 publication, Fischer described his novel topical “hyperbaric” oxygen system used to treat a variety of chronic wounds in an in-patient environment [1]. Since the pO2 in the center of a chronic wound can be as low as 10 mmHg, maximal enzymatic activity and collagen production can only be achieved by increasing oxygen concentrations above normal physiologic levels This is true for NADPH oxidase where maximal ROS production occurs at oxygen levels approaching 300 mmHg [8,12]. NADPH: nicotinamide adenine dinucleotide phosphate; VEGF: vascular endothelial growth factor; PDGF: platelet derived growth factor
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