Topical oxygen therapy stimulates healing in difficult, chronic wounds: a tertiary centre experience
Abstract
Objective:
Oxygen plays a central role in wound healing. Recent technological advances have miniaturised oxygen delivery systems, with novel topical oxygen therapy allowing patients to receive oxygen therapy 24 hours a day while remaining completely mobile. Here we aim to examine the efficacy and safety of continuous topical oxygen diffusion in a ‘real-world’ setting.
Methods:
Topical oxygen therapy (TOT) was evaluated in patients with chronic, nonhealing wounds in a tertiary referral specialist clinic.
Results:
The mean wound duration before TOT was 15 months. Regardless of treatment duration, in this previously non-healing group complete wound closure was observed in 32% of the total patients treated with the TOT device. However, optimal wound healing occurred when the device was used for >25 days, with an 83% wound area reduction and 47% wound closure rate seen in venous leg ulcers (VLUs) and a 74% reduction and a 57% wound closure rate in arterial foot ulcers.
Conclusion:
Use of TOT in chronic wounds stimulates a healing state. In our study, almost half of the previously non-healing wounds closed.
Declaration of interest:
Paul Hayes acts as Medical Director for Inotec AMD and has a share-holding in the company.
Wound prevalence is increasing every year due to an aging population with increasing rates of diabetes and obesity.1 Wounds impact at a personal level2 and increasing numbers of chronic wounds also have a detrimental impact on health-care systems as they consume resources. Innovation has led to novel approaches to wound care which offer the promise of closing previously unhealed wounds, along with improving the patients' quality of life (QoL).
Topical oxygen therapy (TOT) is one such innovation. Oxygen-dependent energy production is required for the cellular processes of fighting infection, cell division, angiogenesis and collagen production, all of which are essential for wound healing.3 Local metabolic needs increase 5-fold in skin with a wound.4 Hypoxia (low oxygen) inhibits crucial cellular mechanisms that promote and underlie tissue healing such as collagen synthesis and cross linking, sustained angiogenesis, bacteria-targeted cellular release of reactive oxygen species (phagocytosis) and epithelialisation.4,5 It is therefore unsurprising that low transcutaneous oxygen pressure is associated with inferior wound healing outcomes.6,7 When oxygen levels in a wound are low, one molecule of glucose generates just 2 molecules of adenosine triphosphate (ATP), the molecular unit used for the generation of energy. However, with plentiful local oxygen at the wound site, the process is 18 times more efficient, with each glucose molecule generating 36 molecules of ATP. As such, by creating an oxygen-rich environment, cellular resources are increased and wound healing is improved.8–10 Some of the roles of oxygen in wound healing is summarised in Fig 1.
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