Topical Wound Oxygen Therapy in the Treatment of Chronic Diabetic Foot Ulcers

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.

Efficacy of Topical Wound Oxygen Therapy in Healing Chronic Diabetic Foot Ulcers: Systematic Review and Meta-Analysis

“…These patients are likely to benefit from advanced wound healing therapies, such as topical oxygen therapy (TOT). 7 , 9 , 10 …”

Efficacy and safety of topical oxygen therapy for diabetic foot ulcers: An updated systematic review and meta‐analysis

“…Currently, SOC alone may not be sufficient to prevent and treat DFUs, and novel adjunctive therapies are urgently needed 27 . For all this, it is also critical to emphasise that TOT (as for adjunctive therapy) must be administered in conjunction with optimal wound care 28 . In other words, DFU patients still need to receive SOC combined with other adjunctive therapies.…”

“… 27 For all this, it is also critical to emphasise that TOT (as for adjunctive therapy) must be administered in conjunction with optimal wound care. 28 In other words, DFU patients still need to receive SOC combined with other adjunctive therapies. This combination therapy can not only achieve better therapeutic effects but also complies with ethical principles.…”

Oxygenation therapies for improved wound healing: current trends and technologies

“…38 In light of these adverse effects of HBOT, researchers chose topical oxygen treatment (TOT), in which oxygen is applied topically to the site of the wound. 39 Besides, the TOT setup (Natrox®, EpiFlo®, and TransCu O 2 ®) and the applied pressure are much less in contrast to HBOT. Moreover, the overall treatment cost involved in TOT is also much less.…”

“…38 In light of these adverse effects of HBOT, researchers chose topical oxygen treatment (TOT), in which oxygen is applied topically to the site of the wound. 39 Besides, the TOT setup (Natrox s , EpiFlo s , and TransCu O 2 s )…”