Topical oxygen treatment for wound healing a review of clinical and cost-effectiveness

Summary: Chronic wounds are often associated with diabetes or vascular disease and have a high impact on the quality of life of those affected. Hypoxemia, caused by disrupted or compromised vasculature, is a key factor limiting wound healing, especially because of its high prevalence in lower extremities. In ischemic wounds, limited oxygen supply and increased oxygen demands used to fight infection and repair tissue lead to extreme hypoxia. Oxygen (O2) is essential for collagen synthesis and cross-linking, fibroblast and leukocyte activation, and angiogenesis associated with tissue repair. Clinical use of O2 to promote wound healing began in the 1960s with the administration of systemic full body hyperbaric oxygen therapy (HBOT) to treat wounds. HBO is administered in single-or multiplace chambers using pressures of 2,500 millibar (mb) or higher. A Cochrane review by Kranke at al. demonstrated that HBO significantly reduced the risk of major amputation and may improve the chance of healing within one year in patients with diabetic foot ulcers (DFU). The availability of HBO facilities, contraindications to their use, patient transfer requirements and risk of undesired systemic side effects limit widespread HBO use. In the late 1960s, pressurized topical wound oxygen (TWO2) was introduced in an effort to address these limitations. In contrast to HBO, topically oxygenating the wound does not involve high pressures and is portable so it can be administered in a variety of settings. Conventional wound care often involves dressing the wound to create a moist environment for epithelialization and collagen synthesis.