We have long understood the importance of oxygen in healing wounds. Oxygen is needed in the syntheses of collagen, in building the Extra Cellular Matrix, and in neovascularization. It is also necessary in aiding in the fight against infection. It is, however, the chronic wound that suffers from a lack of oxygen, and so continues to remain stuck in its chronic state. The chronic wound is hypoxic and without adequate oxygenation of the granular bed, the stalled healing sequence cannot move forward. Whole body Hyperbaric Oxygen Therapy has been studied and has been shown to be effective in promoting wound healing. However, not everyone has access to, nor is a candidate for this type of therapy.

Cyclical Pressurized Topical Oxygen is another treatment option available for these patients, and in doing so, we are now able to heal more chronic wounds. Studies have demonstrated that this form of delivery, that applies pressures up to 1.05 atm, in a sealed and humidified environment, allows for oxygen to penetrate 3-4 mm into the granulation bed. At this level, collagen synthesis will occur, as will antimicrobial activity and neovascularization. In addition to the re-oxygenation of the tissues, the pressure is cycled from 5 mb to 50 mb, so as to produce a sequential compression "pump" effect, thereby increasing perfusion and reducing lower extremity edema. This by itself has a positive effect on the patient and wound healing outcomes.

This is a non-invasive system, and best of all, it is used right in the patient's home for 90 minutes a day, without the need for a skilled caregiver. It is important to note that the patient does not need to remove their dressings in order for the treatment to be effective. As long as the dressings are not impervious to the oxygen gas diffusion, effective wound healing will occur, even with a compression dressing or UNNA boot. A wide variety of wound dressings and skin substitutes can be used complimentary to this therapy. This allows for patient mobility, increased quality of life, and greatly reduced cost to the health care system, while producing positive outcomes.

The following case study demonstrates a patient with a chronic posterior heel ulcer with exposed Achilles Tendon, which has been chronic for no less than six months. Cyclical Pressurized Topical Oxygen was used along with a skin substitute and the wound showed dramatic progress towards closure at weeks 3, 6, and 9 with epithelial budding gradually overtaking the wound bed. This patient went on to have a successful outcome.

Three Weeks of Cyclical Pressurized Oxygen Therapy After Six Months of Little Progress

Six Weeks and Nine Weeks After Starting Cyclical Pressurized Oxygen Therapy

Regards,

Matthew Garoufalis, DPM, CWS