Gabriel Urrea-Botero, MD, Wound Care Specialist at Gonzaba Medical Group, San Antonio, TX
When other modalities fail to heal chronic wounds, this author suggests that continuous diffusion of oxygen could be a viable adjunct or stand-alone therapy, and shares a few case studies from his clinical experience.
The management of chronic wounds can challenge even the experienced clinician. General principles include debridement, moist wound therapy, and occlusive dressings. More specific treatments vary according to etiology. For instance, as a general rule diabetic foot ulcerations (DFU) require off-loading, while one usually employs compression therapy for venous stasis ulcers. However, skin ulcers due to peripheral arterial disease may worsen if one institutes aggressive debridement and compression therapy. Clearly, accurate diagnosis is key to proper treatment.
Over the last couple of decades, a wide variety of therapies have emerged, the cost of wound care increased dramatically and wound care became a new clinical specialty. Despite important advances in new modalities like skin substitutes and growth factors and a better understanding of the wound healing process, clinicians still struggle with the “microenvironment” once a wound has become chronic (i.e., a non-healing or “stagnant wound”). The formation of biofilm, the lack of oxygen supply at a cellular level and an abnormal concentration of matrix metalloproteinases (MMPs) are all factors that can impair the natural wound healing process.
Oxygen is required for the synthesis of collagen, enhancement of fibroblasts, angiogenesis, and leukocyte function. Oxygen also enhances the leukocyte bactericidal effect, including the killing of aerobic Grampositive and Gram-negative organisms, and it is cytotoxic to anaerobes. The efficacy of oxygen therapy is still somewhat under dispute, but new strategies and modalities for delivering oxygen directly to the wound bed proliferate. Recently published clinical studies have demonstrated significantly positive effects using diffusion of oxygen therapy.1-3 The positive effects include faster wound closure, improved wound closure success rate, pain reduction, reduction in methicillin resistant Staphylococcus aureus (MRSA) infection, increased vascular endothelial growth factor (VEGF) expression and angiogenesis, and reduced venous stasis recurrence.
Three types of oxygen-based therapies are in current clinical use: hyperbaric oxygen therapy (HBOT), topical oxygen, and continuous diffusion of oxygen. Each of these technologies uses a unique method to deliver oxygen, which of course affects how the body uses oxygen. Hyperbaric oxygen is currently the most widely used and most commonly accepted form of oxygen therapy for wounds. There have been significant advances with the technology of topical oxygen and the support of good clinical trial data.1–6 Continuous diffusion of oxygen, the newest treatment of the group, delivers continuous therapy, allows for full patient mobility and is building a credible body of clinical evidence.7
Over the last year, I have been using CDO therapy on patients whose unresponsiveness to advanced wound care therapies (such as HBOT, negative pressure, compression, surgical debridement, grafts and general medical treatment) resulted in chronic non-healing wounds (of more than 4 months old in duration). I use TransCu O2®
(EO2 Concepts®), which generates and delivers oxygen directly and continuously into a chronic non-healing wound environment. This device monitors and adjusts for flow and pressure, and allows for full patient mobility. While the underlying concept of the device is being established, the manner of oxygen the device provides is novel, unique, and worthy of clinical consideration.
Our results using continuous diffusion of oxygen therapy are similar to those for intermittent diffusion of oxygen therapy with regard to efficacy. However, continuous diffusion of oxygen therapy has shown significant advantages over intermittent therapies, including ease of application (one can be apply continuous diffusion of oxygen in any setting), continuous treatment, full patient mobility during treatment, no known safety issues or risks, lower cost, and high patient adherence.1-3
Wounds that I have treated successfully thus far with continuous diffusion of oxygen include venous stasis ulcers, pressure ulcers, diabetic foot ulcers and gangrenous ulcers. I have also found the modality beneficial for wound bed preparation for skin grafting, full- and split- thickness skin grafts, radiation burns, dehiscent surgical wounds, and diabetic amputation wounds among others. The device and technology are safe. There are no known risks to the patient and there are currently no reported adverse effects or reactions associated with the use of continuous diffusion of oxygen therapy in the literature.