Fundamentals of Topical Oxygen Therapy

Matthew Regulski, DPM:

I am Dr. Matthew Regulski. I'm the medical director of the Wound Institute of Ocean County, New Jersey, here in Toms River, New Jersey. And I'm partner of Ocean County Foot and Ankle Surgical Associates in Toms River, New Jersey. I've been in practice now for 18 years, treating mostly, doing wound healing, chronic wound, diabetic reconstructive surgery, and limb salvage.

Oxygen is needed in every phase of the wound healing cycle. So a term that I've coined or trademarked is "oxygen CARES." Collagen synthesis, angiogenesis, resistance to infection, epithelialization, sustained healing. Each phase of the wound healing paradigm is deficient in oxygen and we've known that, I don't know how long, that's one of the reasons why we want to revascularize limbs or that's one of the reasons we want to put things into it, to remove the chronic biofilm infection that's going on that's consuming oxygen. Your white cells are consuming the molecular oxygen. Your white cells use oxygen in their respiratory burst. 98% of the oxygen they consume is for that oxidated burst to release these reactive oxygen species in order to kill pathogens. And where do you get reactive oxygen species? You get them from oxygen. So it's necessary for collagen cross-linking in the hydroxylation that occurs, particularly for those enzymes utilizing oxygen at very high concentration.

And in fact, these enzyme systems that are working only work at about 50%. Their maximal effectiveness in normal healing pressures that are 40 to 80 millimeters of mercury. So we want to raise the oxygen level within the wound bedding 150 to 400 is where they work at 100% their maximal capability. And that's where we talk about putting oxygen into that wound at a high pressure to raise those systems for collagen synthesis, angiogenesis, resistance to infection, and epithelialization all require high levels of oxygen so that we can have sustained healing. So that's why I came up with that phrase. "Oxygen CARES." I think it's a good way for physicians and clinicians and some of the lay people to get a little bit of understanding of what oxygen is and why it's so needed in every phase of the wound healing cycle.

Oxygen therapy is a simple, usable device right in your home, right in the comfort of your home, which is great. People can watch TV, take a nap, read a book, and they're relaxed. They're in, they don't have to travel somewhere, spend two hours a day doing something, they can do it right at home. And the topical oxygen that we are utilizing puts 10 liters per minute of oxygen into that wound. It goes right through your dressing. It can go right through a total contact cast that has been proven to show that. And you're getting pressures of up to 800 millimeters of mercury within your chronic wound. And when we are at the center of the chronic wound, the oxygen is zero to 10 millimeters of mercury. On the periphery it's around 40 to 60, and in that peripheral tissue is about 80. So with that oxygen level is not very high in the wound bed.

That's why I say all chronic wounds are hypoxic because of the deficiencies that we talked about with "Oxygen CARES." So the topical oxygen can put a lot of that oxygen, raise those pressures up so that all of these different processes can work at a 100% of their maximal output in order to produce those different things. The collagen, new blood vessel, bringing new cell migration into the area to complete epithelialization. The topical oxygen also has some humidification. It can add a little bit of moisture into the wound to help facilitate cell migration. And we know for instance, when you have oxygen in your nose, your nose can get very dry and oxygen can be drying. So this is another great advance that the topical oxygen has by adding some humidification into the wound to help facilitate proper moisture balance for also cell migration, which is another added feature that this can do.

Well, they are completely different. Now, hyperbaric oxygen has a list of criteria that you have to meet in order to do that. Hyperbaric oxygen is going to require an intact vascular supply as well, to bring that down and to get that oxygen out. That gets up to about 300 to 400 millimeters of mercury after it's dissolved in the plasma and it gets pushed out into it. So people need to really have an intact vascular supply. Now, how many of our diabetic people have significant vascular disease, have one vessel or two vessel runoff? They have a lot of monophasic flow on their PVR because of their lead pipes all the way down with intense calcification. And I think that the advantage that topical oxygen has is that every chronic wound can benefit from topical oxygen. People can use it at their home.

What if they can't travel for HBO? What if they don't want to sit there for two hours? Now, I try to get people in for HBO that meet the criteria, and if we don't meet that criteria, or people don't want to come forward, or they can't have transportation, this offers them a significant value and a good treatment paradigm to help their chronic wound. Because all chronic wounds are hypoxic and deficient in oxygen. And so this is something they can do right in their home. And that's why the compliance rate on it is so high because they're comfortable, they're at home, they feel relaxed. They don't have to travel and get rides to go to places, and spend a couple hours at something. And I think that's where the advantage of the topical oxygen comes in.