Application of Topical Oxygen Therapy in Healing Dynamics of Diabetic Foot Ulcers - A Systematic Review

Abstract

BACKGROUND: Individuals with diabetes may develop diabetic foot ulcers due to diabetic peripheral neuropathy. Multiple factors influence the ulcer healing process; oxygen helps in facilitating the different stages of wound healing. OBJECTIVE: The objective of this systematic review was to analyze the different levels of evidence available in the application of topical oxygen therapy, warm oxygen therapy, or other modes of topical oxygen delivery in the healing dynamics of diabetic foot ulcers. METHODS: Databases searched included Pubmed/Medline, Science Direct, Web of Science, Scopus, Cochrane, and CINAHL. The eligibility criteria of studies included participants ≥18 years with chronic non-healing diabetic foot ulcer (duration ≥3 months) receiving warm oxygen or topical oxygen therapy (TOT), and other modes of topical oxygen administration, which were compared with standard care group. Randomized and non-randomized studies were included. The primary outcome measure assessed was the rate of wound healing or wound closure. RESULTS: The review included 5 studies which used different modes of topical oxygen administration. The healing trajectory of the wounds was completely achieved in low-grade ulcers (grade 1), whereas all highgrade ulcers (grades 2, 3, and above) showed either 100% or 50% healing with a reduction in ulcer size and ulcer tissue depth. CONCLUSION: Topical oxygen therapy facilitates wound healing dynamics among individuals with chronic diabetic foot ulcers.

Editorial and Mini-Review: Topical Oxygen Therapy for Diabetic Foot Ulcerations - Avenue Towards New Hope?

“…While the findings by Nataraj et al are encouraging for the use of TOT, we must not ignore several limitations [14]. The first relates to the small sample size.…”

“…Overall, 5 studies were reviewed involving 80 participants. The authors concluded that the use of TOT led to a higher complete wound healing rate in chronic, less severe DFUs and also improved the percentage area reduction in more severe ulcers [14].…”

“…In this volume of The Review of Diabetic Studies, Nataraj et al report their findings of a systematic review of TOT on wound healing in DFUs [14]. They included studies of patients with chronic DFUs receiving TOT compared with individuals who received standard care.…”

“…Secondly, most studies had a brief duration of follow-up, mainly between 4-8 weeks, and only 1 study with a 12-week follow-up was included [14]. Moreover, there was significant heterogeneity between the studies in terms of inclusion criteria, duration of ulceration, DFU characteristics, previous foot care, and reporting of results [14]. Furthermore, the authors did not use the 21-point assessment criteria to evaluate the quality of studies [15].…”

“…Furthermore, the authors did not use the 21-point assessment criteria to evaluate the quality of studies [15]. Finally, it was not possible for the authors to conclude on the costeffectiveness of TOT [14].…”