Wound healing. New modalities for a new millennium

Area of Science:

• Wound Healing
• Hyperbaric Medicine
• Tissue Oxygenation

Background:

• Chronic wounds require conversion to an acute state for effective treatment.
• Diabetic ulcers are often attributed to neuropathy, with less focus on impaired healing mechanisms.
• Precise wound care documentation is crucial to isolate the effects of specific therapies.

Purpose of the Study:

• To evaluate wound healing failure components beyond neuropathy in diabetic ulcers.
• To assess the efficacy of hyperbaric oxygen therapy (HBOT) in correcting abnormal wound oxygen tension.
• To explore the potential of combining HBOT with advanced therapies like skin substitutes for complex wounds.

Main Methods:

• Review of existing literature on wound healing modalities, including HBOT, growth factors, and skin equivalents.
• Analysis of patient populations typically referred for HBOT, characterized by severe peripheral vascular disease and comorbidities.
• Discussion of the limitations of current studies, such as lack of standardized protocols and outcome measures.

Main Results:

• Abnormally hypoxic wounds may benefit from HBOT, which directly addresses tissue oxygenation.
• HBOT is considered more specific for correcting hypoxia than growth factors are for promoting growth.
• Current skin substitutes have limitations and have not been tested in severely compromised patients (ABI < 0.7, TcPO2 < 30-40 mm Hg).

Conclusions:

• HBOT can create a granulation base, potentially enabling combined use with allogenic grafts and skin equivalents in complex wound cases.
• Long-term wound healing outcomes are likely more influenced by neuropathy and large vessel disease than microangiopathy.
• Further research is needed to establish the cost-effectiveness and practicality of these advanced wound healing modalities.