Tips for Topical Oxygen Therapy

Topical oxygen therapy (aka topical hyperbaric oxygen therapy, THOT or topox) is a form of hyperbaric oxygen therapy for wound treatment in which part of the person's body is encased in a polyethylene bag that is inflated to a pressure slightly above normal atmospheric level while 100 percent oxygen is administered to the surface of the body rather than systemically through breathing oxygen.

Application

• One system is the Numobag (Numotech Inc.), which should encase the legs and the torso below the arms, so the head is outside of the bag, which is pleated to fit snugly and fastened with tape to avoid air leaks that would reduce pressure. (Other companies offer smaller bags for just a limb or for the sacral area.) Topical oxygen therapy is used for treatment of wounds, such as burns, diabetic ulcers (open sores), pressure ulcers, stasis ulcers (from poor circulation in the legs), skin grafts and other nonhealing lesions. Wounds often lack adequate oxygen supply because of damage to vessels and tissue, so oxygen applied to the skin at pressure helps the open wound to absorb oxygen directly into the tissue, promoting growth of new vessels and healing.

Treatment

• Eschar (thick, hard black dead tissue) often covers ulcers and other wounds, and this prevents oxygen from reaching the tissue underneath, so dead tissue around wounds must be removed before topical oxygen therapy begins. According to Numotech Inc., treatment usually is provided for four hours a day for four consecutive days, with three days off, for four weeks. If healing is not complete in that time, therapy is discontinued for one week (to avoid oxygen toxicity) and then resumed for another four weeks. Most wounds heal by 10 weeks.

  Although topical oxygen therapy is less toxic than conventional hyperbaric oxygen therapy (provided in a chamber while the person breaths pure oxygen) and avoids decompression illness, localized oxygen toxicity can occur after about three weeks of treatment. Toxicity requires a break in treatment. Indications include slower healing and evidence of wound deterioration, such as white areas forming in the middle of new vessels and the edges of the wound undermining (pockets forming). Those at increased risk for oxygen toxicity include those with uncontrolled diabetes or undiagnosed and untreated infection. People taking drugs that constrict vessels, such as illicit drugs, tobacco or narcotics, may also develop toxicity

Advantages

• One advantage of topical hyperbaric oxygen therapy over therapy in conventional hyperbaric chambers is that the inflatable bags are portable, so treatment can be administered in areas where no hyperbaric chambers are available and in homes and skilled nursing facilities. People can be treated in their own beds or even reclining chairs if necessary.

  A study at Ohio State University (2003) using topical oxygen therapy to treat 30 patients with 56 wounds showed that various types of wound (surgical, ulcers, traumatic injuries) healed faster than with conventional treatment. The researchers reported that 75 percent of the wounds healed with topical oxygen therapy, scarring was reduced and healing occurred faster, so treatment was cost-effective. The research concluded that topical oxygen may also be used along with other treatments for chronic wounds, and Numotech advises combined conventional and topical hyperbaric oxygen therapy.