Journal
CURRENT PHARMACEUTICAL DESIGN
Volume 25, Issue 15, Pages 1682-1693Publisher
BENTHAM SCIENCE PUBL LTD
DOI: 10.2174/1381612825666190703162648
Keywords
Chronic wounds; diabetic ulcer; hyperbaric oxygen; reactive species; wound healing; antibiotic treatment
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Funding
- Instituto de Salud Carlos III through the Fondo de Investigacion para la Salud (FIS)
- European Regional Development Fund [PI14/00636, PI17/01827, Red Predimed-RETIC RD06/0045/1004, CIBEROBN CB12/03/30038]
- Balearic Islands Govnt. [35/2011, AAEE066/2017]
- Fundacio La Marato TV3 (Spain) [201630.10]
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Chronic and non-healing wounds, especially diabetic foot ulcers and radiation injuries, imply remarkable morbidity with a significant effect on the quality of life and a high sanitary cost. The management of these wounds requires complex actions such as surgical debris, antibiotic treatment, dressings and even revascularization. These wounds are characterized by poor oxygen supply resulting in inadequate oxygenation of the affected tissue. The adjuvant treatment with hyperbaric oxygen therapy (HBOT) may increase tissue oxygenation favoring the healing of wounds which do not respond to the usual clinical care. The increase in the partial pressure of oxygen contributes to cover the energy demands necessary for the healing process and reduces the incidence of infections. Moreover, the increase in oxygen leads to the production of reactive species with hormetic activity, acting on signaling pathways that modulate the synthesis of inflammation mediators, antioxidants and growth factors which can contribute to the healing process. Studies performed with cell cultures and in animal models seem to demonstrate the beneficial effects of HBOT. However, clinical trials do not show such conclusive results; thus, additional randomized placebo-controlled studies are necessary to determine the real efficacy of HBOT and the mechanism of action for various types of wounds.
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