Abstract
Objective:
Diabetic foot ulcers and venous leg ulcers (VLUs) frequently recur after closure, and because the underlying disease persists, a more meaningful endpoint to consider is durable healing: sustained closure with low recurrence and fewer complications. Mechanistically, topical wound oxygen supports antimicrobial defence, angiogenesis and collagen cross-linking, while cyclical compression reduces oedema and enables timely resolution of inflammation, improving the structural quality of repaired tissue rather than merely closing the wound. Combining both modalities in one device offers a plausible mechanism for the durability observed across diverse wound aetiologies and comorbid populations.
Method:
Clinical and mechanistic evidence was synthesised on the durability of healing achieved by intermittent cyclically pressurised topical wound oxygen (CPTWO) therapy in hard-to-heal (chronic) lower extremity wounds.
Results:
In a double-blind randomised trial, adjunctive CPTWO therapy doubled the proportion of ulcers closed at 12 months (56% versus 27%) and tripled 12-week closure (41.7% versus 13.5%; adjusted odds ratio: 6.00). In refractory VLUs, an observational comparative study reported 36-month recurrence with CPTWO of 5.9% versus 46.7% without. In a large retrospective cohort study among 3126 previously refractory wounds, 64.8% healed completely with 2.7% recurrence-related retreatment with CPTWO, and a propensity score-matched Veterans Affairs cohort showed 73% fewer amputations and 82% fewer hospitalisations. As most meta-analyses pool mechanistically different oxygen devices, durability-specific evidence rests uniquely on the CPTWO studies.
Conclusion:
Randomised, real-world, and mechanistic evidence converge in support of durable healing with reduced recurrence in hard-to-heal lower extremity wounds. Together with its home-based, patient-administered delivery, these findings favour earlier, durability-focused adoption of CPTWO therapy in refractory wounds.