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TOPICAL OXYGEN THERAPY

Date: 5/11/99

The answer is that topical hyperbaric oxygen does not work. It is a hoax. If you understand the method by which HBO promotes wound healing then you understand why it doesn't work. The reason that some wound do not heal is that they are hypoxic. For some reason, oxygen cannot get to the wound or its margins. Fibroblasts which are the mediators for wound healing need oxygen to work. Lack of oxygen in the area kills off fibroblasts so they are unable to send their chemical mediators that stimulate other growth factors to the site. Over time the body fails to recognize the low oxygen gradient in the vicinity of the wound. The body in effect "walls" off the area and considers it healed. As you are aware the oxyhemoglobin dissociation curve tells us that the red blood cells in our body can only carry a certain amount of oxygen bound atomically to itself. I believe the max is 4 molecules per RBC (but don't quote me on that). So putting someone on oxygen with a mask can effectively saturate all the red blood cells and you have reached the capacity of the blood carrying system. This can be seen by use of a pulse ox. Once the pulse ox reaches 100% that is the limit of the RBC oxygen carrying capacity. So the key is to find another way to transport oxygen using the vascular system by a method other than conventional. Henry's law states that a mixture of gassesin contac tiwth a liquied will dissolve in that liquid in direct proportion ot the individual partial pressure of that gas. So there you have it...voila....administering oxygen underpressure will allow the oxygen to dissolve into the plasma. Your entire plasma becomes an oxygen carrying mechanism. In the Netherlands a researcher by the name of Borema in 1959 published a paper "Life Without Blood" In this paper he describes where he placed a pig in a hyperbaric chamber, took him to pressure and by pheresis removed all the red blood cells and the pig lived....because his plasma was carrying the oxygen. So as you can see, it is impossible to "push" oxygen into a wound. It must dissolve into the plasma and go to the wound bed from the inside out. As the oxygen gradient rises in the body to super saturated level (often greater than 1000mmHg) then the body recognized the decreased gradient at the chronic wound site. It then begins the healing process again and stimulates new growth...and this time the cells have the oxygen they need to do their job. Also the body needs oxygen to produce good collagen. Poorly oxygenated wounds produce skin of poor quality. So there you have it, topical hyperbaric oxygen is a hoax. If you don't believe me ask HCFA. They know it is too so that's why they won't pay for it anymore! So after you talk to your CEO I think he will see the dollar signs going down the toilet and will agree that you should not start doing topical HBO. I would refer you to the book "Hyperbaric Medicine Practice" by Eric P. Kindwall, Best Publishing Co, Flagstaff, 1995 and "Textbook of Hyperbaric Medicine" by KK Jain, 2nd Revised edition, Hogrefe & Huber Publishers, Seattle, 1996. Also a search in your medical library would turn up a lot of research article in the medical journals. Also check out the undersea and hyperbaric medical society home page at www.ushms.org. Hope this helps!