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Skin Integrity and Pressure Injuries

Topical Oxygen

Chronic hypoxia of a wound and periwound tissues is known to impede wound healing by impairing collagen formation, angiogenesis, and epithelialization. Hypoxia also lowers a wound’s resistance to infection (Stotts et al. 2007). Oxygen supply to chronic wounds has been augmented by treatment with systemic (hyperbaric) oxygen therapy or through a less studied modality, topical oxygen therapy (Stotts et al. 2007; Kalliainen et al. 2003). No controlled studies have examined the efficacy of hyperbaric oxygen on the healing of pressure injuries (Houghton & Campbell 2007; Consortium of Spinal Cord Medicine 2000; Houghton et al. 2013). Kalliainen et al. (2003) studied topical oxygen and its effects on the healing of chronic wounds, some of which were noted to be pressure injuries but the exact number was not reported. Among 58 wounds, 38 (65.5%) healed during treatment with topical oxygen alone but pressure injuries were included in wounds found to be least responsive to topical oxygen.

Author Year
Research Design
Sample Size



Banks & Ho 2008
Population: Mean age=61 yr; Gender: males; Level of injury: C7, T12, T10; Severity of injury: AIS A.
Intervention: SCI patients with stage IV pressure injuries in their pelvic region were treated with an EpiFLO device (extracts oxygen from the air, concentrates to near 100%, and delivers oxygen via cannula to saturate wound) daily during rehabilitation.
Outcome Measures: Wounds linear measure and volume.
1. First patient linearly had 49% improvement 9 wk post treatment; pre-treatment the patient’s wound measured 20.5cm linearly and volume was 252cm3, while 9 wk later, the linear measure reduced to 10.2cm linearly with a volume of 24 cm3.
2. The second patient’s wound reduced from 10.5 cm linearly to 5.5cm after 5 wk treatment and volume decreased from 30cm3 to 4 cm3, linearly this was a 48% improvement from baseline.
3. The last patient’s wound decreased by 31% from baseline after 5 wk treatment.


In one very small pre-post study of three patients, Banks and Ho (2008) demonstrated that when topical oxygen (EpiFLO device) was applied to stage IV pelvic pressure injuries, a comparison of pre- and post-treatment linear measurements showed 49%, 48%, and 31% improvement, respectively, for each patient. While a positive effect was shown, more research is needed to determine the role of topical oxygen therapy as adjunctive therapy for the healing of pressure injuries post-SCI.


There is level 4 evidence (from one pre-post study: Banks & Ho 2008) that topical oxygen therapy may improve healing of pressure injuries post-SCI.

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