Experts Unveil Breakthrough Consensus on Topical Oxygen Therapy

Reinforces Evidence-Based Approach Set to Transform Wound Healing

NATROX® Wound Care, a leading innovator in wound care technology, is delighted to announce the Journal of Wound Care has published a new expert-led consensus on the practical, evidence-based use of topical oxygen therapy (TOT) across chronic wound care.¹

Together, an international group of clinical experts reviewed the substantial evidence on the essential role of oxygen in the wound healing process and acknowledged the growing body of evidence supporting TOT as part of wound protocols to help non-healing wounds progress. They also offered practical guidance on how the therapy can be incorporated into current best practices to improve outcomes and ultimately patients’ lives.

Expert Endorsement and Scientific Insights Amplify Oxygen’s Vital Role in Wound Healing

“According to Dr. Thomas Serena, MD, FACS, FACHM MAPWCA, Founder and Chief Executive Officer – SerenaGroup® Inc. and Chief Medical Officer – Mendota Health, a renowned authority and dedicated wound care advocate for over two decades, “The evidence supporting the efficacy of TOT is undeniable. It is imperative that healthcare professionals worldwide embrace this innovative yet simple approach to achieve improved healing outcomes.”

The panel highlights the demand for oxygen in wounds: “Physiological features of wounds which affect oxygenation include, high metabolic activity in the tissue, oedema, poor blood circulation, diffusion constraints (surface area vs volume), and O₂ consumption by bacteria.” They also call attention to the vital role of oxygen in wounds: “Oxygen (O₂) plays an important role in the reconstruction of new vessels, connective tissue, the migration of epithelial cells, and allows for normal local metabolism while facilitating resistance to infection. One way of locally delivering more O₂ to a wound is by the use of Topical Oxygen Therapy (TOT) provided by the clinician or administered at home.”

In-Depth Analysis Reinforces NATROX® O₂’s Pivotal Role in Healing

NATROX® O₂ and the evidence to support the use of continuous delivery of oxygen (CDO), one of the topical oxygen therapy modalities examined, are comprehensively reviewed with clear clinical benefits and outcomes highlighted in non-healing wounds. The panel findings state “multiple reasonably robust RCTs, systematic reviews and meta-analyses provide supportive evidence for the more established TOTs”, reflected in the GRADE A evidence rating in the recent American Diabetes Association (ADA) 2023 Standards of Care guidelines.2

Breakthrough Studies Spotlight Transformative Effects of TOT

Several RCTs were considered in detail highlighting the significant impact of CDO on wound healing compared to controls over a 12-week intervention period. One study demonstrated more than twice the number of healed wounds, with further improvements observed when combined with frequent debridement highlighting the importance of good wound bed preparation when considering adjunctive therapies. The positive impact of CDO on reducing wound pain is also of great importance to the practicing clinician as this can have a positive impact on reducing opioid use and compliance with ongoing treatments.

Navigating Topical Oxygen Therapy Landscape: Methods and Modalities

The document also reports the current evidence across TOT therapies highlighting similarities and differences in delivery, practicalities, and outcomes. In addition to providing a comparison of TOT modalities, the panel also reviews the methods available to measure oxygen in wounds, a key component to understanding the impact of TOT adjunctive therapy in daily practice.

Empowering Patients: Consensus Eases Concerns, Paving the Way for Home-Based TOT

While the panel recognizes the need for large-scale qualitative research in their patient-centred recommendations, they did address common patient concerns. The topics included pain management, duration/frequency of treatment, side effects, probability of improvement, lifestyle changes, risk of sudden cessation, and safety considerations—all of which CDO offers favourable results. The panel also notes that patients are often “pleased to hear that there are efficacious treatment modalities that can be carried out in the privacy of their home or long-term care facility.”

Redefining Value in Wound Care: Experts Illuminate Cost Savings with TOT

Cost effectiveness of TOT is discussed with a recent cost-utility analysis: “CDO would save $4800 compared with NPWT and increase quality of life years (QALYs) by 0.025. Lower cost and improved outcomes were observed in most scenarios with savings ranging from $1,800 to $14,060 versus moist wound therapy, NPWT & HBOT”. The panel recommends “broad access to therapy with appropriate reimbursement by payers and health systems.”

Guiding the Way to Enhanced Healing: Expert Panel’s Clear Roadmap for Topical Oxygen Therapy

Final recommendations by the panel are clear. “There is an expanding evidence base for wound closure after treatment with TOT products, especially in a subset of non-healing patients who failed to achieve adequate closure with SOC. The panel endorses the adjunctive administration of TOT for hard-to-heal wounds.” Further clarification from a practical perspective emphasizes “TOT is an appropriate adjunctive therapy after 4 weeks of optimal SOC without achieving at least 50% reduction in wound area” and “is generalisable to all hard-to-heal wounds (not just DFUs).”

Elevating Patient-Centered Wound Care: NATROX® Vision Aligns with Expert Consensus’s Game-Changing Insights

NATROX® Wound Care CEO, Craig Kennedy, expressed his gratitude for the panel’s “comprehensive evaluation of topical oxygen therapy’s role in chronic wound care that underscores its undeniable efficacy, highlighting its vital role in the wound healing process. As we continue to push the boundaries of wound care technology, we are proud to stand at the forefront of a new era in patient-centred wound management, dedicated to improving patients’ lives through the power of NATROX® O₂ and evidence-based practices.”

This consensus review follows the May 2023 inclusion of TOT in newly published IWDGF guidelines, clinical treatment algorithms in Central and Eastern Europe, and American Diabetes Association evidence incorporation into its Standards of Care in Diabetes as a key adjunctive therapy in wound healing.2–4



  1. Frykberg, R. et al. Use of Topical Oxygen Therapy in wound healing. J Wound Care, 32(S8B), S3-S30 (2023).
  2. ElSayed, N. A. et al. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2023Diabetes Care 46, S203–S215 (2023).
  3. Chen, P. et al. IWGDF Guidelines on interventions to enhance healing of foot ulcers in people with (2023).
  4. Bem, R. et al. A new algorithm for the management of Diabetic Foot Ulcer recommendations from Central and Eastern Europe. J Wound Care 32, 264–272 (2023).