TO2® is Topical Oxygen® Hyperbaric Oxygen is oxygen delivered at above-normal pressure. When hyperbaric oxygen is delivered to the surface of the skin it is topical. When hyperbaric oxygen is delivered to the surface of the wound, it is Topical Oxygen Therapy, an innovative approach to healing difficult wounds. The typical regimen lasts six weeks. TO2 is not the same as systemic hyperbaric oxygen, which is delivered in full-body chambers and is most often related to treating divers for the bends and treating victims of carbon monoxide poisoning.

THBO is an adjunctive therapy. It does not replace any therapy being used to treat wounds. When TO2 is being used, medical-grade oxygen is maintained at hyperbaric pressure on the surface of a wound for ninety minutes a day, for four consecutive days. Three days of rest follow, then the cycle is repeated. Wounds cannot heal without oxygen. TO2 delivers oxygen directly to the vital fluids in the surface of a wound.

DEFINITIONS

Hyperbaric Oxygen:
Oxygen applied at pressure greater than one atmosphere. Pressure is typically expressed as atmospheres, millimeters of mercury (mm Hg) or as pounds per square inch (psi). One atmosphere is ambient pressure at sea level, which is equivalent to 760 mm Hg., or 14.7 psi.
Systemic Hyperbaric Oxygen (HBO):
Hyperbaric oxygen administered in full body chambers. The patient breathes 100% oxygen intermittently while the pressure of the treatment chamber is increased to 2-3 atmospheres, equivalent to 1500-2500 mm Hg or 30-45 psi.
Topical Oxygen ( TO2):
Oxygen applied directly to the base of an open wound at pressure slightly above atmospheric, e.g. 1.03 atmospheres (22 mm Hg or 0.4 psi.).
Disposable, Topical Oxygen devices:
Disposable TO2 devices are designed to be used one time and discarded. (Earlier multiple use extremity chamber devices were heavy, awkward to handle and difficult to clean and disinfect, increasing the risk of cross contamination between patients, and making home care use impractical.)
PURPOSE OF TOPICAL OXYGEN THERAPY

Oxygen is required for all new cell growth. Tissue at the base of chronic or non healing wounds tends to be ischemic. Application of topical hyperbaric oxygen induces the growth of new blood vessels at the wound base. The new blood vessels allow an increased flow of oxygenated blood to the wound which begins the healing process.
As healing progresses, new granulation tissue that is exposed to hyperbaric oxygen is better vascularized. This in turn leads to higher tensile strength collagen being formed during wound healing, which reduces scarring and the risk of recidivism.

Another important benefit of hyperbaric oxygen is that it is bactericidal for anaerobic bacteria e.g. Staphylococcus aureus and E.coli.

The difference between systemic HBO and topical oxygen TO2 in therapeutic approach is that systemic HBO increases blood oxygen levels. However, blood oxygen levels are normally adequate for wound healing. The problem is that oxygen delivery to the wound site can be limited by poor wound tissue vascularization.

Topical oxygen TO2 on the other hand delivers oxygen directly to the wound. Transcutaneous oxygen levels are increased, despite the lack of well vascularized wound tissue. In addition, because this therapy is topical and relatively low pressure, there is no systemic absorption of oxygen, and therefore no risk of pulmonary or central nervous system toxicity that can result from breathing high pressure (30 - 45 psi) oxygen in full body chambers.

TREATMENT PROTOCOL - TOPICAL OXYGEN, DISPOSABLE

Week 1.
  • One (1) 90 minute treatment per day for four (4) consecutive days, followed by ...
  • Three (3) days with no TO2 therapy. This period of relative hypoxia is an important step in the healing process.
  • Continue using preferred conventional modalities between TO2 sessions.
Week 2 and beyond, until wound is healed.
Same as week one.