Specialized Wound Healing Program

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Wound care is constantly evolving as advances in medicine show new and developing ways of managing diabetic ulcers, skin ulcers and surgical incisions. Research into natural means of wound healing have shown benefit in both reducing the amount of time required to close a wound, and in reducing infection of the area. Overall, the primary goals of the treatment of wounds are to close the wound quickly, and to ensure a aesthetically pleasing scar. 

The primary function of the skin is to serve as a protective barrier against the environment. Loss of the integrity of large portions of the skin can impact not only the area of the wound, but the overall integrity of our body systems. By ensuring rapid closure of the wound we can decrease the burden on the body’s circulatory, immune and physiological systems. 

 

Stages of Wound Healing

Wound healing itself has three phases - inflammation, tissue formation and tissue remodelling. The inflammation phase of wound healing is your body’s natural response to injury. Blood vessels in and around the wound contract and a clot is formed which stops the bleeding, then they dilate to allow essential cells like antibodies, white blood cells and other healing mechanisms of your immune system to reach the injured area. It is this influx of cells that causes the area of injury to become warm, swollen and sometimes painful.

The inflammatory phase of wound healing then leads to the tissue formation phase (also known as the proliferative phase). At this point, the wound is “rebuilt” with new tissue composed of collagen, an extracellular matrix and new blood vessels (via a process called angiogenesis). This phase is dependent upon the fibroblast cells (which build the new tissue) receiving enough oxygen and nutrients via red blood cells to ensure that the wound heals correctly. The colour of the tissue around the wound is often an indicator of how well the wound is healing. Pink tissue is usually an indication of good perfusion, whereas dark tissue can be indicative of poor perfusion, ischemia (no oxygen perfusion) or infection.

The final phase of wound healing is known as tissue remodelling (or the maturation phase). This phase occurs when the wound has closed, and the collagen put down during the proliferative phase is remodelled from type III collagen to type I collagen. It is at this phase of wound healing that cellular activity reduces and the number of blood vessels in the area both regress and decrease.  

 

Ozone Therapy

At Cornerstone Naturopathic we use ozone therapy to increase oxygenation to a particular area, thereby improving the healing response time, as well as reducing the risk of infection to the area. Ozone has been widely recognized as one of the best bactericidal, antiviral and antifungal agents (1, 2) and it has been used in the treatment of chronic wounds, such as trophic ulcers, ischemic ulcers and diabetic wounds (3-5), as well as in aiding in the improvement of surgical wound healing outcomes. The beneficial effects associated with ozone therapy on wound healing is due to a combination of factors including decreased bacterial infection, improvement of dermal wound healing and an increase in oxygenation externally to the wound area (6, 7).

Biochemically speaking, ozone also activates certain immunological factors that are vital to the well functioning of wound healing. This includes the activation of transcription factor NF-κB, FGF, PDGF, TGF-β and VEGF (1, 11-16)

 

Ulcer Management

Although most wound healing follows the above process, skin ulcers (especially diabetic ulcers) are an excellent example of how multiple physiologic and biochemical impairments can lead to poor healing. Skin ulcers occur due to an impairment in the normal healing response of an area due to a pre-existing condition (such as diabetes) or pressure (such as bed sores). Diabetic ulcers particularly occur in areas of reduced sensation (usually the feet and legs) due to peripheral neuropathy. Ischemia of the area then impedes healing by reducing the supply of oxygen and other nutrients. A physiological impairment of granulocytic function and chemotaxis (8) also makes diabetic ulcers prone to infection, and a decreased synthesis of collagen and defective white blood cell (particularly macrophage) function increases healing time (9, 10). 

Ozone Therapy can be used to improve the recovery of skin ulcers by improving the oxygenation of the area through external means. The area affected is inclosed in a bag which is then filled with ozone set to a specific concentration based on the action required and circulated for 10 to 20 minutes. The ozone is then released from the bag through a destructor device. 

 

Surgical Wound Healing

One of the limiting factors surrounding the good healing of surgical incisions and scar formation is oxygenation of the area. Similar to healing of skin and diabetic ulcerations, bagging of the area and infusion with ozone is utilized to ensure proper oxygenation of the area allowing for proper granulation and tissue formation. The scar formed after surgery is then followed carefully and 6 to 8 weeks after the wound has closed prolotherapy with a procaine solution is performed on the scar. This ensures that the scar tissue formation does not disrupt the fascial planes and that the cells have the proper physiological polarization. This reduces the risk of chronic pain in years to come and ensure full range of motion of the area.

 

Case Results

The attached photos are graphic in nature, but show the improvement of both a surgical scar (trauma originally caused by a rototiller) of a 40-year old active man with no pre-existing conditions. In this case limb bagging with ozone was performed in addition to nutrient IV's specifically designed to speed wound healing. You can see for yourself the healing response that took place. 

If you have a wound which needs some attention please call us to book an appointment with Dr. Ben Connolly 902 820 3443

 

References

  1. Valacchi G, Fortino V, Bocci V. The dual action of ozone on the skin. Br J Dermatol 2005;153:1096–1100.
  2. Al-Dalain SM, Martinez G, Candelario-Jalil E, Menendez S, Re L, Giuliani A, Leon OS. Ozone treatment reduces markers of oxidative and endothelial damage in an experimental diabetes model in rats. Pharmacol Res 2001;44:391–396.
  3. Martinez-Sanchez G, Al-Dalain SM, Menendez S, Re L, Giuliani A, Candelario-Jalil E, Alvarez H, Fernandez-Montequin JI, Leon OS. Therapeutic efficacy of ozone in patients with diabetic foot. Eur J Pharmacol 2005;523:151–161.
  4. Bocci V. In: Ozone: a new medical drug. Dordrecht: Springer; 2005.
  5. de Monte A, van der Zee H, Bocci V. Major ozonated autohemotherapy in chronic limb ischemia with ulcerations. J Altern Complement Med 2005;11:363–367.
  6. Lim Y, Phung AD, Corbacho AM, Aung HH, Maioli E, Reznick AZ, Cross CE, Davis PA, Valacchi G. Modulation of cutaneous wound healing by ozone:differences between young and aged mice. Toxicol Lett 2006;160:127–134.
  7. Gajendrareddy PK, Sen CK, Horan MP, Marucha PT. Hyperbaric oxygen therapy ameliorates stress-impaired dermal wound healing. Brain Behav Immun 2005;19:217–222. 
  8. Nolan CM, Beaty HN, Bagdade JD. Further characterization of the impaired bactericidal function of granulocytes in patients with poorly con- trolled diabetes. Diabetes 1978;27:889-94.
  9. Fahey TJ III, Sadaty A, Jones WG II, Barber A, Smoller B, Shires GT. Diabetes impairs the late inflammatory response to wound healing. J Surg Res 1991;50:308-13.
  10. Loots MA. Differences in cellular infiltrate and extracellular matrix of chronic diabetic and venous ulcers versus acute wounds. J Invest Dermatol 1998;111:850-7.
  11. Janic B, Umstead TM, Phelps DS, Floros J. Modulatory effects of ozone on THP-1 cells in response to SP-A stimulation. Am J Physiol Lung Cell Mol Physiol 2005;288:L317–L325.
  12. Valacchi G, van der Vliet A, Schock BC, Okamoto T, Obermuller-Jevic U, Cross CE, Packer L. Ozone exposure activates oxidative stress responses in murine skin. Toxicology 2002;179:163–170.
  13. Bocci V. Biological and clinical effects of ozone. Has ozone therapy a future in medicine? Br J Biomed Sci 1999;56:270–279.
  14. Valacchi G, Bocci V. Studies on the biological effects of ozone: 10. Release of factors from ozonated human platelets. Mediators Inflamm 1999;8:205–209.
  15. Lang DS, Jorres RA, Mucke M, Siegfried W, Magnussen H. Interactions between human bronchoepithelial cells and lung fibroblasts after ozone exposure in vitro. Toxicol Lett 1998;96-97:13–24.
  16. Sen CK, Khanna S, Babior BM, Hunt TK, Ellison EC, Roy S. Oxidant-induced vascular endothelial growth factor expression in human keratinocytes and cutaneous wound healing. J Biol Chem 2002;277:33284–33290.

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