The Power of Oxygen in Wound Healing — and How NATROX® O₂ Helps Restore It 

EVERY STAGE OF WOUND HEALING DEPENDS ON OXYGEN 

From injury to the final stages of tissue remodeling, oxygen fuels the cellular activity that allows wounds to repair, close, and strengthen. But in many chronic wounds, oxygen levels are severely reduced — resulting in stalled wound healing. 

Let’s explore how oxygen drives each stage of healing, and how new delivery technologies are changing what’s possible for patients. 

Oxygen Fuels Cellular Energy and Repair 

All wound healing processes rely on energy — and the energy comes from ATP (adenosine triphosphate). 

ATP production is oxygen-dependent: 

  • Anaerobic metabolism (without oxygen) produces only 2 ATP. 
  • Aerobic metabolism (with oxygen) generates 36 ATP per glucose molecule. 

LOW OXYGEN MEANS A 94% REDUCTION IN ENERGY NEEDED TO AUGMENT WOUND HEALING. 

97% of chronic wounds are hypoxic. This impacts the amount of ATP production necessary to optimize fibroblast activity, immune efficiency, and keratinocyte migration. (Hauser CJ, 1987) 

Continuous oxygen delivery helps re-establish aerobic metabolism — providing the fuel necessary to repair damaged tissue and enabling healing progression. 

Oxygen Enables Antibacterial Defense 

For healing to occur, wounds must be free of infection. The body’s white blood cells — neutrophils and macrophages help with the cleanup process through phagocytosis. This triggers the respiratory burst, and it’s almost entirely oxygen-dependent. (Oropallo, 2022) 

During phagocytosis, phagocytes consume oxygen to generate reactive oxygen species (ROS). These ROS kill bacteria and signal other immune cells to respond. Hydrogen peroxide and hypochlorous acid, powerful antibacterials, are byproducts of the respiratory burst. Up to 98% of oxygen consumed by neutrophils goes toward the respiratory burst. 

In hypoxic conditions, this process weakens, allowing bacterial biofilms to persist and inflammation to linger; leaving wounds vulnerable to infection and delaying healing. 

By supplying supplemental oxygen continuously, NATROX® O₂ supports optimal immune function and microbial clearance — a key step toward progressing from inflammation to repair. 

Oxygen Drives Repair and Regeneration 

Once the wound is clean, oxygen continues to play a leading role in rebuilding tissue: 

➡Growth Factor Production and Signaling 

Reactive Oxygen Species (ROS) are not only oxygen dependent but also responsible for cell signaling to bring growth factors to the wound. Normal oxygen levels are needed for the ROS to recruit key growth factors such as VEG-F, EGF, PDGF, FGF, and TGF to the wound to drive angiogenesis, fibroblast migration, and reepithelialization . 

➡Angiogenesis and Revascularization 

Oxygen supports the formation of new blood vessels. Notably, VEGF supports new blood vessel formation by increasing vascular permeability to create a provisional fibrin matrix and stimulating endothelial cell migration, guiding the sprouting of new capillaries essential for angiogenesis.  

➡Collagen Synthesis and Tissue Strength 

Fibroblasts depend on oxygen for collagen formation. Enzymes like prolyl hydroxylase and lysyl oxidase are oxygen-dependent — without them, collagen loses up to two-thirds of its tensile strength. 

➡Cell Proliferation and Reepithelialization 

Oxygen promotes the cellular division and migration needed for reepithelialization — restoring the wound’s structure and barrier function. 

Modern Oxygen Therapies Help Restore Balance 

Oxygen is a cornerstone of wound healing. From cellular energy production to bacterial defense and tissue regeneration, every step of repair depends on adequate oxygen. 

But as we know, chronic wounds are often hypoxic, trapping them in a non-healing cycle and interrupting the healing cascade. That’s why some clinicians turn to hyperbaric oxygen therapy (HBOT)—a proven way to super-saturate the blood with oxygen and improve tissue perfusion. 

However, not every patient can tolerate HBOT sessions, nor are all wounds ideal for HBOT. Plus, tissue oxygen levels often drop soon after a dive. To maintain oxygenation where it matters most—the wound bed—continuous oxygen support is key. 

That’s where NATROX® O₂ comes in: 

A small, wearable device that delivers Continuous Topical Oxygen Therapy (cTOT) directly to the wound site. Portable, non-invasive, and able to sustain oxygenation between or instead of chamber sessions. It’s the power of oxygen therapy—in the palm of your hand. 

Complementary Therapies, Shared Goal 

Whether used independently or in tandem, HBOT and NATROX® O₂ both deliver oxygen where healing depends on it—HBOT through systemic hyperoxygenation, NATROX® O₂ through continuous local delivery. Let’s take a look at 2 case studies showing the oxygen therapies used together and sequentially. (Cole 2024) 

Case Example 1: Sequential HBOT and Continuous Topical Oxygen Therapy (cTOT) 

A 57-year-old man with insulin-dependent diabetes presented with a necrotic heel ulcer and confirmed calcaneal osteomyelitis. After surgical debridement and partial calcanectomy, he received six weeks of IV antibiotics and postoperative negative pressure wound therapy (NPWT). 

Following discharge, he completed 40 hyperbaric oxygen (HBOT) sessions, which improved but did not fully close the wound. Continuous Topical Oxygen Therapy (cTOT) was then initiated directly to the wound bed under a semi-occlusive dressing. 

With weekly monitoring, the wound fully healed within four months of surgery. 

This case highlights how cTOT can effectively complement HBOT, sustaining oxygen delivery between or after chamber sessions and supporting complete wound closure. 

 

Case Example 2: Complementary Use of HBOT and Continuous Topical Oxygen Therapy (cTOT) 

A 51-year-old man with insulin-dependent diabetes and a history of transmetatarsal amputation presented with a Wagner Grade 3 ulcer on the lateral forefoot. He received standard wound care, including systemic antibiotics, debridement, and offloading, but after four weeks the wound showed less than 50% area reduction. 

Continuous Topical Oxygen Therapy (cTOT) was initiated while authorization for hyperbaric oxygen therapy (HBOT) was obtained. Once HBOT began, cTOT was continued between dives and on weekends, maintaining consistent oxygenation of the wound bed. 

The combination of HBOT and cTOT resulted in significant wound improvement, with ongoing cTOT therapy supporting continued progression toward closure. 

This case illustrates how HBOT and cTOT can work together as complementary oxygen therapies—HBOT enhancing systemic oxygenation and cTOT providing continuous local delivery to sustain healing momentum between chamber sessions. 

How NATROX® O₂ Supports Healing at Every Stage 

Chronic wounds are often trapped in a hypoxic state due to poor perfusion, infection, or underlying vascular disease. NATROX® O₂ addresses this directly by delivering Continuous Topical Oxygen Therapy to the wound bed through a simple, wearable device. 

Unlike intermittent or pressurized systems, NATROX® O₂ provides 24/7 oxygenation, supporting proper moisture balance while driving key biological processes: 

  • ⚡ Boosts ATP production for cell repair and proliferation 
  • 🦠 Enhances immune function and bacterial clearance 
  • 🌱 Stimulates angiogenesis and growth factor signaling 
  • 🧬 Promotes collagen synthesis and tissue strength 

By replenishing oxygen continuously, NATROX® O₂ helps “restart” stalled healing and supports progression through all phases of repair — from inflammation to full closure. 

Conclusion 

Oxygen is more than just a vital element — it’s the cornerstone of wound healing. When chronic wounds become oxygen-deprived, the healing cascade of repair slows or stops. NATROX® O₂ delivers the oxygen wounds need to heal, supporting natural cellular processes and restoring the body’s ability to repair itself. 

Discover the Power of Oxygen with NATROX® O₂

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References 

  • Hauser CJ. Tissue salvage by mapping of skin surface transcutaneous oxygen tension index. Arch Surg. 1987;122(10):1128-1130. doi:10.1001/archsurg.1987.01400220038006 
  • Younis, I. (2020). Role of oxygen in wound healing. J Wound Care, 29(Sup5b), S4–S10. 
  • Oropallo, A., Andersen, C. A. (2022). Topical Oxygen. StatPearls. 
  • Tang, T. Y., et al. (2018). NATROX® – Let the topical oxygen flow for healing complex wounds. Wounds Asia, 1(2), 1–4. 
  • Cullen, B., et al. (2018). Consensus round table meeting: Topical oxygen therapy for healing complex wounds. Wounds International. 
  • Kimmel, H. M., Grant, A., Ditta, J. (2016). The presence of oxygen in wound healing. Wounds, 28(8), 264–270. 
  • Cole W, McFee K, Woodmansey E. (2024) Supplemental Oxygen Therapy in Wound Healing. Podiatry M, Nov/Dec:101-8.