Transdermal Continuous Oxygen Therapy (TCOT, also known as Transdermal Continuous Oxygen Wound Therapy) is a

wound A wound is a rapid onset of injury that involves laceration, lacerated or puncture wound, punctured skin (an ''open'' wound), or a bruise, contusion (a ''closed'' wound) from blunt force physical trauma, trauma or compression. In pathology, a '' ...

closure technique for chronic and acute wounds which blankets a wound in

oxygen Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as wel ...

on a 24-hour basis until the wound heals. Unlike hyperbaric oxygen treatment for

chronic wound A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are often considered chronic. Chronic wounds seem to be detained in on ...

s, oxygen treatment used in this therapy is not systemic in nature and treats only the wound area. This treatment differs from topical oxygen treatments, as topical oxygen typically involves sporadic treatments of 1–3 hours several times per week, while TCOT treatment is 24/7 by nature.

Overview

Though early use focused on

burn A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation (like sunburn). Most burns are due to heat from hot liquids (called scalding), solids, or fire. Burns occur mainl ...

s and surgical wounds, wider use of wounds treated with TCOT have become more common in

diabetic foot A diabetic foot is any pathology that results directly from peripheral arterial disease (PAD) and/or sensory neuropathy affecting the feet in diabetes mellitus; it is a long-term (or "chronic") complication of diabetes mellitus. Presence of severa ...

ulcers,

venous stasis Venostasis, or venous stasis, is a condition of slow blood flow in the veins, usually of the legs. Presentation Complications Potential complications of venous stasis are: * Venous ulcers * Blood clot formation in veins (venous thrombosis), tha ...

and decubitus ulcers (pressure sores). TCOT involves inserting a thin tube which delivers the oxygen above the wound bed of a cleaned wound. An absorbent dressing is then placed above the tube and an occlusive or semi occlusive dressing is placed over the entire wound site. The far end of the tube is connected to an oxygen delivery unit, often portable, which delivers oxygen at a slow rate, typically 3ml per hour.

Indications

Although the FDA has approved treatment for at least one company using TCOT for the following indications, most of the interest in TCOT at present concerns diabetic foot ulcers, venous stasis, and decubitus ulcers. •

Skin ulcer An ulcer is a sore on the skin or a mucous membrane, accompanied by the disintegration of tissue. Ulcers can result in complete loss of the epidermis and often portions of the dermis and even subcutaneous fat. Ulcers are most common on the skin of ...

s due to

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

•

s due to

• Decubitus ulcers (bed sores,

pressure sores Pressure ulcers, also known as pressure sores, bed sores or pressure injuries, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combi ...

)
•

Skin ulcers An ulcer is a sore on the skin or a mucous membrane, accompanied by the disintegration of tissue. Ulcers can result in complete loss of the epidermis and often portions of the dermis and even subcutaneous fat. Ulcers are most common on the skin ...

due to

post-surgical infections Perioperative mortality has been defined as any death, regardless of cause, occurring within 30 days after surgery in or out of the hospital. Globally, 4.2 million people are estimated to die within 30 days of surgery each year. An important consid ...

• Lesions due to

gangrene Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the ga ...

•

Skin grafts Skin grafting, a type of graft surgery, involves the transplantation of skin. The transplanted tissue is called a skin graft. Surgeons may use skin grafting to treat: * extensive wounding or trauma * burns * areas of extensive skin loss du ...

•

Burn A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation (like sunburn). Most burns are due to heat from hot liquids (called scalding), solids, or fire. Burns occur mainl ...

s
•

Frostbite Frostbite is a skin injury that occurs when exposed to extreme low temperatures, causing the freezing of the skin or other tissues, commonly affecting the fingers, toes, nose, ears, cheeks and chin areas. Most often, frostbite occurs in the han ...

Effectiveness

Animal studies conducted in 2004-2005 have demonstrated the effectiveness of TCOT on Rabbit ear wounds. A recently published study documented two prevented amputations which have shown TCOT to be highly effective on diabetic foot ulcers, venous stasis and decubitus ulcers and a study completed in 2010 by Dr. Gary Sibbald documented the effectiveness of TCOT on 9 diabetic foot ulcer patients. Manufacturers of devices used in TCOT have published several additional cases whereby treatment using TCOT prevented previously scheduled amputations.

References

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