Research on The Application of Medical Ozone in The Treatment of Chronic Wounds in Diabetic Foot

Research on the Application of Medical Ozone in the Treatment of Chronic Wounds in Diabetic Foot

Diabetic foot, as one of the serious chronic complications of diabetes, poses a severe threat to patients' health. Traditional treatment methods often prove ineffective in dealing with the complex pathophysiological process of diabetic foot ulcers. However, medical ozone therapy, as an emerging treatment approach, has shown promising application prospects with the increase of clinical trials and the clarification of its mechanism of action.

01 Current Situation of Diabetic Foot

Diabetes is a group of metabolic diseases characterized by chronic hyperglycemia. Poor long-term blood sugar control and high plantar pressure are prone to cause diabetic foot ulcers. The prevalence of diabetic foot ulcers in the global population is approximately 6.3%, and it is on the rise. It is predicted that by 2025, among the more than 500 million diabetic patients worldwide, 125 million will have diabetic foot ulcers. In hospitalized patients, the proportion of diabetic foot ulcers is relatively high. If the lesion is not treated in time, it can lead to gangrene and even amputation, causing nearly 80% of non-traumatic lower limb amputations. The continuous increase in the incidence and mortality rate of this disease has urged researchers to urgently explore new treatment methods.

The treatment of diabetic foot ulcers faces many difficulties. Traditional treatment methods are difficult to effectively deal with its complex pathophysiological process. After diabetic foot ulcers are complicated with infection, the treatment is difficult and the course of treatment is long. If the infection cannot be controlled in time, patients will face the risk of amputation and death. This not only brings great pain to patients, but also brings a heavy burden to patients' families and society.

02 Characteristics and Mechanism of Ozone

Ozone is a gas with a cyclic structure composed of three oxygen atoms, also known as superoxide or trioxygen, and is an allotrope of oxygen. Its molecular structure is triangular, and it is a pale blue, unstable gas with a special odor and strong oxidizing properties. The density of ozone is 1.6 times that of oxygen, and its solubility in water is 10 times that of oxygen. At 0℃, 49ml of ozone can be dissolved in 100ml of water. Due to its instability, the half-life of ozone at 20℃ is approximately 40 minutes, and it easily decomposes into oxygen in the air and human tissues without leaving any permanent residue, thus not causing damage to organs and tissues.

Medical ozone has multiple mechanisms of action. In terms of antioxidation, ozone can produce a mixture of hydrogen peroxide, reactive oxygen species, and lipid peroxidation products. By inducing a brief and moderate oxidative stress response, it increases the activation of nuclear factor erythroid 2-related factor 2, promotes the formation of antioxidant enzymes, eliminates excessive free radicals in the body, and enhances the body's antioxidant and anti-infection capabilities. In terms of inactivating pathogens, as a strong oxidant, ozone destroys the cell walls of bacteria by oxidizing phospholipids and lipoproteins on the cytoplasmic membrane, penetrates microorganisms, oxidizes glycoproteins and glycolipids, causes the loss of enzyme function, leading to bacterial death and dissolution. Additionally, ozone can improve microcirculation and hemorheology, increase tissue oxygen supply, activate the immune system, and facilitate wound healing.

03 Clinical Application of Medical Ozone

Medical ozone has been used in clinical practice abroad for over 50 years and has a wide range of applications, covering pain disorders, joint diseases, infectious diseases, autoimmune diseases, ischemic diseases, gynecological diseases, oral diseases, skin ulcers and injuries, metabolic diseases, medical aesthetics and many other fields. In recent years, its application in tumor adjuvant therapy has also been included in research. There are various common treatment methods, mainly including major autohemotherapy, minor autohemotherapy, ozone bath therapy, rectal therapy, ozone water irrigation, ozone oil or ozone ointment, etc.

Major autohemotherapy and minor autohemotherapy are both methods of mixing the blood drawn from the patient's vein with ozone gas of appropriate concentration and then reinfusing it into the body. In major autohemotherapy, 100 - 200 ml of venous blood is usually drawn and mixed with ozone gas before being reinfused intravenously. In minor autohemotherapy, about 5 ml of blood is drawn, treated with high-concentration ozone, and then injected intramuscularly. Autohemotherapy is suitable for various diseases such as ischemic arterial diseases, immune diseases, joint diseases, infectious diseases, pain disorders, diabetes and diabetic foot. Local injection methods include subcutaneous injection, intramuscular injection, and injection around and into the joint cavity with ozone gas or ozone water, mainly used for the treatment of pain disorders and joint diseases.

04 Ozone Therapy for Diabetic Foot Conditions

Ozone water irrigation can effectively eliminate common bacteria in infectious wounds, promote granulation tissue growth, and facilitate wound repair. Some studies suggest that, on the basis of conventional treatment, ozone water irrigation combined with acupoint massage can promote wound healing in patients with diabetic foot, improve their prognosis and quality of life. After ozone water irrigation, it can reduce putrefaction and discharge, and acupoint massage can strengthen the body and restore health. The combination of the two can improve local microcirculation perfusion and alleviate the ischemic and hypoxic state of surrounding tissues.

There are various methods for ozone gas bath treatment of diabetic foot. The ozone bag therapy involves continuously injecting ozone into a closed bag through an ozone generator to maintain a certain concentration and duration. Studies have shown that this therapy is effective in the treatment of diabetic foot, with simple, effective and low-cost methods, and broad clinical prospects. Local gas injection of ozone can accelerate the healing of diabetic foot ulcers and reduce the disability rate. Ozone oil or ozone ointment for the treatment of diabetic foot has a simple application method, obvious local sterilization effect, and is not limited to diabetic foot ulcer wounds.

05 Advantages of Ozone Combined Therapy

Ozone combined with other therapies has significant advantages in treating diabetic foot. The combination of ozone water and negative pressure closed drainage therapy can provide sufficient oxygen to the wound and is less likely to cause bacteria and viruses to develop drug resistance. Studies have shown that after covering the diabetic foot wound with negative pressure closed drainage, continuous flushing with ozone and normal saline has a significant anti-infection effect, which is conducive to reducing edema at the lesion site, promoting the growth of granulation tissue, and accelerating wound healing.

The combination of ozone major autologous blood therapy and negative pressure system treatment can lower lipid levels, enhance red blood cell metabolism in patients, improve the oxygen-carrying capacity of cells, and alleviate hypoxia in the affected limb. The combination of ozone gas bath and interventional surgery treatment can restore blood flow through interventional surgery, and ozone has the ability to kill bacteria. The two complement each other's advantages. The combination of ozone gas bath and epidermal growth factor treatment can shorten the healing time of diabetic foot, is simple to operate, has good results, and is easy to popularize. The combination of ozone gas bath, major autologous blood and hyperbaric oxygen therapy has better therapeutic effects than single therapy, can promote wound healing, and reduce the disability rate.

06 Prospects for Ozone Therapy

At present, the clinical methods for treating diabetic foot, such as hyperbaric oxygen, local laser irradiation, and comprehensive physical therapy, have disadvantages such as high professional requirements, complex operation, huge costs, and obvious trauma. However, medical ozone therapy, as a new biological therapy, has the advantages of low technical cost, few adverse reactions, good safety, and easy operation. Moreover, ozone treatment methods are diverse and can be combined with various traditional therapies to enhance therapeutic effects, which has been recognized by many clinical doctors and patients and has broad therapeutic prospects, worthy of clinical promotion and application. In recent years, with the in-depth research on medical ozone therapy in domestic clinical practice, the research on its mechanism of action and the standardization of ozone dosage in treatment is expected to become a new hotspot in the field of diabetic foot ulcer treatment. This review provides the latest ozone treatment methods and clinical trials for diabetic foot, enriches the treatment options for chronic diabetic foot wounds, and also provides convincing evidence for ozone therapy, providing a reference for the safe clinical application of ozone in treating chronic diabetic foot wounds. It is believed that in the future, medical ozone therapy for diabetic foot will play a greater role.