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The initial inflammatory phase of wound healing involves hemostasis to prevent excessive blood loss.This is instigated by activation of the clotting cascade by injured cells, and involves cleavage of fibrinogen to fibrin by thrombin.Within 6 hours of injury, numerous inflammatory growth factors are released, which aid the recruitment of neutrophils and subsequently macrophages to the wound site.Many of these processes require extra cell metabolism for biosynthesis and transport of proteins, which requires oxygen.Keywords: clinical trials, foot ulceration, non-healing wounds, oxygen Introduction Chronic wound ulcers can be categorized into four main groups, ie, venous, arterial, diabetic, and pressure/decubitus ulcers.All cause a significant financial and social burden worldwide.

Hyperbaric oxygen influences the biochemistry of whole cells, altering cell proliferation, angiogenesis, clotting, and tissue regeneration.Accepted for publication 11 February 2015 Published 22 April 2015 Volume 2015:2 Pages 81—93 DOI https://doi.org/10.2147/CWCMR.S60319 Checked for plagiarism Yes Review by Single-blind Peer reviewer comments 3 Editor who approved publication: Professor Marco Romanelli DDRC Healthcare, Plymouth, UKAbstract: The breathing of pure oxygen under pressure to treat tissue damage has been employed for almost 45 years and has been investigated in prospective, retrospective, and randomized controlled trials.The hypoxic conditions in the damaged vascularized wound area trigger in part the production of transcription factors such as hypoxia-inducible factor 1-α and vascular endothelial growth factor by endothelial cells and macrophages.As the macrophages remove necrotic cellular debris, the phagocytic processes trigger production of reactive oxygen species, which requires significant amounts of oxygen.

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