Modern Modalities in Wound Healing: A Look Back
Available interventions in lower extremity wound care have skyrocketed in the last 25 years, allowing clinicians to target specific facets of healing. In this retrospective, we look at just a few options that have emerged, and how they drive limb preservation forward.
Thoughts on Topical Oxygen Therapy (TOT)
Specifically in the last decade, advances in this treatment option have shown consistent positive outcomes in multiple wound types.1 There has also been positive evidence for topical oxygen’s capability to contribute to pain reduction, recurrence mitigation, improved patient adherence, and infection reduction.1
David Armstrong, DPM, MD, PhD also recalls the last decade of randomized clinical trials. “I used to make fun of it,” he said. “(I thought), unless our patients’ legs have evolved gills on them, I’m not sure how this is going to work.” In hindsight, Dr. Armstrong acknowledges his initial reaction was wrong.
“In fact, recent systematic reviews and meta-analyses strongly suggest that topical oxygen can significantly increase the likelihood of closure in chronic diabetic foot ulcers, particularly those without critical limb threatening ischemia. In contrast to the year 2000, when the data were sparse and devices less reliable, we now have moderate-quality evidence supporting its role as a viable adjunct to standard of care.”
Windy Cole, DPM, CWSP remembers topical oxygen therapy being as largely experimental within the wound care community, with limited clinical adoption in the early 2000s. “At the time,” she noted, “hyperbaric oxygen therapy (HBOT) was the predominant oxygen-based modality, despite its logistical complexities and high costs.” Between 2017 and 2020, however, she shared that clinical interest in topical oxygen therapy surged, driven in part by increasing restrictions on HBOT usage.
“My own introduction to TOT came through participation in a multicenter clinical study focused on DFUs,” she said. “I was immediately impressed by the outcomes I observed, which exceeded expectations and highlighted the therapy’s potential. Notably, the American Diabetes Association (ADA) has awarded TOT an ‘A’ grade recommendation for chronic DFUs in its clinical guidelines.2 I continue to use TOT in my clinical practice and see utility of the therapy across a multitude of wound types.”
Autologous and Allogeneic Blood Products
Autologous platelet-rich plasma (PRP) is another evolving option. The thinking behind this therapy is that fibrin and growth factors may support healing.3 Dr. Armstrong recalls a surge of enthusiasm for PRP and other autologous products in the early 2000s, and feels the biologic rationale is compelling. However, he also noted that translation to predictable, large-scale clinical benefit is not clear.
“Over time, the field has refined its approaches, moving beyond simple preparations toward extracellular vesicle-based and engineered products that are showing more consistency. Compared to 2 decades ago, autologous therapies today are more mechanistically targeted but still await robust multicenter validation.”
Smart Dressings/Bandages
Digital health was certainly not at the forefront 25 years ago, but now, wearable sensors in a variety of forms may allow patients and clinicians to manage wounds in new ways. Such sensors embedded in dressing or bandage materials can collect and transmit key data on vital signs and other biomarkers in real time.4
“The last 5 to 7 years have seen the most dramatic transformation,” said Dr. Armstrong. “We now have wireless, stretchable, smart dressings capable of multiplexed biomarker monitoring, infection detection, controlled drug delivery, and even electrical stimulation to accelerate healing. What was science fiction in 2000—real-time wound chemistry analysis and closed-loop treatment at the point of care—is now being tested in first-in-human trials.”
Final Thoughts
Multiple innovative ways of thinking continue to evolve in wound care, including biomaterials, regenerative medicine, tissue engineering, and digital advances. “In short, while the dressings of (the year) 2000 were largely passive, today’s are active, data-rich, and increasingly therapeutic,” shared Dr. Cole. “The coming years promise even greater integration of smart biomaterials with AI-driven decision support to help us end preventable amputations.”
References
1. Oropallo A, Andersen CA. Topical oxygen. In: StatPearls. StatPearls Publishing; 2023.
2. American Diabetes Association Professional Practice Committee. 12. Retinopathy, neuropathy, and foot care: standards of care in diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S252-S265.
3. Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, et al. Autologous platelet-rich plasma for treating chronic wounds. Cochrane Database Syst Rev. 2016;2016(5):CD006899.
4. Shirzaei Sani E, Xu C, Wang C, et al. A stretchable wireless wearable bioelectronic system for multiplexed monitoring and
combination treatment of infected chronic wounds. Sci Adv. 2023;24;9(12):eadf7388.
