Topical oxygen therapy with Granulox
Wounds cannot heal without oxygen 1 . Topical oxygen therapy with Granulox can help ensure adequate oxygen diffusion to drive sustained wound healing 1 .
Cost effectiveness
Scottish Health Technologies Group: Innovative Medical Technology Overview
Expert opinions and guidelines
Appropriate use of topical haemoglobin in chronic wound management: consensus recommendations
Expert panel report: The role of topical oxygen therapy in the management of diabetic foot ulcers
Oxygen therapies for wound healing: EWMA findings and recommendations
Standards of ICW e. V. for diagnostics and treatment of chronic wounds (DE)
Innovative topical haemoglobin spray helps drive the MOIST concept in saving patients’ limbs
Chronic wounds share a common challenge: a lack of oxygen reaching the wound. Wound healing requires large amounts of oxygen 1 2 3 , and healing is delayed when insufficient oxygen is available in the wound. A sustained failure of oxygenation at the tissue level – one of the barriers to healing for chronic wounds – is called hypoxia 1 .
Patients with chronic wounds, such as pressure ulcers, diabetic foot ulcers and venous leg ulcers suffer from underlying conditions that compromise the body’s ability to move oxygen to the wound. The situation is worsened by a combination of reduced blood flow in the region of the wound, due to underlying diseases such as diabetes or chronic venous insufficiency, and less efficient 2 3 , healing because the wound healing process consumes more oxygen 1 .
*Hauser CJ. Tissue salvage by mapping of skin surface transcutaneous oxygen tension index. Archives of surgery (Chicago, Ill : 1960) 1987; 122(10): 1128-30.
Oxygen therapies can be delivered from the inside or outside (topically) of the body. Both approaches influence wound healing in different ways 1 .
Oxygen provided from the inside via hyperbaric treatment improves oxygen supply thanks to improved blood oxygenation, but this effect is temporary and best used as an adjunct treatment 1 .
Oxygen provided from the outside via various topical oxygen therapy methods facilitates the availability of oxygen to the base of the wound 1 . This can lead to sustained healing, but needs a vehicle for diffusing oxygen and penetrating the wound’s exudate layer. Wounds are not able to access oxygen from the air – the atmosphere is 21% oxygen, but the diffusion rate of oxygen is reduced substantially when a thin liquid layer is present in the wound. Haemoglobin helps to transport oxygen to low-oxygen environments in the wound bed, naturally moving to where oxygen is most needed.
Topical haemoglobin treatment is a simple way to facilitate oxygen diffusion directly within a chronic wound 1 . A haemoglobin spray can be applied to a wound as an adjunct to standard therapy 1 to accelerate oxygen delivery 4 .
Controlling for condition-specific symptoms is central to healing – but this plays just one role in a host of therapies that contribute to successful healing of chronic wounds.
Using a topical, purified haemoglobin spray on hard-to-heal wounds provides a direct channel for oxygen-loaded haemoglobin to diffuse through wound exudate 5 and reach the wound for increased oxygen saturation.
In vivo measurements has demonstrated the increase in tissue oxygenation following topical application of haemoglobin spray (Granulox) on chronic wounds:
- Haemoglobin (Hb) spray (Granulox) is sprayed. Hb diffuses into the wound exudate and starts binding oxygen 5
- Oxygen is readily available at the surface, and Hb binds more oxygen 5
- Hb diffuses within the wound bed 5
- Driven by the oxygen gradient, Hb releases oxygen to hypoxic regions 6 , contributing to multiple cycles of binding and release of oxygen
- The process is reversible, and Hb can absorb more oxygen where available
Research supports the efficacy of wound oxygenation using facilitated diffusion. A EWMA group of experts has assessed the various treatment options available for addressing non-healing wounds 1 , citing topical oxygen therapy as offering accelerated healing with a high level of accessibility and ease of use, even for at-home use by patients.
Clinical studies report that using Granulox haemoglobin spray leads to shorter healing time, reduced pain scores and total cost savings for healthcare providers compared to the standard of care 4 .
- Twice as many chronic wounds healed at 8–16 weeks compared to standard of care 6
- Time to heal diabetic foot ulcers 50% shorter than with standard of care 7
- More than 70% of patients reported lower average pain scores at four weeks than with standard of care in chronic wounds 4
- 99% less slough in chronic wounds after 4 weeks compared to 33% with standard of care 8
3D imaging of a leg ulcer shows 56% O2 saturation, with large areas of deoxygenated Hb (blue) and no Hb (black)
79% saturation, 20 minutes after Granulox (p=0.043), with large areas of oxygenated Hb (red and white)Interested in learning more about Granulox?
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'References'
- Gottrup F, Dissemond J, Baines C, et al. Use of Oxygen Therapies in Wound Healing. Journal of wound care 2017; 26(Sup5): S1-s43.
- Sen CK. Wound healing essentials: let there be oxygen. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society 2009; 17(1): 1-18.
- Hauser CJ. Tissue salvage by mapping of skin surface transcutaneous oxygen tension index. Archives of surgery (Chicago, Ill : 1960) 1987; 122(10): 1128-30.
- Dissemont J, Kröger K, Storck M, Risse A, Engels P. Topical oxygen wound therapies for chronic wounds: a review. Journal of Wound Care, 2015, Feb, 24(2);53-63.
- Petri M, Stoffels I, Griewank K, et al. Oxygenation Status in Chronic Leg Ulcer After Topical Hemoglobin Application May Act as a Surrogate Marker to Find the Best Treatment Strategy and to Avoid Ineffective Conservative Long-term Therapy. Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging 2018; 20(1): 124-30.
- Hunt SD, Elg F. Hemoglobin spray as adjunct therapy in complex wounds: Meta-analysis versus standard care alone in pooled data by wound type across three retrospective cohort controlled evaluations. SAGE Open Medicine, 2018; 6:1-9.
- Hunt SD, Elg F. Clinical effectiveness of hemoglobin spray (Granulox(R)) as adjunctive therapy in the treatment of chronic diabetic foot ulcers. Diabetic foot & ankle 2016; 7: 33101.
- Hunt S, Elg F, Percival S. Assessment of clinical effectiveness of haemoglobin spray as adjunctive therapy in the treatment of sloughy wounds. Journal Wound Care. 2018 Apr; 27(4): 210-219
