The Presence of Oxygen in Wound Healing

Howard M. Kimmel, DPM, MBA; Anthony Grant, DPM; James Ditata, BSN, RN, CNOR


Wounds. 2016;28(8):264-270. 

In This Article

Abstract and Introduction


Oxygen must be tightly governed in all phases of wound healing to produce viable granulation tissue. This idea of tight regulation has yet to be disputed; however, the role of oxygen at the cellular and molecular levels still is not fully understood as it pertains to its place in healing wounds. In an attempt to better understand the dynamics of oxygen on living tissue and its potential role as a therapy in wound healing, a substantial literature review of the role of oxygen in wound healing was performed and the following key points were extrapolated: 1) During energy metabolism, oxygen is needed for mitochondrial cytochrome oxidase as it produces high-energy phosphates that are needed for many cellular functions, 2) oxygen is also involved in the hydroxylation of proline and lysine into procollagen, which leads to collagen maturation, 3) in angiogenesis, hypoxia is required to start the process of wound healing, but it has been shown that if oxygen is administered it can accelerate and sustain vessel growth, 4) the antimicrobial action of oxygen occurs when nicotinamide adenine dinucleotide phosphate (NADPH)-linked oxygenase acts as a catalyst for the production of reactive oxygen species (ROS), a superoxide ion which kills bacteria, and 5) the level of evidence is moderate for the use of hyperbaric oxygen therapy (HBOT) for diabetic foot ulcers, crush injuries, and soft-tissue infections. The authors hypothesized that HBOT would be beneficial to arterial insufficiency wounds and other ailments, but at this time further study is needed before HBOT would be indicated.


Oxygen is a significant factor in wound healing. In general, living tissue needs oxygen and nutrients to thrive, and with wounds, it is needed to regenerate healthy tissue. In normal wound healing, the wound either requires conditions of hypoxia or normal levels of oxygen (ie, normoxia). These different conditions occur in all phases of wound healing. A wound is dependent on both the supply of oxygen to the wound tissue, which is determined by the pulmonary gas exchange, and the blood hemoglobin level. The cardiac output of the patient, the perfusion rate, and the amount of capillaries around the wound along with the consumption rate of parenchymal and stromal cells determine these levels.[1] This paper will discuss the role of oxygen in healthy wound healing. The discussion will examine how oxygen is produced, consumed, and used in the various stages of wound healing at both a molecular level and a cellular level. Finally, there will a brief discussion on the use of oxygen as therapy.