Ozone therapy for the treatment of chronic wounds: A systematic review

Abstract

Chronic wounds present a significant burden to the health care system and the patient. Ozone therapy has been proposed as a treatment for chronic wounds, potentially acting by eliciting mild oxidative stress or disinfection. The purpose of this systematic review is to evaluate the potential benefits and harms of ozone therapy as an advanced care intervention for chronic wounds. Studies were extracted from Google Scholar, PubMed, the Cochrane Library, and reference lists. General inclusion criteria included English-language randomised human trials reporting the use of ozone therapy in the topical treatment of chronic wounds. Primary outcome data included the extent of chronic wound healing, and secondary outcomes included adverse effects. Studies were assessed for level of bias and data quality. Nine studies (n = 453 patients) matched the inclusion criteria and underwent meta-analysis. Overall, there was a significant improvement in wound closure with ozone therapy. Results consistently favour the application of ozone as a treatment for chronic wounds; however, there is no conclusive evidence of ozone therapy as superior compared with standard treatments. Compared with standard care, ozone therapy as an advanced wound care treatment may improve the proportion of chronic wounds healed in a shorter amount of time, but further research is required.

Keywords: chronic wound; healing; ozone; ozone therapy; ulcer.

Figure 1

Flow diagram of the search strategy and study selection. A total of 12 455 studies were retrieved from Google Scholar, Medline databases, Cochrane Library, existing systematic reviews, and reference lists. After excluding irrelevant studies, duplicates, and studies where full texts could not be accessed, 9 studies were assessed eligible and included in this systematic review

Figure 2

Meta‐analysis of studies reporting on ozone treatment for chronic wounds. The outcomes in terms of wound healing and percent closure shift in favour of ozone treatment (P‐value <.05). Dotted line shows mean

Figure 3

Risk of bias in studies. (A) Risk of bias item presented as percentages across all included trials. Visual representation of the measure of bias in each bias category across all studies. Green, low risk of bias; Yellow, moderate risk of bias; Red, high risk of bias. There is low risk of attrition and reporting bias across all studies but higher levels of bias with regards to selection and performance bias. (B) Detailed visual bias assessment of each study. Green “+”, low level of bias; Yellow “?”, moderate levels of bias; Red “X”, high level bias. Of the 9 studies, 6 did not effectively blind their participants or researchers; however, 5 of the studies were of low bias in the other areas