Ozone, an allotropic form of oxygen possesses unique properties which are being defined and applied to biological systems as well as to clinical practice. As a molecule containing a large excess of energy, ozone, through incompletely understood mechanisms, manifests bactericidal, virucidal and fungicidal actions which may make it a treatment of choice in certain conditions and an adjunctive treatment in others.

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Ozone, an allotropic form of oxygen, possesses unique properties which are being defined and applied to biological systems as well as to clinical practice. As a molecule containing a large excess of energy, ozone, through incompletely understood mechanisms, manifests bactericidal, virucidal, and fungicidal actions which may make it a treatment of choice in certain conditions and an adjunct to treatment in others.

The oxygen atom exists in nature in several forms: (1) As a free atomic particle (0), it is highly reactive and unstable. (2) Oxygen (02), its most common and stable form, is colorless as a gas and pale blue as a liquid. (3) Ozone (03), has a molecular weight of 48, a density one and a half times that of oxygen, and contains a large excess of energy in its molecule (03 -> 3/2 02 + 143KJ/mole). It has a bond angle of 127 ± 3, resonates among several forms, is distinctly blue as a gas, and dark blue as a solid. (4) 04 is a very unstable, rare, nonmagnetic pale blue gas, which readily breaks down into two molecules of oxygen.

Ozone is a powerful oxidant, surpassed in this regard only by fluorine. Exposing ozone to organic molecules containing double or triple bonds yields many complex and as yet incompletely configurated transitional compounds (i.e. zwitterions, molozonides, cyclic ozonides), which may be hydrolysed, oxidized, reduced, or thermally decomposed to a variety of substances, chiefly aldehydes, ketones, acids or alcohols. Ozone also reacts with saturated hydrocarbons, amines, sulfhydryl groups, and aromatic compounds.

Importantly relevant to biological systems is ozone's interaction with tissue--including blood--constituents. The most studied is lipid peroxidation, although interactions have yet to be more fully investigated with complex carbohydrates, proteins, glycoproteins, and sphingolipids.

Introduction

Diabetes is a disorder of metabolism and of the circulation. Chronic metabolic irregularities linked to poor circulatory perfusion and nerve damage can affect a number of organ systems, including skin tissues. In this article, the focus is on factors in diabetes that can contribute to dermal breakdown, ulceration, and infection. Most importantly, it proposes a treatment modality, which, backed by solid experimental, and clinical data cumulated worldwide, shows great promise in the management of diabetes-related skin lesions.

The conditions surveyed include infected wounds, skin ulcers and gangrene. These wounds, in the context of diabetes, are notoriously difficult to resolve. Healing resistance is thus a well-recognized element of frustration in their clinical care.

In most of the above conditions, multiple factors play into healing resistance. Among them are circulatory impairments, neurological deficits, tissue injury, and immunological compromise. A central factor is the proliferation of infectious microorganisms that, by the variety of their families, their toxin-producing capacities, and their resistance to antibiotics, offer daunting obstacles to standard treatment regimens.

Approximately 15% of the estimated 20 million Americans afflicted with diabetes mellitus develop lower leg skin ulcers. Of those patients, 20% will eventually require amputations. Diabetes mellitus is the leading cause of nontraumatic lower extremity amputation in the United States (LeRoith 2003).

The therapeutic actions of gaseous ozone/oxygen mixtures applied to wounds have long been recognized. Only recently, however, have we seen major advances in the understanding of their biochemical and physiological mechanisms.