Pressure ulcers are chronic wounds characterized by repeated ischemia–reperfusion injury, persistent inflammation, and redox imbalance, in which excessive production of reactive oxygen species (ROS) contributes to delayed healing. Thus, debridement is an essential therapeutic procedure for removing necrotic tissue and biofilm, thereby reconstructing the wound microenvironment. Recent experimental studies suggest that molecular hydrogen may improve wound healing through attenuation of oxidative stress and modulation of inflammatory responses, while debridement represents a dynamic intervention phase in which redox imbalance may transiently develop. Here, we propose the hypothesis that the use of hydrogen-enriched saline as an irrigation solution during hydrosurgical debridement may attenuate excessive redox imbalance and stabilize the wound microenvironment during this dynamic intervention phase. Such intra-procedural modulation may facilitate the transition from inflammation to the proliferative phase of wound healing, thereby promoting tissue repair. This approach is expected to attenuate the transient oxidative burst following debridement, as reflected by reductions in redox-related biomarkers in the wound environment, including ROS levels and oxidative damage markers such as 8-hydroxy-2′-deoxyguanosine and lipid peroxidation products, with relative decreases in these biomarkers compared with conventional debridement, potentially consistent with reductions observed in preclinical oxidative stress models. These findings are consistent with findings from previous experimental studies demonstrating attenuation of oxidative stress markers following hydrogen administration. This hypothesis introduces a novel therapeutic concept, redox modulation during the debridement process, offering a practical strategy for integrating hydrogen-based therapy into existing wound management without altering current surgical techniques.
Shinkai et al. (2026) studied this question.