Abstract
Background: Chronic wounds are a growing problem internationally, termed a silent epidemic. To combat this epidemic, it is not sufficient to rely on traditional wound care treatments alone, but to look to innovative and alternative therapies. The indispensable role of oxygen in wound healing is well-discussed in the literature, and in the past two decades the topical application of oxygen has shown promising results in the healing of chronic wounds. However, the toxic effects of oxygen are usually not appreciated and can often lead to wound necrosis and gangrene in wounds with compromised blood supply. While wounds with adequate blood supply contain free radical quenchers (catalase, superoxide dismutase and reduced glutathione) which neutralize the free radicals (reactive oxygen species) released as a by-product of the Krebs cycle, wounds with deficient blood supply are deficient in free radical quenchers and are further damaged by exposure to oxygen as a result of reperfusion injury/oxygen toxicity. Topical hyperbaric oxygen (THOT®) uses low oxygen tensions in the hyperbaric range to stimulate angiogenesis, while preventing excessive oxygen toxicity. The result is the induction of marked angiogenesis, with increasing capacity for quenching reactive oxygen species, resulting in wound healing of ischemic wounds. Case Presentation: This case report describes a 95-year-old Caucasian female who presented with a stage IV chronic necrotic ulcer on her lower left leg. Surgical pathology results revealed calcifying vasculopathy, which is thought to be responsible for deficient blood supply to the leg, leading to a necrotic, chronic leg ulcer of her left leg. After traditional wound therapies were unsuccessful, she was considered for leg amputation. The introduction of adjunctive treatment with topical hyperbaric oxygen therapy saw complete healing of the wound within 15 weeks. The wound remained closed, without the presence of scar tissue, with no signs of wound breakdown at three-month and six-month follow-ups. Conclusions: Chronic hypoxic wounds with vascular insufficiency are considered “unlikely to heal” and tend to lead to limb amputation. The use of THOT® technology, with low hyperbaric oxygen tensions to neutralize free radicals released by the Krebs cycle when oxygen contacts the wound, prevents oxygen toxicity and results in angiogenesis necessary for wound healing. In this way, THOT® treatment was able to convert the hypoxic “unlikely to heal” wound considered for limb amputation into one which healed, with limb salvage. The results of this case report demonstrate the potential for complete healing of chronic hypoxic wounds even in complex cases with multiple confounding factors preventing wound healing, using a cost-effective treatment that is easily accessible to patients.
Highlights
Chronic wounds, defined as wounds that fail to heal, are placing an increased burden on a health care system already encumbered by increased patient morbidity, an aging population, and rising health care costs [1] [2]
These findings are consistent with the notion that as the new blood vessels became more numerous, less necrotic tissue was formed from reperfusion injury, since free radical quenchers were contained within blood vessels, The turning point came when the number of new blood vessels provided free radical quenching properties that was sufficient to neutralize the free radicals produced by oxidative phosphorylation so that there was no further reperfusion injury when wound tissues were exposed to oxygen (Figures 13-21)
Hypoxic wounds covered by black or yellow necrotic tissue are associated with insufficient blood supply leading to low TcPO2 values
Summary
Chronic wounds, defined as wounds that fail to heal, are placing an increased burden on a health care system already encumbered by increased patient morbidity, an aging population, and rising health care costs [1] [2]. Oxygen is required for tissue repair and regeneration, necessary in nearly every phase of the wound healing process. Is it a component of cellular metabolism, yielding energy for use by the cells in the repair process, but it is essential for the synthesis of protein and the production of blood vessels and collagen—vital materials in wound repair and quality healing [5] [6]. Fibroblasts are involved in the process of collagen deposition, help form granulation tissue whose presence is the hallmark of an established healing response, and produce the glycoprotein Vascular Endothelial Growth Factor (VEGF) [11]. Chronic wounds, suffering from hypoxia, are more prone to infection and lack the necessary energy, vascularization, and collagen production required for effective tissue repair
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