Abstract
Peripheral circulation is severely compromised in the advanced stages of peripheral arterial disease. Recently, it was shown that the application of −40 mmHg intermittent negative pressure (INP) to the lower leg and foot enhances macro‐ and microcirculation in healthy volunteers. In this case report, we describe the effects of INP treatment on four patients with lower limb ischemia and hard‐to‐heal leg and foot ulcers. We hypothesized that INP therapy may have beneficial hemodynamic and clinical effects in the patients. Four patients (age range: 61–79 years) with hard‐to‐heal leg and foot ulcers (6–24 months) and ankle‐brachial pressure indices of ≤0.60 on the affected side were included. They were treated with an 8‐week intervention period of −40 mmHg INP (10 sec negative pressure and 7 sec atmospheric pressure) on the lower limbs. A custom‐made vacuum chamber was used to apply INP to the affected lower leg and foot for 2 h per day. After 8 weeks of INP therapy, one ulcer healed completely, while the other three ulcers were almost completely healed. These cases suggest that INP may facilitate wound healing. The theoretical foundation is that INP assists wound healing by improving blood flow to the small blood vessels in the affected limb, increasing the flow of oxygen and nutrients to the cells.
Highlights
Arterial leg ulcers result from insufficient blood supply to the tissues
Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society
In these cases involving patients with hard-to-heal leg and foot ulcers, we observed that intermittent negative pressure (INP) therapy improved ulcer healing considerably
Summary
Arterial leg ulcers result from insufficient blood supply to the tissues. In patients with advanced stages of peripheral arterial disease (PAD), ulcers of the lower leg are common, due to reduced microcirculation in the extremities (Mekkes et al 2003; Grey et al 2006). Smyth (1969) applied a similar INP methodology to the lower limb (À150 mmHg), and observed increased wound healing and walking distance after 6 weeks of INP-therapy in patients with peripheral vascular disease (Smyth 1969). Despite these results, little attention has been given to the INP method in recent years. After 8 weeks of INP-therapy 2 h per day, the leg ulcer almost healed (Fig. 1), and the SPP measured on the patient’s right anterior and posterior tibial artery angiosomes on his right foot changed from 51 to 72 mmHg and 14 to 11 mmHg, respectively. The wound on the dorsum of the foot healed completely, while the size of the wound on the heel was almost healed after 8 weeks of INP treatment (Table 1 and Fig. 1)
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