Topical wound oxygen therapy for chronic diabetic lower limb ulcers and sacral pressure ulcers

20 Wounds International 2015 | Vol 6 Issue 1 | ©Wounds International 2015 | www.woundsinternational.com The global incidence of chronic wounds has increased in recent years, driven by the increase in aging and bed-bound populations, with a concomitant upsurge in peripheral arterial disease and diabetes. The lack of adequate tissue oxygenation stemming from poor blood circulation is a common characteristic of diabetic and pressure ulcers. Oxygen plays an important role in the wound healing process[1,2], as well as in infection control[3-5]. Enhanced wound healing and a reduced bacterial burden are thus expected to be advantageous outcomes following the direct local administration of oxygen to chronic ulcers of the skin[6-10]. Local topical oxygen wound therapy is widely employed in North American and European countries, with good reported efficacy [7,11,12]. In late 2010 after Institutional Review Board (IRB) approval, our research group at the Saitama Medical University Hospital (Saitama, Japan) initiated the first clinical investigation of this therapy in Japan and introduced this treatment with two case reports[13,14]. These reports looked at the efficacy of topical oxygen wound therapy in inducing healthy granulation tissue, improvement of transcutaneous oxygen tension and successful wound closure in patients with diabetic foot wounds and pressure ulcers. The following case report follows up on the initial study with results from six patients who presented at the hospital with either chronic diabetic leg or foot ulcers, or sacral pressure ulcers, providing full details of one case. Treatment protocol Six patients with diabetic leg or foot ulcers (n=5) or sacral pressure ulcers (n=1) that had not healed in 3 months, despite use of best practice standard wound care — including surgical debridement and negative pressure wound therapy followed by moist wound dressings — were enrolled in the trial [Table 1]. In addition to IRB approval from the Saitama Medical University Hospital, informed consent was obtained from each enrollee. Local topical wound oxygen therapy was applied along with best practice standard wound care. Sharp debridement was performed in five cases (n=4 diabetic ulcers; n=1 sacral pressure ulcer) to remove unproductive and infected tissue. The single-use HyperBox topical wound oxygen (two2TM) extremity chamber (AOTI, Oceanside, CA, USA) [Figure 1a] was employed for diabetic foot and leg ulcers, and the sacral topical hyperbaric oxygen chamber unit (AOTI) [Figure 1b] was employed for sacral pressure ulcers. Treatment was provided for 5 days a week, 90 minutes a day, according to the protocol recommended by the manufacturer. This treatment plan was continued for 4 weeks at the outset, or until spontaneous wound closure or sufficient granulation tissue formation was attained for operative wound closure via skin grafting. The wound dressings were removed at the beginning of each treatment session. In the case of diabetic foot and leg ulcers, the affected Topical wound oxygen therapy for chronic diabetic lower limb ulcers and sacral pressure ulcers in Japan