Topical Wound Oxygen Versus Conventional Compression Dressings in the Management of Refractory Venous Ulcers

Abstract

Topical wound oxygen (TWO 2 ) proposes an innovative therapy option in the management of refractory non-healing venous ulcers (RVU) that aims to accelerate wound healing. TWO 2 accelerates epithelialisation. This leads to the development of a higher tensile strength collagen, which lessens scarring and the risk of recurrence. Sixty-seven limbs with 67 ulcers were managed using TWO 2 therapy, and 65 limbs with 65 ulcers were managed using conventional compression dressings (CCD). The proportion of ulcers completely healed by 12 weeks was 76% in patients managed with TWO 2 , compared to 46% in patients managed with CCD (p < 0.0001). The mean reduction in ulcer surface area at 12 weeks was 96% in the TWO 2 therapy group, compared to 61% in patients managed with CCD. The median time to full ulcer healing was 57 days in the TWO 2 group, in contrast to 107 days in patients managed with CCD (p < 0.0001). TWO 2 patients had a significantly improved Quality-Adjusted Time Spent Without Symptoms of disease and Toxicity of treatment (Q-TWiST) compared to CCD patients, denoting an improved outcome (p < 0.0001). TWO 2 reduces the time needed for RVU healing and is successful in pain alleviation and MRSA elimination. TWO 2 therapy radically degrades recurrence rates. Utilising diffused oxygen raises the capillary partial pressure of oxygen (Po 2 ) levels at the wound site, stimulating epithelialisation, and granulation of new healthy tissue. Taking the social and individual aspects of chronic venous ulceration into account, the use of TWO 2 can provide an overwhelmingly improved quality of life for long-time sufferers of this debilitating disease.

Comparison of the efficacy of topical hyperbaric oxygen therapy alone vs a combination of physical methods including topical hyperbaric oxygen therapy, magnetotherapy, and low‐energy light therapy in the treatment of venous leg ulcers

“…Due to the complex etiopathogenesis of such wounds, the most beneficial therapeutic results are obtained in case of multidirectional treatment model, taking into consideration the synergies between individual therapeutic methods, including also the physical ones. 23,24 The results of the current study have confirmed the therapeutic efficacy of both forms of T A B L E 1 Comparison of results concerning pain experienced, provided in Laitinen scale in both groups of patients undergoing treatment, before the beginning and after the completion of applied cycle of physical procedures (after 17 weeks), with statistical assessment as well as reduced pain intensity, whatever the ulceration etiology was. In some available papers the results of topical hyperbaric oxygen therapy were slightly better when compared to those obtained by application of only compression therapy and dressing.…”

“…Treatment of wounds, particularly those which are hard to heal, should be conducted in a complex manner in specialized centers, as the therapeutic procedures provided at basic level are not sufficient in many cases, and do not give fully satisfactory results. Due to the complex etiopathogenesis of such wounds, the most beneficial therapeutic results are obtained in case of multidirectional treatment model, taking into consideration the synergies between individual therapeutic methods, including also the physical ones 23,24 . The results of the current study have confirmed the therapeutic efficacy of both forms of physical treatment compared, while the results in the group of patients where combined physical procedures were applied with the use of LASEROBARIA‐S device were significantly better.…”

“…In some available papers the results of topical hyperbaric oxygen therapy were slightly better when compared to those obtained by application of only compression therapy and dressing 28,29 . In none of the studies, were significant side effects or complications of topical hyperbaric oxygen therapy found 8,9,24,30‐32 …”

“…28,29 In none of the studies, were significant side effects or complications of topical hyperbaric oxygen therapy found. 8,9,24,[30][31][32] It was confirmed in experimental and clinical studies conducted so far that one of the basic underlying mechanisms of regenerative effect of topical HBO in patients with chronic leg ulcers is the restoration, via trans-dermal application of hyperbaric oxygen, of the proper oxygenation of tissues in the ulceration area, despite arterial occlusion by leucocytes and platelet plugs forming the no-reflow phenomenon, as well as deteriorated blood rheology parameters, which result in hindering the access of arterial blood, saturated with oxygen. 8,23,24 A sufficient amount of oxygen in tissues is indispensable for regular development of all stages of ulcer healing process.…”

Venous Leg Ulcers: Advanced Therapies and New Technologies

“…TOT is applied directly to the wound and does not require a full-body compression chamber. That is why TOT has much lower systemic complications and can be the alternative for patients with contraindication to HBOT [ 26 , 30 ].…”