Transcutaneous oxygen tension: a useful predictor of ulcer healing in critical limb ischaemia

Ruangsetakit, Chanean; Chinsakchai, Khamin; Mahawongkajit, Prasit; Wongwanit, Chumpol; Mutirangura, Pramook

doi:10.12968/jowc.2010.19.5.48048

Cited by 75 publications

(37 citation statements)

References 15 publications

(12 reference statements)

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“…In the group exhibiting impaired wound healing, TcPO 2 at the dorsum of the foot averaged 13 mmHg whereas it was 60 mmHg at a reference point on the chest. In a study of ulcer healing in patients with critical limb ischemia Ruangsetakit et al, reported that none of the patients with TcPO 2 less than 20 mmHg showed signs of ulcer healing, whereas all of the patients with a TcPO 2 greater than 40 mmHg showed a progression toward healing during the study period. The poor healing of ischemic wounds underscores the importance of oxygen supplied to the wound via blood circulation.…”

mentioning

confidence: 99%

Microsensor and transcriptomic signatures of oxygen depletion in biofilms associated with chronic wounds

James

Zhao

Usui

et al. 2016

Wound Repair Regeneration

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Biofilms have been implicated in delayed wound healing, although the mechanisms by which biofilms impair wound healing are poorly understood. Many species of bacteria produce exotoxins and exoenzymes that may inhibit healing. In addition, oxygen consumption by biofilms and by the responding leukocytes, may impede wound healing by depleting the oxygen that is required for healing. In this study, we used oxygen microsensors to measure oxygen transects through in vitro-cultured biofilms, biofilms formed in vivo within scabs from a diabetic (db/db) mouse wound model, and ex vivo human chronic wound specimens. The results show that oxygen levels within mouse scabs had steep gradients that reached minima ranging from 17-72 mmHg on live mice and 6.4-1.1 mmHg on euthanized mice. The oxygen gradients in the mouse scabs were similar to those observed for clinical isolates cultured in vitro and for human ex vivo specimens. To characterize the metabolic activities of the bacteria in the mouse scabs, we performed transcriptomics analyses of Pseudomonas aeruginosa biofilms associated with the db/db mice wounds. The results demonstrated that the bacteria expressed genes for metabolic activities associated with cell growth. Interestingly, the transcriptome results also indicated that the bacteria within the wounds experienced oxygen-limitation stress. Among the bacterial genes that were expressed in vivo were genes associated with the Anr-mediated hypoxia-stress response. Other bacterial stress response genes highly expressed in vivo were genes associated with stationary-phase growth, osmotic stress, and RpoH-mediated heat shock stress. Overall, the results support the hypothesis that bacterial biofilms in chronic wounds promote chronicity by contributing to the maintenance of localized low oxygen tensions, through their metabolic activities and through their recruitment of cells that consume oxygen for host defensive processes.

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mentioning

confidence: 99%

Microsensor and transcriptomic signatures of oxygen depletion in biofilms associated with chronic wounds

James

Zhao

Usui

et al. 2016

Wound Repair Regeneration

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“…Many factors, including sex, 6,7 age, 6,7 physiological 8 and biochemical 9,10 variables, nutritional status, 9 and complications, 11–13 have been reported to be predictors of wound prognosis in chronic ulcers. Another key predictor of limb prognosis may be the initial location of necrosis.…”

Section: Discussionmentioning

confidence: 99%

Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis

Sano¹,

Ichioka

2014

Plastic and Reconstructive Surgery Global Open

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Summary:The initial location of necrosis may affect the limb salvage rate. This study of 130 patients with chronic toe ulcers or gangrene was performed to assess whether the location of initial necrosis in the toes affected limb salvage prognosis. The patients were divided into 2 groups according to whether the initial necrosis was in the great toe or in other toes. Limb salvage prognosis was determined retrospectively. In the great toe group, the rates of total toe loss and major amputation were 50.0% and 24.4%, respectively. When the initial necrosis was in other toes, these rates were 27.3% and 9.3%, respectively. Great toe necrosis is associated with significantly higher rates of total toe loss (odds ratio = 3.10; P = 0.003; 95% confidence interval, 1.43−6.68) and major amputation (odds ratio = 3.66; P = 0.007; 95% confidence interval, 1.37−9.79). The great toe is supplied by 3 source arteries, whereas the lesser toes are fed by 1 or 2 arteries. Therefore, necrosis initiating from the great toe may reflect the presence of severe vascular disorders. The great toe is also anatomically connected to much of the foot via the tendons. Infection is more likely to spread along these tendons, which may reduce limb prognosis. Thus, the initial location of necrosis may be predictive of limb prognosis.

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“…Among patients with ischemic ulcers, a transcutaneous oxygen tension of more than 40 mm Hg was predictive of complete closure. 8 No improvement was noted in the wound condition in patients with TcPO 2 of less than 20 mm Hg. The key question is whether there is any merit in considering supplementary oxygen in wound management.…”

Section: Oxygen and Wound Healingmentioning

confidence: 91%

Continuous Topical Oxygen for the Treatment of Chronic Wounds

Woo

Coutts²,

Sibbald³

2012

Advances in Skin &Amp; Wound Care

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Oxygen is essential for all stages of wound healing. Previous research has shown topical administration of oxygen to have positive effects on wound healing. In this study, the application of transdermal continuous topical oxygen therapy (TCOT) was evaluated for its effect on chronic wound healing in 9 patients. After 4 weeks of treatment, mean wound surface area and wound infection checklist scores were significantly reduced. Signs of bacterial damage were also reduced. Findings from this study suggest TCOT may be beneficial in promoting chronic wound healing.

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Transcutaneous oxygen tension: a useful predictor of ulcer healing in critical limb ischaemia

Cited by 75 publications

References 15 publications

Microsensor and transcriptomic signatures of oxygen depletion in biofilms associated with chronic wounds

Microsensor and transcriptomic signatures of oxygen depletion in biofilms associated with chronic wounds

Great Toe Necrosis Predicts an Unfavorable Limb Salvage Prognosis

Continuous Topical Oxygen for the Treatment of Chronic Wounds

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