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Nussbaum SR, Carter MJ, Fife CE An economic evaluation of the impact, cost, and medicare policy implications of chronic nonhealing wounds. Value Health. 2018; 21:(1)27-32 https://doi.org/10.1016/j.jval.2017.07.007

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Castilla DM, Liu ZJ, Velazquez OC. Oxygen: implications for wound healing. Adv Wound Care. 2012; 1:(6)225-230 https://doi.org/10.1089/wound.2011.0319

Ennis WJ, Huang ET, Gordon H. Impact of hyperbaric oxygen on more advanced wagner grades 3 and 4 diabetic foot ulcers: matching therapy to specific wound conditions. Adv Wound Care. 2018; 7:(12)397-407 https://doi.org/10.1089/wound.2018.0855

Niederauer MQ, Michalek JE, Liu Q Continuous diffusion of oxygen improves diabetic foot ulcer healing when compared with a placebo control: a randomised, double-blind, multicentre study. J Wound Care. 2018; 27:S30-S45 https://doi.org/10.12968/jowc.2018.27.Sup9.S30

Kalliainen LK, Gordillo GM, Schlanger R, Sen CK. Topical oxygen as an adjunct to wound healing: a clinical case series. Pathophysiology. 2003; 9:81-87

Padberg FT, Back TL, Thompson PN, Hobson RW Transcutaneous oxygen (TcPO2) estimates probability of healing in the ischemic extremity. J Surg Res. 1996; 60:(2)365-369 https://doi.org/10.1006/jsre.1996.0059

Kabon B, Kurz A. Optimal perioperative oxygen administration. Curr Opin Anaesthesiol. 2006; 19:11-18

Niinikoski JH. Clinical hyperbaric oxygen therapy, wound perfusion, and transcutaneous oximetry. World J Surg. 2004; 28:307-11

Hopf HW, Rollins MD. Wounds: an overview of the role of oxygen. Antioxid Redox Signal. 2007; 9:1183-1192

Hyperbaric, transcutaneous oximetry. 2020. https://tinyurl.com/y7nml3lv (accessed 26 May 2020)

Blake DF, Young DA, Brown LH. Transcutaneous oximetry: variability in normal values for the upper and lower limb. Diving Hyperb Med. 2018; 48:(1)2-9 https://doi.org/10.28920/dhm48.1.2-9

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Bosschaart N, Edelman GJ, Aalders MC A literature review and novel theoretical approach on the optical properties of whole blood. Lasers Med Sci. 2014; 29:(2)453-479 https://doi.org/10.1007/s10103-013-1446-7

Tseng SH, Bargo P, Durkin A, Kollias N. Chromophore concentrations, absorption and scattering properties of human skin in-vivo. Opt Express. 2009; 17:(17)14599-14617 https://doi.org/10.1364/oe.17.014599

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Trinks TP, Blake DF, Young DA Transcutaneous oximetry measurements of the leg: comparing different measuring equipment and establishing values in healthy young adults. Diving Hyperb Med. 2017; 47:(2)82-87 https://doi.org/10.28920/dhm47.2.82-87

Boezman PRE, Becx BP, Heuvel DAF Monitoring of foot oxygenation with near-infrared spectroscopy in patients with critical limb ischemia undergoing percutaneous transluminal angioplasty: a pilot study. Eur J Vasc Endovasc Surg. 2016; 52:(5)650-656 https://doi.org/10.1016/j.ejvs.2016.07.020

Landsman AS, Barnhart D, Sowa M. Near-infrared spectroscopy imaging for assessing skin and wound oxygen perfusion. Clin Podiatr Med Surg. 2018; 35:(3)345-355 https://doi.org/10.1016/j.cpm.2018.02.005

McKenna JA, Pabbies A, Friesen JR Assessing flap perfusion: optical spectroscopy versus venous doppler ultrasonography. J Otolaryngol head Neck Surg. 2009; 38:(5)587-594

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Clinical/pre-clinical research
Hard-to-heal wounds

Comparing near infrared spectroscopy and transcutaneous oxygen measurement in hard-to-heal wounds: a pilot study

02 July 2020
Clinical Focus
02 July 2020
Volume 4 · Issue 3

Abstract

Objective:

Oxygen plays an integral role in all phases of the wound healing process and tissue oxygenation is a key determinant of wound healing. A comprehensive evaluation of patients with hard-to-heal wounds must include measurement of oxygenation in and around the area of skin breakdown. The current gold standard, transcutaneous oxygen measurement (TCOM), has numerous drawbacks and as a result has fallen into disuse.

Method:

This study compared measurement of tissue oxygenation of near infrared spectroscopy (NIRS) with TCOM in patients with acute and hard-to-heal wounds. The Shapiro-Wilk test was used to evaluate the normality of the data. The level of agreement between NIRS and TCOM was determined using Bland-Altman analysis. The relationship between TCOM and NIRS was examined using Pearson correlation.

Results:

A total of 24 observations were obtained from 10 patients using TCOM and NIRS. The weighted mean partial pressure of oxygen (pO2) in the study population was 39.54mmHg (8.96 standard deviation). Bland–Altman analysis showed that mean difference was positive (18.75), suggesting an overestimation of oxygen measurements using TCOM compared with NIRS. The oxygen levels measured by TCOM and NIRS showed a strong correlation (r=0.74).

Conclusion:

The wound and hyperbaric community would benefit from a simplified procedure for measuring tissue oxygenation. These findings suggest a strong trend toward correlation between NIRS and TCOM. A further study in a larger population is recommended. NIRS offers several advantages over TCOM. Clinicians have immediate point-of-care visualisation of tissue oxygenation using a handheld device. The procedure takes minutes to perform and is less operator-dependent than TCOM. Finally, NIRS allows measurement of oxygenation in the wound bed, while TCOM does not.

Hard-to-heal wounds can take weeks to months to heal, resulting in pain and diminished quality of life (QoL). In addition, open wounds can lead to complications, such as infection, amputation, sepsis and death.1,2,3 An estimated 8.2 million people in the US have hard-to-heal wounds, at a cost exceeding $28 billion dollars annually.3,4 A number of factors impede wound healing: moderate-to-heavy bacterial load, low tissue oxygen tension, elevated inflammatory proteases, diminished growth factors, the presence of nonviable tissue and host factors, such as age and comorbid conditions.5,6

Tissue oxygenation is a key determinant of wound healing.7,8 Oxygen is involved in numerous biological processes including cell proliferation, angiogenesis and protein synthesis.8 In patients with Wagner 3 and 4 diabetic foot ulcers (DFUs), hyperbaric oxygen therapy (HBOT) has been shown to promote healing.9 Similarly, in Wagner 1 and 2 DFUs, topical oxygen treatment has been shown to be efficacious.10 Wound oxygenation measurement is part of the standard evaluation of a patient with a hard-to-heal wound. The gold standard in assessing oxygenation, transcutaneous oxygen measurement (TCOM), measures the partial pressure of oxygen on the skin surface using heated electrodes.10,11,12,13,14,15 Several studies have demonstrated the value of TCOM.10,11,13 It can predict the likelihood of wound healing in patients with and without diabetes. In addition, it is used to decide on the level of amputation and determine the best candidates for HBOT.14,16 However, TCOM has several drawbacks: the procedure is labour and time-intensive, room temperature must be kept between 68°F and 72°F, probes cannot be applied directly to the wound bed or over bony prominences, and the disposable electrodes are expensive.16,17 As a result, the search for a simpler alternative continues.

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advancements in wound care
hard-to-heal wounds
near infrared spectroscopy
oximetry
peripheral vascular insufficiency