Topical oxygen therapy in acute traumatic musculoskeletal wounds of the foot and ankle
To quantify the reduction in wound size and change in wound quality following low-cost topical oxygen therapy (TOT) in patients with acute traumatic musculoskeletal wounds of the foot and ankle.
This prospective interventional study included patients with acute traumatic musculoskeletal wounds of the foot and ankle of <3 weeks' duration after they had undergone debridement and required subsequent wound coverage. A sterile C-Arm cover was used to cover the wound and 100% oxygen was administered at 1 atm, at a rate of 10l/min for 90 minutes on each of four consecutive days, through a suction catheter connected to an oxygen cylinder. The cycle was repeated after a three-day break. Wound surface area (by plotting on graph paper) and wound quality (by modified wound infection checklist score and swabs for culture and Gram staining) were assessed before and after TOT application.
The study cohort included 20 patients ≥18 years of age. There was a statistically significant (p<0.001) reduction in mean wound surface area from 79.3cm2 at baseline to 69.6cm2 after two cycles of TOT. The mean modified wound infection checklist score was 13.6 and 0.8, respectively, before and after two cycles of TOT, suggesting statistically significant improvement (p=0.02) in wound quality. All patients showed no growth in their wound culture after TOT.
TOT appears to be a promising and cost-effective alternative in the management of traumatic wounds. However, future studies with larger sample sizes and control groups for comparison are needed to establish the benefit of TOT in acute traumatic musculoskeletal wounds.
Disrupted vasculature, and high energy and oxygen demand result in hypoxia at the tissue level in regenerating wounds. Oxygen delivery is a critical element in all stages of wound healing. Factors that can increase oxygen delivery to the injured tissue, such as supplemental oxygen, can accelerate the process of wound healing.1
Topical oxygen therapy (TOT) represents a cost-effective approach to promote wound angiogenesis. It is associated with vascular endothelial growth factor (VEGF) expression in wound edge tissue and improvement in wound closure outcomes.2 Although TOT is being used for the treatment of open wounds, it remains a less-explored modality. Its advantages include non-dependence on the wound's microcirculation, low cost, no systemic oxygen toxicity and the ability to provide treatment at the patient's home.3
This study was conducted to assess the reduction in wound size and change in wound quality following the use of low-cost TOT in patients with acute traumatic musculoskeletal wounds of the foot and ankle. There is no previously published report on this topic to our knowledge.
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