References
Topical oxygen treatment relieves pain from hard-to-heal leg ulcers and improves healing: a case report
Abstract
Pain from hard-to-heal wounds is common and challenging to manage with current therapies. Most hard-to-heal wounds show some degree of hypoxia that impairs healing and contributes to pain. Regular oxygen therapy is given in hyperbaric oxygen chambers and is costly, time-consuming and cannot be offered to most patients. Moreover, hyperbaric oxygen therapy (HBOT) only increases tissue oxygen for a short time and is given only for a few hours per week. Topical oxygen therapy (TOT) was introduced as an alternative and in this report we focus on topical continuous oxygen therapy (TCOT), which has been shown to be associated with healing of hard-to-heal ulcers. We report on a patient with type 1 diabetes with a painful hard-to-heal lower leg ulcer that failed to heal with standard wound dressings and that had insufficient response to pharmacological analgesia. The patient was on three different analgesics before treating the wound with TCOT. As the wound was considered hypoxic, due to longstanding diabetes and probable microangiopathy, TCOT was commenced. Within one week of treatment starting, the patient spontaneously ceased all his analgesics as he was free of pain; and after 2.5 months, the ulcer healed. The patient reported no adverse effects. In addition to promoting healing, TCOT may also be considered for its potential analgesic effects in hard-to-heal wound management.
Hard-to-heal leg ulcers cause great suffering and are very costly to society. In particular, wound pain is difficult to manage because analgesics often have insufficient effect. Hard-to-heal wounds caused by arterial insufficiency and diabetic microangiopathy are well known for being hypoxic;1 however, the most common ulcer type, venous ulcers, are also hypoxic.2
Hyperbaric oxygen therapy (HBOT) increases the oxygen systemically in the whole body and has been used for different wound types for decades; however, it is only used for selected cases and has had limited success and availability.3 In an experimental study, topically applied oxygen was shown to increase the oxygenation of superficial wound tissue in pigs,4 and because of the limitations with HBOT, topical oxygen therapy (TOT) has been introduced successfully. TOT is divided into four categories: pressurised oxygen therapy; wound dressings that release oxygen; topical oxygen emulsion; and topical continuous oxygen therapy (TCOT). The patient in this report received TCOT.5 TCOT was shown to improve healing of diabetic foot ulcers (DFUs) compared with placebo,6 and was also associated with hard-to-heal leg and foot ulcer healing.7,8 Randomised controlled trials (RCTs) on DFUs support these findings.9,10 The analgesic properties of TOT have thus far not been studied. Here, we present a novel case on the potential wound analgesic effect of TCOT.
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