Topical oxygen therapy stimulates healing in difficult, chronic wounds: a tertiary centre experience

Skin necrosis after autologous fat grafting for augmentation rhinoplasty: a case report and review of the literature

BACKGROUND

Autologous fat transplantation has gained increasing attention in the field of cosmetic surgery. However, a series of complications can occur after fat transplantation.

CASE PRESENTATION

A 24-year-old woman presented at our Hospital with nasal skin necrosis and ulceration. She had undergone autologous fat transplantation on the nose six days ago. Physical examination showed an abnormal skin range of approximately 5 × 2 cm on the left side of the nose. The initial diagnosis was "skin necrosis after autologous fat grafting for augmentation rhinoplasty." In addition to the conventional treatment, topical oxygen therapy (TOT) and platelet-rich fibrin (PRF) injection were applied to the nasal wounds area. After 16 days, the pale and dark areas of necrosis on nose were scabby, and the local skin conditions were significantly improved.

CONCLUSION

We treated a case of ischemic necrosis of the skin after autologous fat grafting for augmentation rhinoplasty. For this kind of local vascular embolism, we first proposed a comprehensive therapy of "biological + physical + drug." The therapeutic method achieved satisfactory results, providing a new strategy for the clinical treatment of vascular embolism.

Arterial Leg Ulcers in the Octogenarian

Arterial leg ulcers are a debilitating sequela of chronic ischemia, and their management, particularly in the octogenarian, is an immense challenge. ALUs are frequently a manifestation of end-stage peripheral arterial disease, and their presence portends a high morbidity and mortality. Management primarily relies on restoration of flow, but in the geriatric population, interventions may carry undue risk and pathologies may not be amenable. Adjunctive therapies that improve quality of life and decrease morbidity and mortality are therefore essential, and understanding their benefits and limitations is crucial in developing a multimodal treatment algorithm of care for the uniquely challenging octogenarian population.

Silicone dressing combined with topical oxygen therapy alleviates incontinence-associated dermatitis via NF-κB p65/STAT1 signaling pathway

BACKGROUND

Incontinence-associated dermatitis (IAD) is a tough problem in clinical settings, not only increasing the risk of complications like catheter-related urinary tract infections and pressure ulcers in elderly and critically ill patients, but also prolonging hospital stays, raising hospital costs, and possibly leading to medical disputes. This study is aimed to evaluate the therapeutic effect of silicone dressing combined with topical oxygen therapy on IAD in a rat model.

METHODS

An IAD rat model induced by synthetic urine with trypsin was established. Hematoxylin & eosin staining was carried out to examine skin histology. Using immunofluorescence, the microvessel density in the affected skin tissues was determined. ELISA was performed to measure the concentrations of inflammatory cytokines and angiogenic factors in serum. The mRNA expression of EGF, PDGF, and VEGF was detected via qRT-PCR. Western blotting was employed to determine NF-κB p65/STAT1 pathway-related protein levels.

RESULTS

Compared to single therapy, silicone dressing combined with topical oxygen therapy could significantly reduce the severity of IAD, improve skin histology, inhibit inflammation, and promote angiogenesis in IAD rat models. Additionally, the results showed that relatively speaking, the combined therapy suppressed the NF-κB p65/STAT1 signaling pathway more effectively.

CONCLUSION

These findings indicated that silicone dressing combined with topical oxygen therapy can alleviate IAD through promoting wound healing and inhibiting inflammation via NF-κB p65/STAT1 signaling pathway in a rat model, which provided a theoretical basis for the prevention and treatment of IAD in clinic.

An Observational Clinical Trial Examining the Effect of Topical Oxygen Therapy (Natrox™) on the Rates of Healing of Chronic DiAbetic Foot Ulcers (OTONAL Trial)

Natrox™ topical oxygen therapy (TOT) (Inotec AMD Ltd, Cambridgeshire, UK) employs a small battery-powered "oxygen generator" to concentrate atmospheric oxygen and feeds pure, moist, oxygen through a fine, soft tube to a dressing-like "oxygen distribution system", which is placed over the wound and is held in place by a conventional dressing. The aim was to determine the effectiveness of Natrox™ for non-healing diabetic foot ulcers (DFU) over a 3-month period.Longitudinal, single-arm, open prospective registry study using 12 weeks of TOT using a 4 week run-in period. 20 patients recruited to OTONAL had chronic DFU greater than 3 months duration or minor amputation sites with less than 50% healing in 4 weeks.There were 13 (65%) males and the mean age was 65.7 (±11.6) years. The mean glycated haemoglobin (HbA1c) was 6.9 (±1.3) mmol mol-1 and mean wound duration before TOT was 114 (±79.1) days. 18/20 (90.0%) patients had concomitant lower limb revascularization angioplasty for chronic limb threatening ischaemia. The mean size of the foot ulcer at baseline was 11.3 ± 14.8 cm2 and mean transcutaneous oxygen measurement value was 34.1 (±19.6) mm Hg. Wound closure of >75% was observed in 14/20 (70.0%) patients. There was a 91.3% (±14.9%) wound area reduction by 3 months (P = .001) and mean time for 100% closure was 77.6 ± 32.5 days. Mean pain scores reduced from 2.4 (±1.8) at baseline to .5 (±1.0) at 3 months (P = .008). All patients were very satisfied using the ambulatory device. Use of TOT in chronic diabetic foot wounds stimulates a healing state, underpinning the concept that oxygen plays a central role in wound healing. Our results are more compelling if you consider they started with relatively large-sized DFUs and majority of patients were frail with underlying peripheral artery disease. (NCT03863054).

Systematic review of the effects of topical oxygen therapy on wound healing

Background

Various adjunct therapies are available for wound healing in addition to standard care. Topical oxygen therapy (TCOT) is one such novel therapy. We conducted a systematic review and meta-analysis to evaluate the role of TCOT in the healing of cutaneous wounds of any etiology.

Methods

The review was conducted on articles related to wounds treated with TCOT identified through PubMed, MEDLINE/OVID, Cochrane, and Google Scholar. We included randomized controlled trials, double-arm prospective studies, single-arm prospective studies, case-control series, and case reports published on or after 2012. Only articles addressing TCOT were included; other forms of oxygen delivery were excluded. We aimed to evaluate the proportion of wounds completely healed, the percent decrease in wound area of those not completely healed, the recurrence of wounds after treatment, and effects on pain and ulcer rating scales.

Results

A total of 22 articles were included in this review. The results showed that TCOT has a significant salutary effect on complete wound healing in case-control studies (odds ratio, 4.48; 95% confidence interval, 2.05-9.77; P < .001; I 2 = 76.34%) and in single-arm studies (pooled prevalence, 0.48 [48.0%]; 95% confidence interval, 0.34-0.62; P < .001; I 2 = 86.58). However, no significant effect was observed for percent wound reduction, the difference in ulcer grade scores, or the difference in pain scores. Most of the included studies had a high risk of bias because they were not blinded, were single-arm studies, or were case reports.

Conclusions

Our findings indicate that TCOT can have a positive effect on wound healing when compared with standard care. However, owing to the lack of randomized, controlled trials or studies with comparable end points, a definitive conclusion on the full impact of TCOT on wound healing cannot be reached. More high-quality data are needed to definitively determine the effects of TCOT on wound healing, preferably from a comprehensive, randomized controlled trial.

An oxygen-releasing agent promotes healing of skin wounds in rats

OBJECTIVE

To evaluate the local effect of a slow oxygen-release gel on the healing of standardised skin wounds caused in rats.

METHOD

Skin wounds were created on the backs of male rats (Rattus norvegicus, Wistar) that were randomly allocated into two groups. In the treated (T) and control (C) groups, oxygen gel and distilled water, respectively, were applied to the wounds on alternate days for 28 days. Postoperatively, euthanasia was performed at 5, 10, 14, 21 and 28 days, followed by clinical, histological (Masson's trichrome) and immunohistochemical analysis. Data were subjected to analysis of variance (ANOVA) and Bonferroni's test.

RESULTS

The cohort comprised 50 rats. On clinical and histological analysis, groups C and T showed similar characteristics 5 days post-operation. Subsequently, group T showed better healing at 14, 21 and 28 days and presented more intense inflammatory infiltrate up to 10 days. At days 14, 21 and 28, group T exhibited a reduction in oedema and increased angiogenesis, granulation tissue formation, and deposition of collagen fibres than group C. Immunohistochemical analysis showed the presence of tumour necrosis factor (TNF)-α and vascular endothelial growth factor (VEGF) in both the groups, but the levels were significantly higher in group T (p<0.05).

CONCLUSION

The local application of slow oxygen-release gel accelerated the healing of standardised skin wounds created surgically in rats, with increased angiogenesis and better collagen fibre formation.

Consenso de expertos sobre la eficacia clínica y directrices sobre la terapia de oxígeno transdérmico continuo para la cicatrización de las heridas complejas o difíciles de cicatrizar

INTRODUCTION

Oxygen is pivotal for wound healing. Its lack or hypoxia can delay this process, especially in individuals with comorbidities, potentially resulting in complex or hard-to-heal wounds. The Colombian Association of Diabetes (ACD) and the Colombian Association of Internal Medicine (ACMI) collaborated with a diverse group of experts to provide recommendations on the efficacy and best practices of continuous transdermal oxygen therapy (TOTc) in the care of such wounds.

METHOD

A modified Delphi technique was employed to obtain controlled feedback and responses. Experts from various disciplines engaged in reviewing and discussing numerous relevant scientific studies, focusing on the role of TOTc in treating chronic ulcers.

RESULTS

Continuous transdermal oxygen therapy has proven to be an effective and safe treatment for chronic and/or hard-to-heal ulcers. This therapy directly addresses the wound's oxygen deficiency, providing an environment conducive to healing. Significant benefits were observed, including the acceleration of the healing process, wound size reduction, and an enhancement in patient quality of life. Its efficacy was found across various ulcer etiologies, underscoring its therapeutic versatility.

CONCLUSIONS

Continuous transdermal oxygen therapy is effective and safe for treating chronic and hard-to-heal ulcers. It's crucial to address each case individually and through a multidisciplinary approach to maximize this therapy's benefits. Both evidence and clinical experience back its utility across a variety of ulcer etiologies.

Oxygen-releasing biomaterials for chronic wounds breathing: From theoretical mechanism to application prospect

Chronic wounds have always been considered as "gordian knots" in medicine, in which hypoxia plays a key role in blocking healing. To address this challenge, although tissue reoxygenation therapy based on hyperbaric oxygen therapy (HBOT) has been performed clinically for several years, the bench to bedside still urges the evolution of oxygen-loading and -releasing strategies with explicit benefits and consistent outcome. The combination of various oxygen carriers with biomaterials has gained momentum as an emerging therapeutic strategy in this field, exhibiting considerable application potential. This review gives an overview of the essential relationship between hypoxia and delayed wound healing. Further, detailed characteristics, preparation methods and applications of various oxygen-releasing biomaterials (ORBMs) will be elaborated, including hemoglobin, perfluorocarbon, peroxide, and oxygen-generating microorganisms, those biomaterials are applied to load, release or generate a vast of oxygen to relieve the hypoxemia and bring the subsequent cascade effect. The pioneering papers regarding to the ORBMs practice are presented and trends toward hybrid and more precise manipulation are summarized.

Effectiveness of topical oxygen therapy in wound healing for patients with diabetic foot ulcer

Objectives: Non-healing wounds have been one of the major challenges in health care because of increased morbidity, especially for those who have diabetes mellitus. Numerous regimens are being innovated to produce an evidence-based practice that would minimize complications and promote healing. Topical oxygen therapy is an innovation in wound care that has been considered influential in the wound healing process. This intervention aims to increase the oxygen concentration in the affected limb to promote wound healing.

Methods: This research applied an experimental design that targeted a total of 60 adult patients aged 45–64 years with diabetic foot ulcers. A randomized systematic sampling technique was used to allow equal chances and prevent bias. In total, 30 patients in the control group received usual care for diabetic foot ulcers, and the remaining 30 patients in the experimental group received topical oxygen therapy together with standard care for diabetic foot ulcers. Subjects were assessed using the Wagner-Meggitt Wound Classification System.

Results: The result proved that there was a significant difference in the wound grade of patients in the experimental group after the application of the usual wound care plus the topical oxygen therapy using Friedman’s test. The control and experimental groups were compared using Mann–Whitney statistical analyses, and the results showed that there was a significant difference between the control and experimental groups after the application of topical oxygen therapy.

Conclusions: Topical oxygen therapy was demonstrated to be effective to aid in the wound healing process of patients with diabetic foot ulcers. Further research was recommended to improve the application of topical oxygen therapy to patients with chronic wounds and promote the wound healing process.

Nanomaterials and nanomaterials-based drug delivery to promote cutaneous wound healing

Various factors could damage the structure and integrity of skin to cause wounds. Nonhealing or chronic wounds seriously affect the well-being of patients and bring heavy burdens to the society. The past few decades have witnessed application of numerous nanomaterials to promote wound healing. Owing to the unique physicochemical characteristics at nanoscale, nanomaterials-based therapy has been regarded as a potential approach to promote wound healing. In this review, we first overview the wound categories, wound healing process and critical influencing factors. Then applications of nanomaterials with intrinsic therapeutic effect and nanomaterials-based drug delivery systems to promote wound healing are addressed in detail. Finally, current limitations and future perspectives of nanomaterials in wound healing are discussed.

Efficacy and safety of topical oxygen therapy for diabetic foot ulcers: An updated systematic review and meta-analysis

To evaluate the efficacy and safety of topical oxygen therapy (TOT) in diabetic foot ulcers (DFUs), researchers systematically retrieved relevant studies from PubMed, EMBASE, Web of Science, CENTRAL and ClinicalTrials.gov. Relevant studies were searched from database inception to January 2022. Two researchers independently screened the literature, extracted data and assessed the quality of the included studies. Statistical analysis was performed in Stata 16.0. A total of seven RCTs involving 614 participants were included. Compared with the control group, the TOT group had a higher healing rate (RR = 1.63, 95% CI [1.33, 2.00]). According to descriptive analysis, TOT reduced the ulcer area and improved healing durability and quality of life. Furthermore, it had no effect on the occurrence of adverse events. However, it was unclear whether it would be able to reduce the healing time. The existing evidence suggests that TOT is effective and safe for chronic DFUs. Further studies are warranted to validate our findings.

Management of Diabetic Foot Ulcers Using Topical Oxygen Therapy: A Case Series

BACKGROUND AND AIM

Surgical and endovascular revascularization procedures along with hyperbaric oxygen therapy (HBOT) and topical oxygen therapy (TOT) for chronic oxygen-deprived wounds are standard care treatment protocols for diabetic foot ulcer (DFU). Topical developments in the delivery of topical oxygen therapy have made this a more feasible treatment in practice. The present case series highlights the efficacy of NATROX therapy as TOT in wound healing and the impact of increased oxygenation on ulcer healing in patients with diabetic foot ulcers.

METHODS

The TOT was evaluated in 6 patients with DFU who have applied NATROX topical oxygen delivery system for a period ranging from 6 weeks to 24 weeks at Kahel Specialized Centre, located in Olaya, Riyadh, Saudi Arabia.

RESULTS

The administration of TOT demonstrated complete wound healing in all the six patients who either had ulcers with minor amputation of toes/heel or had ulcers with other comorbidities in a range from 3 to 8 weeks.

CONCLUSION

NATROX therapy is an advanced topical oxygen delivery system compared to other conventional oxygen delivery systems; however, the study warrants further research to assess its potential applicability in DFU wound healing in large sample size and across the races.

Inflammatory Biomarkers as Predictors of Infected Diabetic Foot Ulcer

Diabetic foot ulcer infection is a crucial complication associated with lower-limb amputation and postoperative mortality in individuals with diabetes mellitus. Deciding if a diabetic foot ulcer is infected in a community setting is challenging without validated point-of-care tests. Early detection of infected diabetic foot ulcers can reduce the frequency of hospitalizations, the occurrence of disability, and chances of mortality. Inflammatory biomarkers are predictors of infected diabetic foot ulcers and lower-limb amputation. Procalcitonin, CRP, pentraxin-3, interleukin-6, and calprotectin may help distinguish uninfected from mildly infected diabetic foot ulcers and diagnose soft tissue infections, bone lesions, and sepsis in diabetic patients. Moreover, these biomarkers may be predictors of lower-limb amputation and postoperative mortality. The current management of infected diabetic foot ulcers is disappointing and unsatisfactory, both in preventing its development and halting and modifying its progression. The use of new (molecular) techniques for the identification of the IDFU has not yet to be proven superior to classic cultural techniques for the management of such patients. For clinicians, if the risk stratification of DFU can be obtained earlier in diabetic patients, the hospitalization, disability, and mortality rate will be reduced. For the practical application of these biomarkers, it is important to correlate these quantitative parameters with clinical symptoms. Based on clinical observations and inflammatory biomarker evaluation, it can be used to guide clinical treatment methods. This review details clinical information published during the past several decades and discusses inflammatory biomarkers that may determine the risk and level of infection of diabetic foot ulcers.

The Effect of Topical Oxygen Therapy in Horses Affected with Mycosis of the Guttural Pouch: An Experimental Pilot Study and a Case Series

Simple Summary

Resolution of macroscopic inflammatory lesions in case of guttural pouch mycosis (GPM) in horses is highly variable, and resolution of neurological disorders is inconstant and challenging. We hypothesized that topical oxygen therapy (TOT) would safely modulate GPM by reversing the course of the disease. The objective of a phase-1 pilot study was to validate the safety and feasibility of TOT in horses inoculated with Aspergillus fumigatus. The objective of a phase-2 clinical study was to report its effect in horses with a naturally occurring GPM. After more than two TOT administrations, inflammatory lesions decreased faster in size in the treated GP. In phase 2, partial or total recovery of neurological disorders (2/4 laryngeal hemiparesis, 3/5 dysphagia, 1/2 dorsal displacement of the soft palate, 1/1 Horner’s syndrome) was recorded. TOT can be recommended in two clinical presentations. If no history of epistaxis exists, and if lesions are not overlying major arteries, TOT alone can be instituted. In the case of a patient at risk of epistaxis, a multimodal approach with a transarterial coil embolization (TACE) procedure should be proposed. In both situations, TOT administration four times a day at 15 L/min for one to two weeks are probably sufficient to reverse the course of the disease.

Abstract

Background: The management of bleeding originating from the guttural pouch (GP) has a high success rate, but the resolution of the macroscopic inflammatory lesions in the case of mycosis (GPM) is highly variable; the resolution of neurological disorders is inconstant and challenging. Objectives: Our aim was to test the feasibility and safety of topical oxygen therapy (TOT) in horses after induction of GPM and in cases with naturally occurring disease. Study design: This study was an in vivo experimental and retrospective two-phase study. Methods: During phase 1, the pilot study, both GPs were inoculated with Aspergillus fumigatus. One GP was randomly assigned to receive one to four TOT 30 min sessions with 100% medical oxygen at 9 L/min. Follow-up endoscopic images were assessed for scoring macroscopic inflammatory lesions of the pharynx and both GPs. In phase 2, the clinical study, TOT was administered for 45 to 60 min at 15 L/min in six horses presenting with GPM. Results: In phase 1, TOT administration was easy to perform in the standing horse with no adverse effects. After more than two administrations, macroscopic inflammatory lesions decreased more quickly in size in the treated GP. In phase 2, horses were treated with TOT only (n = 1) or combined with a transarterial coil embolization (TACE) procedure (n = 5). After TOT and discharge from the hospital, nasal discharge resolved in three horses, and improvement was noted in the fourth one. Between days 2 and 10 after admission, upper respiratory tract endoscopy (URTE) indicated size reduction and alteration in the appearance of all the macroscopic inflammatory lesions. The partial or total recovery of neurological disorders (2/4 laryngeal hemiparesis, 3/5 dysphagia, 1/2 dorsal displacement of the soft palate (DDSP), and 1/1 Horner’s syndrome) was recorded. Main limitations: In phase 1, the small number of horses did not allow for statistically significant conclusions; in phase 2, clinical signs at admission varied between horses, which made comparison difficult. Conclusions: In adult horses, TOT alone or in combination with TACE is feasible and safe with a propensity to reverse the course and the progression of inflammatory lesions without additional local or systemic treatment.

Impact of topical oxygen therapy on diabetic foot ulcer healing rates: a systematic review

OBJECTIVE

The aim of this systematic review was to determine the impact of topical oxygen therapy (TOT) on diabetic foot ulcer (DFU) healing.

METHOD

Using systematic review methodology, we considered randomised controlled trials (RCTs), controlled trials, pilot studies and observational studies. The search was conducted in January 2019, using PubMed, CINAHL, Ovid, Cochrane, Web of Science and EMBASE databases. Data analysis was undertaken using RevMan and a narrative synthesis. The article titles were assessed by two authors independently, and the abstracts (when available) of the studies identified by the search strategy were screened for their eligibility, according to the inclusion and exclusion criteria. The full-text version of potentially relevant studies was obtained and two authors independently screened this against the inclusion criteria. Data were extracted using a predesigned extraction tool and all included studies were quality appraised using the Evidence-Based Librarianship checklist.

RESULTS

The search returned 565 records of which eight met the inclusion criteria. Of the included studies, three were set in single centre outpatient wound clinics, two studies were set in an outpatient wound care research clinic and three studies were multisite. Meta-analysis of four studies was undertaken. DFUs are >2 times more likely to heal with TOT than with standard care alone. The odds ratio (OR)=2.49 (95% confidence interval (CI): 1.59-3.90, p=0.00001). The remaining four studies also showed that using TOT increased healing rates. An included study reported that time to 50% DFU closure was significantly shorter in participants who received the TOT, mean 18.4 days versus 28.9 days in the sham therapy group (p=0.001). However, the validity of 65.5% of the eight studies was assessed as low.

CONCLUSION

The findings suggest that TOT enhances healing for patients with hard-to-heal DFUs when used with standard care. The results from the trials reviewed also indicate a benefit for patients over standard care alone. However, the sample sizes in the studies were generally small, thus, more RCTs are warranted to further validate these findings.

DECLARATION OF INTEREST

The authors have no conflicts of interest to declare.

Topical oxygen treatment relieves pain from hard-to-heal leg ulcers and improves healing: a case report

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.

Topical oxygen therapy in the treatment of diabetic foot ulcers: a multicentre, open, randomised controlled clinical trial

OBJECTIVES

Perfusion and blood oxygen levels are frequently insufficient in patients with hard-to-heal wounds due to poor circulation, vascular disruption and vasoconstriction, reducing the wound's capacity to heal. This study aimed to investigate the effect of topical oxygen on healing rates in patients with hard-to-heal diabetic foot ulcers (DFUs) (i.e., non-responsive over four weeks).

METHOD

This multicentre, open-label, community-based randomised clinical trial compared standard care (SOC) with or without continuous topical oxygen therapy (TOT) for 12 weeks in patients with DFUs or minor amputation wounds. SOC included debridement, offloading with total contact casting (TCC) and appropriate moisture balance. Primary endpoints were the number of patients to achieve complete wound closure and percentage change in ulcer size. Secondary endpoints were pain levels and adverse events.

RESULTS

For the study, 145 patients were randomised with index ulcers graded Infectious Diseases Society of America (IDSA) 1 or 2, or Wagner 1 or 2. In the intention-to-treat analysis, 18/64 (28.1%) patients healed in the SOC group at 12 weeks compared with 36/81 (44.4%) in the SOC plus TOT group (p=0.044). There was a statistically significant reduction in wound area between the groups: SOC group mean reduction: 40% (standard deviation (SD) 72.1); SOC plus TOT group mean reduction: 70% (SD 45.5); per protocol p=0.005). There were no significant differences in changes to pain levels or adverse events.

CONCLUSION

This study suggests that the addition of TOT to SOC facilitates wound closure in patients with hard-to-heal DFUs.

Therapeutic effect of continuous diffusion of oxygen therapy combined with traditional moist wound dressing therapy in the treatment of diabetic foot ulcers

AIMS

To investigate the therapeutic effect of continuous diffusion of oxygen (CDO) combined with traditional moist wound dressing (MWD) on the diabetic foot ulcers (DFUs) inpatients.

METHODS

The inpatients from May 2016 to April 2018 were enrolled and randomly divided into MWD, CDO and combination treatment groups (n = 40 each group). The moist dressing was used in the MWD group while a micro-oxygen supply device was used in the CDO group. The combination treatment group was given both MWD and CDO. All patients were treated for 8 weeks. The wound healing, amputation rate, and inflammatory control were evaluated.

RESULTS

Compared with MWD and CDO groups, the combination group showed a higher wound healing rate (P < 0.05), lower white blood cell count (P < 0.05) and lower high-sensitivity C-reactive protein level (P < 0.05). During 1-year follow-up, the amputation rate was 0% in combination group, which was significantly lower than that in other two groups (P < 0.05).

CONCLUSIONS

The combination of MWD and CDO was effective in promoting healing and preventing infection of DFUs, which holds a potential to be a new strategy for the treatment of this critical clinical condition.

Managing Diabetic Foot Ulcers: Pharmacotherapy for Wound Healing

Historically, there has been a scarcity of evidence-based topical therapy to hasten the healing of diabetic foot ulcers. But recently new evidence-based treatments have emerged from multicentre, randomised, controlled trials. This article highlights those trials, and describes the current pharmacological management of the diabetic foot ulcer and the advances that have been made in wound therapy to date. It provides an overview of topical and systemic pharmacotherapies in current use and those in development for future use in managing the diabetic foot. For each treatment, proposed mechanisms of action and evidence available to support their clinical use are presented. There is supporting randomised, controlled evidence for sucrose octasulfate in the treatment of neuro-ischaemic ulcers, and multi-layered patch of autologous leucocytes, platelets and fibrin in ulcers with or without ischaemia. There is also evidence for placentally derived products and for topical and systemic oxygen therapy in the healing of diabetic foot ulcers. Growth factors, bio-engineered tissues, stem cell therapy, gene therapy and peptide therapy also have some supporting evidence in the healing of diabetic foot ulcers. Nonsurgical debriding agents may be useful when the optimum approach of sharp debridement is not possible, and immunomodulators may be helpful for their antimicrobial effects, but robust data is still required to strengthen the case for general use. The review does not cover antimicrobials as their primary role are as anti-infectives and not in wound healing. The development of nanotechnology has created a means of prolonging the bioavailability of target molecules at the wound site, with the use of glass/hydrogel nanoparticles, polyethylene glycol and hyaluronic acid. Looking forward, novel therapies, including traction force-activated payloads, local delivery of short-interfering RNA and finally hydrogels incorporating bioactive agents or cells may provide possibilities for pharmacotherapy in the future.

An Updated Review on Silver Nanoparticles in Biomedicine

Silver nanoparticles (AgNPs) represent one of the most explored categories of nanomaterials for new and improved biomaterials and biotechnologies, with impressive use in the pharmaceutical and cosmetic industry, anti-infective therapy and wound care, food and the textile industry. Their extensive and versatile applicability relies on the genuine and easy-tunable properties of nanosilver, including remarkable physicochemical behavior, exceptional antimicrobial efficiency, anti-inflammatory action and antitumor activity. Besides commercially available and clinically safe AgNPs-based products, a substantial number of recent studies assessed the applicability of nanosilver as therapeutic agents in augmented and alternative strategies for cancer therapy, sensing and diagnosis platforms, restorative and regenerative biomaterials. Given the beneficial interactions of AgNPs with living structures and their nontoxic effects on healthy human cells, they represent an accurate candidate for various biomedical products. In the present review, the most important and recent applications of AgNPs in biomedical products and biomedicine are considered.

Strategies and challenges in the treatment of chronic venous leg ulcers

Evaluating patients with chronic venous leg ulcers (CVLUs) is essential to find the underlying etiology. The basic tenets in managing CVLUs are to remove the etiological causes, to address systemic and metabolic conditions, to examine the ulcers and artery pulses, and to control wound infection with debridement and eliminating excessive pressure on the wound. The first-line treatments of CVLUs remain wound care, debridement, bed rest with leg elevation, and compression. Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable. Hydrogen peroxide is harmful to the growth of granulation tissue in the wound. Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency. Yet, not all CVLUs are candidates for surgical treatment because of comorbidities. When standard care of wound for 4 wk failed to heal CVLUs effectively, use of advanced wound care should be considered based on the available evidence. Negative pressure wound therapy facilitates granulation tissue development, thereby helping closure of CVLUs. Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.

Strategies and challenges in the treatment of chronic venous leg ulcers

Evaluating patients with chronic venous leg ulcers (CVLUs) is essential to find the underlying etiology. The basic tenets in managing CVLUs are to remove the etiological causes, to address systemic and metabolic conditions, to examine the ulcers and artery pulses, and to control wound infection with debridement and eliminating excessive pressure on the wound. The first-line treatments of CVLUs remain wound care, debridement, bed rest with leg elevation, and compression. Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable. Hydrogen peroxide is harmful to the growth of granulation tissue in the wound. Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency. Yet, not all CVLUs are candidates for surgical treatment because of comorbidities. When standard care of wound for 4 wk failed to heal CVLUs effectively, use of advanced wound care should be considered based on the available evidence. Negative pressure wound therapy facilitates granulation tissue development, thereby helping closure of CVLUs. Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.

A Multistep Iter for Functional Reconstruction in Mangled Upper Limb: A Retrospective Analysis of Integrated Surgical and Medical Approach

Background and objectives: Complex limb wounds with multiple tissue involvement are commonly due to high energy trauma. Tissue damage is a dynamic entity and the exact extent of the injury is rarely instantly perceptible. Hence, reconstruction frequently involves a multi-stage procedure concluding with tissue replacement. Materials and Methods: A retrospective study was conducted between 2006 and 2018 and included 179 patients with contaminated multi-tissue injuries treated with hyperbaric oxygen therapy, negative pressure therapy, physiotherapy and drug treatment associated with multiple surgical time in a multistep approach, focusing on pain levels and wound closure rates. Results: Despite the long-term response to traumatic events, a combined approach of delayed surgical reconstructive time in mangled upper limb yielded satisfactory functional outcomes. Conclusions: The complex upper limb wound with deep tissue exposure may be treated with a multi-stage procedure alternatively to immediate reconstruction. The integrated technique enables the preservation of existing healthy tissue and concurrent radical debridement, reducing the risk of infection, as well as avoiding the loss of free flaps and dehiscence due to incorrect wound estimation.

Oxygen therapy: evidence base

The evidence base for the different methods of oxygen therapy ranges from systematic reviews and meta-analyses to case series evaluations. A common thread running through the assorted evidence is that oxygen therapy accelerates healing and reduces healing times. This article summarises the clinical evidence produced on this therapy.

Role of oxygen in wound healing

Not only does oxygen play an essential role in each stage of the wound healing process. It also helps to increases host resistance to infection. Any impairment to the oxygen supply can therefore delay healing. This article explores the affects of oxygen on the wound cells and tissue, and explains how an adequate supply is required for granulation tissue formation and epithelialisation to occur

Therapeutic advances in wound healing

Wound healing is a complex physiological process that occurs in the human body involving the sequential activation of multiple cell types and signaling pathways in a coordinated manner. Chronic wounds and burns clearly decrease quality of life of the patients since they are associated with an increase in physical pain and socio-economical complications. Furthermore, incidence and prevalence of chronic wounds (unlike burns) have been increasing mainly due to population aging resulting in increased costs for national health systems. Thus, the development of new and more cost-effective technologies/therapies is not only of huge interest but also necessary to improve the long-term sustainability of national health systems. This review covers the current knowledge on recent technologies/therapies for skin regeneration, such as: wound dressings; skin substitutes; exogenous growth factor based therapy and systemic therapy; external tissue expanders; negative pressure; oxygen; shock wave, and photobiomodulation wound therapies. Associated benefits and risks as well as the clinical use and availability are all addressed for each therapy. Moreover, future trends in wound care including novel formulations using metallic nanoparticles and topical insulin are herein presented. These novel formulations have shown to be promising therapeutic options in the near future that may change the wound care paradigm.

Drug therapies and delivery mechanisms to treat perturbed skin wound healing

Acute wound healing is an orderly process of four overlapping events: haemostasis, inflammation, proliferation and remodelling. A drug delivery system with a temporal control of release could promote each of these events sequentially. However, acute wound healing normally proceeds very well in healthy individuals and there is little need to promote it. In the elderly and diabetics however, healing is often slow and wounds can become chronic and we need to promote their healing. Targeting the events of acute wound healing would not be appropriate for a chronic wound, which have stalled in the proinflammatory phase. They also have many additional problems such as poor circulation, low oxygen, high levels of leukocytes, high reactive oxygen species, high levels of proteolytic enzymes, high levels of proinflammatory cytokines, bacterial infection and high pH. The future challenge will be to tackle each of these negative factors to create a wound environment conducive to healing.