Adjunctive topical oxygen therapy for wound healing in patients with peripheral arterial disease

Abstract

Introduction: While the use of hyperbaric oxygen therapy has been supported by randomized prospective trials for the use of selective lower extremity wounds, it is associated with significant cost, inconvenience, and a small risk of pneumothorax, barotrauma to the tympanic membrane, and severe hypoglycemia. As topical oxygen therapy (tOT) avoids these issues and there is little literature examining its use for patients with peripheral arterial disease (PAD), we reviewed our experience with tOT as an adjunctive technique for wound healing with arterial wounds.

Methods: We reviewed our experience with tOT for lower extremity wounds over 8 years. PAD patients with non-healing ulcers were referred to tOT after having revascularization of the limb and/or debridement where appropriate. tOT was administered to affected areas 4 times a week with a local boot that delivered 100% oxygen to the wound at 1.03 atm for 90-min sessions. We had 28 patients with PAD, 57.1% male, and 36 individual wounds. Ages ranged from 37 to 93 (mean 62 ± 13.7). 82% had a history DM, 75% hypertension, and 60.7% hyperlipidemia. 78% had lower extremity arterial angioplasty and 11% had a LE bypass. The remainder had a debridement only and were not candidates for arterial revascularization.

Results: tOT duration ranged from 1 to 7 months (mean 3 ± 2). 29% stopped tOT before healing. 25% healed completely. One died during follow-up. Overall, 66% had reduction of the wound area ranging from 12% to 100%. None had major limb amputation. 18% underwent toe amputations. 25% of our patients were lost to follow-up.

Conclusion: While these data are from a single-center and are single-armed, they represent the largest reported series of this therapy. This home-based therapy does show promise and warrants further investigation.

Keywords: Topical oxygen therapy; ischemic ulcers; pad; peripheral arterial disease; wound healing.