Intermittent Topical Wound Oxygen Therapy Promotes Closure in Calciphylaxis Wounds

Introduction: Calciphylaxis is a rare disorder that presents with painful, necrotic, ischemic skin and tissue lesions resulting from arteriole calcification and reduced blood flow. Most often noted in patients with end-stage renal disease (ESRD) who are undergoing hemodialysis (HD), it is highly lethal and poorly understood. While there is no recognized standard of care for treatment, hyperbaric oxygen therapy (HBOT) has been trialed in addition to standard evidence-based wound care.

Methods:A 64-year old African American male with ESRD, on HD 3 times weekly, presented with multiple large, necrotic, painful, eschar-covered wounds to his lower extremities in the setting of significant edema, worsening for 5-months. The wounds were previously diagnosed as calciphylaxis by punch biopsy. The patient did not tolerate compression garments secondary to pain, and refused HBOT due to time constraints from his thrice weekly HD. The patient agreed to daily, intermittent Topical Wound Oxygen (ITWO) Therapy, in which he applied a sleeve over his lower legs with an occlusive seal that filled with hyper concentrated oxygen for 90-minutes daily. The ITWO was an adjunctive therapy, enabling the wound care team to continue applying and revising primary dressing plans throughout the treatment course, which included sharp debridement every 1-2 weeks, with antimicrobial absorbent primary and secondary dressings changed every 2-3 days. Wound dressings were not removed during ITWO therapy.

Results: The patient reported decreased wound pain, and all wounds were completely re-epithelialized after 118 days. The patient continued applying the daily ITWO after wound closure, and at his last follow-up, on day 366, the wounds remained closed with no recurrence, pain, or new lesions.

Discussion: Calciphylaxis remains a devastating and difficult-to-treat wound disorder. These results demonstrate a safe and user-friendly therapy that can supplement evidence-driven wound care, such as frequent debridement, edema control, and bioburden management. As the mechanism of action in topical oxygen and hyperbaric oxygen diverges, these results support further investigation to determine if ITWO provides a foundation for which treatment can be built upon in calciphylaxis patients.