Continuous topical oxygen therapy as part of the reconstructive ladder of limb salvage: a case series

Introduction: Complex lower extremity wounds are often plagued by a combination of soft tissue damage and poor patient protoplasm. Successful limb salvage requires a multimodal approach with the involvement of evidence-based therapies that can facilitate soft tissue repair. Traditionally, such cases were managed primarily with surgical interventions. However, a more modern approach to limb salvage embraces the use of advanced technologies as part of the reconstructive ladder. Following injury, edema, injured microcirculation, and contraction of vessels in traumatized tissue limit oxygen to the wound, thereby reducing the wound’s capacity to heal. Continuous topical oxygen therapy (cTOT) delivers supplemental oxygen directly to the injured tissues. The treatment has been validated as low-risk and it is easy to use in a wide range of wound types. In this case series the investigators evaluated the value of adding cTOT to their existing complex wound algorithm of care.Methods:Patients presenting with complex open surgical wounds of the lower extremity without contraindications to cTOT were included in this case series. Data collection consisted of weekly wound photos and measurements. Additionally weekly wound assessments included: 1.       Wound progress 2.      Wound tissue type (%) and periwound tissue quality 3.       Clinical signs and symptoms of infection 4.      Exudate amount and quality 5.       Adverse events 6.       Wound related pain levels  Results:Following well-planned surgeries, cTOT was used to treat a series of complex open surgical wound of the lower extremity.  The addition of cTOT to the ladder of limb salvage helped to reduce the need for further surgical interventions and amputation in this patient cohort. Lower limb salvage was successful, and patients regained mobility of the lower extremities and resumed ambulation.Discussion: This case series reinforces the value of using cTOT the management of complex, open surgical wounds of the lower extremity injuries. CTOT supported healing of these wounds by secondary intention. Furthermore, post op management with cTOT can positively impact the incidence of surgical site complications such as infection. The addition of cTOT to existing care algorithms supported wound healing in this at-risk population.References: