From the Divisions of Plastic and Reconstructive Surgery and Vascular Surgery, Department of Surgery, Stanford University School of Medicine; the Advanced Wound Care Center, Stanford University Medical Center; and the Division of Plastic Surgery, University of Florida.
Plast Reconstr Surg. 2021 Jan 1;147(1):209-214. doi: 10.1097/PRS.0000000000007482.
The authors present indocyanine green angiography to assess the effects of hyperbaric oxygen therapy and as a potential biomarker to predict healing of chronic wounds. They hypothesize that favorable initial response to hyperbaric oxygen therapy (improved perfusion) would be an early indicator of eventual response to the treatment (wound healing). Two groups were recruited: patients with chronic wounds and unwounded healthy controls. Inclusion criteria included adults with only one active wound of Wagner grade III diabetic foot ulcer or caused by soft-tissue radionecrosis. Patients with chronic wounds underwent 30 to 40 consecutive hyperbaric oxygen therapy sessions, once per day, 5 days per week; controls underwent two consecutive sessions. Indocyanine green angiography was performed before and after the sessions, and perfusion patterns were analyzed. Healing was determined clinically and defined as full skin epithelialization with no clinical evidence of wound drainage. Fourteen chronic-wound patients and 10 controls were enrolled. Unlike unwounded healthy volunteers, a significant increase in indocyanine green angiography perfusion was found in chronic-wound patients immediately after therapy (p < 0.03). Moreover, the authors found that 100 percent of the wounds that demonstrated improved perfusion from session 1 to session 2 went on to heal within 30 days of hyperbaric oxygen therapy completion, compared with none in the subgroup that did not demonstrate improved perfusion (p < 0.01). This study demonstrates a beneficial impact of hyperbaric oxygen therapy on perfusion in chronic wounds by ameliorating hypoxia and improving angiogenesis, and also proposes a potential role for indocyanine green angiography in early identification of those who would benefit the most from hyperbaric oxygen therapy.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
作者采用吲哚菁绿血管造影来评估高压氧治疗的效果，并将其作为一种预测慢性伤口愈合的潜在生物标志物。他们假设高压氧治疗的初始反应良好（灌注改善）将是对治疗（伤口愈合）最终反应的早期指标。招募了两组患者：患有慢性伤口的患者和未受伤的健康对照组。纳入标准包括患有 Wagner 分级 III 糖尿病足溃疡或软组织放射性坏死引起的单一活动性伤口的成年人。慢性伤口患者接受 30-40 次连续高压氧治疗，每天一次，每周 5 天；对照组接受两次连续治疗。在治疗前后进行吲哚菁绿血管造影，分析灌注模式。愈合通过临床确定，并定义为完全皮肤上皮化，无伤口引流的临床证据。共纳入 14 例慢性伤口患者和 10 例对照组。与未受伤的健康志愿者不同，治疗后慢性伤口患者的吲哚菁绿血管造影灌注明显增加（p<0.03）。此外，作者发现，与未显示灌注改善的亚组相比，100%的伤口在第 1 次到第 2 次治疗中显示灌注改善的伤口在高压氧治疗完成后 30 天内愈合，而未显示灌注改善的亚组无一例愈合（p<0.01）。这项研究表明，高压氧治疗通过改善缺氧和促进血管生成对慢性伤口的灌注有有益影响，并提出吲哚菁绿血管造影在早期识别最受益于高压氧治疗的患者方面可能具有潜在作用。
临床问题/证据水平：治疗，IV。
