Vulakh Gennady M, Hingorani Anil P, Ascher Enrico, Marks Natalie
Total Vascular Care, Brooklyn NY, USA.
Vascular. 2023 Aug;31(4):737-740. doi: 10.1177/17085381221080270. Epub 2022 Mar 24.
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.
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.
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.
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.
虽然高压氧疗法已得到随机前瞻性试验的支持，可用于治疗选择性下肢伤口，但它存在成本高昂、不便，且有气胸、鼓膜气压伤和严重低血糖等小风险。由于局部氧疗（tOT）可避免这些问题，且几乎没有文献研究其在周围动脉疾病（PAD）患者中的应用，我们回顾了我们将tOT作为动脉伤口愈合辅助技术的经验。
我们回顾了8年来使用tOT治疗下肢伤口的经验。肢体血运重建和/或在适当情况下进行清创后，将不愈合溃疡的PAD患者转诊至tOT治疗。使用局部靴式装置每周对受影响区域进行4次tOT治疗，该装置在1.03个大气压下向伤口输送100%的氧气，每次治疗90分钟。我们有28例PAD患者，男性占57.1%，共有36个伤口。年龄范围为37至93岁（平均62±13.7岁）。82%有糖尿病史，75%有高血压，60.7%有高脂血症。78%接受了下肢动脉血管成形术，11%进行了下肢搭桥手术。其余患者仅进行了清创，不适合进行动脉血运重建。
tOT治疗持续时间为1至7个月（平均3±2个月）。29%的患者在伤口愈合前停止了tOT治疗。25%的患者完全愈合。1例在随访期间死亡。总体而言，66%的患者伤口面积缩小了12%至100%。无一例进行大肢体截肢。18%的患者接受了趾截肢。25%的患者失访。
虽然这些数据来自单中心且为单臂研究，但它们代表了该疗法报道的最大系列病例。这种居家治疗确实显示出前景，值得进一步研究。
