Sharon Cassidy, Clinical Nurse Specialist/Manager, SOS Nursing Wound Clinic , Christchurch, New Zealand
Topical Oxygen Therapy in Non-Healing Chronic Wounds
Background and Purpoe
Oxygen is an important requirement for wound healing pathways, yet the wound beds of chronic, non-healing wounds are typically hypoxic.1
Initially, hypoxia acts as a signal to stimulate the wound healing process; however, persistent hypoxia is detrimental to healing progression.2Oxygen is an important requirement for wound healing pathways, yet the wound beds of chronic, non-healing wounds are typically hypoxic.1
Initially, hypoxia acts as a signal to stimulate the wound healing process; however, persistent hypoxia is detrimental to healing progression.2
Results
References:
Aim
The aim of this evaluation was to assess the performance of Granulox Topical Oxygen therapy
Methods
D
Patient History
Treatment
70-year-old; female
Chronic pain post-spinal surgery (NSAIDs).
Wound: Left malleolus ulcer (caused by traumatic injury)
Duration: 19 months Area: 1.3cm2
Increased pain; baseline pain severity VAS score: 4
Previous treatments: lignocaine, antimicrobial emollient. Various dressings.
THS a (Granulox)
Bordered foam dressing (changed to nanocrystalline silver-coated polyethylene net for 7-day period to address hyper-granulation)
Elasticated tubular bandage c (light compression)
Outcome
3% reduction in wound area by Day 7; healed at Day 70
Healthy peri-wound skin throughout apart from mild erythema (Days 21-48)
Steady reduction in pain severity VAS scores; patient pain free by Day 70
70-year-old; male
Type 1 DM (peripheral neuropathy, retinopathy); vascular disease; chronic venous insufficiency; heart disease/failure; asthma (ex-smoker); lung nodule; osteoarthritis (hands); high BMI.
Traumatic wound (right hallux)
Duration: 5 weeks Area: 1.8cm2
No exudation; no pain
Wound Cleansing
THS a (Granulox)
Bordered foam dressingb
Tubular retention bandaged (final visit only)
Wound healed at Day 70
Peri-wound skin issues (mild-moderate maceration / blistering) resolved, resulting in healthy peri-wound skin, apart from mild dryness
Patient pain-free throughout
70-year-old; male
Surgical history: wide local excision of malignant melanoma (sole of foot and heel); Tumour removed from left groin; immune-therapy for unresectable non-regional lymph nodes.
Healing surgical wound (left heel)
Duration: 3 months Area: 13.1cm2; maximum depth: 3mm
Moderate increase in exudation, wound edges rolled; hyper-granulation; baseline pain severity VAS score: 4.
Previous treatments: various dressings, keratin-containing gel, antimicrobial emollient, wound irrigation solution.
THS a (Granulox)
Silver-containing gelling fibre dressingf (only required up to Day 43)
Bordered foam dressingb
Silicone adhesive tapeg and tubular retention sockd
73.3% reduction in wound area by Day 65; healed at Day 170
Peri-wound skin hyperkeratosis throughout.
Reduced pain severity VAS scores (2); no pain during application of THSa and dressings
a Granulox (Mölnlycke Health Care) b Mepilex Border Flex (Mölnlycke Health Care)
c Tubigrip (MölnlyckeHealth Care) d Tubifast (Mölnlycke Health Care)
e Mepore (MölnlyckeHealth Care) f Exufiber Ag+ (MölnlyckeHealth Care)
g Mepore (MölnlyckeHealth Care)
1. Bishop, A. Role of oxygen in wound healing. Journal of Wound Care 2008; 17(9): 399-402.
2.. Gottrup, F., Dissemond, J., Baines, C., Frykberg, R., Jensen, P., Kot, J., Kröger, K., Longobardi, P. Use of oxygen therapies in wound healing. Journal of Wound Care 2017; 26(5 Supplement): S1-S42
3. Dissemond, J., Kröger, K., Storck, M., Risse, A., Engels, P. Topical oxygen wound therapies for chronic wounds: a review. Journal of Wound Care 2015; 24(2): 53-63.
Case study series sponsored by Mölnlycke
Poster presentation at the New Zealand Wound Care Conference, 9-11 September 2022
CASE STUDY TWO
CASE STUDY ONE
66-year-old; male. Managed for venous stasis.
Surgical history: V-Y reconstruction of left Achilles tendon (complicated by infection, requiring scar revision). Non healing.
Duration: 3 years Area: 1.04 cm2
Mild maceration of peri-wound skin.
Previous treatments: various dressings
Wound Cleansing
Skin wipe
THS a
Absorbent dressinge
Tubular retention stockingd
86.5% reduction in wound area by Day 70; almost healed (0.02cm2) at Day 157
Peri-wound skin issues (mild maceration / dryness) resolved, resulting in healthy peri-wound skin
Patient pain-free throughout
CASE STUDY THREE
CASE STUDY FOUR
Before
Day 70
Based on the accelerated wound healing observed in 5 of the 6 cases, the ease of application of THS a and the lack of observed adverse effects, THS a will now be considered for other patients who present with chronic wounds. The reduction in pain observed during the use of THS a helped to improve patient compliance, thus reducing the frequency of dressing changes
Conclusion