Oxygen tension assessment: an overlooked tool for prediction of delayed healing in a clinical setting (original) (raw)
Related papers
Journal of Anaesthesiology Clinical Pharmacology, 2012
Background: Hyperbaric oxygen therapy (HBOT) is a treatment option for chronic nonhealing wounds. Transcutaneous oximetry (TCOM) is used for wound assessment. We undertook a randomized prospective controlled trial to evaluate the role of HBOT in healing of chronic nonhealing wounds and to determine whether TCOM predicts healing. Materials and Methods: This study was conducted in 30 consenting patients with nonhealing ulcer. The patients were randomized into group HT (receiving HBOT in addition to conventional treatment) and group CT (receiving only conventional treatment). Duration of treatment in both the groups was 30 days. Wound ulcer was analyzed based on size of the wound, exudates, presence of granulation tissue, and wound tissue scoring. Tissue oxygenation (TcPO 2) was measured on 0, 10 th , 20 th , and 30 th day. Results: There was 59% reduction in wound area in group HT and 26% increase in wound area in group CT. Ten patients in group HT showed improvement in wound score as compared to five patients in group CT. Complete healing was seen in three patients in group HT as compared to none in group CT. Surgical debridement was required in 6 patients in group HT and 10 patients in group CT. One patient in group HT required amputation as compared to five patients in group CT. A positive correlation was found between TcPO 2 value and various markers of wound healing. Conclusion: HBOT has a definitive adjunctive role in the management of chronic nonhealing ulcers. It decreases the amputation rate and improves patient outcome. Periwound TcPO 2 may be used as a predictor of response to HBOT and has a positive correlation with wound healing.
Transcutaneous oxygen tension: a useful predictor of ulcer healing in critical limb ischaemia
Journal of wound care, 2010
To investigate the threshold of transcutaneous oxygen tension (TcPO(2)) values in predicting ulcer healing in patients with critical limb ischaemia in a prospective study. 50 patients suffering from critical limb ischaemia with chronic ischemic ulcers or gangrenous toes were enrolled in this study between January and December 2008. Their demographic data and ankle brachial pressure index (ABPI) were collected. Baseline ulcers were measured with a wound measurement system (Visitrak, Smith & Nephew). TcPO(2) was measured at rest in the supine position and with 30 degrees leg elevation. The patients with infective and ischemic ulcers underwent debridement and gangrenous toes were amputated. Ulcer outcome was classified as either: (1) A healing ulcer, showing good epithelialisation or granulation at both base and edges, or a decrease in ulcer area during the study; or (2) A non-healing ulcer, showing poor granulation tissue formation or a pale base and necrotic edges, or deterioration i...
The American surgeon, 2001
Hyperbaric oxygen (HBO) therapy may be a useful adjunct in the treatment of patients with wounds associated with critical limb ischemia. These patients either cannot undergo a successful bypass or may not heal after vascular reconstruction alone. Identification of patients likely to benefit from HBO is essential before treatment, as this therapy is time-consuming, costly, and not without risk. Transcutaneous oxygen measurements (TCOM) can be used to evaluate the degree of hypoxia in ischemic tissue. In this study we evaluated whether TCOM could be used to identify those patients who would or would not benefit from HBO therapy. Our hypothesis is that a difference in transcutaneous oxygen tension readings measured near the ischemic lesion with the patient breathing room air and while breathing 100 per cent oxygen at ambient pressure may be predictive of wound healing with adjunctive hyperbaric oxygen therapy. Thirty-six patients with critical limb ischemia and nonhealing ulcers were r...
Diabetologia, 2011
Aims/hypothesis The randomised, double-blind, placebocontrolled Hyperbaric Oxygen Therapy (HBOT) in Diabetic Patients with Chronic Foot Ulcers (HODFU) study showed beneficial effect of HBOT. As this treatment is expensive and time-consuming, being able to select patients for therapy would be very useful. The aim of this study was to evaluate whether circulatory variables could help in predicting outcome of HBOT. Methods All HODFU study participants who completed therapy, predefined as receiving at least 36 out of 40 scheduled HBOT/placebo sessions, were included in this study (n=75). Baseline transcutaneous oximetry (TcPO 2 ), toe blood pressure (TBP) and ankle-brachial index (ABI) were measured. Ulcer healing rate was registered at the 9-month follow-up visit. An ulcer was considered healed when it was completely epithelialised and remained so at the 12-month follow-up.
2014
Peripheral Occlusive Vascular Disease impairs the healing process in diabetic foot ulcers. Ankle Brachial Index is the conventional method of assessing POVD and Transcutaneous Partial Pressure of Oxygen. It is a relatively new measure of assessing microvascular circulation. Our aim was to compare and contrast the utility of ABI and TcPO 2 in predicting wound healing in diabetic foot ulcers. The study included 118 diabetic foot ulcer patients who had their ABI and TcPO 2 measured. A handheld doppler device measured the ABI, and an electrochemical transducer measured the TcPO 2 . Wound outcome was classified as either healed or not healed. The mean ABI in the healed group was 0.96±0.24 and 0.61±0.27 (p<0.001) in the not healed group. The mean TcPO 2 in the healed group was 33.77±15.51 and 23.29±14.77 (p=0.002) in the not healed group. The agreement rate of ABI with TcPO 2 was 59.3%. More than 90% of ulcers with normal ABI and/or TcPO 2 healed. With aggressive management of POVD a g...
Diabetes Care, 1999
R E S U LT S -Of the 13 patients who deteriorated, 11 had Tc PO 2 25 mmHg, while 34 of the 37 patients who improved had Tc PO 2 25 mmHg. The sensitivity and specificity for Tc PO 2 w e re 85 and 92%, re s p e c t i v e l y, when a cutoff level of 25 mmHg was used for determination of outcome of ulcer healing (healing or nonhealing). The corresponding values for TBP at 30 mmHg w e re 15 and 97%. Measurement of Tc PO 2 p rovided a higher positive predictive value (79%) than TBP (67%).
Wound Repair and Regeneration, 2019
Venous leg ulcers are complex, and their multifactorial etiology make successful treatment a difficult and long process. Nonhealing ulcers are the greatest challenge because they are resistant to standard therapies. In this study, we analyzed whether monitoring the temperature of the ulcered limb wound area could benefit the diagnosis of the wound's tendency to heal (estimating the presence of a healing or nonhealing wound) in patients with two-sided venous leg ulcers. This prospective, 12-week observational study included 57 adult individuals with chronic venous leg ulcers. The dynamics of wound healing was assessed by planimetry and infrared thermography every two weeks. We analyzed temperatures measured at three marked areas-the wound, the periwound skin and the reference area. An initial wound area larger than 1 cm 2 was associated with a temperature increase of 0.027°C in the periwound skin. A 1-cm 2 decrease in the wound area was associated with a 0.04°C decrease in the temperature difference between the periwound skin and wound. A strong positive relationship was identified for both the bacteriology variables (the presence of bacteria: temperature increase in the periwound skin of 0.4°C, p<0.001; the number of bacterial species in a wound, temperature increase of 0.95°C, p<0.001). The temperature in the reference area was significantly correlated with the failure of the superficial and perforating veins (temperature increase of 0.69°C, p=0.04). This study reports that the assessment of the temperature a limb may be beneficial in predicting whether an ulcer is a healing or a nonhealing ulcer. The decrease in the temperature differences between the areas referred to as healing wounds was the only beneficial prognostic marker. Other temperature differences in the periwound skin were caused by disorders, such as multibacterial wound infections and superficial venous inflammation.
Journal of Clinical Medicine
Visual and empirical assessments do not enable the early detection of wound deterioration or necroses. No suitable objective indicator for predicting poor wound-healing is currently available. We used infrared thermography to determine the association between wound temperature and pressure-wound healing. We examined patients with grades 2–4 pressure ulcers from a medical center in southern Taiwan and recorded the temperatures of the wound bed, periwound, and normal skin using infrared thermographic cameras. A total of 50 pressure ulcers and 248 infrared-thermography temperature records were analyzed. Normal skin temperature was not related to pressure ulcer wound healing. In a multivariate analysis, higher malnutrition universal-screening-tool scores were associated with poor wound-healing (p = 0.020), and higher periwound-temperature values were associated with better wound-healing (p = 0.028). In patients who had higher periwound-skin temperature than that of the wound bed, that r...
PubMed, 2013
Hypoxia is a major factor in delayed wound healing. The aim of this prospective, randomized, clinical trial was to compare outcomes of treatment in persons with chronic diabetic foot ulcers (DFUs) randomly assigned to transdermal continuous oxygen therapy (TCOT) for 4 weeks as an adjunct to standard care (debridement, offloading, and moisture). Nine patients (age 58.6±7.1, range 38-73 years) received TCOT (treatment group) and eight patients (age 59.9±12.6, range 35-76 years) received standard care alone (control group). Most patients (12) were male, and all had a Wagner I or II foot ulcer for an average of 14 (control group) or 20 months (treatment group). Weekly wound measurements and wound tissue biopsies were obtained and wound fluid collected. Levels of pro-inflammatory cytokines and proteases in wound fluid samples were analyzed using Luminex-based multiplex assays. Tissue-resident macrophages were quantified by immunohistochemistry. At week 4, average wound size reduction was 87% (range 55.7% to 100%) in the treatment group compared to 46% (15% to 99%) in the control group (P <0.05). Changes in cytokine levels (IL-6, IL-8) and proteinases (MMP-1,-2,-9, TIMP-1) at weeks 2 to 4 in wound fluid correlated with clinical findings. CD68+ macrophage counts showed statistically significant reduction in response to TCOT compared to the control group (P <0.01). The results of this study show that TCOT may facilitate healing of DFUs by reversing the inflammatory process through reduction in pro-inflammatory cytokines and tissue-degrading proteases. Additional research to elucidate the effects of this treatment on complete healing and increase understanding about the role of wound fluid analysis is needed.