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Abstract
Continuous Diffusion of Oxygen (CDO) has been shown to stimulate wound healing by increasing angiogenesis, collagen production and cell metabolism 1,2,3,4 This case study describes an interdisciplinary approach and the use of CDO in combination with wound care best practice for a patient with complex skin loss due to vasculitis.
Clinical situation: We present a case of an 83 year old male with Polymyalgia Rheumatica, treated with high dose prednisone. During this treatment the patient was admitted to the hospital with septic shock secondary to left leg cellulitis.
Leukocytoclastic vasculitis was later confirmed with biopsy. The lower left leg deteriorated to full thickness skin loss, extending from the dorsal aspect of the foot and circumferentially to the mid-calf area. Skin grafting was not recommended. Below knee amputation was offered and declined by the patient. The interdisciplinary team suggested medical reconditioning in a rehabilitation institute. Weekly bloodwork was performed to monitor for inflammation and infection.
Modified compression therapy to control edema was employed for the first eight weeks. With no wound healing progress achieved, CDO was applied with two units at 15ml/hr with dressing changes three times a week. At each dressing change, wound cleansing with 1% acetic acid and conservative debridement was performed.
Results/outcomes and implications for practice: After 8 weeks of treating the left lower leg with CDO, the wound bed progressed from 100% dry eschar to 100% granulation. The wound bed was deemed appropriate for amniotic membrane allograft (amnion) application to continue the healing process.
This case demonstrates the importance of interdisciplinary collaboration and treatment of a complex wound with advanced therapies to promote healing. The CDO therapy aided in wound bed preparation, which is required prior to the application of amnion. Use of CDO therapy research for other wound etiologies is warranted.