A Complex Surgical Wound Dehiscence Case Managed with Continuous Topical Oxygen Therapy

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Case History

  • 65-year-old male
  • Current smoker
  • BMI 17
  • High-dose steroid treatment for cutaneous lupus
  • Opioid use
  • Multiple surgical and radical radiotherapy interventions since the diagnosis of a squamous cell carcinoma 3 years previously
  • Development of ORN
  • Surgical wound dehiscence (SWD) following segmental mandibulectomy and closure of an oro-cutaneous fistula
  • Following multiple attempts at skin closure, in conjunction with management of modifiable risk factors, the wound remained unhealed after 4 months

Introduction:

Wounds that fail to heal are detrimental to a patient’s quality of life and a burden to health care systems. Wound healing can be compromised by intrinsic, extrinsic, and iatrogenic factors. It is well documented that prolonged high-dose steroid therapy and exposure to radiotherapy both undermine healing. Osteoradionecrosis (ORN) is a side effect of radiation treatment for head and neck cancers that can disrupt the blood supply within the bone and surrounding structures. Subsequent reconstructive surgical interventions can be challenging to heal as poor circulation, oedema, injured microcirculation, and contraction of vessels in traumatised tissue all limit oxygen distribution to a wound. Topically administered oxygen has been shown to increase healing in chronic wounds of all etiologies.

Results:

cTOT, used as an adjunctive therapy, achieved full closure in 5 weeks to a wound that had failed to progress with standard care alone.

Authors:

Andrew Camilleri, Irena Kamenska, Sana Kurian, Cydney West, Lisa Thomas