Continuous Topical Oxygen Therapy (cTOT) Used to Support Healing of a Recalcitrant Donor Site Wound
Case History
- 54-year-old female
- PMH of LcSSc treated with corticosteroids, vasodilators, immunosuppressants, gabapentin, and opioids
- Severe extravasation injury to left forearm in 2019 reconstructed with anterolateral thigh (ALT) flap
- Recurrent donor site complications including infection, seroma, and pain
- Wound closure attempted with advanced wound care therapies and surgical interventions, including larval therapy, negative pressure wound therapy (NPWT), and split thickness skin grafts (STSG), but the wound remained unhealed
- Wound duration of 5 years
- With patient consent, cTOT was commenced
Introduction:
Donor site morbidity refers to the adverse effects that a patient experiences following the harvest of graft tissue. These complications can be both physical and psychological, and commonly include pain, scarring, functional limitations, and infection, and can negatively impact the patient’s quality of life and rehabilitation. Factors that impede restoration of skin integrity may be modifiable, such as smoking and malnutrition, but some pathologies and their medical management can disrupt healing and delay wound closure. Limited cutaneous systemic sclerosis (LcSSc) is an autoimmune condition known for its impact on wound healing due to the abnormal deposition of collagen, vasculopathy, and other fibrotic changes. Medications to manage the condition can have negative cutaneous effects, which may derail healing processes, particularly in times of increased disease activity. Continuous Topical Oxygen Therapy (cTOT) is a simple to use, adjunctive wound treatment that can support wound healing where perfusion is sub optimal and contributing to delays in healing. This case study follows the progress of a recalcitrant donor site wound that had failed to heal after 5 years of conventional treatments in a patient with LcSSc.
Results:
The cycle of relapse and remission of LcSSc affected the wound healing process with several setbacks, particularly when intravenous steroid infusions were required to treat severe symptom flares. However, a WAR of 81% within 8 weeks of cTOT provided a good foundation for healing. After remaining recalcitrant for over 5 years, the wound achieved full closure within 8 months of treatment. Baseline VAS of 2 was reduced to 0 at all subsequent clinic visits.
The patient maintained independent community living and employment during cTOT treatment.
Authors:
Mr. Norbert Kang, Rebekkah Sekyi, Barbara Costa, Lisa Thomas