Promoting Healing of Chronic Wounds Using cTOT in a Patient with Chronic Limb Threatening Ischaemia Having No Revascularisation Option
Introduction:
Chronic limb threatening ischaemia (CLTI) is associated with mortality, limb amputation and impaired quality of life. When vascular interventions, medical management and modifiable risks are addressed but wounds fail to heal, adjunctive treatments need to be considered. Continuous topical oxygen therapy (cTOT)simply delivers oxygen directly to the wound bed to address tissue hypoxia and supports wound healing.
Case History
- 61-year-old female with Type 2 Diabetes and hypertension
- Initial presentation September 2023 with a deteriorating blister on left hallux
- CLTI diagnosed and underwent amputation of left hallux and two unsuccessful attempts of bypass grafts due to lack of appropriate target artery
- Further ischaemic changes resulted in necrosis of remaining toes, ulceration at 5th metatarsal head, and 2 hard to heal wounds in left medial malleolar area
- Wounds were treated with appropriate standard of care, regular debridement, and off-loading until May 2024
- Due to the deteriorating condition of limb, recurrent infections, and pain, the patient was offered below knee amputation which was declined
- Patient priorities were limb preservation, pain reduction and personal independence including the ability to work
Results:
- Medial malleolar wounds: healed in 6 weeks with 3/10 baseline VAS pain reduction to 0/10 by week 4
- Lateral & forefoot wound size reduction: 90% and 98% (respectively) by week 10
- Lateral & forefoot wound VAS pain reduction: 7/10 to 0/10 by week 4
Conclusion:
A patient-centered approach to treatment choice was adopted in this case. Using evidence-based adjunctive therapy, the patient realized her priorities of limb salvage, wound healing, pain reduction, and returning to her usual, independent activities of daily living, including work.