The Use of cTOT in Combination with Cellular, Acellular and Matrix-like Products to Treat Complex, Chronic Wounds: a Retrospective Case Series

DOWNLOAD NOW
Use of Continuous Topical Oxygen Therapy in Combination to Optimize the Chronic Wound Environment Prior to Cellular, Acellular, and Matrix-Like Product Application
READ THE ARTICLE

Introduction

  • Most clinical studies focus on the effectiveness of a singular treatment but routinely, chronic wounds are treated with various topical therapies.
  • The goals of topical wound management include supporting tissue repair, preventing infection, reducing pain, eliminating devitalized tissue, creating a moist environment, and decreasing edema.
  • The objective of this case series is to investigate chronic wound progress when a continuous topical oxygen therapy (cTOT) device was used to optimize the wound environment prior to application of a cellular, acellular and matrix-like product (CAMP).

Methods

A retrospective records review was conducted in a single outpatient wound care center. Treatment consisted of 2 weeks of cTOT followed by CAMP application. Weekly wound photos and measurements were obtained through chart review. Patients included in this study did not achieve complete wound closure within the 2-week cTOT treatment period and therefore were transitioned to CAMP application as per standard practice at the lead author’s clinic.

Patient History

  • Five wounds from four male patients (mean age 71.8 years) were identified in this case review
  • Wound types included 3 DFUs and 2 VLUs

Results

  • The mean wound area reduction seen in this patient cohort undergoing therapy with cTOT and subsequent CAMPs was 74.7% and 76.1% at 4 and 6 weeks respectively.
  • Mean time to wound closure = 8 weeks
  • Mean number of CAMPS applications = 6
  • Serial NIRS images showed an increase in tissue StO2 after 1 week.
  • No adverse events were noted.

Discussion

  • Wound healing should be approached in a systematic algorithmic way for wound bed optimization.
  • cTOT is a novel therapy that should be included in the wound bed optimization pathway.
  • Changing the oxygen gradient in the wound bed via cTOT helps recruit fibroblast, and epithelial cells to support tissue repair and regeneration.
  • cTOT bolsters immune system functions to aid in phagocytosis leading to clearing and disruption of bacteria in the wound bed and peri-wound.
  • The authors believe that this combination of topical methods might have synergistic effects and improve wound healing, and the results of this study support this assumption.
  • With looming limitations in the number of CAMP applications permitted under various LCD/LCA policies in the United States, as well as the constraints in accessing certain CAMPs, finding innovative methods to improve wound healing will have great value across all clinical settings.

Authors:

Dr. Naz Wahab, MD; Lisa Thomas, RN; Dr. Windy Cole, DPM, CWSP