Management of a Complex Post-Amputation Infected Wound Using Combined Topical Oxygen and VAC Therapy

Background

A middle toe amputation was performed on a 74-year-old male who had a history of peripheral arterial disease (PAD) that was got worse by severe limb ischemia in his right leg. Following evaluation, atherosclerosis was discovered, and treatment options were further restricted by a failed angioplasty brought on by nicotine usage. The patient’s circulation was judged sufficient, consequently above-knee amputation was performed.

Postoperatively, the wound became heavily infected as shown in Figure-1, with a CRP level of 119, indicating severe inflammation. The wound was stuck in the inflammatory phase and required advanced wound care to manage infection and promote healing. The Auxilium Health, an innovative AI technology, rapidly analyzes the initial wound image and provides significant insights on the wound’s state, shown in Figure 2.

Treatment Plan

A combined topical oxygen and vacuum-assisted closure (O2+VAC) therapy was applied to the wound as shown in Figure-3. This advanced therapy aimed to deliver localized oxygen to the wound bed, reduce bacterial load and infection by removing excess exudate and edematic fluid, promote angiogenesis and granulation tissue formation.

In this case, the advanced “Intermittent Mode” was chosen as the mode of operation, with the high pressure set to 130 mmHg and maintained for one minute and the low pressure set to 40 mmHg for one minute. The topical oxygen will be delivered into the differential negative pressure volume, and the specified mode is represented graphically in Figure 4.

Outcomes

Following the first six days of O2+VAC treatment, there was a considerable reduction in inflammation and infection, showing the effect of the hyperoxic environment established by the therapy, as well as slight granulation in the wound bed, as shown in Figure 5.

In the second application, the wound showed a marked reduction in size, granulation tissue formation was evident and indicating a transition into the proliferative phase after another four days of O2+VAC treatment as shown in Figure-6.

The hyperoxia environment created by the therapy reduced the bacterial growth in the wound bed and enhanced immune cells activity, contributing to effective infection control. This confirms the significant reduction in the patient’s CRP test results, as shown in Figure-7

The topical oxygen was used for ten days during the first and second applications of the therapy, and 500 ml of fluid was collected from the wound site, which included the exudate and inflammatory secretions due to the advanced intermittent mode of action. This minimized swelling and edema while accelerating the transition to the proliferative phase of wound healing.
The topical oxygen promotes vascular endothelial growth factor (VEGF) production, encouraging new blood vessel creation. The wound was granulating well, and the depth and size decreased significantly. In response to the substantial progress, the treating physician stapled the wound borders and continued using the VAC without topical oxygen for another six days, as shown in Figure-8, using an advanced “Bilevel Continuous Mode” of operation with the high pressure set to 130 mmHg and the low pressure set to 60 mmHg, the specified mode is represented graphically in Figure-9, to promote further closure and full healing. Following sixteen days of treatment, there were no symptoms of infection or inflammation and the wound margins healed well. The wound was clean, and ready for conventional dressing care.

Discussion

The O2+VAC therapy, which combines vacuum-assisted exudate management with localized oxygen delivery, successfully treated the patient’s severely infected wound. By reducing inflammation and infection, promoting a transition from an inflamed, infected state to active granulation and healing. The Auxilium Health, the same AI technology platform, further examined the resulting, Figure-6, and revealed essential details on the condition of the wound, as seen in Figure 10.

The foam dressing creates micro deformation in the wound bed and improves the effectiveness of O₂+VAC therapy by promoting cellular activity, angiogenesis, and collagen synthesis while improving oxygen delivery. By reducing edema and removing debris, an optimal environment for healing is created, leading to significant granulation tissue formation. The wound demonstrated substantial progress, with the edge stapled and further closure achieved as shown in Figure 11. Progress milestones included visible wound closure at six weeks, as shown in Figure 12, and complete healing achieved within two months, as shown in Figure 13.

Conclusion

The O₂+VAC therapy successfully managed a heavily infected and inflamed post-amputation wound in a patient with critical limb ischemia and PAD. Through the sequential application of the ‘Intermittent Mode of operation’ and the ‘Bilevel Continuous Mode of operation,’ the therapy achieved remarkable results, including adequate wound closure and healing. Following an effective sixteen-day novel therapy, the patient transitioned to conventional dressing care without any signs of infection or inflammation. Complete wound closure was achieved within two months, highlighting the immense potential of advanced wound care methods like O₂+VAC therapy in overcoming challenging clinical scenarios.

*This case was managed at Ahalia Diabetes Hospital, Palakkad, under the supervision of Dr. Jayanthinathan S, Consultant Plastic, Cosmetic & Podiatric Surgeon*

* Auxilium Health is the Wound AI utilized in this case *
Document No: CMD/CS/1003