Case Report: Management of Osteomyelitis and Complex Infected Post-Sequestrectomy Wound Using Combined Topical Oxygen and VAC Therapy

Background

A 51-year-old man presented with a transverse amputation of his right middle toe at the metatarsophalangeal joint due to osteomyelitis. The patient’s third metatarsal bone became infected two months after amputation. Surgical intervention, including sequestrectomy, was done to remove the contaminated bone while maintaining the healthy bone and surrounding tissues (Figure-1)

The wound was extremely infected, with a C-reactive protein (CRP) score of 228, indicating significant inflammation. Conventional wound care was insufficient, so O₂+VAC therapy was used to treat the infection and improve healing. The Auxilium Health, an innovative AI technology, rapidly analyzes the wound image and provides significant insights on the wound’s state, shown in Figure 2.

Treatment Plan

Following sequestrectomy, a combined topical oxygen and vacuum-assisted closure (O₂+VAC) therapy was applied to the wound for five days (Figure-3). This advanced therapy aimed to deliver localized oxygen to the wound bed, reduce bacterial load and infection by removing excess exudate, 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

Considerable granulation tissue was seen following five days of O₂+VAC treatment, indicating active fibroblast activity and wound healing. The CRP levels improved in tandem with a noticeable decrease in exudate, edema, and redness. There was no infection and the wound environment was cleaner as shown in Figure-5.

The topical oxygen promotes vascular endothelial growth factor (VEGF) production, encouraging new blood vessel creation. 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-6.

During the therapy, 300 ml of fluid was collected from the wound, which included the exudate and inflammatory secretions due to the advanced intermittent mode of action (Figure-7). This minimized swelling and edema while accelerating the transition to the proliferative phase of wound healing.

The wound edges were granulating well, and the depth and size of the wound decreased significantly. Based on the substantial progress, the treating physician recommended stapling the wound edges to promote further closure and full healing.

Discussion

The use of O₂+VAC therapy effectively addressed the patient’s heavily infected wound by combining localized oxygen delivery with vacuum-assisted exudate management. The therapy reduced inflammation and infection, promoting a transition from an inflamed, infected state to active granulation and healing. The wound image was analysed by the same AI technology platform, Auxilium Health, which revealed important insights into the wound’s status, as shown in Figure 8.

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. Remarkable recovery milestones were observed, including noticeable progress within two weeks (Figure 9), further improvement at six weeks (Figure 10), and complete wound closure achieved in just two months following a brief six-day treatment period (Figure 11).

Conclusion

This case demonstrates the success of O₂+VAC therapy in managing a complex, infected post-sequestrectomy wound. The therapy significantly improved wound healing outcomes by reducing inflammation, controlling infection, and promoting granulation tissue formation. Remarkably, wound closure was achieved in just six days of novel therapy, highlighting the efficiency of this advanced approach. These results underscore the utility of O₂+VAC therapy in creating optimal healing environments and overcoming challenges in complex 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 *