CASE REPORT: Use of Combined Topical Oxygen and VAC Therapy for an ischemic Diabetic Foot Ulcer.

Background

A 65-year-old male with a history of diabetes mellitus and peripheral vascular disease presented with a chronic non-healing wound on the left foot. The wound was persistent for six months with traditional wound care treatment, primarily due to ischemia. Additionally, gangrene of the left little toe was detected. Surgical intervention, including debridement and fifth toe amputation, was performed to manage necrotic tissues. (Figure1)

Treatment Plan

Post-amputation, a combined topical oxygen and vacuum-assisted closure (O2+VAC) device was applied to the wound and left in place for six days (Figure 2).

This therapy aimed to enhance wound healing through localized oxygen delivery to the tissues, infection control, exudate management, stimulation of angiogenesis, and revascularization.

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 two minutes and the low pressure set to 60 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 3.

After removing the O2+VAC dressing, signs of angiogenesis and early granulation tissue formation were observed (Figure 4). This indicates that the therapy effectively supported fibroblast activity and collagen synthesis, essential for wound healing.

The topical oxygen promotes vascular endothelial growth factor (VEGF) production, encouraging new blood vessel creation, and immediately addresses the localized hypoxia which is a significant barrier to healing in ischemic wounds.

The hyperoxia environment created by the therapy reduced the bacterial growth in the wound bed and enhanced leukocyte activity, contributing to effective infection control. This confirms the significant reduction in the patient’s CRP test results, as shown in Figure 5.

However, gangrene developed in the middle and fourth toes, requiring surgical amputation. Following that, the wound was treated with conventional dressings for two weeks. (Figure 6)

At the conclusion of therapy, there were no further signs of gangrene, and the wound showed significant progress towards healing. After a month of O2+VAC therapy, the wound was fully granulated. (Figure 7).

Discussion

The combination of topical oxygen therapy and VAC eliminated key barriers to healing in this ischemic wound by enhancing angiogenesis and promoting granulation tissue formation.

Chronic wounds are often in an inflammatory state due to hypoxia and infection. Topical oxygen therapy reduces inflammation by increasing oxygen availability and promotes the progression from the inflammatory to the proliferative phase by enhancing removal of cellular debris and pathogens.

While systemic vascular issues caused gangrene in adjacent toes, the wound bed itself shown no further gangrene, proving localized effectiveness of O2+VAC therapy.

The combination of surgical intervention and the O₂+VAC therapy demonstrates significant results in promoting wound healing. By enhancing angiogenesis and revascularization, it not only manages infection but also sets the stage for further healing, ultimately enabling the skin grafting procedure to close the wound completely as shown in figure -8 & Figure-9.

Conclusion

This case demonstrates the effectiveness of O2+VAC therapy in healing chronic ischemic wounds, even in the presence of conditions like diabetes and peripheral vascular disease. The therapy significantly supported granulation and restored circulation, resulting in Effective wound management and prevention of future problems.

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