Paths to Practice Perfection
Measurement of Tissue Oxygenation and Temperature in Wounds Treated with TWO2 Therapy

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This case series involves patients with chronic ulcers to assess healing of their wounds treated with TWO₂ therapy using a multispectral near-infrared spectroscopy (NIRS) imaging device to measure tissue oxygenation (StO₂) and temperature.

TWO₂ therapy has been shown to increase tissue oxygenation and sustain it over time, resulting in reduced infection, improved angiogenesis, and the formation of higher tensile strength collagen during wound healing^1–3. Cyclical pressurized topical oxygen (TWO₂) therapy combines high concentration oxygen delivery with therapeutic level cyclical compression, which reduces edema, improves wound bed perfusion, and allows more efficient oxygen diffusion, nutrient exchange, and removal of inflammatory factors. Both patients self-administered TWO₂ therapy, 5 days a week, 90 minutes per session, within the comfort of their own homes.

Patient 1

A 55-year-old male smoker, with a left lateral diabetic foot ulcer, present for 3 months.

Figures 1a-1c: Start of TWO₂ therapy and NIRS imaging. Figure 1c: No increase in temperature within wound compared to control site. Note: Reviewing the visual images of wound bed oxygenation with the patient convinced him to try to stop smoking. Figures 1d-1f: Week 5. Figure 1d: Wound closed. Figure 1e: Black arrow - 39% increase in StO₂. White arrow - 24% increase in StO₂ (tissue oxygenation within wound bed). Figure 1f: No increase in temperature within wound compared to control site.

Patient 2

A 76-year-old female, with a five-year history of recurrent right, medial ankle ulceration, complicated by lupus, chronic venous insufficiency and treated with radiation therapy for skin cancer. Prior to initiation of TWO₂ therapy patients had been treated with standard of care for at least two months, including debridement, edema management, moist wound dressings, and appropriate medical management, with little wound improvement. TWO₂ therapy was initiated one year prior to the imaging shown in Figures 2a-2c, and her wound volume had decreased by 95% during that time. Her wound at the start of TWO₂ treatment is shown in Figure 2a.

NIRS imaging depicts the final 12 weeks of healing.

Figures 2b-2d: Start of NIRS imaging. Figure 2d: Thermal image shows 2.3°F (1.3°C) increase in wound bed compared to control site. Possible sign of inflammation. Figures 2e-2g: Week 12 of NIRS imaging. Figure 2e: Wound closed. Figure 2f: Black arrow - 18% increase in StO₂. White arrow - 29% increase in StO₂. Figure 2g: Thermal imaging of wound bed is cut-off.

Conclusion

NIRS data provided objective measures of increases in StO₂, allowing for quantitative assessment of oxygen delivery to the tissue. Using NIRS data, it is clear that using TWO₂ therapy, via pressurized oxygen delivery, can lead to a dynamic increase in oxygen saturation levels as measured by StO₂. As a result of this rapid increase in oxygen saturation, the wound healing sequence, as we understand it, was able to accelerate in function, as the wound healing environment continued to improve⁴. This allowed for rapid angiogenesis and new capillary bed formation. TWO₂ therapy was effective in decreasing pain, via improving wound bed vascularity and achieving significant wound size reduction. This was demonstrated in two medically complex patients with a late-effect soft tissue radiation injury, and chronic ulcer that were refractory to standard of care and had few other options for treatment.

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As with any case study, the results and outcomes should not be interpreted as a guarantee or warranty of similar results. Individual results may vary depending on the patient’s circumstances and condition.

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