Pain from hard-to-heal wounds is common and challenging to manage with current therapies. Most hard-to-heal wounds show some degree of hypoxia that impairs healing and contributes to pain. Regular oxygen therapy is given in hyperbaric oxygen chambers and is costly, time-consuming and cannot be offered to most patients. Moreover, hyperbaric oxygen therapy (HBOT) only increases tissue oxygen for a short time and is given only for a few hours per week. Topical oxygen therapy (TOT) was introduced as an alternative and in this report we focus on topical continuous oxygen therapy (TCOT), which has been shown to be associated with healing of hard-to-heal ulcers. We report on a patient with type 1 diabetes with a painful hard-to-heal lower leg ulcer that failed to heal with standard wound dressings and that had insufficient response to pharmacological analgesia. The patient was on three different analgesics before treating the wound with TCOT. As the wound was considered hypoxic, due to longstanding diabetes and probable microangiopathy, TCOT was commenced. Within one week of treatment starting, the patient spontaneously ceased all his analgesics as he was free of pain; and after 2.5 months, the ulcer healed. The patient reported no adverse effects. In addition to promoting healing, TCOT may also be considered for its potential analgesic effects in hard-to-heal wound management.
Keywords: HBOT; TCOT; TOT; diabetes; dressing; hard-to-heal leg ulcer; hyperbaric oxygen therapy; pain; topical continuous oxygen therapy; topical oxygen therapy; ulcer; wound.