Case Series/Study

(CS-011) Topical Oxygen Therapy for a chronic irradiated breast incisional wound monitored by Near Infrared Spectroscopy (NIRS)

Co-Author(s):

Homer-Christian Reiter, BS – Research Assistant

Introduction: <span lang="EN-US" style="font-size: 12.0pt; font-family: 'Calibri Light',sans-serif; mso-ascii-theme-font: major-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: major-latin; mso-bidi-font-family: 'Times New Roman'; color: black; mso-bidi-font-weight: bold;">Delayed healing and surgical site complications are a well-documented complications of mastectomy performed for breast cancer in combination with postoperative radiation therapy. Because of the impact of the radiation on the skin perfusion, these wounds are very difficult to heal and can lead to persistent non healing wounds. (1) We present a patient with a chronic wound that failed basic wound care therapy that was treated successfully with topical oxygen therapy. Topical oxygen therapy has been shown to heal chronic wounds in randomized controlled studies. (2)
<span lang="EN-US" style="font-size: 12.0pt; font-family: 'Calibri Light',sans-serif; mso-ascii-theme-font: major-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: major-latin; mso-bidi-font-family: 'Times New Roman'; color: black;">Near infrared spectroscopy (NIRS) was utilized to document the beneficial results of the topical oxygen therapy with increased levels of tissue oxygenation. Methods: The patient is a 62 y/o female who underwent a right modified radical mastectomy and a left simple mastectomy. She received one month of radiation therapy to the right mastectomy site. Following the radiation therapy, she developed a chronic non healing wound. When first seen in the wound care clinic the wound had been present for 38 days and measured 5.4 cm X 1.7 cm with a depth of 0.2cm. Topical Oxygen therapy was initiated with tissue oxygenation levels monitored with NIRS. Results: <span lang="EN-US" style="font-size: 12.0pt; font-family: 'Calibri Light',sans-serif; mso-ascii-theme-font: major-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: major-latin; mso-bidi-font-family: 'Times New Roman'; color: black;">Base line NIRS studies prior to topical oxygen therapy demonstrated oxygen levels of 67%. Following 32 days of treatment there was a very significant decrease in the size of the wound and oxygen levels in the wound were measured at 80%. At 60 days the wound was epithelialized and the oxygen level was 84%. The patient was followed with sequential NIRS studies until the inflammation under the epithelialized wound had subsided indicating deep healing. At that time a bra with a prosthetic breast was placed across the previous wound with no recurrence. Discussion: <span lang="EN-US" style="font-size: 12.0pt; line-height: 107%; font-family: 'Calibri Light',sans-serif; mso-ascii-theme-font: major-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: major-latin; mso-bidi-font-family: 'Times New Roman'; color: black; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA; mso-bidi-font-weight: bold;">This case demonstrates the ability of topical oxygenation therapy to heal a chronic irradiated wound. The case also demostrates how NIRS can be used clinically to track and document a repsonse to an advanced wound therapy, in this case the increase in tissue oxygenation brought on by topical oxygen therapy. Trademarked Items: References: 1. Impaired wound healing after radiation therapy: A systematic review of pathogenesis and treatment
Lia K. Jacobson, Maxwell B. Johnson, Raj D. Dedhia, Solmaz Niknam-Bienia, Alex K. Wong
2. Niederauer MQ, Michalek JE, Liu Q, Papas KK, Lavery LA, Armstrong DG. Continuous diffusion of oxygen improves diabetic foot ulcer healing when compared with a placebo control: a randomised, double-blind, multicentre study. J Wound Care 2018;27:S30-S45 25.