Comparison of the efficacy of topical hyperbaric oxygen therapy alone vs a combination of physical methods including topical hyperbaric oxygen therapy, magnetotherapy, and low-energy light therapy in the treatment of venous leg ulcers

Is combined physical therapy more effective than topical hyperbaric oxygen therapy in the treatment of venous leg ulcers? Preliminary study

Introduction

Recently, increased frequency of chronic leg ulcers has been observed. The aim of the study was to compare therapeutic efficacy of combined physical therapy to topical hyperbaric oxygen therapy in the treatment of venous leg ulcers.

Materials and Methods

Participants included 36 patients (14 females and 22 males) between 18 and 80 years of age with chronic venous leg ulcers. They were randomly divided into two study groups. Group I underwent topical hyperbaric oxygen therapy; group II underwent combined physical therapy. Before and after the therapeutic cycle (15 procedures) measurement of ulceration size by planimetry and analysis of laboratory parameters of blood was performed.

Results

In both groups, a statistically significant reduction of ulcer surface area was obtained (25.11±17.8cm2 to 16.93±13.89cm2, p=0.000196) vs. (34.17±14.82cm2 to 23.99±15.15cm2, p=0.004337). Blood morphology revealed a statistically significant reduction in patients from group II who underwent combined physical therapy (p=0.01). In both groups, statistically significant reduction of fibrinogen level (p=0.01 and p<0.001), and total protein level (p=0.01) was achieved. In group II reduction of the inflammation marker C-reactive protein (CRP) was noted.

Conclusions

Topical hyperbaric oxygen therapy and combined physical therapy had statistically significant effects on the reduction of surface area of treated venous leg ulcers. The changes in morphological and biochemical parameters may indicate the anti-inflammatory and anti-clotting action effects of combined physical therapy.

Local Ozone Therapy in Complex Treatment of Venous Leg Ulcers: Ozone therapy for venous leg ulcers

A significant health problem in many countries of the world is the occurrence of hard to heal leg ulcers. In recent years modern methods of physical medicine in comprehensive treatment have been used often including ozone therapy. The study included 54 patients, 25 male and 29 female in age between 39 and 87 years (mean age: 66.7 ± 11.9 years) with venous leg ulcers who underwent a cycle of local ozone therapy. The progress in wound healing was evaluated by computerized planimetry and pain intensity was assessed with use a visual analog scale (VAS) . As a result of the applied local ozone therapy a statistically significant reduction of the ulcer area was achieved from median 7.1 (5.6-9.4) cm2 to 4.4 (3-7) cm2 (P = .000001), which was on median 38.74 (27.27-51.42)% compared to the baseline values ​​before the start of the therapy. In 2 patients (3.7%) the ulcers were completely healed. 18 patients (33.3%) achieved a reduction in ulcer area of ​​more than 50% of the baseline value and the remaining 34 patients (63%) also achieved a reduction in ulcer area. A statistically significant in the percentage of surface area was observed in the group of 19 patients suffering from > 5 years of age compared to the group of 35 patients suffering from ≤5 years (median 50 (32.03-67.16)% versus 33.96 (23.71-45); P = .033178), while percentage changes in ulcer surface area did not differ significantly between all other subgroups of patients. There was also a statistically significant reduction in the intensity of pain in VAS scale in all patients, median 6 (5-7) points before treatment versus 4.4 (3-7) points after treatment, P = .000001). Local ozone therapy of venous leg ulcers accelerate the healing process of ulcers in objective planimetric assessment and reduce the intensity of pain ailments.

Resistant Chronic Venous Leg Ulcers: Effect of Adjuvant Systemic Hyperbaric Oxygen Therapy Versus Venous Intervention Alone

The aim of this study was to assess the adjuvant efficacy of adding systemic hyperbaric oxygen therapy (HBOT) to definitive venous intervention for healing of resistant chronic venous leg ulcers (VLUs). From 97 chronic VLUs, 63 were subjected to a pre-study standard wound care. Thirty three ulcers failed to achieve 50% size reduction, after the 4-weeks standard care, and were allocated to be treated with: HBOT plus venous intervention (n = 17), or venous intervention alone (n = 16). Primary outcomes were the change in ulcer area, complete healing frequency and time, as well as ulcer recurrence. There was a history of recurrent ulcer (82.3% vs. 69%) in HBOT versus venous intervention groups, respectively. The comparison between both groups with regard to area change showed non-significant difference after 3 months of therapy, while there was a significant difference at 6 and 12 months. A significant positive correlation was found between the HBO sessions numbers (20-40) and the rate of ulcer size reduction. Ulcer complete closure after 3 months was observed in (41.7%) of HBOT group, versus (23%) in venous intervention group; (p = 0.33). After 12 months, complete closure was observed in (83.3%) of HBOT group, versus (53.8%) in venous intervention group; (p = 0.02). The mean time of complete closure was significantly shorter in HBOT group, (p = 0.001). HBOT may be effective as adjuvant to venous intervention in treatment of chronic resistant VLUs, it should be reserved for persistent ulcer. Randomized controlled trials with larger numbers is still needed to elucidate its exact role and specific indications.

Thermal Effects of Topical Hyperbaric Oxygen Therapy in Hard-to-Heal Wounds-A Pilot Study

Clinical studies have been performed to evaluate the thermal response of topical hyperbaric oxygen therapy (THBOT) in patients suffering from hard-to-heal wounds diagnosed as venous leg ulcers located on their lower extremities. It was found that this therapy leads to a temperature decrease in areas around the wound. Moreover, a minor temperature differentiation between all areas was seen in the third period of topical hyperbaric oxygen therapy (THBOT) that may suggest that microcirculation and thermoregulation improvement start the healing process. On the other hand, the results of the conducted studies seem to prove that thermal imaging may provide a safe and effective method of analyzing wound healing of hard-to-heal wounds being treated with THBOT. This is the first study that tries to show the possibilities of a very new method by evaluating treatment of hard-to-heal wounds using thermal imaging, similar to the hyperbaric oxygen therapy effects evaluated by thermal imaging and described previously. However, the first clinical results showed a decrease in temperature due to the THBOT session and some qualitative similarities in the decrease in temperature differentiation between the studied areas and the temperature effects obtained due to hyperbaric oxygen therapy.