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Wound healing

The recognition of the importance of proper microcirculatory function has been growing rapidly in recent years, suggesting that improved microcirculatory health can support better outcomes in a wide variety of conditions, both localized and systemic.Optimal microvascular function is critical in regulating blood flow and tissue perfusion, blood pressure, oxygen delivery, and waste removal.

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Wound healing

  1. 1. Introduction: New Prospect of treatment of wound healing Ito Puruhito, MD Thoracic, Cardiac and Vascular Surgery, Medical Faculty, Universitas Airlangga , Surabaya, Indonesia Presented at : 6th Surabaya Vascular Update (SURVUE-6) , Surabaya, July 22-23, 2016
  2. 2. DISCLOSURE The author disclosed that the investigation is sponsored by Circularity Healthcare, LLC
  3. 3. Introduction The recognition of the importance of proper microcirculatory function has been growing rapidly in recent years, suggesting that improved microcirculatory health can support better outcomes in a wide variety of conditions, both localized and systemic. Optimal microvascular function is critical in regulating blood flow and tissue perfusion, blood pressure, oxygen delivery, and waste removal.
  4. 4. The clinical application : Proper functioning of these processes can have a beneficial effect on prevention and treatment of disease states such as sepsis , non-healing wounds, diabetes , hypertension , obesity , metabolic syndrome , respiratory disorders, sexual dysfunction, and age-related syndromes.
  5. 5. The basic knowledge : • Increased microcirculation with CO2 is widely known to increase the perfusion of oxygen throughout the body based on the Bohr effect. • CO2 is widely accepted as a natural vasodilator. • Increased oxygen-rich microcirculatory tissue perfusion throughout the body is widely reported in medical research to improve physiological processes including but not limited to healing, performance, stamina, sleep quality, skin health, and much more.
  6. 6. In addition, when the Bohr effect is stimulated, the increase in blood CO2 concentration causes greater oxygen unloading by hemoglobin proteins, thereby increasing oxygen- rich blood flow in the local microcirculatory system
  7. 7. According to Bohr’s Law, increased CO2 leads to a shift to the right of the curve balance of he Oxygen Dissociation curve, and this will increase the release of Oxygen to red blood cells. So increased CO2 content has a positive benefit to wound healing due to increased release of Oxygen to tissues.
  8. 8. Wound healing process by Transdermal CO2 Delivery • Soft vapor of water and CO2 readily and safely dissolves in the skin to increase skin perfusion pressure or microcirculation • D`OXYVA delivers the highest possible concentration of CO2 and has been clinically studied to significantly increase lasting blood flow volume that reportedly results in a long-term increase of blood flow in the body's microcirculatory system. • It is non-electrical, handheld, painless, easy to use, and safe, with no detrimental or adverse side effects, according to years of user feedback and the results of past clinical trials with D`OXYVA
  9. 9. the effect of transdermal CO2 delivery on remote microvascular perfusion in subjects with and without diabetes by assessing skin perfusion pressure of the foot after bathing the thumb in CO2. D’oxyva device Inside : CO2 cartridge thumb Foot with wound
  10. 10. Scientific reasoning • Introduction Medical gases have historically been delivered via the inhalation route of administration. However, in light of the physiology of human skin, it may be possible to deliver medical gases transdermally. • Transdermal gas delivery is non-invasive and can interact with dermal capillary and cellular receptors near the skin, producing a desired systemic effect. • The work (using D’oxyva device) (*) studied a novel method for boosting microcirculation using diffusive non- invasive transdermal delivery of a supersaturated solution of carbon dioxide (CO2) in water. (*) Lee C. Rogers, D.P.M., Judy M. Muller-Delp, Ph.D., Topy A. Mudde, MSc.
  11. 11. Conclusion of the study for clinical use • Application of transdermal CO2 produces a remote vasodilation that may be mediated through release of a circulating humoral agent • Transdermal Delivery of Carbon Dioxide Boosts Microcirculation (Lee C. Rogers1, D.P.M., Judy M. Muller-Delp3, Ph.D., Topy A. Mudde2, MSc.) • Impairments in microcirculation are detrimental to skin repair and regeneration • the D`Oxyva® delivery system of transdermal carbon dioxide improves parameters of dermal microcirculation. • using the D’Oxyva® device shows promise for improving the microcirculation in multiple disease states and may improve skin repair or delayed wound healing.
  12. 12. First Case report • Case : 48yrs M with prolonged wound healing after bone fracture of tibia, more than 2 years of classical wound treament, received D’oxyva treatment in 4 weeks’ session, 7x per week, twice daily (total 60 cartridges) : 1st week 2nd week 3rd week 4th week • Case-2 : 65 yrs F with Diabetes and open wound treated by herself at home for 4 weeks, then consulted to me : After 7 days of treatment with D’oxyva (1x per day) – same wound dressing as before (unfortunately the patient did not appear again at my practice office since then..)
  13. 13. Observation 1 (14 February 2015) Location : Left Foot-plantar OBSERVATIONS DONE AT SANGLAH HOSPITAL, BALI (Courtesy : Dr.I.N.Semadi) Case: diabetic foot, left plantar and toe
  14. 14. Observation 2 : (21 February 2015) Location : Plantar pedis sinistra Treatment with D’oxyva device, twice daily, 5 days per week 1st week’s appearance
  15. 15. Observation 3 : (7 March 2015) Location : Plantar pedis sinistra 2nd week (20 x treatment)
  16. 16. Observation 4 : (28 March 2015) Location : Plantar pedis sinistra 3rd week (30 x treatment)
  17. 17. Observation 1 : (14 Februari 2015) Location : 1st digiti pedis sinistra Wound of the toe (same side of foot)
  18. 18. Observation 2 : (21 Februari 2015) Location : 1st digiti pedis sinistra 1st week (10 x treatment)
  19. 19. Observation 3 : (7 March 2015) Location : 1st digiti pedis sinistra 2nd week (20 x treatment)
  20. 20. Observation 4 : (28 March 2015) Location : 1st digiti pedis sinistra 3rd week (30 x treatment) : toe completely healed
  21. 21. Result of our experience using D’oxyva apparatus for Diabetic foot ulcer • 6 patients, observed for 5 consecutive days, treatment with D’oxyva app. 2x/ day • Perfusion Index (PI) observed (Masimo) (*) • Same wound dressing treatment • Observer : Dr.Chiquita (*) Perfusion index (PI) is a ratio between pulsatile blood flow or static blood flow to nonpulsatile in peripheral tissues. PI is a non-invasive and continuous mean to measure peripheral perfusion obtained pulse oximetry. The measuremen t of PI is not influenced by physiologic variables susch as heart rate, SaO2, oxugen consumption, and temperature. Change of PI is parallel to peripheral perfusion. Location with high pulsatile (high PI) is an optimal place to measure with pulse oximetry and pulse CO-Oximetry. The best location is the tip of the toe.
  22. 22. Measurement of PI (Perfusion Index) Masimo® by means of gadget (Android or Apple) Finger / toe tip
  23. 23. Result of preliminary observations taken from our Ambulatory patients : • N : 6 • Status : - Wagner-1 = 2 - Wagner-2 = 3 - Wagner-3 = 1 • Indication of improved wound healing : significant increase of PI • Improved healing (after 5 days) = 6 (100%)
  24. 24. Pat.1 Day-1 (PI : 0,29) Day-5 (PI : 0,41)
  25. 25. Pat.2 Day-1 (PI : 4,2) Day-5 (PI : 7,8)
  26. 26. Pat.3 Day-1 (PI : 2,9) Day-5 (PI : 5,6)
  27. 27. Pat.4 Day-1 (PI : 1,8) Day-5 (PI : 2,4)
  28. 28. Pat.5 Day-1 (PI : 0,52) Day-5 (PI : 3,9)
  29. 29. Pat.6 Day-1 (PI : 2,6) Day-5 (PI : 4,6)
  30. 30. Practical tips • if they use their D'Oxyva less frequently, the supply of cartridges will last longer, saving them money. I try to stress to my patients that the first box of 25 cartridges should last two months. The second box of 25 should last about three months. • These estimates are based on using the device 5 times a week for the 1st month (5 days a week), and then using it 3 times a week for the second month, for a total of 32 treatments. As the first box of cartridges is nearing empty, the patient should purchase the next box. This box would be used for at least 3 treatments per week for roughly the next 6 weeks  50 cartridges
  31. 31. Recommended use and benefit • Increase in muscle mass • Increase in skin collagen • Improvement in circulation • Increase in overall energy • Increase in body/digestive track eliminations • Increase in blood oxygen levels • Improvement in my digestive system • Improvement in absorption of nutritional supplements • Decease in overall pain and inflammation in bones, muscles, and joints • Reduction in spider veins • Reduction in body fat Dr. Jim Bledsoe PhD. N.S My personal experience using D’oxyva in 50 consecutive session (5x per week in 10 weeks) – 50 cartridges :
  32. 32. D'Oxyva impacts the body in much the same way as supplements do. • The reason for using D’Oxyva more often in the first month is that, similar to most nutritional supplements, it is necessary to upload at a higher dosage in the initial stages of usage. This uploading allows the supplementation process to have a greater effect on the body, jump- starting the beneficial effects. • For more severe conditions, it is usually possible to see meaningful results by using D’Oxyva about twice a day, or roughly ten applications a week, for the first two months. Once the desired improvement has been achieved, the treatments can be scaled back to a maintenance mode of 3 – 5 times a week.