SCIENCE, PRACTICE AND EDUCATION DOI: 10.35279/jowm202104.07 Rare ulcer in a neonate: Experience using topical oxygen therapy based on the M.O.I.S.T. Principle Chin Yen Lee 1 , Yun Ying Ho 2 , Mohanaprakash Arasappan 3 , Yeang Wee Koay 3 , Jacob Abraham 1 1 Wound Care Unit, Department of Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia 2 Department of Internal Medicine, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia 3 Department of Paediatric Surgery, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia Correspondence: drmaramihai@gmail.com · Conflicts of Interest: None Keywords: Haemoglobin spray, internal iliac artery thrombosis, ischaemic wound, neonate, topical oxygen therapy ABSTRACT Background Ischaemic wounds are notoriously difficult to treat, as poor perfusion often leads to chronic, non-healing wounds. Conclusions Wound management in neonates is extremely chal- lenging, due to their relatively small physical size and the preference for less invasive management strategies. Aim This case study describes the successful treatment of an ischemic ulceration in a neonate using topical oxygen therapy (TOT). Implications for clinical practice TOT has proven to be an easily accessible, effica- cious, non-invasive and cost-effective method for treating ischaemic wounds in neonates. Methods BACKGROUND A large necrotic ulceration quickly developed over Adequate oxygenation is one of the keys for achieving the left gluteal area in a 2-week-old child and en- wound healing. Oxygen plays a pivotal role through- larged to cover the entire gluteal area in one week. out the process of normal wound healing, namely The aetiology of the wound was ischaemic, due to for controlling inflammation and proliferation and internal iliac artery thrombosis after an umbilical vein tissue remodelling. 1 During the inflammatory stage catheterisation. The wound was initially managed of the wound-healing process, the respiratory burst of using the standard of care and surgical debridement activated phagocytes consumes oxygen to produce re- of the necrotic tissue with saline dressing; however, active oxygen species. A similar process happens when the condition worsened with the development of a a wound becomes infected. Besides that, oxygen is new necrotic patch. vital for activating the transcription factors that pro- mote angiogenesis stimulated by lactate production Topical oxygen therapy (TOT) was applied using by the NADPH oxidase of phagocytes. The rate of the M.O.I.S.T. concept. After the second surgical connective tissue formation is also heavily dependent debridement, TOT in the form of haemoglobin spray on oxygen availability for fibroblast proliferation and was administered on alternate days and a moist collagen maturation. 2 dressing was applied. Many chronic wounds develop when the partial pres- Results / Findings sure of oxygen is below the critical hypoxic threshold The wound healed progressively, with granulation level. Hypoxia can be caused by damaged vascula- tissue formation and epithelisation after 6 weeks. ture, such as trauma, cardio-embolic or atheroscle- rotic processes, or other systemic conditions that lead 38 JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION
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