Discussion
In this case report, we present the successful treatment of a high-risk
diabetic foot ulcer in an older adult using ozone therapy and collagen
powder. The patient’s comorbidities, including uncontrolled diabetes
mellitus and severe heart failure, precluded surgical management,
necessitating a non-surgical approach in an outpatient setting.
Diabetic foot ulcers are a life-threatening and debilitating
complication of advanced diabetes, often resulting in amputations and
substantial socio-psychological burden for patients. Prevention is a key
component of diabetic foot ulcer management (4). Additionally, managing
underlying diabetes is crucial to prevent further microvascular changes
and decrease the recurrence rate. Conventional treatment methods for
diabetic foot ulcers have had limited success, highlighting the need for
new and innovative approaches (5).
While local muscle flaps are the preferred option for small foot and
ankle ulcers with exposed bone or tendon, non-surgical approaches can
serve as an alternative, especially when patients have comorbidities.
Soft tissue defects involving tendons in the foot and ankle present
challenges in healing due to limited availability of epithelial cells
and lack of soft tissue coverage, further compounded by additional
comorbidities such as severe heart failure (6).
Ozone therapy has emerged as a potential treatment modality in recent
years. Possible mechanisms associated with wound healing in ozone
therapy include antibacterial effects, growth factor release, and tissue
oxygenation (7). However, improper application of ozone therapy can lead
to respiratory tract damage, gastrointestinal symptoms, and headaches
(8).
The use of ozone therapy in diabetic foot ulcers remains controversial,
and its safety and efficacy have not been extensively investigated.
Previous case reports utilizing ozone therapy for diabetic foot ulcer
management have shown positive results, but these studies used different
methods such as ozone bagging (9, 10). In our case, we utilized ozone
therapy by tent.
A study by Kadir et al. showed that ozone therapy as an adjunct to
standard treatment did not significantly impact the healing process but
did reduce bacterial infections (11). Additionally, Uzun et al. reported
a case in which intralesional ozone injection resulted in severe foot
infection and necrosis, suggesting the potential risks of ozone therapy
(12). However, it is important to note that the patient in the Uzun et
al. study had poor adherence to diabetes treatment, which may have
contributed to the negative outcome.
Conclusion:
In conclusion. Critical tendon exposed diabetic foot ulcers can be
healed rapidly by ozone therapy and collagen powder. Consequently,
preventing tendon loss and further complications is more convenient when
the healing process is faster. The authors recommend additional research
in this area to better understand the wound healing process in diabetic
foot ulcers and to determine the optimal use of ozone therapy as a
non-surgical treatment option.
Declarations:
- Ethical approval and consent to participant
A written informed consent was obtained from the next of kin. Authors
confirm that all methods were performed in accordance with
institutional ethical standards and Declarations of Helsinki.
- Consent for publication
A written informed consent for publicly reporting the information of
the condition was obtained from the participant.
- Availability of data and materials
All data are available from the corresponding author on reasonable
request.
- Competing interests
All the authors declared no conflict of interest.
- Funding
This article was no funded by any individual or organization.
- Authors’ contributions
Study conception and review of the Literature: HMT, MSF, JJ. Clinical
management: HMT. Manuscript preparation: HMT, MSF. Supervision,
Administrative support and critical revision of the paper: JJ. All
authors read and approved the final manuscript.
- Acknowledgment
- we would like to extend our sincere thanks to Dr. Maryam Jenabi, Dr.
Sahba Sheikholeslami and Dr. Sophia Emamdoost for helping us with
material supports.
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