Abstract
Background:
Despite the best clinical practice, chronic nonhealing ulcers of the lower extremities present a significant challenge. Nitric oxide (NO) has been shown to play a significant role in biological functions including wound healing and as an antimicrobial agent in nonspecific immune response.
Objective:
Our goal was to study the effect of gaseous NO (gNO) administered directly to a two-year-old nonhealing chronic venous ulcer in a 55-year-old male presenting with a 30-year history of severe venous disease.
Methods:
gNO (200 ppm) was applied to the lower extremity using a delivery system connected to a “single patient use” plastic boot, at 1.0 L/min.
Results:
The patient received an average of 8.1-h treatments for 14 consecutive nights. On day 0 the wound was malodorous and covered by bacterial biofilm with little healthy granulation tissue present. Following 3 days of gNO treatment, healthy granulation tissue was noted with absence of malodorous odor. At day 14, the ulcer was significantly reduced in size (p = 0.014) and almost completely reepithelialized. Day 10 post-treatment did not reveal any deterioration in healing. Six weeks later, the wound was 90% healed. At 26 weeks post gNO discontinuation, the ulcer was completely healed.
Conclusions:
This single case study demonstrated that gNO as a topical agent was well tolerated by the patient without any report of discomfort or side effect. The result of wound healing was very promising and warrants future exploration.
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