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بسم الله الرحمن الرحيم

This study presents the clinical experience of using ozone therapy in treating problematic wounds over a one-year period in the Naval Medical Services. The patients' profiles, wound diagnoses, outcome of therapy, and commitment of patients are discussed. Treatment modalities, general rules to treat wounds, and protocols of ozone therapy are also included. The clinical applications of ozone therapy in necrotizing soft tissue infections and non-healing wounds are demonstrated through case studies. The benefits and improvements observed during the treatment are highlighted.

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بسم الله الرحمن الرحيم

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  1. بسم الله الرحمن الرحيم

  2. Ozone Therapy in Problematic Wounds One -Year Clinical Experience in the Naval Medical Services By Prof. Dr. M. Nabil Mawsouf Professor of Pain Management Head of Ozone Therapy Unit National Cancer Institute, Cairo University Dr. Ahmed M. Fathi General Surgeon, Oxy-Therapist Head of the Therapeutic Unit Naval Hyperbaric Medical Institute

  3. Patients’ Profile 59 Patients Treated for their Wounds 24 August 06 - 23 August 07 Age Range23 – 75 years Mean57 ± 11 years

  4. Patients’ Profile

  5. Wounds Diagnoses

  6. Outcome of Therapy

  7. Outcome of Therapy

  8. Commitment of Patients

  9. Treatment Modalities

  10. General Rules to Treat Wounds • Accurate Diagnosis/Classification of the Wound • Determine Vascular Status (ABPI) • Good Control of Blood Glucose • Correction of Underlying Cause • Correction of Malnutrition • Treatment of Infection • Debridement: • Of Necrotic Tissue / Underlying Osteomyelitis. • Obliteration of Dead Space as a Result of Debridement. • Off-Loading • Wound Care • Adjuvant Therapy

  11. Debridement

  12. Protocols of Ozone Therapy Ozone Bag–Rectal Insufflations: • Daily: • Gangrene • Severe Infection • Three Sessions per Week: • Clean Wounds • Healing Wounds • Two / One Session per Week: • Healing Wounds (long Duration)

  13. Protocols of Ozone Therapy Ozonated Water Compresses: • Superficial Wounds • Adjuvant to Bagging: • Before Debridement • Before Bagging Local Injections: • Not Routine • Promote Healing : 5μgm • Peri-Debridement : 10μgm

  14. Duration of Therapy Till Maximum Benefit

  15. CLINICAL APPLICATIONS Lovely Alexandria

  16. Necrotizing Soft Tissue Infections Bibliotheque Alexandrina

  17. Necrotizing Soft Tissue Infection • Female, 59 yrs • IDDM • Unfit to HBOT for her bad cardiac, hepatic, renal functions. • NSTI progressive for 1 month • Recommended for Rt Upper Limb Disarticulation.

  18. 4 sessions

  19. 12 6 sessions 12

  20. 1 month after Grafting Last Session

  21. Before Before After After 18 Sessions - 25 Days

  22. Notes During Treatment • Psychologically: • Adjusted Mood • Hopeful • Sleep Well • Physically: • Easier Control of Diabetes • Decreased Pain • Easy Painless Debridement

  23. Non-Healing Wounds Montaza Palace

  24. Male, 66 yrs Smoker IDDM Unfit to HBOT for his bad cardiac and pulmonary functions. Amputated left little toe since 11/2 month. Non-Healed Wound. Non-Healing Wounds

  25. 10 sessions 20 sessions

  26. 40 sessions 3 weeks later

  27. 45 ses 50 sessions

  28. 60 sessions

  29. Last Session

  30. Before After 86 Sessions - 147 Days

  31. Notes During Treatment • Psychologically: • Adjusted Mood, Hopeful • Sleep Well • Physically: • Decreased Pain • Better Walking • Leg can be in Dependency • No More Need to Nitroglycerine Patch

  32. Female, 63 yrs IDDM Unfit to HBOT for her bad Cardiac functions Impaired Renal & Hepatic functions Left B K Amputation since 4 months. Non-Healed Wound. Non-Healing Wounds

  33. 36 cm First Seen

  34. 6 Sessions

  35. 12 Sessions

  36. 17 Sessions

  37. 20 Sessions

  38. 33.5 cm 25 Sessions

  39. Before After 25Sessions –90Days

  40. Notes During Treatment • Psychologically: • Adjusted Mood, Hopeful • Sleep Well • Physically: • Decreased Pain • Easy Painless Debridement • Good Response to Renal & Hepatic treatment.

  41. DIABETIC FOOT INFECTION Stanley Bridge

  42. Diabetic Foot Infection • Male, 54 yrs • IDDM, Hypertension • Impaired Cardiac & Renal functions • Severe Infection for 2 Months • Amputation of Little Toe since 1 week • Unfit to HBOT • Recommended for Rt. B K Amputation.

  43. 1st seen

  44. 1st seen

  45. Plain X-Ray: Before Amputation ? No Apparent Changes

  46. CTA-Abdominal Aorta • S. Femoral Arteries: • Atherosclerotic changes with multifocal stenotic segments (All Length) • Near total occlusion along the adductor canals • Popliteal Arteries: • Attenuated in caliber notably the right one

  47. CTA-Lower Limbs Arteries • Rt Peroneal &Ant TibialAs: • Nearly totally occluded all length. • Rt Dorsalis Pedis A: • Distally reconstituted in parts.

  48. CTA-Lower Limbs Arteries • Rt Post TibialA: • Patent all through its length apart from multifocal stenotic segments • Deep planter branches are fairly opacified

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