(CS-038) Ulcer Unplugged: How Detour Bypass and Oxygen Therapy Accelerate Repair

Purpose: To demonstrate the synergistic impact of combining topical oxygen therapy (TOT) with percutaneous transvenous femoropopliteal bypass in the management of complex diabetic foot ulcers and advanced peripheral arterial disease. 

Background: TOT is an emerging adjunct for chronic wounds complicated by vascular insufficiency. Oxygen supports angiogenesis, collagen synthesis, epithelialization, and immune defense. A 2024 meta‑analysis showed significantly improved healing rates with TOT compared to standard care, while consensus guidelines endorse its use in multidisciplinary wound management. Percutaneous transvenous femoropopliteal bypass provides a minimally invasive solution for long‑segment superficial femoral artery disease, achieving durable revascularization with high technical success and low adverse event rates. 


Methods:

Case Presentation: A 68‑year‑old male with hypertension, diabetes, dyslipidemia, and coronary artery disease presented with progressive peripheral arterial disease and recurrent ulcerations. Wound dehiscence was noted at the left hallux amputation site with avascular necrosis, and a second ulcer under the right third metatarsal head showed purulent drainage and probe‑to‑bone. His vascular history included multiple prior revascularizations and interventions, with new stenosis of the right SFA and restenosis of the left SFA/popliteal segment. 

Results: Outcome: Stage 1 involved left first and right third metatarsal resections, thrombectomy, and deployment of a percutaneous transvenous femoropopliteal bypass to the left leg, followed by wound vac therapy and debridement. Stage 2 began two weeks later with TOT five times weekly for 1.5 hours/day. Wounds decreased progressively, with complete healing of the right foot by two months and near‑complete healing of the left foot by four months. Stage 3 included right SFA stenting and angioplasty. By six months, both ulcerations had fully resolved, and at one‑year follow‑up, closure was sustained without recurrence. 

Discussion:

Conclusion: This case illustrates the synergistic benefit of combining endovascular bypass with topical oxygen therapy in complex limb salvage. Through serial interventions and longitudinal management, the patient achieved complete bilateral wound healing within six months and durable closure at one year, highlighting the potential of integrated perfusion and oxygen strategies in advanced vascular and diabetic foot ulcers.