Treating Wounds Occurring in Radiated Tissue With Nitric Oxide/Plasma Therapy

At SAWC Spring 2023, Dr. Terry Treadwell presented the findings from a case series in which 5 patients were treated with nitric oxide/plasma therapy to heal wounds occurring from radiotherapy.

Transcript:

I'm Dr. Terry Treadwell from the Institute for Advanced Wound Care in Montgomery, Alabama. I've been asked to tell you about our poster that we have at the Spring SAWC. It's a poster about our success in treating patients who have radiation wounds. Wounds that are due to radiation therapy are wounds that are occurring in tissue that have been irradiated. These can be very, very difficult to manage, as you know. Very few treatments are available short of big operating procedures requiring muscle flaps, skin flaps, and things along those lines. Hyperbaric oxygen for prolonged periods of time sometimes will be of benefit. But we were looking for something that would be a little bit better and a little less invasive. We discovered the gaseous nitric oxide and decided we should try that to see if we could make it work in the treatment of those diseases.

As you know, when you have a radiation wound, you have cells, especially fibroblasts, which are not responsive to healing. They have been damaged by the radiation therapy. The microcirculation has been damaged, and so the area is without circulation and sometimes exceedingly ischemic. We also have an inflammatory response that's in the wound that's related to the radiation therapy.

These things don't just go away with time. They continue to stay present and continue to cause problems and continue to worsen as the years go by after the radiation therapy. So it's not unexpected to see patients present with wounds in radiated tissue years after they've had their radiation therapy or treatment for their malignancies or however they receive their radiation therapy.

We had the nitric oxide gas available to us. This is a very special gas in that it's made in a special machine. The nitric oxide is made from ambient air. You don't have to have a canister of nitrogen and a canister of oxygen to make this. It makes it out of the air, and when it combines those two atoms into the molecule of nitric oxide, it also generates plasma energy. The plasma energy attaches itself to the nitric oxide. It allows the nitric oxide to last longer. Normally, a nitric oxide molecule has a half life of about 1 to 2 seconds. When combined with the plasma energy, it'll last up to 30 seconds or maybe even a little longer, allowing us to dispense it where we need it to go.

The device makes it in the machine, and then an air compressor blows the nitric oxide gas combined with the plasma energy to the skin surface or wherever you want it to go, and this allows it to contact the skin and cause a healing effect. The interesting thing is, once the plasma energy has been attached to that, it will penetrate intact skin up to 3 cm. Yes, it will go through intact skin up to 3 cm depth to treat just about anything that you want to treat, whether it be infection or, especially in this case, wounds related to radiation therapy.

We presented our poster, a series of 5 patients that were referred to us with unhealed wounds due to their radiation therapy. The wounds had been present for from 3 to 20 years... 3 to 20 years without any significant healing. Several patients had had hyperbaric oxygen. Several had had skin grafts. All of them had had multiple different types of wound dressings, including tissue-engineered skin products and other things along those lines with no significant closure. The average size of the wounds that we saw was 6.8 cm average.

We were able to treat those patients with a nitric oxide stream and we'd blow the hot air, blow the nitric oxide gas onto the wound. It really is just like blowing a hair dryer on your wound itself. The temperature of the gas is around 100°F, so it is well within the safe range for treatment. The treatment is once a week for 6 minutes. Six minutes is all it takes to cover the wound with nitric oxide, and then you put a standard moisture-retaining dressing on the wound and treat them again in another week.

In our time of being able to treat these patients, 2 of the patients, 1 who had had a wound open for 4 years, healed within 6 weeks. Six weeks, had healed with 1 treatment of nitric oxide per week. Another one healed completely in 6 weeks, and he had had his wound open for 3 years. The other 3 patients who had wounds as far as up to 20 years and they are continuing therapy, they've healed over 50% during the first 6 to 8 weeks of therapy, and they continue to get better and better. We look forward to continuing their therapy and getting them to closure.

We hope that we will be able to get this advanced therapy onto everybody's doorstep so that anyone who has a radiation wound or even a problem with a tissue that's been radiated will be able to have access to the nitric oxide therapy. It seems to us like it's going to be the next best thing for this type of treatment.