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ESRA19-0410 Synergy between locoregional analgesia (LRA) and IV ozone (O3) therapy in microvascular recruitment: a challenge to save limb after femur nail infection. a case report
  1. M Mazzocchi1,
  2. MB Mascia1,
  3. C Perotti2,
  4. P Quaretti3,
  5. G Ragni1 and
  6. GA Iotti1
  1. 1IRCCS Policlinico San Matteo Foundation, University of Pavia, Anesthesia and Intensive Care Unit I, Pavia, Pavia Italy
  2. 2IRCCS Policlinico San Matteo Foundation, University of Pavia, Diagnostic Medicine Department and Immunotransfusional Service, Pavia, Italy
  3. 3IRCCS Policlinico San Matteo Foundation, University of Pavia, Diagnostic Medicine Department, Radiology and Radiodiagnostic Service, Pavia, Italy


Background and aims Infection can seriously complicate surgical treatment of fractures (up to 30%)1; if significant tissue damage is involved, compromised vasculature impairs access of host defences and antibiotics to affected areas, leading to permanent functional loss.

O3 is a gas that can be administered iv after melting with saline solution (10–80 mcg/mL); combination with biological water leads to formation of reactive oxygen and lipid oxidation products, thus activating biochemical pathways that increase: erythrocytes’ ATP and 2,3-DPG, NO release, platelets and neutrophil-phagocytic activity, antioxidant enzymes upregulation, staminal cells migration/differentiation at injured sites and re-endothelization.2 3

LRA allows post-operative pain control and vasodilation, improving microcirculation4 and antibiotic delivery to the infection site.

Methods A 45-year-old woman (BMI 40) with severe femur nail infection, submitted to multiple surgical debridements and antibiotic therapies with poor effects during 3 weeks, was finally scheduled for hip disarticulation. as a last chance, lumbar epidural catheter was placed to optimize pain control and O3 was started (35 mcg/ml, 500 ml/day during 15 days) through CV access. No complication happened.

Circulating endothelial progenitors cells (CEPs) were evaluated using monoclonal-antibodies labeled towards CD106+45- and CD90+45; blood samples were obtained at days 0, 7, and 15 after starting O3.

Results At day 15 patient was free from infection: no clinical signs, wound healing (figure 1), negative cultural exams. Simultaneously increased levels of CEPs released from bone-marrow in response to flogosis fell, probably showing complete endothelial repair (figure 2).

Abstract ESRA19-0410 Figure 1
Abstract ESRA19-0410 Figure 2

Conclusions Synergy between LRA and O3 in microvasculature recruitment is a challenge to heal severe infections after surgical treatment of fractures; CEPs levels could correlate with response to therapy.

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