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Abstract
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).
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.