Our Experience

Oxygen-Ozone-lipofilling

Madeyski and colleagues.

Trophic lesions of the legs: their treatment with the Madeyski

Local Chamber.

Madeyski P.

With the collaboration of G. Amato (ozone therapy)

And the collaboration of A. Corezzola (lipofilling)

Sileno e Anna Nursing Home, Rizzola. S. Dona di Piave

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Types of ULCERS

1) Venous stasis ulcers

2) Arterial ulcers

3) Traumatic ulcers

4) Collagenopathy ulcers

5) Diabetic ulcers

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Pathophysiology of ulcerstranscutaneous oximetry has shown that

at a vascular lesion, the pO2 reaches

values of up to 5-10 mm Hg.

This value is incompatible with living cells and

impedes the proliferation and activity of leukocytes, which

require pO2 values of 30-40 mm Hg: from which

the danger of infection arises.

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Pathophysiology of ulcers

The synthesis of collagen by

fibroblasts too cannot be separated from oxygen, and

an immature and unstable collagen forms, with

inevitable healing problems.

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Pathophysiology of ulcers

We should aim for:

a) An optimal supply of oxygen,

b) Complete wound cleansing,

c) A cellular stimulation,

d) Good blood perfusion.

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TREATMENTS proposed .

1) Medical treatments 2) Surgical treatments 3) Hyperbaric chamber treatment4) Topical oxygen therapy5) Oxygen-ozone therapy 6) Lipofilling

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Hyperbaric oxygenation therapyHyperbaric oxygen therapy is a systemic therapy

based on the respiration of O2 at high pressure.

THE ULTIMATE PURPOSE IS TO BRING O2 IN AMOUNTS THAT ARE

ADAPTED TO THE METABOLIC NEEDS OF THE TISSUES.

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Advantages Disadvantages

Increase in disolved O2Bactericidal actionAnti-edema action

Healing action

-Not tolerated by many patients.

- Cardiac, vestibular and psychological problems etc. - Limited number of centres.

- Problems with transport.

- Higher costs Rizzola 2015

Hyperbaric Chamber

Advantages Disadvantages High oxygen concentration at

the lesion Minor or no increase in oxygen dissolved in the

plasma

NO LOCAL OR SYSTEMIC CONTRAINDICATIONS

The Madeyski Normobaric Chamber

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Total-body chamber Local chamber

The oxygen concentration reaches 22%

The oxygen concentration reaches 95%

Dissolved oxygen in the blood equal to 6 ml %

Dissolved oxygen in the blood equal to 2%

DIFFERENCES BETWEEN THE "TOTAL BODY" CHAMBER AND THE LOCAL CHAMBER.

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DIFFERENCES BETWEEN THE "TOTAL BODY" CHAMBER AND THE LOCAL CHAMBER.

Basically, thetotal body chamber actsdue to an increase in dissolved oxygen whilst

the local chamber acts due to a raised concentration of oxygen being achieve at

trophic lesions.

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Characteristics and benefits1) Localised therapy

2) Appreciated by patients and the healthcare team

3) Easy to use

4) No local or systemic contraindications

5) Small and easy to carry

6) Possible domiciliary use

8) Low cost to operate and maintain

10) Documented efficacy

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The Madeyski chamber

Personal cases 2014 204 patients sub-divided as follows:

1) 127 venous stasis ulcers,

2) 35 arterial ulcers,

3) 15 traumatic ulcers,

4) 3 collagenopathic ulcers,

5) 22 diabetic ulcers,

6) 2 chemotherapy ulcers,

7) 33 patients with skin grafts.

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Methodology Patients underwent daily sessions

of an hour and occasionally underwent two sessions a day.

The number of sessions varied from case to case, but was never lower than thirty.

The pressure within the chamber was maintained slightly above 760 mm

of Hg and the humidity between 60 and 80%

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Results1) Reduction in secretions and wound cleansing.

2) Improvement of subjective symptoms (pain, burning, itching).

1) Early appearance of good tissue granulation.

2) Reduction in the diameter of lesions until their complete closure in 70% of cases.

5) Favourable effect on attachment in subsequent grafts in 20% of patients.

6) Zero result in 20% of cases.

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Oxygen-Ozone therapy

Up to now, we have had a positive experience with the local chamber with oxygen

There are also a large number of case histories

that demonstrate the effectivenessof oxygen-ozone administered

via a bag. Rizzola 2015

The future….

Is it possible to combine the two methods, to exploit the benefits

of both?

Local chamber

with oxygen-ozone Rizzola 2015

Effects of localised ozoneEffects of localised ozone

At high concentrations (70-80 gamma/ml) disinfection and cleansing of the lesions.

At low concentrations (range 10-2/ cc) a healing and stimulating effect on the tissues.

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Treatment ProtocolTreatment ProtocolNo.5, weekly sessionsNo.5, weekly sessions

Duration of session 60 minutes.1 or 2 sessions per day.At the end of the session, aspiration of the gaseous mixture.Duration of treatment varies, depending on the progress of the lesions.

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Treatment ProtocolTreatment ProtocolNo.5, weekly sessionsNo.5, weekly sessions

Surgical cleansing of the lesions. Humidification of the lesions with physiological water Introducing the limb into the chamber. Airtight closure of the chamber and production of the

vacuum. Filling the chamber with the gas at variable concentrations.

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Conclusions It appears we can say that using the

local chamber with ozone improves the results obtained with oxygen alone or

with the bag technique.

This improvement involves both the percentage success rate as well as

healing speed.

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Conclusions (hypotheses)

The greater effectiveness of the chamber with ozone could either be due to an intrinsic effect of ozone, or the control of important parameters

such as humidity and pressure on tissues, resulting in a potentiation of

the actions of the gas.

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Conclusions (problems)

Using the chamber with ozone poses a few problems however:

The hermetic sealing of the chamber The time needed to create the vacuumThe time needed to aspirate the gasThe need for an ozone generator

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Conclusions (problems)

Using the chamber with ozone poses a few problems however:

Higher costs Problematic domiciliary useCreation of suitable centres

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Personal case histories 2004 141 patients divided as follows:

1) 87 venous stasis ulcers,

2) 10 arterial ulcers,

3) 5 traumatic ulcers,

4) 3 collagenopathic ulcers,

5) 22 diabetic ulcers,

6) 1 chemotherapy ulcers,

7) 13 patients with skin grafts.

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Regenerative LipofillingRegenerative Lipofilling

Rizzola Nursing Home ExperiencesDr. P. Madeyski (Surgeon)

Dr. A. Corezzola (Plastic Surgeon)

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Regenerative Lipofilling

Limited case histories Recent 2014

Cases selectedIndications not recorded

Times performed

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HISTORYHISTORY

1893 German surgeon Gustav Neuber (1850-1932) used adipose tissue taken from an arm to transfer it to the orbital region1912 The first injection of adipose tissue was performed by Eugene Hollander (1867-1932)1980 Pierre Fournier 1990 Sydney Coleman2000 Bill Futrell demonstated that adipose tissue is the largest stem cell bank (ASCs: adipose derived stem cells)2007 Gino Rigotti treated an ulcer with injections of adipose tissue, with full restoration to integrity. 2009 publication of fat injections for regenerative use, published by Sydney Coleman and Richard Mazzola, which highlighted the regenerative potential of fat for repairing lesions due to tissue damage or loss

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Adipose stem cells ASCs Adipose stem cells ASCs (Adipose-Derived Stem Cells)(Adipose-Derived Stem Cells)

Cells present in abundance in the adipose tissue

Capable of regenerating tissuesEasy to take samples (liposuction)

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Technique UsedTechnique Used

WITHDRAW SAMPLES WITH A 10 CC LUER LOK SYRINGE

CENTRIFUGE AT 3000 RPM FOR 3 MINUTES REMOVAL OF OILY AND AQUEOUS PORTIONS TRANSFER INTO INSULIN SYRINGES INJECTION INTO ULCER MARGINS AND

BASES

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Case histories 2014Case histories 201424 patients16 phlebostatic ulcers8 arteriopathic ulcersBefore topical oxygen therapy variable x time10 with successive free graft90% healing100% graftattachment

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