1. بسم الله الرحمن الرحيم

2. Ozone Therapy in Problematic Wounds
One -Year Clinical Experience
in the Naval Medical Services By
Prof. Dr. M. Nabil Mawsouf
Professor of Pain Management
Head of Ozone Therapy Unit
National Cancer Institute, Cairo University
Dr. Ahmed M. Fathi
General Surgeon, Oxy-Therapist
Head of the Therapeutic Unit
Naval Hyperbaric Medical Institute

3. 59 Patients Treated for their Wounds
Patients’ Profile
59 Patients Treated for their Wounds
24 August August 07
Age
Range 23 – years
Mean 57 ± 11 years

4. Patients’ Profile

5. Wounds Diagnoses

6. Outcome of Therapy

7. Outcome of Therapy

8. Commitment of Patients

9. Treatment Modalities

10. General Rules to Treat Wounds
Accurate Diagnosis/Classification of the Wound
Determine Vascular Status (ABPI)
Good Control of Blood Glucose
Correction of Underlying Cause
Correction of Malnutrition
Treatment of Infection
Debridement:
Of Necrotic Tissue / Underlying Osteomyelitis.
Obliteration of Dead Space as a Result of Debridement.
Off-Loading
Wound Care
Adjuvant Therapy

11. Debridement

12. Protocols of Ozone Therapy
Ozone Bag–Rectal Insufflations:
Daily:
Gangrene
Severe Infection
Three Sessions per Week:
Clean Wounds
Healing Wounds
Two / One Session per Week:
Healing Wounds (long Duration)

13. Protocols of Ozone Therapy
Ozonated Water Compresses:
Superficial Wounds
Adjuvant to Bagging:
Before Debridement
Before Bagging
Local Injections:
Not Routine
Promote Healing : 5 μgm
Peri-Debridement : 10 μgm

14. Duration of Therapy
Till Maximum Benefit

15. CLINICAL APPLICATIONS
Lovely Alexandria

16. Necrotizing Soft Tissue Infections
Bibliotheque Alexandrina

17. Necrotizing Soft Tissue Infection
Female, 59 yrs
IDDM
Unfit to HBOT for her bad cardiac, hepatic, renal functions.
NSTI progressive for 1 month
Recommended for Rt Upper Limb Disarticulation.

19. 4 sessions

20. 12
6 sessions 12

21. 1 month after Grafting
Last Session

23. Before
Before
After
After
18 Sessions - 25 Days

24. Notes During Treatment
Psychologically:
Adjusted Mood
Hopeful
Sleep Well
Physically:
Easier Control of Diabetes
Decreased Pain
Easy Painless Debridement

25. Non-Healing Wounds
Montaza Palace

26. Non-Healing Wounds Male, 66 yrs Smoker IDDM
Unfit to HBOT for his bad cardiac and pulmonary functions.
Amputated left little toe since 11/2 month.
Non-Healed Wound.

27. 10 sessions
20 sessions

28. 40 sessions
3 weeks later

29. 45 ses
50 sessions

30. 60 sessions

31. Last Session

32. Before
After
86 Sessions Days

33. Notes During Treatment
Psychologically:
Adjusted Mood, Hopeful
Sleep Well
Physically:
Decreased Pain
Better Walking
Leg can be in Dependency
No More Need to Nitroglycerine Patch

34. Non-Healing Wounds Female, 63 yrs IDDM
Unfit to HBOT for her bad Cardiac functions
Impaired Renal & Hepatic functions
Left B K Amputation since 4 months.
Non-Healed Wound.

35. 36 cm
First Seen

36. 6 Sessions

37. 12 Sessions

38. 17 Sessions

39. 20 Sessions

40. 33.5 cm
25 Sessions

41. Before
After
25 Sessions – 90 Days

42. Notes During Treatment
Psychologically:
Adjusted Mood, Hopeful
Sleep Well
Physically:
Decreased Pain
Easy Painless Debridement
Good Response to Renal & Hepatic treatment.

43. DIABETIC FOOT INFECTION
Stanley Bridge

44. Diabetic Foot Infection
Male, 54 yrs
IDDM, Hypertension
Impaired Cardiac & Renal functions
Severe Infection for 2 Months
Amputation of Little Toe since 1 week
Unfit to HBOT
Recommended for
Rt. B K Amputation.

45. 1st seen

46. 1st seen

47. Plain X-Ray:
Before Amputation
? No Apparent Changes

48. CTA-Abdominal Aorta S. Femoral Arteries:
Atherosclerotic changes with multifocal stenotic segments (All Length)
Near total occlusion along the adductor canals
Popliteal Arteries:
Attenuated in caliber notably the right one

49. CTA-Lower Limbs Arteries
Rt Peroneal & Ant Tibial As:
Nearly totally occluded all length.
Rt Dorsalis Pedis A:
Distally reconstituted in parts.

50. CTA-Lower Limbs Arteries
Rt Post Tibial A:
Patent all through its length apart from multifocal stenotic segments
Deep planter branches are fairly opacified

51. 12 sessions

52. 35 sessions

53. 51 sessions

54. Before
After
51 Sessions – 127 Days

55. 51 Sessions – 127 Days
Follow-up 8 Weeks Later

56. Peripheral Vascular Disease
La Corniche at Night

57. Chronic Ischemia Female, 65 yrs NIDDM Impaired Bypass Operation.
Black hard tip of Big , 2nd & 3rd toes
Aim: Auto - Separation

58. CTA-Abdominal Aorta
(Before Bypass(
Rt Common Iliac A:
Occluded

59. Occluded: CTA-Rt Lower Limb Arteries Tibio-Peroneal Trunk
Posterior Tibial A
Peroneal As

60. CTA-Rt Lower Limb Arteries
Anterior Tibial A:
Proximal short segment Occlusion
Reconstitution of the rest
Dorsalis Pedis:
Patent
Average caliber

61. 1st seen

62. 25 sessions

63. 30 sessions

64. 35 sessions

66. Before
After
35 Sessions – 102 Days

67. Pressure Ulcers
The Memorial of the Unknown Soldier

68. Pressure Ulcer Male, 32 yrs SCUBA Diver DCS II: Paraplegia
DM (temporary)
Depressed
On HBOT
Pressure Ulcer

70. Follow-up 2 months
15 sessions
25 sessions

71. Before
After
38 Sessions – 79 Days

72. Non-Healing Post-Surgical Wounds
East Port

73. Non-Healing Post-Surgical Wounds
Male, 64 yrs
Not Diabetic
Ant Abdominal Wall Tumor
Laparotomy; Excision of most of the Ant Abd Wall
Repair with Extensive Mesh Graft

75. 4 Sessions
10 Sessions

76. Last Session

77. Before
After
20 Sessions – 54 Days

78. Real Problems
In Pain
Sad
Stressed
Desperate
OZONE
GIVES HOPE