Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2022; 10(21): 7545-7552
Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7545
Effect of hydrogen intervention on refractory wounds after radiotherapy: A case report
Peng-Xiang Zhao, Rui-Liu Luo, Zheng Dang, You-Bin Wang, Xu-Juan Zhang, Zi-Yi Liu, Xiao-Hu Wen, Meng-Yu Liu, Ming-Zi Zhang, Yao Mawulikplimi Adzavon, Xue-Mei Ma
Peng-Xiang Zhao, Rui-Liu Luo, Zheng Dang, Xu-Juan Zhang, Zi-Yi Liu, Xiao-Hu Wen, Meng-Yu Liu, Yao Mawulikplimi Adzavon, Xue-Mei Ma, Faculty of Environment and Life Science, Beijing International Science and Technology, Cooperation Base of Antivirus Drug,Beijing University of Technology, Beijing 100124, China
You-Bin Wang, Ming-Zi Zhang, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing 100032, China
Author contributions: Zhao PX and Luo RL designed the study; Luo RL and Dang Z collected, analyzed, and interpreted the data, wrote the manuscript, and reviewed the literature; Dang Z, Wang YB, and Zhang XJ performed the surgery, and collected, analyzed, and interpreted the data; Liu ZY and Wen XH made critical revisions to the manuscript, and approved the final version; Liu MY and Adzavon YM collected, analyzed, and interpreted the data; Zhang MZ and Ma XM made critical revisions to the manuscript for important intellectual content, approved the final version, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; and all authors agreed to be accountable for the content of the work.
Supported by National Natural Science Foundation of China, No. 81602408; and Military Logistics Key Open Research Projects, China, No. BHJ17L018.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Mei Ma, PhD, Professor, Faculty of Environment and Life Science, Beijing International Science and Technology, Cooperation Base of Antivirus Drug, Beijing University of Technology, No. 100 Pingleyuan, Chaoyang District, Beijing 100124, China. xmma@bjut.edu.cn
Received: February 6, 2022
Peer-review started: February 6, 2022
First decision: March 23, 2022
Revised: April 1, 2022
Accepted: May 27, 2022
Article in press: May 27, 2022
Published online: July 26, 2022
Processing time: 154 Days and 24 Hours
Abstract
BACKGROUND

Patients with keloids who receive radiotherapy (RT) after surgery can develop refractory wounds that cannot be healed by the patient's own repair system. Such chronic wounds are uneven and complex due to persistent abscess and ulceration. Without external intervention, they can easily result in local tissue necrosis or, in severe cases, large area tissue resection, amputation, and even death.

CASE SUMMARY

This article describes the use of hydrogen to treat a 42-year-old female patient with a chronic wound on her left shoulder. The patient had a skin graft that involved implanting a dilator under the skin of her left shoulder, and then transferring excess skin from her shoulder onto scar tissue on her chest. The skin grafting was followed by two rounds of RT, after which the shoulder wound had difficulty healing. For six months, the patient was treated with 2 h of hydrogen inhalation (HI) therapy per day, in addition to application of sterile gauze on the wound and periodic debridement. We also performed one deep, large, sharp debridement to enlarge the wound area. The wound healed completely within 6 mo of beginning the HI treatment.

CONCLUSION

After HI therapy, the patient showed superior progress in reepithelialization and wound repair, with eventual wound closure in 6 mo, in comparison with the previous failures of hyperbaric oxygen and recombinant bovine basic fibroblast growth factor therapies. Our work showed that HI therapy could be a new strategy for wound healing that is cleaner, more convenient, and less expensive than other therapies, as well as easily accessible for further application in clinical wound care.

Keywords: Hydrogen; Inhalation therapy; Wound healing; Reepithelialization; Refractory wounds; Case report

Core Tip: A keloid is a benign protuberance of scar tissue formed after a skin wound. Radiotherapy (RT) immediately after surgical resection can effectively reduce the recurrence rate of keloids, but can also disrupt the ordered sequence of cell interactions, leading to repeated inflammatory responses and inadequate healing, thus resulting in a chronic wound. We aimed to test the efficacy of hydrogen inhalation (HI) therapy in the treatment of a patient who developed a chronic wound after skin grafting and RT. The novel adjuvant therapy of HI resulted in effective reepithelialization and successful healing.