Increasing Health Care Equity for Patients in Remote Rural California: How Topical Oxygen Therapy Improves Access and Saves Limbs

Introduction: Chronic wounds, including diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), and arterial wounds, pose significant challenges to healing, particularly for patients in remote or rural areas. Inadequate tissue perfusion is a key factor in most chronic wounds, due to disrup- tion of the microvasculature, inflammation, edema, increased metabolic demand, and underlying chronic conditions. While traditional hyperbaric oxygen (HBO) is an established modality for improving wound healing, it is not covered by insurance for most wounds, and its accessibility remains a barrier for patients in remote settings. A unique, portable, multi-mo- dality topical oxygen therapy (TOT) device*, which concurrently delivers both intermittent compression and pressurized topical oxygen therapy, presents a home-based alternative that may address these challenges. Methods: This case series examines four patients with chronic wounds, who were treated with multi-modality TOT in rural California. Patients received multi-modality TOT in their homes, and outcomes such as wound healing progression, treatment compliance, and overall limb salvage were assessed. Results: Four multi-morbid patients with 5 wounds (2 DFU, 1 mixed arterial/venous/DFU, and 2 DFU s/p amputation due to osteomyelitis) were treated with multi-modality TOT. Four wounds healed completely, and one wound achieved 95% closure in an average of 3 months. Discussion: Multi-modality TOT enabled improved access to oxygen therapy for patients in remote areas. All patients experienced accelerated wound healing, with reduced time to closure and improved quality of healed scars. Multi-modality TOT demonstrated effectiveness in man- aging difficult chronic wounds and provided additional benefits such as mitigating chronic lymphedema and resolving postoperative surgical site dehiscence. The portability and home-based application of multi-modali- ty TOT enhanced patient compliance, contributing to positive outcomes.