Case Study of Ozone Bagging Adjuvant Therapy in Wagner II and III Diabetic Foot Ulcers on Wound Healing Process: Three Patients Recovered Completely

Background: Diabetic foot ulcer is a chronic complication of diabetes mellitus in the form of ulceration with or without infection. Diabetic foot ulcers that are not handled properly can cause damage to the foot that requires amputation. Wound care techniques for treating diabetic foot ulcers are starting to develop, one of which is ozone bagging therapy. This ozone bagging therapy in diabetic foot ulcers is reported to be useful as an anti-microbial effect, increasing glycemic control, increasing insulin sensitivity, preventing oxidative stress, increasing fibroblast proliferation, and increasing the release of growth factors. This case study will report 3 patients with Wagner II and III-foot ulcers who healed completely within 28 days using ozone bagging treatment as an adjuvant. Methods: 3 patients with diabetic foot ulcers Wagner II and III received ozone bagging therapy every 4 days for 7 sessions (a total of 28 days) as an additional therapy besides treating moist gauze using NaCl. This study used a Medical Ozone Generator. The dose of ozone used with medical oxygen is 1 lpm, flow 0.6, in the first session "high dose" with an output dose of 80-100 mg/l and in the 2nd-7th session with a low dose (25-35 mg/l). Macroscopic assessment of the wound using the Wagner scale and the progress of each treatment session is documented in photographs. Results: On macroscopic measurements, the process of wound healing leading to wound closure was better in the treatment group and was taken as a case for 3 patients who recovered completely. It resulted in 3 patients who recovered completely with a measurement of the Meggitt-Wagner scale of 0.26. Conclusion: For these recovered patients, there was a decrease in VEGF, TGF-β, and PDGF levels. The VEGF, TGF-β, and PDGF levels tested were VEGF, TGF-β, and PDGF levels in wound exudate by comparing them on the 3rd day. 1st and 12th day. Supported by macroscopic data showing that the wound healing process was better in the group that received ozone bagging therapy as an adjuvant. From this study it was found that the trend of decreasing levels of VEGF, TGF-β, and PDGF in wound exudate occurred because the inflammatory and proliferative processes in the treatment group lasted more faster than the control group. Keywords: ozone bagging therapy, diabetic ulcers, wound exudate, growth factors, VEGF, TGF-β, and PDGF, Meggitt-Wagner scale.