The usage of a Topical Desiccating Agent (TDA) for Chemical debridement of non healing wounds and its pain perception and management – a retrospective case series analysis

Introduction: A Topical Desiccating Agent (TDA) based on methanesulfonic acid (MSA) and dimethyl sulfoxide (DMSO) has proven to be an effective biofilm- and necrosis-removing chemical debridement option. Its application can be accompanied by a transient but severe pain perception, depending on the individual patient. This study aims to assess the application-associated pain and management strategies.   Methods:A single-center, retrospective, case-series study design was used to assess pain associated with the usage of the agent. Pain was assessed using the visual analog scale (VAS). Pain was assessed before, during and 15 minutes after treatment. Overall wound pain, pain during dressing change in general and during last change and during last sharp debridement was assessed. Additionally, baseline pain medication, medication during treatment and local anesthetic management was assessed. Patients with peripheral neuropathy were excluded from the analyses.  Results:A total of 31 patients treated with the agent were identified, 25 cases could be assessed as they had a complete dataset. Three local anesthetic procedures were applied using either an anesthetic crème, a form of tumescent local anesthesia (TLA) or a custom-made local anesthetic hydrogel. Application time ranged between 30-45 minutes before treatment. Chemical debridement was associated with individual pain during application (VAS range 3-8). However, using adequate pain management, pain could be effectively reduced.Discussion: Accompanying pain during TDA treatment, chemical debridement was well manageable using the various ready-to-use anesthetic approaches. It’s demonstrated that for TDA a comparable or even lower pain perception compared to sharp or surgical debridement.  References: