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Pearls for Practice: Hypochlorous Acid and Hydroconductive Dressing Used in Conjunction for Management of Complex Wounds
Hypochlorous acid (HOCl) is a substance in the body that kills invading pathogens by the oxidative burst in neutrophils. It has been demonstrated to decrease bacteria both in vitro and in vivo and to be noncytotoxic.1 Other antiseptics, such as sodium hypochlorite or hydrogen peroxide, are cytotoxic to fibroblasts. The HOCl used in this series, Vashe Wound Therapy (SteadMed Medical LLC, Fort Worth, TX), has a pH similar to skin and has been demonstrated to be useful in a variety of wounds.2 Hydroconductive dressing (HCD, Drawtex [SteadMed Medical, LLC, Fort Worth, TX]) draws wound exudate, debris, slough, bacteria, and deleterious cytokines from wounds.3,4 When HOCl has been used in conjunction with HCD in complex wounds, we have seen rapid improvement in healing. In this series of three patients, the wounds were treated with both HOCl (as a daily compress for 15 minutes) and HCD. The patients also were treated with low-frequency, noncontact ultrasound.
Case 1
The patient, a 24-year-old Marine, had a bilateral hip disarticulation following a dismounted improvised explosive device (IED) blast. He developed a Stage III pelvic pressure ulcer that failed an attempted split-thickness skin graft, and the wound did not improve with the use of hydrofiber or collagen dressings. He was started on HOCl irrigations and soaks followed by HCD with an immediate positive effect. Within 2 weeks, the wound was clean and measured 6.3 cm x 3.9 cm x 2.5 cm (see Figure 1a). Healing progressed with the same treatment regimen and by 5 weeks measured 6.0 cm x 2.0 cm x 0.1 cm (see Figure 1b). Despite a setback (the patient fell onto his wound), by 18 weeks of the HOCl and HCD regimen the wound had decreased in size to 2.4 cm x 1.3 cm x 0 cm (see Figure 1c). The wound continued to closure over the 6 weeks.
Case 2
A 22-year-old Marine suffered a left hip disarticulation and right above-knee amputation secondary to an IED blast 2 years previous. Following removal of heterotopic bone and a flap revision over his pelvis and perineum, his wound dehisced and the flap was undermined to a depth of 15 cm. He was admitted for multiple surgical debridements and treated with negative pressure wound therapy (NPWT) with HOCl washouts for 3 months; maintaining a seal for his NPWT was difficult. When we were consulted, the wound measured 14 cm x 7.9 cm x 4.5 cm (see Figure 2a). We elected to change his treatment to intermittent NPWT with HCD use during the intervals. At each dressing change, HOCl soaks and irrigations were used. Within 3 weeks of this new regimen, the wound measured 7.8 cm x 8.1 cm x 3.7 cm (see Figure 2b). The patient continued to use intermittent NPWT and the HOCl-HCD regimen. The wound dramatically improved and in 11 weeks measured 6.0 cm x 5.0 cm x 2.2 cm (see Figure 2c). Eight additional weeks of treatment brought the wound size to 5.1 cm x 4.7 cm x 0.1 cm. The wound continues on a healing trajectory.
Case 3
A 24-year-old Marine with an open Gustillo IIIB tibia-fibula fracture initially underwent a soleus muscle flap as a limb salvage attempt. He later elected to have an amputation to gain more rapid mobility. To prepare for an eventual below-knee amputation (BKA), fracture healing was required. The open soleus flap was critically colonized with Pseudomonas aeruginosa. An external fixator device was applied. Wounds measured 5.0 cm x 7.2 cm x 0.1 cm, 3.0 cm x 8.0 cm x 0.1 cm, and 4.9 cm x 2.6 cm x 0.1 cm (see Figure 3a). The patient was started on an HOCl-HCD protocol, and the wounds decreased in size and were brought into bacterial balance (see Figure 3b). After 12 weeks on the combination regimen, the remaining wounds measured 0.5 cm x 1.1 cm x 0.1 cm and 1.7 cm x 1.6 cm x 0.1 cm, and the external fixator device was removed (see Figure 3c). The wounds were healed well enough for the patient to undergo a successful BKA.
In summary, the combination of HOCl and HCD has been extremely effective in reducing critical colonization and improving healing in complex wounds.
Pearls for Practice is made possible through the support of SteadMed Medical, LLC, Fort Worth, TX (www.steadmed.com). The opinions and statements of the clinicians providing Pearls for Practice are specific to the respective authors and not necessarily those of SteadMed Medical, LLC, OWM, or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process.
References
1. Robson MC, Payne WG, Ko F, Mentis M, Shafii SM, Culverhouse S, et al. Hypochlorous acid: its role in decreasing tissue bacterial bioburden and decreasing the inhibition of infection on wound healing. J Burn Wounds. 2007;6(4):80–90.
2. Liden BA. Hypochlorous acid: its multiple uses in wound care. Ostomy Wound Manage. 2013;59(9):10–12.
3. Wolvos T, Livingston M. Wound fluid management in wound care: the role of a hydro-conductive dressing. WOUNDS. 2013;25(1):7–14.
4. Ochs D, Uberti MG, Donate GA, Abercrombie M, Mannari R, Payne WG. Evaluation of mechanisms of action of a hydroconductive wound dressing, Drawtex, in chronic wounds. WOUNDS. 2012;24 (9 suppl):6–8.
