Title: Level 1 Trauma Center Experience Utilizing Negative Pressure Wound Therapy with Instillation: Hypochlorous Acid versus Normal Saline Solution in Complex or Infected Wounds
Authors: Emily C. Alberto, MD, Luis Cardenas, DO, PhD, Mark Cipolle, MD, PhD, Kathy E. Gallagher, DNP, APRN, FNP-C, CWS, WCC, FACCWS
DOI: https://dx.doi.org/10.18535/jmscr/v8i6.79
Abstract
Negative pressure wound therapy with instillation and dwell time is widely accepted as adjunct treatment for complex infected wounds; however, results vary by irrigant. This study compared effects of hypochlorous acid versus 0.9% sodium chloride solution on clinical outcomes. We present a single-institution, comparative, observational, retrospective analysis of medically complicated patients with complex or grossly infected wounds. The primary endpoints were length of hospital stay, number of wound-related operating room procedures, and days to wound closure. The study included 24 patients with 27 wounds. Their diagnoses included: necrotizing soft tissue infections, necrotizing fasciitis, infected stage IV ulcers, and multi drug-resistant abscesses. Results indicated a trend towards fewer operating room trips, fewer days to closure, and shorter length of stay when patients were treated with hypochlorous acid compared to sodium chloride solution. (3.3 vs. 4.1, p=0.19; 19.4 vs. 22.5, p=0.33; and 24.3 vs. 37.9, p=0.27 respectively). Our clinical experience utilizing negative pressure wound therapy with instillation and dwell time with hypochlorous acid has shown favorable outcomes suggesting hypochlorous acid as an effective irrigant in the management of grossly infected and complex wounds. As a result we have standardized our institutional protocol to incorporate hypochlorous acid for challenging or infected wounds.
Keywords: Hypochlorous Acids; Vacuum-Assisted Closure; Wound Infection; Wound Infection, Surgical; Wounds and Injury.
References
- Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997; 38(6): 563-576.
- Fleishmann W, Russ M, Westhauser A, Stampehl M. Vacuum sealing as carrier system for controlled local drug administration in wound infection. Unfallchirurg. 1998; 101(8):649-654. doi: 10.1007/s001130050318
- Brinkert D, Ali M, Naud M, Marie N, Trial C, Téot L. Negative pressure wound therapy with saline instillation: 131 patient case series. Int Wound J. 2013; 10 Suppl 1:56-60. doi: 10.1111/iwj.12176
- Goss SG, Schwartz JA, Facchin F, Avdagic E, Gendics C, Lantis JC 2nd. Negative pressure wound therapy with instillation (NPWTi) better reduces post-debridement bioburden in chronically infected lower extremity wounds than NPWT alone. J Am CollClin Wound Spec. 2014; 4:74-80. doi: 10.1016/j.jccw.2014.02.001
- Gabriel A, Kahn K, Karmy-Jones R. Use of negative pressure wound therapy with automated, volumetric instillation for the treatment of extremity and trunk wounds: clinical outcomes and potential cost-effectiveness. Eplasty. 2014; 14:328-338.
- Kim PJ, Attinger CE, Steinberg JS, Evans KK, Powers KA, Hung RW, Smith JR, Rocha ZM, Lavery L. The impact of negative-pressure wound therapy with instillation compared with standard negative-pressure wound therapy: a retrospective, historical, cohort, controlled study. Plast Reconstr Surg.2014; 133: 709-716. doi: 10.1097/01.prs.0000438060.46290.7a
- Felte R, Gallagher KE, Tinkoff GH, Cipolle M. A Case Review Series of Christiana Care Health System’s Experience with Negative Pressure Wound Therapy Instillation. 2016; 8(11): e865.doi: 10.7759/cureus.865
- Couch KS, Miller C, Cnossen LA. Stead Med Medical. Non-cytotoxic wound bed preparation: Vashe hypochlorous acid wound cleansing solution. Updated 2016. http://www.steadmed.com/wp-content/uploads/2016/11/Vashe-Wound-Cleansing-Final-final.pdf. Accessed 25 July, 2019.
- Khamaisi M, Balanson S. Dysregulation of wound healing mechanisms in diabetes and the importance of negative pressure wound therapy (NPWT). Diabetes Metab Res. Rev. 2017; 33: e2929.doi: 10.1002/dmrr.2929
- Gallagher, KE, Felte, R, Alberto, EC, Cipolle, M, Cardenas, L. A Case Review Series Of Negative Pressure Wound Therapy with Instillation and Dwell Time (NPWTI-d) Using Hypochlorous Acid (Vashe®, HOCI) vs Sodium Hypochlorite 0.125% (Dakin’s, NaOCL) or 0.9% Normal Saline in Complex Infected Wounds. Presented at: Diabetic Limb Salvage Conference, Washington, D.C., April, 2018.