The malodor that emanates from some wounds has been recognized throughout human history, as starkly demonstrated in the ancient Greek play named after the principal character, Philoctetes. Written by Sophocles in the fifth century BCE, Philoctetes (pronounced fil-ok-tee’-teez) was a warrior of outstanding marksmanship who set out to win the hand of Helen of Troy, considered the most beautiful woman in the world.
On the journey, his foot was bitten by a snake. The bite caused a chronic, painful wound that emitted such a foul odor that his fellow soldiers abandoned him on the deserted island of Lemnos. Philoctetes remained stranded on Lemnos with his nonhealing wound for 10 years and sustained himself by hunting with bow and arrow. Later, the Greeks realized they needed Philoctetes’ warrior skills to conquer Troy, and Odysseus sent soldiers to retrieve him and heal his wounds by using herbs. Once healed, Philoctetes participated in conquering Troy by hiding with a band of warriors inside the famed wooden horse, a feat that would not have been possible with a malodorous wound.
Foul-smelling wounds are common in clinical situations, including necrotic or infected pressure injuries, tissue death related to diabetic or vascular ulcers, and malignant wounds. The odor results from putrefying flesh and metabolic byproducts of organisms that have colonized the wound. Wounds infected with Pseudomonas can yield a fruity scent, whereas anaerobic bacteria emit a foul smell. Malodor from a wound can produce psychological discomfort, embarrassment, and social isolation, as occurred with Philoctetes.
A variety of compounds and antimicrobials can reduce bacterial bioburden in the wound bed to control odor, including topical and systemic antibiotics, charcoal, silver, iodine, and metronidazole (off-label use). Surgical interventions such as sharp excisional debridement and drainage of abscess pockets can eliminate or diminish wound odor. Limbs that are malodorous with gangrene are often subject to amputation. Palliative care principles and advance directives must be considered when deciding on aggressive measures, particularly when healing is not expected.
The first reported remedy for malodorous wounds was offered by Theophrastus, a Greek philosopher in the third century BCE. His treatise, titled De Odoribus in Latin, records a recipe of aromatic tree bark, cinnamon, and myrrh. Theophrastus named this compound megaleion after the Greek physician Megallus, and it is used today in perfume and aromatherapy.
Wound odor remains a major concern for clinicians across the health care continuum. Recorded over 2000 years ago, the story of Philoctetes and the remedy of Theophrastus remain relevant by demonstrating debility and social isolation caused by wounds and the need for odor control. The passage of time and growing demographic of older persons and patients with chronic disease have increased the importance of familiarity with the therapeutic armamentarium used in caring for wounds.
Jeffrey M. Levine, MD, AGSF, CWSP, is a geriatrician and wound care specialist in New York City. He enjoys writing about the fascinating history of wound care, and you can see his website and blog here.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.