A Case Series Comparing Negative Pressure Wound Therapy with Instillation: Hypochlorous Acid vs Normal Saline for Complex Infected Wounds
Luis Cardenas DO, PhD1,2
Mark Cipolle MD, PhD1
Emily C. Alberto, MD1
1. Department of Surgery, Christiana Care, Newark, DE
2. Acute Surgical Wound Service, Christiana Care, Newark, DE
Negative pressure wound therapy with instillation and dwell time (NPWTi-d) has become widely accepted as adjunct treatment for complex infected wounds; however, the results vary with the chosen irrigant. The objective of this study was to compare effects of different NPWTi-d irrigants on clinical outcomes of patients with complex, infected wounds. Hypochlorous acid† (HOCl), chosen for its antimicrobial and biofilm-disruptive properties, was compared to 0.9% sodium chloride solution (NSS).
This is a single-institution, comparative, observational, and retrospective analysis of patients with multiple comorbidities and complex wounds or grossly infected wounds with multi-drug resistant pathogens. The primary endpoints were length of hospital stay (LOS), number of wound-related operating room procedures, and days to wound closure. Our institutional standard NPWTi-d of ten minutes dwell time every four hours was employed for patients treated with both HOCl† and NSS.
The study includes 24 patients with 27 complex wounds of various etiologies, all with NPWTi-d incorporated into their wound management regimen. There was a trend towards fewer operating room visits for patients treated with HOCl† compared to NSS (3.3 vs. 4.1, p=0.19). There was also a trend towards fewer days to wound closure and shorter LOS for patients treated with HOCl† compared to NSS (19.4 vs. 22.5, p=0.33 and 24.3 vs. 37.9, p=0.27, respectively). Diagnoses included: necrotizing soft tissue infections, necrotizing fasciitis, infected stage IV ulcers, and complex multidrug-resistant abscesses.
Our clinical experience utilizing NPWTi-d with HOCI† in grossly infected and complex wounds has shown favorable outcomes. Additionally, this study demonstrated a trend toward decreased operative visits, days to closure, and LOS for medically complicated patients. These outcomes suggest the effectiveness of HOCl† as an irrigant for NPWTi-d and have resulted in an update to our institutional protocol, making HOCl our standard irrigant when using NPWTi-d for complex, infected wounds.
Trademarked Items (if applicable): †Vashe® Wound Solution, Urgo Medical North America, Fort Worth, Texas, USA