Providing patients with advanced wound care choices not only offers options for healing, but it also presents opportunities to explore and test technology synergies in wound care. One area of particular interest is the discovery of treatment regimens that improve wound bed preparation, which includes the deliberate and controlled removal of nonviable tissue, encrusted exudates, microbes, and associated biofilms. Wound healing cannot start with creating a clean wound bed.1 We present here the synergies we have observed in the removal of unwanted matter from wounds using 2 technologies that may be synergistic: hypochlorous acid (HOCl)-containing solutions and hydroconductive dressings.
Hypochlorous acid. The use of prepackaged solutions of pure HOCl for wound cleansing is an emergent concept. Hyphochlorous acid often is confused with, but distinct from, an entirely different chemical species (ie, the hypochlorite anion or sodium hypochlorite) that is present in Dakin’s solution and is associated with cytotoxicity, even when diluted.2 In contrast to the hypochlorite anion, HOCl exists naturally in mammalian tissue within the phagosomes of neutrophils and macrophages.3 Use of HOCl as a preservative in a cleansing solution does not introduce a harmful, non-natural substance to the fragile cells involved in wound healing; in fact, HOCl, in addition to acting as a powerful antimicrobial preservative, works well in the mechanical removal of microbes and necrotic tissue.4-7
The pH of materials introduced to the wound needs to be carefully monitored; in general, a pH between 3 and 6 is known to be associated with wound healing.7-9 This is also the pH range associated with nonionized, pure HOCl— that is, HOCl without contamination with the problematic hypochlorite species that can be created from the HOCl at higher pH values.9-11 A plethora of published evidence4-7 supports the ability of this pH-controlled solution (Vashe Wound Solution, Urgo Medical North America) to mechanically remove necrotic tissue as well as microbes and biofilm matter. Additionally, recent studies show that when combined with negative pressure wound therapy in managing deep chronic and acute wounds, HOCl use can decrease length of hospital stay, decrease need for surgical debridement, and substantially improve wound healing.12
Hydroconductive dressings. Necrotic wounds, bioburden, and biofilm-containing wounds also benefit from the use of fiber-based technologies such as hydrofibers, alginates, and more recently, hydroconductive fibers.13-17 The hydroconductive dressing (Drawtex; Urgo Medical North America), which has the advantage of not disintegrating in the wound, has the ability to physically transport negative elements such as microbes, debris/necrotic tissue, biofilm elements, matrix metalloproteinases, and wound exudates (substances that contain inflammatory cytokines and harmful proteases) away from the wound.13-17 The hydroconductive dressing is available in sheets and rope and may be cut to the necessary size without affecting product integrity. The exact mechanism of a hydroconductive dressing’s ability to remove harmful components is not known and is a subject of continued research. In our practice, we use hydroconductive technology to implement wound bed preparation.