Wound bed preparation using appropriate cleansing products is essential for wound healing. Wounds have been cleansed with antimicrobial products such as Dakin’s solution since World War I. The main component of Dakin’s solution is sodium hypochlorite—specifically, the hypochlorite ion. This solution typically exists in a high pH that has proven to be cytotoxic to fibroblasts1; the literature indicates cytotoxicity is noted in solutions that have 0.00005% hypochlorite (ie, as low as 0.5 ppm hypochlorite2). Like Dakin’s solution, chlorhexidine (CHG) is cytotoxic to fibroblasts and exhibits an antimicrobial effect3,4; in addition, it may cause an allergic reaction including painful skin rash in sensitive patients.5,6 As such, cleansing agents that are more tissue-friendly and that avoid the use of any sodium hypochlorite species should be considered.
A cleansing solution containing the antimicrobial preservative hypochlorous acid (HOCl) in its pure form (Vashe Wound Solution, Urgo Medical North America) has been used in recent years in various pediatric units as a gentle and effective wound cleanser.3 In our experience, the pH range and the additional absence of the hypochlorite species have facilitated pain-free application that requires no dilution or rinsing.
The 3.5 to 5.5 pH range associated with wound healing7 of HOCl also effectively removes necrotic tissue and microbes.8,9 This pH range allows the antimicrobial preservative to exist almost entirely as the specific, desired molecule (ie, HOCl) without contamination by undesired sodium hypochlorite.
It is important to reiterate that, given the laws of physical chemistry, any chlorine-containing cleansing solution with a pH value greater than 5.5 will yield increasing quantities of HOCl being converted by a chemical reaction to a sodium hypochlorite species.10
The following 3 cases of complex skin and wound conditions in pediatric patients demonstrate successful treatment using topical HOCl as an adjunct to each patient’s treatment.