Complex wounds such as deep pressure ulcers, epidermolysis bullosa, sternal wounds following cardiac surgery, and wounds in patients with comorbidities frequently require multiple modalities to advance the healing trajectory. Surgical correction of the wound with certain techniques (eg, pedicled or free flaps) often is not possible because of the overall condition of the patient, and surgical debridement may be contraindicated in the most severely ill patients.
Because the eschar presenting on most of these wounds is dry, a Leptospermum honey (MEDIHONEY, Derma Sciences, Inc, Princeton, NJ) has been the mainstay of our nonsurgical debridement. We recently added hypochlorous acid (Vashe Wound Solution, SteadMed Medical LLC, Fort Worth, TX) irrigation and soaks to the wounds. The hypochlorous acid treatment not only served as an adjunct to debridement, but it also accelerated the wounds into a healing trajectory.1,2 Once debridement was complete, continued soaks with hypochlorous acid led to rapid and complete healing of the wounds. In patients with multiple areas of skin breakdown, hypochlorous acid also was used to cleanse around tracheostomy sites and gastrointestinal tube egress sites, successfully healing denuded areas.1
This treatment has been used in a series of 12 patients with a total of 16 wounds. Four illustrative cases from the series are presented.
Case 1. An infant with an atrioventricular canal defect and postoperative pulmonary hypertension developed an occipital pressure ulcer secondary to positioning of a blanket roll (see Figure 1a). The eschar was debrided with a MEDIHONEY hydrocolloid dressing (see Figure 1b). Treatment commenced with hypochlorous acid soaks for 5 minutes, followed by honey dressings every other day. The ulcer demonstrated a healing trajectory on the hypochlorous acid/honey regimen (see Figure 1c) and was completely healed after 5 weeks of treatment (see Figure 1d).
Case 2. The patient in Case 1 also developed a left gluteal pressure ulcer that initially was debrided with MEDIHONEY dressings (see Figure 2a). Treatment with hypochlorous acid soaks was provided, followed by honey dressings changed every other day. This resulted in an excellent healing trajectory (see Figure 2b), with complete healing at 5 weeks.
Case 3. A toddler was seen 3 days after a lawn mower accident that injured her arm. Following debridement, the wound was treated with hypochlorous acid soaks for 5–10 minutes, followed by application of negative pressure wound therapy (NPWT) (see Figure 3a). While the wound steadily improved, the exposed bone required a muscle flap for coverage (see Figure 3b). Hypochlorous acid and NPWT allowed the muscle flap to close most of the defect (see Figure 3c). The patient was discharged on hypochlorous acid soaks and NPWT to await final skin-grafting at 6 weeks following initial injury (see Figure 3d).
Case 4. A teenager with severe pneumonia and a tracheostomy due to respiratory arrest developed an occipital pressure ulcer (see Figure 4a). The wound was provided sharp debridement and Leptospermum honey (see Figure 4b). Treatment was changed to hypochlorous acid soaks and honey dressings every other day; this put the wound on a healing trajectory (see Figure 4c). The ulcer continued to heal (see Figure 4d) and was totally closed at 12 weeks without requiring any surgery.
Hypochlorous acid proved to be a beneficial adjunct to debridement in 12 patients with 16 wounds. Continued use of hypochlorous acid soaks following debridement put wounds on a healing trajectory in these complex wounds in children.