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Comparison of Conventional Wet Dressing and Vacuum Assisted Closure with Hypochlorous Acid Application in Fournier Gangrene Treatment

Year 2022, Volume: 19 Issue: 2, 239 - 244, 28.08.2022
https://doi.org/10.35440/hutfd.1071388

Abstract

Background: Bacterial toxins cause local tissue damage and necrosis. This can continue until a significant amount of tissue becomes necrotic. Neutralization of bacterial toxins improves results. Low concentrations of Hypochlorous Acid can be antimicrobial without causing cytotoxicity in normal cells in the wound and surrounding tissues. In this study, we aimed to compare the results of patients treated with hypochlorous acid (0.01% w/v) through Vacuum Assisted Closure and with traditional wet dressing after surgical debridement due to Fournier Gangrene in our clinic.
Materials and Methods: 73 patients treated for Fournier Gangrene between 2009-2019 in our clinic were evaluated retrospectively. The patients were divided into two groups: those who received Hypochlorous Acid with Vacuum Assisted Closure (Group A, n = 30) and those who received traditional wet dressing (Group B, n = 42) after the first debridement.
Hypochlorous Acid (0.01% w/v), known to destroy bacteria and bacterial toxins, was administered to 30 patients with Fournier Gangrene in saline with a pH of 4-5, 5-6 times a day. Using Vacuum Assisted Closure, 5-10 ml of 0.01% Hypochlorous Acid was applied to the wound and aspirated. For wet dressing application, the wound was closed by applying mupirocin calcium and rifamycin to an appropriate number of wet sponges suitable for the wound surface and depth after cleansing the wound with sponges moistened with isotonic 3 times a day. The collected data were compared. P values smaller than 0.05 were considered significant.
Results: The hospitalization time and wound healing time of 30 patients who received Hypochlorous Acid with Vacuum Assisted Closure were shorter (p <0.05), and the number of patients requiring secondary debridement was also lower (p <0.05).
Conclusion: Hypochlorous Acid application with Vacuum Assisted Closure is an effective, successful and important postoperative treatment and wound care method that provides shorter hospital stay and faster recovery time. Toxicity and immune dysfunction due to bacterial toxins and toxins released from damaged cells can be alleviated with 0.01 Hypochlorous Acid application via Vacuum Assisted Closure. We recommend this method, which is easy to apply and inexpensive in certain Fournier Gangrene cases.

References

  • Fournier JA. Gangrene foudroyante de la verge (overwhelming gangrene) Dis. Colon Rectum 1883, 31(12), 984-988.
  • Safioleas M, Stamatakos M, Mouzopoulos A. Fournier’s gangrene: exists and it is still lethal. Int Urol Nephrol 2006, 38(3-4), 653-657.
  • Zagli G, Cianchi G, Degl'Innocenti S, Parodo J, Bonetti L, Prosperi P, et al. Treatment of fournier's gangrene with combination of vacuum-assisted closure therapy, hyperbaric oxygen therapy, and protective colostomy. Case reports Anesth, 2011.
  • Shyam DC, Rapsang AG. Fournier's gangrene. The Surgeon, 2013, 11(4), 222-232.
  • Tucci G, Amabile D, Cadeddu F, Milito G. Fournier’s gangrene wound therapy: our experience using VAC device. Langenbecks Arch Surg 2009, 394(4), 759-760.
  • Armstrong DG, Bohn G, Glat P, Kavros SJ, Kirsner R, Snyder R, et al. Expert Recommendations for the Use of Hypochlorous Solution: Science and Clinical Application. Ostomy Wound Manage 2015, 61(5), S2-S19.
  • McKenna SM, Davies KJA. The inhibition of bacterial growth by hypochlorous acid. Possible role in the bactericidal activity of phagocytes. Biochem. J. 1988, 254(3), 685-692.
  • Knox WE, Stumpf PK, Green DE, Auerbach VH. The inhibition of sulfhydryl enzymes as the basis of the bactericidal action of chlorine. J. Bacteriol. 1948, 55(4), 451.
  • Barrette WC, Albrich JM, Hurst JK. Hypochlorous acid-promoted loss of metabolic energy in Escherichia coli. Infect. Immun. 1987, 55(10), 2518-2525.
  • Rani SA, Hoon R, Najafi, RR, Khosrovi B, Wang L, Debabov D. The in vitro antimicrobial activity of wound and skin cleansers at nontoxic concentrations. Adv Skin Wound Care 2014, 27(2), 65-69.
  • Wang L, Bassiri M, Najafi R, Najafi K, Yang J, Khosrovi B, et al. Hypochlorous acid as a potential wound care agent: part I. Stabilized hypochlorous acid: a component of the inorganic armamentarium of innate immunity. J. Wound Care 2007, 6: e5
  • Sakarya S, Gunay N, Karakulak M., Ozturk B, Ertugrul B. Hypochlorous acid: an ideal wound care agent with powerful microbicidal, antibiofilm and wound healing potency. Wounds 2014, 26(12), 342-50.
  • Selkon JB, Babbt JR, Morris R. Evaluation of the antimicrobial activity of a new super-oxidized water, Sterilox®, for the disinfection of endoscopes. J. Hosp. Infect. 1999, 41(1), 59-70.
  • Robson MC, Payne WG, Ko F, Mentis M, Donati G, Shafii SM, et al. Hypochlorous acid as a potential wound care agent: part II. Stabilized hypochlorous acid: its role in decreasing tissue bacterial bioburden and overcoming the inhibition of infection on wound healing. J. Wound Care 2007, 6:e6.
  • Ramey DW, Kinde H. Commercial and homemade extremely dilute hypochlorous acid solutions are bactericidal against Staphylococcus aureus and Escherichia coli in vitro. J. Equine Vet. Sci. 2015, 35(2), 161-164.
  • Selkon JB, Cherry GW, Wilson JM, Hughes MA. Evaluation of hypochlorous acid washes in the treatment of chronic venous leg ulcers. J. Wound Care 2006, 15(1), 33-37.
  • Liden BA, Center DRP, Reynoldsburg OH, Foot C, Ankle C. Hypochlorous acid: Its multiple uses for wound care. Ostomy Wound Manage 2013, 59, 8-10.
  • Pernetti R, Palmieri F, Sagrini E, Negri M, Morisi C, Carbone A, et al. Fournier's gangrene: Clinical case and review of the literature. Arch Ital Urol Androl 2016, 88(3), 237-238.
  • Ozturk E, Ozguc H, Yilmazlar T. The use of vacuum assisted closure therapy in the management of Fournier's gangrene. Am. J. Surg. 2009, 197(5), 660-665.
  • Lambert KV, Hayes P, McCarthy M. Vacuum assisted closure: a review of development and current applications. Eur J Vasc Endovasc Surg 2005, 29(3), 219-226.
  • Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J. Am. Coll. Surg. 2009, 208(2), 279-288.
  • Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997, 38(6), 553-562.
  • Czymek R, Schmidt A, Eckmann C, Bouchard R, Wulff, B, Laubert T, et al. Fournier's gangrene: vacuum-assisted closure versus conventional dressings. Am. J. Surg. 2009, 197(2), 168-176.
  • Horsanali MO, Eser U, Horsanali, BO, Altas O, Eren, H. Comparison of vacuum-assisted closure therapy and debridement with primer surgical closure for fournier’s gangrene treatment: 10 years’ experience of a single centre. Int Braz J Urol 2017, 43. doi: 10.1590/S1677-5538
  • Aslam R, Rehman B, Nasir II, Ahmed R, Iftikhar M, Sayyar M. Comparison of vacuum assisted closure versus conventional dressings in treatment of diabetic foot ulcers. KJMS 2015, 8(2), 226.
  • Aragón-Sánchez J, Lázaro-Martínez JL, Quintana-Marrero Y, Sanz-Corbalán I, Hernández-Herrero MJ, Cabrera-Galván JJ. Super-oxidized solution (Dermacyn Wound Care) as adjuvant treatment in the postoperative management of complicated diabetic foot osteomyelitis: preliminary experience in a specialized department. Int J Low Extrem Wounds 2013, 12(2), 130-137.
  • de Angelis B, Lucarini L, Agovino A, Migner A, Orlandi F, Floris M, et al. Combined use of superoxidised solution with negative pressure for the treatment of pressure ulcers: case report. Int. Wound J. 2013, 10(3), 336-339.
  • Yanaral F, Balci C, Ozgor F, Simsek A, Onuk O, Aydin M, et al. Comparison of conventional dressings and vacuum-assisted closure in the wound therapy of Fournier’s gangrene. Arch Ital Urol Androl 2017, 89(3), 208-211.

Fournier Gangreni Tedavisinde Geleneksel Islak Pansuman’ın ve Vakum Destekli Kapatma eşliğinde Hipoklorik Asit Uygulamasının Karşılaştırılması

Year 2022, Volume: 19 Issue: 2, 239 - 244, 28.08.2022
https://doi.org/10.35440/hutfd.1071388

Abstract

Amaç: Bakteriyel toksinler, lokal doku hasarına ve nekroza neden olur. Önemli miktarda doku nekrotik hale gelene kadar bu devam edebilir. Bakteriyel toksinlerin nötralizasyonu sonuçları iyileştirmektedir. Hipoklorik asit’in düşük konsantrasyonları, yaradaki ve çevre dokulardaki normal hücrelerde sitotoksisiteye neden olmadan antimikrobiyal etkili olabilmektedir. Fournier Gangreni gelişen hastalarda, yapılan operasyon sonrası uygulanan Vakum Destekli Kapatma eşliğinde yaraya hipoklorik asit (% 0.01 w/v) uygulaması ile geleneksel ıslak pansuman tedavisi uygulanan hastaların sonuçlarını karşılaştırmayı amaçlayan bir çalışma hazırladık.
Materyal ve Metod: Merkezimizde 2009-2019 yılları arasında Fournier Gangreni nedeniyle debridman uygulanan 73 hasta retrospektif olarak değerlendirdi. İki grup halinde ele alındılar; debridmandan sonra Vakum Destekli Kapatma ile Hipoklorik asit uygulananlar (A Grubu, n =30) ve geleneksel ıslak pansuman uygulananlar (Grup B, n = 42).
Bakterileri ve bakteriyel toksinleri yok ettiği bilinen Hipoklorik asit (% 0.01 w/v), pH’ı 4-5 olan salin içinde Fournier Gangreni’li 30 hastaya günde 5-6 kez uygulandı. Vakum Destekli Kapatma kullanılarak 5-10 ml % 0.01 Hipoklorik asit yaraya uygulanıp aspire edildi. Islak pansuman uygulamasında ise günde 3 kez, izotonik ile ıslatılan spançlarla yara temizlendikten sonra yara yüzeyine ve derinliğine uygun sayıdaki ıslak spançlara mupirosin kalsiyum ve rifamisin uygulanarak yara kapatıldı. Toplanan veriler karşılaştırıldı. Anlamlılık için 0.05’ten küçük p değeri kabul edildi.
Bulgular: Vakum Destekli Kapatma ile Hipoklorik asit uygulanan 30 hastanın hastanede yatış süresi ve yara iyileşme süresi daha kısaydı (p= 0.018) ve ikincil debridman gereken hasta sayısı da daha düşüktü (p = 0.026).
Sonuç: Vakum Destekli Kapatma ile Hipoklorik asit uygulaması, daha kısa hastanede yatış süresi ve daha hızlı iyileşme süresi sağlayan etkili, ameliyat sonrası için başarılı bir yara tedavi yöntemidir. Bakteri kaynaklı ve zarar gören hücrelerden salınan toksinler nedeniyle ortaya çıkan toksisite ve immun işlevsizlik Vakum Destekli Kapatma eşliğinde 0.01 Hipoklorik asit uygulaması ile hafifletilebilir. Uygun Fournier Gangreni vakalarında kolay uygulanabilir ve ucuz olan bu yöntemi öneriyoruz.

References

  • Fournier JA. Gangrene foudroyante de la verge (overwhelming gangrene) Dis. Colon Rectum 1883, 31(12), 984-988.
  • Safioleas M, Stamatakos M, Mouzopoulos A. Fournier’s gangrene: exists and it is still lethal. Int Urol Nephrol 2006, 38(3-4), 653-657.
  • Zagli G, Cianchi G, Degl'Innocenti S, Parodo J, Bonetti L, Prosperi P, et al. Treatment of fournier's gangrene with combination of vacuum-assisted closure therapy, hyperbaric oxygen therapy, and protective colostomy. Case reports Anesth, 2011.
  • Shyam DC, Rapsang AG. Fournier's gangrene. The Surgeon, 2013, 11(4), 222-232.
  • Tucci G, Amabile D, Cadeddu F, Milito G. Fournier’s gangrene wound therapy: our experience using VAC device. Langenbecks Arch Surg 2009, 394(4), 759-760.
  • Armstrong DG, Bohn G, Glat P, Kavros SJ, Kirsner R, Snyder R, et al. Expert Recommendations for the Use of Hypochlorous Solution: Science and Clinical Application. Ostomy Wound Manage 2015, 61(5), S2-S19.
  • McKenna SM, Davies KJA. The inhibition of bacterial growth by hypochlorous acid. Possible role in the bactericidal activity of phagocytes. Biochem. J. 1988, 254(3), 685-692.
  • Knox WE, Stumpf PK, Green DE, Auerbach VH. The inhibition of sulfhydryl enzymes as the basis of the bactericidal action of chlorine. J. Bacteriol. 1948, 55(4), 451.
  • Barrette WC, Albrich JM, Hurst JK. Hypochlorous acid-promoted loss of metabolic energy in Escherichia coli. Infect. Immun. 1987, 55(10), 2518-2525.
  • Rani SA, Hoon R, Najafi, RR, Khosrovi B, Wang L, Debabov D. The in vitro antimicrobial activity of wound and skin cleansers at nontoxic concentrations. Adv Skin Wound Care 2014, 27(2), 65-69.
  • Wang L, Bassiri M, Najafi R, Najafi K, Yang J, Khosrovi B, et al. Hypochlorous acid as a potential wound care agent: part I. Stabilized hypochlorous acid: a component of the inorganic armamentarium of innate immunity. J. Wound Care 2007, 6: e5
  • Sakarya S, Gunay N, Karakulak M., Ozturk B, Ertugrul B. Hypochlorous acid: an ideal wound care agent with powerful microbicidal, antibiofilm and wound healing potency. Wounds 2014, 26(12), 342-50.
  • Selkon JB, Babbt JR, Morris R. Evaluation of the antimicrobial activity of a new super-oxidized water, Sterilox®, for the disinfection of endoscopes. J. Hosp. Infect. 1999, 41(1), 59-70.
  • Robson MC, Payne WG, Ko F, Mentis M, Donati G, Shafii SM, et al. Hypochlorous acid as a potential wound care agent: part II. Stabilized hypochlorous acid: its role in decreasing tissue bacterial bioburden and overcoming the inhibition of infection on wound healing. J. Wound Care 2007, 6:e6.
  • Ramey DW, Kinde H. Commercial and homemade extremely dilute hypochlorous acid solutions are bactericidal against Staphylococcus aureus and Escherichia coli in vitro. J. Equine Vet. Sci. 2015, 35(2), 161-164.
  • Selkon JB, Cherry GW, Wilson JM, Hughes MA. Evaluation of hypochlorous acid washes in the treatment of chronic venous leg ulcers. J. Wound Care 2006, 15(1), 33-37.
  • Liden BA, Center DRP, Reynoldsburg OH, Foot C, Ankle C. Hypochlorous acid: Its multiple uses for wound care. Ostomy Wound Manage 2013, 59, 8-10.
  • Pernetti R, Palmieri F, Sagrini E, Negri M, Morisi C, Carbone A, et al. Fournier's gangrene: Clinical case and review of the literature. Arch Ital Urol Androl 2016, 88(3), 237-238.
  • Ozturk E, Ozguc H, Yilmazlar T. The use of vacuum assisted closure therapy in the management of Fournier's gangrene. Am. J. Surg. 2009, 197(5), 660-665.
  • Lambert KV, Hayes P, McCarthy M. Vacuum assisted closure: a review of development and current applications. Eur J Vasc Endovasc Surg 2005, 29(3), 219-226.
  • Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J. Am. Coll. Surg. 2009, 208(2), 279-288.
  • Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997, 38(6), 553-562.
  • Czymek R, Schmidt A, Eckmann C, Bouchard R, Wulff, B, Laubert T, et al. Fournier's gangrene: vacuum-assisted closure versus conventional dressings. Am. J. Surg. 2009, 197(2), 168-176.
  • Horsanali MO, Eser U, Horsanali, BO, Altas O, Eren, H. Comparison of vacuum-assisted closure therapy and debridement with primer surgical closure for fournier’s gangrene treatment: 10 years’ experience of a single centre. Int Braz J Urol 2017, 43. doi: 10.1590/S1677-5538
  • Aslam R, Rehman B, Nasir II, Ahmed R, Iftikhar M, Sayyar M. Comparison of vacuum assisted closure versus conventional dressings in treatment of diabetic foot ulcers. KJMS 2015, 8(2), 226.
  • Aragón-Sánchez J, Lázaro-Martínez JL, Quintana-Marrero Y, Sanz-Corbalán I, Hernández-Herrero MJ, Cabrera-Galván JJ. Super-oxidized solution (Dermacyn Wound Care) as adjuvant treatment in the postoperative management of complicated diabetic foot osteomyelitis: preliminary experience in a specialized department. Int J Low Extrem Wounds 2013, 12(2), 130-137.
  • de Angelis B, Lucarini L, Agovino A, Migner A, Orlandi F, Floris M, et al. Combined use of superoxidised solution with negative pressure for the treatment of pressure ulcers: case report. Int. Wound J. 2013, 10(3), 336-339.
  • Yanaral F, Balci C, Ozgor F, Simsek A, Onuk O, Aydin M, et al. Comparison of conventional dressings and vacuum-assisted closure in the wound therapy of Fournier’s gangrene. Arch Ital Urol Androl 2017, 89(3), 208-211.
There are 28 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Hasan Anıl Kurt 0000-0001-7292-2248

Emrah Demirci This is me 0000-0003-4688-5871

Hüseyin Uğur Özkaya This is me 0000-0001-7311-5739

Publication Date August 28, 2022
Submission Date February 11, 2022
Acceptance Date May 10, 2022
Published in Issue Year 2022 Volume: 19 Issue: 2

Cite

Vancouver Kurt HA, Demirci E, Özkaya HU. Comparison of Conventional Wet Dressing and Vacuum Assisted Closure with Hypochlorous Acid Application in Fournier Gangrene Treatment. Harran Üniversitesi Tıp Fakültesi Dergisi. 2022;19(2):239-44.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty