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      The Use of V.A.C. VERAFLO CLEANSE CHOICE in the Burn Population

      case-report
      Author(s): 1 , , 1 , 2 , 1 , 3
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: burn, cleanse choice, hypochlorous acid

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          Abstract

          Negative pressure wound therapy (NPWT) is routinely used in the treatment of acute and chronic wounds. The technology continues to evolve with improved results NPWT is routinely used at the Arizona Burn Center and the addition of the V.A.C. VERAFLO CLEANSE CHOICE TM with its reticulated open foam device has been used with promising results in a variety of complicated wounds. We present a case series involving the use of this negative pressure wound therapy device and irrigation in burn and necrotizing soft tissue patients treated at the Arizona Burn Center.

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          The inhibition of bacterial growth by hypochlorous acid. Possible role in the bactericidal activity of phagocytes.

          Jill K Davies, Benjamin McKenna (1988)
          The 'respiratory burst' of phagocytes such as neutrophils generates superoxide which forms H2O2 by dismutation. H2O2 and Cl- ions serve as substrates for the enzyme myeloperoxidase to generate hypochlorous acid (HOCl). HOCl is thought to play an important role in bacterial killing, but its mechanism of action is not well characterized. Furthermore, although many studies in vitro have shown HOCl to be a damaging oxidant with little or no specificity (particularly at high concentrations), bacteria which have been ingested by phagocytes appear to experience a rapid and selective inhibition of cell division. Bacterial membrane disruption, protein degradation, and inhibition of protein synthesis, do not seem to occur in the early phases of phagocyte action. We have now found that low concentrations of HOCl exert a rapid and selective inhibition of bacterial growth and cell division, which can be blocked by taurine or amino acids. Only 20 microM-HOCl was required for 50% inhibition of bacterial growth (5 x 10(8) Escherichia coli/ml), and 50 microM-HOCl completely inhibited cell division (colony formation). These effects were apparent within 5 min of HOCl exposure, and were not reversed by extensive washings. DNA synthesis (incorporation of [3H]-thymidine) was significantly affected by even a 1 min exposure to 50 microM-HOCl, and decreased by as much as 96% after 5 min. In contrast, bacterial membrane disruption and extensive protein degradation/fragmentation (release of acid-soluble counts from [3H]leucine-labelled cells) were not observed at concentrations below 5 mM-HOCl. Protein synthesis (incorporation of [3H]leucine) was only inhibited by 10-30% following 5 min exposure to 50 microM-HOCl, although longer exposure produced more marked reductions (80% after 30 min). Neutrophils deficient in myeloperoxidase cannot convert H2O2 to HOCl, yet can kill bacteria. We have found that H2O2 is only 6% as effective as HOCl in inhibiting E. coli growth and cell division (0.34 mM-H2O2 required for 50% inhibition of colony formation), and taurine or amino acids do not block this effect. Our results are consistent with a rapid and selective inhibition of bacterial cell division by HOCl in phagocytes. H2O2 may substitute for HOCl in myeloperoxidase deficiency, but by a different mechanism and at a greater metabolic cost.
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            Negative Pressure Wound Therapy for Burns

            Riyam Mistry, Eric Halvorson, David Varon … (2017)
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              Novel foam dressing using negative pressure wound therapy with instillation to remove thick exudate

              Luc Téot, Florian Boissiere, Sergiu Fluieraru (2017)
              Abstract We describe our experience with a novel foam dressing architecture in tandem with negative pressure wound therapy and instillation (NPWTi‐d) for removing viscous wound exudate and infectious materials. A retrospective review was conducted of the outcomes of 21 patients who received NPWTi‐d using a reticulated open cell foam instillation dressing with through holes (ROCF‐CC) designed to facilitate the removal of thick wound exudate and infectious materials. NPWTi‐d with ROCF‐CC was used to treat large complex chronic wounds with viscous wound exudate that contained substantial areas of devitalised tissue. Debridement was performed as appropriate or available. NPWTi‐d with ROCF‐CC assisted in loosening, solubilising and detaching viscous exudate, dry fibrin, wet slough and other infectious materials. Percent surface area of black non‐viable tissue and yellow fibrinous slough was reduced to ≤ 10% in 18/21 (85·7%) and 12/21 (57·1%) wounds, respectively, after an average of 1–3 applications (3–9 days) of NPWTi‐d with ROCF‐CC. Preliminary evidence suggests that adjunctive use of NPWTi‐d with ROCF‐CC may help clean large, complex wounds when complete surgical debridement is not possible or appropriate and/or when areas of slough and non‐viable tissue remain present on the wound surface.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 26 November 2018
                Publication date (Electronic, collection): November 2018
                Volume: 10
                Issue: 11
                Electronic Location Identifier: e3632
                Affiliations
                [1 ] Surgery, Arizona Burn Center, Phoenix, USA
                [2 ] Pharmacy, Maricopa Integrated Health System, Phoenix, USA
                [3 ] Surgery, University of North Texas Health Science Center, Fort Worth, USA
                Author notes
                Article
                DOI: 10.7759/cureus.3632
                PMC ID: 6349569
                PubMed ID: 30705791
                SO-VID: 0536f3c2-e30e-49df-822f-a60d61e2ec04
                Copyright © Copyright © 2018, Matthews et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 21 September 2018
                Date accepted : 15 November 2018
                Categories
                Subject: General Surgery

                Keywords: burn,cleanse choice,hypochlorous acid
                Data availability:
                Keywords: burn, cleanse choice, hypochlorous acid

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