Hypochlorous Acid for Septic Abdominal Processes Using a Unique Negative Pressure Wound Therapy System: A Pilot Study

Abstract

Background: Septic open abdomens occur in trauma, burn and surgery. Currently, multiple concentrations of hypochlorous acid solutions have effectively decreased the microbiotic burden in wounds. We hypothesized that Vashe  , a neutral hypochlorous acid solution (V-HOCL), would be safe as an intraperitoneal irrigation or washout disinfectant for septic open abdomens utilizing negative pressure wound therapy. Methods: This is a retrospective observational review of patients who required delayed abdominal closures after exploratory laparotomies. Group A (n = 8) had cyclical V-HOCL irrigation to their open abdomens combining Abthera TM and V.A.C. Dressing System for negative pressure wound therapy with irrigation (NPWT-i) and Group B (n = 9) had intra-abdominal V-HOCL washouts. Results: Fifty percent of both groups had either septic or hemorrhagic shock on admission. Compared to Group B, Group A patients were older (median 50 vs 37 years), and had a median hospitalization of 28 vs 8 days, 4 times as many operations, more acute renal failure and co-morbidities. No statistically significant differences were detected between the two treatment methods with the V-HOCL delivery and removal. Conclusion: There were no episodes of electrolyte imbalance, hypotension, hypertension, anaphylaxis, hemorrhage, visceral injury or systemic toxicity. V-HOCL with/without NPWT-i irrigation was a safe modality and tolerated well in this study.

Application of Negative Pressure Wound Therapy with Instillation and Dwell Time of the Open Abdomen: Initial Experience

“…The addition of fluid instillation to traditional OA NPWT has been previously reported as a valid method of managing abdominal sepsis in patients requiring an OA approach [11,15-18]. D’Hondt et al reported on the instillation of an antibiotic solution following pancreatic surgery using OAI, concluding that OAI was a promising adjunctive treatment when traditional therapy fails to manage the infection [15].…”

“…OAI is initiated in the operating room (or, if needed, at the patient’s bedside, in the surgical intensive care unit (ICU)). Application of OAI has been previously described [11]. Briefly, following abdominal washout, the OA fenestrated visceral protective layer (Abthera™ Fenestrated Visceral Protective Layer, KCI, an Acelity Company) is cut to size (as needed), placed over the abdominal contents, and the edges tucked into the paracolic gutters (Figures 1A-1C).…”