Wongkietkachorn Apinut, Surakunprapha Palakorn, Wittayapairoch Jakrapan, Wongkietkachorn Nuttapone, Wongkietkachorn Supawich
Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Mae Fah Luang University, Chiang Rai, Thailand.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Plast Reconstr Surg Glob Open. 2020 Jan 24;8(1):e2604. doi: 10.1097/GOX.0000000000002604. eCollection 2020 Jan.
Managing cavity wounds that cannot be cleaned using standard irrigating solution is challenging. An immunocompromised patient with a horseshoe perianal abscess was selected to represent a heavy infection in cavity wounds. Diluted povidone-iodine was initially used to lavage the wounds, but the fever persisted and the irrigation was painful. Hypochlorous acid was then used to irrigate the wound. One day after administration of the hypochlorous acid, the fever began to subside, suggesting that this solution was able to adequately destroy the infecting microorganisms. The patient rated his pain during this procedure as 2/10. The infection had cleared within 2 weeks, and a swab culture found no microbial growth. The wound volume was reduced by more than 90% after 5 weeks, and final wound closure was achieved after 6 weeks. By comparison, another patient with a horseshoe perianal abscess who underwent traditional irrigation with diluted povidone-iodine and wet-to-dry dressing faced similar problems, but the fever in this case did not subside, and the wound became more complicated. He complained of pain during the irrigation with diluted povidone-iodine, giving the procedure a pain score of 10/10. Wound care was also difficult due to fecal contamination. As a result, the patient had to undergo colostomy to divert feces to the abdomen, thus preventing it from contaminating the wound. Time to final wound closure was 10 weeks. These cases illustrate the effectiveness of hypochlorous acid in dealing with infection in wound cavities.
处理无法使用标准冲洗液清洁的腔隙性伤口具有挑战性。选择一名患有马蹄形肛周脓肿的免疫功能低下患者来代表腔隙性伤口的严重感染情况。最初使用稀释的聚维酮碘冲洗伤口，但发热持续且冲洗时疼痛。随后使用次氯酸冲洗伤口。使用次氯酸一天后，发热开始消退，这表明该溶液能够充分杀灭感染微生物。患者将此过程中的疼痛评分为2/10。感染在2周内清除，拭子培养未发现微生物生长。5周后伤口体积减少了90%以上，6周后实现了最终伤口闭合。相比之下，另一名患有马蹄形肛周脓肿的患者接受了用稀释聚维酮碘进行的传统冲洗和湿-干敷料处理，面临类似问题，但此例中的发热未消退，伤口变得更加复杂。他抱怨在用稀释聚维酮碘冲洗时疼痛，该过程的疼痛评分为10/10。由于粪便污染，伤口护理也很困难。结果，该患者不得不接受结肠造口术将粪便转移至腹部，从而防止其污染伤口。最终伤口闭合时间为10周。这些病例说明了次氯酸在处理伤口腔隙感染方面的有效性。
