Patel Parin Y, Rathod Ronak
General Surgery, Health 1 Super Speciality Hospital, Ahmedabad, IND.
Cureus. 2025 Aug 28;17(8):e91157. doi: 10.7759/cureus.91157. eCollection 2025 Aug.
Pressure ulcers in chronically immobilized patients often become infected with multidrug-resistant organisms such as Pseudomonas aeruginosa. Management is particularly challenging in low-resource settings where advanced wound care products are unavailable. Natural, inexpensive alternatives, such as vinegar and papaya, have demonstrated antimicrobial and debriding properties, but their combined use has not been formally documented. A 65-year-old male with advanced Parkinsonian disease and a prior cerebrovascular accident, bedridden and dependent for care, presented with multiple Stage III-IV gluteal pressure ulcers. The largest measured approximately 25 × 25 cm with a depth of 2 cm, all with foul odor, greenish discharge, and heavy slough. Pseudomonas aeruginosa infection was confirmed on wound culture. Initial povidone-iodine dressings for one week failed to improve the ulcers. A novel regimen was then introduced: freshly grated unripe papaya was applied directly to the wound bed, followed by sterile gauze soaked in 5% white vinegar. Dressings were performed twice daily initially, then once daily as the wound improved. Within 3 days, odor and green staining had markedly reduced; by day 5, approximately 70% of slough had cleared; and by day 10, the wounds demonstrated a clean, granulating base. Once the ulcers reached an inflamed "angry wound" stage, papaya-vinegar applications were discontinued, and saline dressings were recommended. The patient tolerated the regimen well, reporting only transient burning with vinegar application. Unfortunately, he died at home soon after, unrelated to the ulcers, precluding long-term follow-up. Grated papaya combined with vinegar dressing may provide a low-cost option for managing Pseudomonas-infected pressure ulcers in resource-limited settings. This approach facilitated rapid odor reduction, slough clearance, and granulation when conventional dressings failed, but requires discontinuation once the wound becomes inflamed. Further studies are needed to establish efficacy and safety.
长期卧床患者的压疮常被多重耐药菌感染，如铜绿假单胞菌。在缺乏先进伤口护理产品的资源匮乏地区，治疗尤其具有挑战性。天然且廉价的替代品，如醋和木瓜，已显示出抗菌和清创特性，但它们的联合使用尚未有正式记录。一名65岁男性，患有晚期帕金森病且曾有脑血管意外，卧床且依赖他人护理，出现多处III - IV期臀压疮。最大的压疮约25×25厘米，深2厘米，均有恶臭、绿色分泌物和大量腐肉。伤口培养证实为铜绿假单胞菌感染。最初使用聚维酮碘敷料一周未能改善溃疡情况。随后引入一种新方案：将新鲜磨碎的未成熟木瓜直接敷于伤口床，然后用浸有5%白醋的无菌纱布覆盖。最初每天换药两次，随着伤口好转改为每天一次。3天内，气味和绿色染色明显减轻；到第5天，约70%的腐肉已清除；到第10天，伤口呈现清洁、有肉芽组织生长的基底。一旦溃疡发展到“炎症性伤口”阶段，停止使用木瓜 - 醋敷料，建议使用生理盐水敷料。患者对该方案耐受性良好，仅报告在使用醋时有短暂烧灼感。不幸的是，他不久后在家中去世，与溃疡无关，无法进行长期随访。磨碎的木瓜与醋敷料联合使用可能为资源有限地区管理铜绿假单胞菌感染的压疮提供一种低成本选择。当传统敷料无效时，这种方法有助于快速减轻气味、清除腐肉和促进肉芽组织生长，但一旦伤口出现炎症就需要停止使用。需要进一步研究以确定其有效性和安全性。
