DOI: http://dx.doi.org/10.18203/2349-2902.isj20210379

Effects of acetic acid and povidone iodine dressings as modulators of local environment in chronic wounds as synergists and separate agents

Tausif Kamal Syed, D. K. Apturkar, K. N. Dandekar, P. K. Baviskar, G. J. Jorwekar, Meena H. Shaikh

Abstract


Background: Wound care management has long been a primary point of care for surgeons and clinicians alike. The burden of care and time required in the management of wounds has led to development of innovative and expensive materials which alleviate the burden of healing on our physiology and reinforce the healing mechanisms.  

Methods: A case series analysis of 240 patients included on accrual was carried out. These patients were randomly assigned to 3 groups. Group A ulcers were dressed with 2% acetic acid soaked sterile pads. Group B received the acetic acid-iodine combination and group C dressed with traditional Povidone-Iodine ointment and solution. These ulcers were evaluated on admission and on intervals of 5 days with a customized scoring system, Dr. Kamal’s adaptive wound healing score (KAWHS). A sterile culture swab with coverage of healthy granulation tissue was considered the primary end point of the study.

Results: Resolution of slough was significantly earlier in group A and B as compared to group C. odor subsided earliest in group A, followed by group B and C. Resolution of purulent discharge was achieved earliest in Group B which was significant in comparison to group A and C. Wound healing was observed to be better in acetic acid usage groups.  

Conclusions: Acetic acid dressings are effective in treating chronic non-healing wounds with mono and poly-microbial culture. 


Keywords


Acetic acid dressings, Chronic wounds, Poly-microbial wounds, Wound healing score, Wound contraction, pH modification

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References


Wilson IA, Henry M, Quill RD, Byrne PJ. The pH of varicose ulcer surfaces and its Relationship to healing. Vasa. 1979;8:339‑42.

Tsukada K, Tokunaga K, Iwama T, Mishima Y. The pH changes of pressure ulcers related to the healing process of wounds. Wounds. 992;4:16‑20.

Romanelli M, Schipani E, Piaggesi A, Barachini P. Evaluation of Surface pH on Venous Leg Ulcers under Allevyn Dressings. London: The Royal Society of Medicine Press; 1997.

Leveen HH, Falk G, Borek B, Diaz C, Lynfield Y, Wynkoop BJ. Chemical acidification of wounds. An adjuvant to healing and the unfavourable action of alkalinity and ammonia. Ann Surg. 973;178:745‑53.

Roberts G, Hammad L, Creevy J, Shearman C, Mani R. Physical changes in dermal tissues around chronic venous ulcers, 7th European Conference on Advances in Wound Management. J Eur Wound Manage Assoc 1997;2:104‑5.

Gethin G, Cowman S. Changes in Surface pH of Chronic Wounds When a Honey Dressing was used. In: Wounds UK Conference Proceedings. Wounds UK, Aberdeen; 2006;13‑15.

Kahle B, Hermanns HJ, Gallenkemper G. Evidence-based treatment of chronic leg ulcers. Dtsch Arztebl Int. 2011;108(14):231–7.

Thomas GW, Rael TL, Bar-Or R, Shimonkevitz R, Mains CW, Slone DS, et al. Mechanisms of delayed wound healing by commonly used antiseptics. J Trauma. 2009;66:82-91.

McCauley RL, Li YY, Poole B, Evans MJ, Robson MC, Heggers JP, et al. Differential inhibition of human basal keratinocyte growth to silver sulfadiazine and mefenide acetate. J Surgic Res. 1992;52:276-85.

Singer AD, Dagum AB. Current management of acute cutaneous wounds. N Eng J Medic. 2008;350:1037-46.

Moncrief JA, Lindberg RB, Switzer WF, Pruitt Jr BA. Use of topical antibacterial therapy in the treatment of the burn wound. Arch Surg. 1966;92:558-65.

Bollinger CG, Conwey H. Effects of silver nitrate and sulfamylon on epithelial regeneration. Plas Reconstruct Surg. 1970;45:582-5.

Kramer SA. Effect of povidone-iodine on wound healing: a review. J Vasc Nurs. 1999;17:17-23.

Cooper ML, Laer JA. Hansbrough. The cytotoxic effects of commonly used antimicrobial agents on human fibroblasts and keratinocytes. Trauma 1991;31:775-84.

Miller JM, Creazzo J, Witt C. Wound healing: an introductory clinical approach. Contempor Pediat Physic. 1992;1:38-42.

Dakins HD. The antiseptic action of hypochlorites: the ancient history of the new antiseptic. Brit Medic J. 1915;2:809-10.

Kozol RA, Gillies C, Elgebaly SA. Effects of sodium hypochlorite (Dakin’s solution) on the cells of wound module. Arch Surg. 1988;123:420-3.

Kjolseth D, Frank JM, Barkar JH, Anderson GL, Rosenthal AI, Acland RD, et al. Comparison of the effects of commonly used wound agents on epithelization and neovascularization. J Am Col Surge. 1994;179:305-12

Faoagali J. Use of antiseptics in managing difficult wounds. Primary Intent. 1999;7(4):156-60.

Lineaweaver W, McMorris S, Soucy D, Howard R. Cellular and bacterial toxicities of topical antimicrobials. Plast Reconst Surg. 1985;75:394-6.

Branemark P, Alberktsson B, Lindstrom J, Lundborg G. Local tissue effects of disinfectants. Acta Chirugica Scandinavica 1966;357(Suppl.):166-76.

O’Meara S, Cullum N, Majid M, Sheldon T. Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration. Health Technol Assess. 2000;4:1‑237.

Stewart CM, Cole MB, Legan JD, Slade L, Vandeven MH, Schaffner DW, et al. Staphylococcus aureus growth boundaries: Moving towards mechanistic predictive models based on solute‑specific effects. Appl Environ Microbiol. 2002;68:1864‑71.

Thomas LV, Wimpenny JW, Davis JG. Effect of three preservatives on the growth of Bacillus cereus, vero cytotoxigenic Escherichia coli and Staphylococcus aureus, on plates with gradients of pH and sodium chloride concentration. Int J Food Microbiol 1993;17:289‑301.

Hoffman R, Noble J, Eagle M. The use of proteases as prognostic markers for the healing of venous leg ulcers. J Wound Care 1999;8:273‑6.

Vermeulen H, van Hattem JM, Storm‑Versloot MN, Ubbink DT. Topical silver for treating infected wounds. Cochrane Database Syst Rev 2007;24;(1):CD005486.

Hunt TK, Beckert S. Therapeutical and practical aspects of oxygen in wound healing. In: Lee B, editor. The Wound Management Manual. New York: McGraw‑Hill Professional; 2004:44‑54.

Molan PC. Re‑introducing honey in the management of wounds and ulcers – Theory and practice. Ostomy Wound Manage. 2002;48:28‑40.

Agrawal KS, Sarda AV, Shrotriya R, Bachhav M, Puri V, Nataraj G. Acetic acid dressings: Finding the Holy Grail for infected wound management. Indian J Plast Surg. 2017;50:273-80

Lachapelle J-M, Castel O, Casado AF, Leroy B, Micali G, Tennstedt D, Lambert J. 2013. Antiseptics in the era of bacterial resistance: a focus on povidone iodine. Clin Pract. 2013;10:579–92.