Hypochlorous Acid for Septic Abdominal Processes Using a Unique Negative Pressure Wound Therapy System

Open abdomen is an abdominal wall defect created by intentionally leaving an abdominal incision open at the completion of intra-abdominal surgery or by opening (or reopening) the abdomen. Open abdomen can also be the result of injuries to the abdominal wall that produce significant soft tissue defects. Currently, multiple concentrations of hypochlorous (HOCL) acid solutions have effectively decreased the microbiotic burden in wounds.

In this paper, the authors 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. They conducted a retrospective observational pilot study (January 2017-January 2018) to determine the feasibility of utilizing V-HOCL as a washout or irrigant for septic open abdomen. Hypochlorous acid was used in surgical patients with either open abdomens who required abdominal washouts during surgery or who required more intensive irrigation treatment with negative pressure wound therapy for a longer term. 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. 

The results showed that 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 be-tween the two treatment methods with the V-HOCL delivery and removal. 

In conclusion, this pilot study has shown that Vashe^®, a 0.033% hypochlorous acid in normal saline solution is safe as a standard surgical intra-abdominal washout or NPWT-i irrigant using the combination of the Abthera^TM device and V.A.C. Dressing System^TM for septic open abdomens. In patients requiring an exploratory laparotomy and possibly an open abdomen for continuous irrigation or a single washout of the abdomen, these interventions may provide a benefit to the patient with a septic open abdomen.

Article by Marc R. Matthews, et al, from USA.

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