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

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 AbtheraTM 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 be-tween 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.

“Streets of Fire”revisited:contact burns

Background:Pavement-street contact burns are rare.This study compared recent contact burns to those published in“Pavement temperature and burns:Streets of Fire”in 1995.The hypothesis was that there were a significantly increased number of pavement-street burns,as a result of increased ambient temperatures,and that motor vehicle crash(MVC)contact burns were less severe than pavements-street burns.Methods:This was a retrospective burn center registry study of naturally heated surface contact burns during May to September from 2016 to 2018.Statistical analyses were performed with one-way analysis of variance(ANOVA)and Maximum Likelihood chi-squared for age,percent of total burn surface area(%TBSA),treatment,hospitalization,comorbidities,hospital charges,mortality,ambient,and surface temperatures(pavement,asphalt,rocks).Results:In the 1995 study,median ambient temperatures were 106(range 100–113)°F compared to the 108(range 86–119)°F highest noon temperature in the current study.No ambient temperature differences were recorded on days with pavement burn admissions compared to days without these admissions.There were 225 pavement,27 MVC,15 road rash,and 103 other contact burns.The major injuries in the pavement group were due to being“down”(unknown reason),falls,and barefoot.Compared to the others,the pavement group was older,56+years,p<0.001,and had smaller burns but similar length of stay.Fifty percent of the 225 pavement group patients with full-thickness burns required skin grafts.There were 13(6%)fatalities in the pavement group vs 1(4%)in the MVC group,p=0.01.Fatalities were secondary to sepsis,shock,cardiac,respiratory,or kidney complications.Compared to survivors,the non-survivors had a significantly higher%TBSA(10%vs 4%),p=0.01,and lower Glasgow Coma Scores(10 vs 15),p=0.002.Conclusion:There was a median 2°F increase in ambient temperature since 1995.The increase in pavement burn admissions was multi-factorial:higher temperatures,population,and the number of older patients,with increased metropolis expansion,outreach,and urban heat indices.Pavement group was similar to the MVC group except for significantly older age and increased mortality.Morbidity associated with age contributed to increased mortality.