RESUMO
Background and Aims: Diverse protocols prevent infection and/or improve ulcer epithelialization. The existing protocols tend to antagonize the risk factors that promote the chronicity of this type of wound. Hypochlorous acid (HOCl) is used to treat ulcers and wounds because of its antiseptic and noncytotoxic properties. Its liquid form is effective but has little residual effect, while in gel it has more residual power. Methods: An experimental nonrandomized study has been carried out treating 346 chronic ulcers of various etiologies in 220 patients. Ulcer outcomes were originally classified as: "complete healing," "incomplete healing without infection," and "incomplete healing with infection." Various antiseptic solutions were used as ulcers cleaning solutions: liquid HOCl, gel HOCl, polymeric biguanide, or chlorhexidine. Only one was applied to the lesion as monotherapy. But, in other cases, we used a combined HOCl (liquid then gel: bitherapy). Bivariate (Chi-square and variance tests) and multivariate studies (logistic regression) evaluated associations of ulcer characteristics and mono or bitherapy outcomes. Results: Four factors reduce the probability of complete ulcer healing: patient age (odds ratio [OR]: 0.97); weeks of ulcer evolution (OR: 0.99); poor granulation on admission (OR: 0.35); and need for antibiotic therapy (OR: 0.41). One factor favored healing: combined HOCl therapy with liquid plus gel (OR: 4.8). Infections were associated with longer times of evolution (OR: 1.002) and bad odor of the ulcer on admission (OR: 14), but bitreatment with HOCl reduced the risk of infection (OR: 0.3). Conclusion: A double HOCl formulation (liquid plus gel) reduces the probability of poor healing and infection, in chronic ulcers of various etiologies.
RESUMO
Our objective was to assess the efficacy of two successive applications of hypochlorous acid, first as a liquid and then as a gel because liquid hypochlorous acid is effective but has little residual effect, while the gel form has more residual power, and compare it with that of other products. An experimental non-randomised study was carried out, treating 346 chronic ulcers in 220 patients. The antiseptic treatment has been divided into 'hypochlorous acid' (Clortech), 'hypochlorous acid liquid + gel' (Clortech + Microdacyn60R -hydrogel) and 'Others' (Prontosan or Chlorhexidine or Microdacyn60R -hydrogel). Bivariate and multivariate studies analysed the characteristics of the patients and their ulcers, including size, symptoms, signs, treatments received and their duration, and so on. The ulcers were complicated, of long evolution, and most had a vascular origin. On average, antiseptic treatment lasted 14 weeks. At the time of their discharge, or last treatment in the clinics, 59% of the ulcers had healed completely, 9.5% worsened, and 6.9% had become infected during this period. In the bivariate and multivariate studies, we took as reference the 'others' treatments that showed no significant differences in healing time or infection rates compared with liquid hypochlorous acid 100-500 mg/L alone. However, hypochlorous acid liquid + gel showed a synergistic effect, with a higher probability of achieving complete healing (four times) and a lower probability of infection (a fifth), compared to the 'other' antiseptics. In conclusion, a synergistic effect was found with the successive application of hypochlorous acid in liquid followed by gel, an effect that increased healing probability and decreased the risk of the ulcer becoming infected.
