Dakin's solution: is there a place for it in the 21st century?

Abstract

Dakin's solution (DS) is a time-honoured antiseptic that still remains part of the wound care armamentarium. In spite of its cytotoxicity, some question its use in the current era. We report the case of a 52-year-old diabetic woman who was admitted for sepsis because of a severely infected diabetic foot. Urgent surgical drainage and debridement left a 9 × 9-cm deep, complex, infected wound with both bone and tendon involvement. Treatment with local negative pressure was unsuccessful. DS was regularly instilled through a tube left in the wound dressing. A marked improvement was observed with this strategy as the wound bed was much cleaner and fully granulated after 6 weeks. No adverse effects were noted. This case debunks the myth that topical antiseptics necessarily impair wound healing. DS can still be considered an option for difficult-to-treat, complex and heavily infected wounds.

Dakin's solution in the treatment of severe diabetic foot infections

“…Some entities have strongly discouraged its use in wound care, especially because of its presumed cytotoxicity to healthy tissues, an observation mostly seen in laboratorial investigations. Nevertheless, this debatable yet relevant concern has not been definitely substantiated by in vivo studies and has especially not been significantly observed in real‐world clinical practice, where several successful reports regarding the medical use of DS have been published . Extremely inflammatory and infected human wounds create a dynamic complex environment that is difficult to replicate with precision in the laboratory, which at least partially justifies the disagreement in the laboratory and real‐world clinical practice with regard to observed cytotoxicity.…”

“…Nevertheless, this debatable yet relevant concern has not been definitely substantiated by in vivo studies 17 and has especially not been significantly observed in real-world clinical practice, where several successful reports regarding the medical use of DS have been published. [8][9][10][11][12] Extremely inflammatory and infected human wounds create a dynamic complex environment that is difficult to replicate with precision in the laboratory, which at least partially justifies the disagreement in the laboratory and real-world clinical practice with regard to observed cytotoxicity. For example, open wounds contain a myriad of components (serum, pus, necrotic debris) that probably mitigate the potential toxicity of DS.…”

“…Diluted sodium hypochlorite, mostly known as Dakin's solution (DS), is a topical antiseptic first introduced to address World War I battle wounds . Its time‐honoured effectiveness, low cost, and wide availability have kept the solution in use to manage infected wounds . Nevertheless, concerns regarding its cytotoxicity and disputes over its effectiveness, coupled with dearth of evidence beyond limited clinical reports, led to several recommendations for its dismissal from the modern wound care armamentarium .…”

“…7 Its timehonoured effectiveness, low cost, and wide availability have kept the solution in use to manage infected wounds. [8][9][10][11][12] Nevertheless, concerns regarding its cytotoxicity and disputes over its effectiveness, coupled with dearth of evidence beyond limited clinical reports, led to several recommendations for its dismissal from the modern wound care armamentarium. 13 Whether this concern is valid in real-word practice remains debatable.…”

Hypochlorites in the treatment of chronic wounds

“…W publikacjach naukowych na temat leczenia ran szczególną uwagę zwraca się na nowoczesne antyseptyczne preparaty ponadtlenkowe zawierające podchloryny [1]. Prace badawcze, których celem jest sprawdzenie skuteczności podchlorynów, oceniają następujące parametry: wysięk, zapach, oczyszczanie martwicy, wielkość rany i tworzenie się tkanki ziarninowej [2,3].…”