Super-Oxidized Solution (Dermacyn Wound Care) as Adjuvant Treatment in the Postoperative Management of Complicated Diabetic Foot Osteomyelitis

Abstract

Surgery is usually used to treat diabetic foot osteomyelitis (DFO), whether primarily or in cases in which antibiotics are not able to control infection. In many cases, the bone is only partially removed, which means that residual infection remains in the bone margins, and the wound is left open to heal by secondary intent. The use of culture-guided postoperative antibiotic treatment and adequate management of the wound must be addressed. No trials exist dealing with local treatment in the postoperative management of these cases of complicated DFO. We decided to test a super-oxidized solution, Dermacyn Wound Care (DWC; Oculus Innovative Sciences Netherlands BV, Sittard, Netherlands) to obtain preliminary experience in patients in whom infected bone remained in the surgical wounds. Our hypothesis was that DWC could be useful to control infection in the residual infected bone and surrounding soft tissues and would thus facilitate healing. Fourteen consecutive patients who underwent conservative surgery for DFO, in whom clean bone margins could not be assured, were treated in the postoperative period with DWC. Eleven cases were located in the forefoot, 6 on the first ray and the rest in lesser toes, 1 in the Lisfranc joint, and 2 on the calcaneus. No side effects appeared during treatment. Neither allergies nor skin dermatitis were found. Limb salvage was successfully achieved in 100% of the cases. Healing was achieved in a median period of 6.8 weeks.

Consensus on Wound Antisepsis: Update 2018

“…Case studies on NaOCl/HOCl report decolonization of MRSA infections on skin and the base of the skull [144,145], decolonization of MRSA, P. aeruginosa , and E. coli in chronic diabetic ulcers [146], and successful adjuvant application in the treatment of necrotizing soft tissue infection [147], osteitis [145], and osteomyelitis [148]. In cases of peritonitis, partially with peritoneal abscess ( n = 7), no bacterial growth was detectable 3-7 days after irrigating twice daily for 9-12 days [149].…”

Eradication of MRSA skull base osteitis by combined treatment with antibiotics and sinonasal irrigation with sodium hypochlorite

“…Studies have shown that Dermacyn Ò is generally well tolerated on skin and mucosa. This is an important point for treating endonasal wounds [24]. According to the manufacturer, the solution is stable for up to 30 days.…”

Advances in Infections and Wound Healing for the Diabetic Foot

“…Complete healing was accomplished in all patients after a median period of 6.8 weeks. 25 No allergies, dermatitis or other untoward effects were seen. This is the first study on the efficacy of DWC in this setting and its results are very promising, but, as the authors acknowledge, its limitations must not be overlooked.…”

“…[22][23][24] Aragón-Sánchez et al 25 present their preliminary experience on the contribution of postoperative treatment with the superoxidized solution Dermacyn Wound Care (DWC) to promote healing in patients with infected bone remaining after incomplete surgery. They included 14 patients with diabetic foot osteomyelitis and unclean bone margins.…”

“…The latter include the small patient series, the relatively short follow-up, and the absence of controls. 25 Additional enquiry is now urgently needed on the role of DWC as adjuvant postoperative treatment for subjects with residual bone infection toward resolution of infection.…”