Cost-Effectiveness of Hypochlorous Acid Preserved Wound Cleanser versus Saline Irrigation in Conjunction with Ultrasonic Debridement for Complex Wounds

Objective: Low-frequency ultrasound debridement with irrigation is an effective method of wound bed preparation. A recent clinical study compared hypochlorous acid preserved wound cleanser (HAPWOC) to saline and found HAPWOC to be a more effective adjunct to low frequency ultrasound debridement. However, HAPWOC has an added cost. The primary objective of this study was to assess the cost-effectiveness of HAPWOC as an irrigation modality with low-frequency ultrasound debridement for the treatment of severely complex wounds that were destined to be closed primarily via a flap. The secondary objective of this study was to estimate the number needed to treat (NNT) to avoid a wound-related complication and its expected cost per NNT. Methods: A patient-level Monte-Carlo simulation model was used to conduct a cost-effectiveness analysis from the US health system perspective. All clinical data were obtained from a prospective clinical trial. Cost data were obtained from the publicly available data sources in 2021 US dollars. The effect measure was the avoidance of wound-related complications at 14-days post-debridement. The primary outcome was the incremental cost-effectiveness ratio (ICER), a measure of the additional cost per benefit. The secondary outcomes were the NNT and expected cost per NNT to avoid one complication (complementary to the ICER in assessing cost-effectiveness). Deterministic and probabilistic sensitivity analyses (PSA) were performed to gauge the robustness and reliability of the results. Results: The ICER for HAPWOC versus saline irrigation was US$90.85 per wound complication avoided. The expected incremental cost per patient in the study and effect was US$49.97 with 55% relative reduction in wound-related complications at day 14 post debridement procedure. The NNT and cost per NNT were 2 and US$99.94, respectively. Sensitivity analyses demonstrated that these results were robust to variation in model parameters. Conclusion: HAPWOC was a cost-effective strategy for the treatment of complex wounds during ultrasonic debridement. For every two patients treated with HAPWOC, one complication was avoided.

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Effect of Mechanical Debridement and Irrigation With Hypochlorous Acid Wound Management Solution on Methicillin-resistant Staphylococcus aureus Contamination and Healing Deep Dermal Wounds in a Porcine Model

Wound Management & Prevention ◽

10.25270/wmp.2021.8.2431 ◽

2021 ◽

Vol 67 (8) ◽

pp. 24-31

Author(s):

Stephen Davis ◽

Joel Gil ◽

Jie Li ◽

Colin Simms ◽

Jose Valdes ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Granulation Tissue ◽

Methicillin Resistant Staphylococcus Aureus ◽

Hypochlorous Acid ◽

Wound Management ◽

Tissue Formation ◽

Saline Irrigation ◽

Granulation Tissue Formation ◽

Methicillin Resistant ◽

Epithelial Thickness

BACKGROUND: Wound cleansing is an important component of wound management. PURPOSE: This study was conducted to examine the effect of a wound management solution (WMS) containing hypochlorous acid (HOCl) on methicillin-resistant Staphylococcus aureus (MRSA) and healing when used in conjunction with debridement. METHODS: Nineteen (19) deep reticular dermal wounds (22 mm × 22 mm × 3 mm deep) were created on the paravertebral and thoracic areas of 3 female pigs using a specialized electrokeratome. Wounds were separated by at least 5 cm to 7 cm of unwounded skin and inoculated with MRSA. After 72 hours, all wounds were debrided with a curette and irrigated with either the WMS or sterile saline solution twice per day from day 0 to day 4. Wounds then were irrigated once a day until the completion of the study (day 11). Wound tissue specimens were taken using punch biopsy for microbiological and histological analysis on days 4, 8, and 11 post treatment. Percent of wound epithelialized, epithelial thickness (cell layers µm), white cell infiltrate (1 = absent, 2 = mild, 3 = moderate, 4 = marked, 5 = exuberant), and percent of granulation tissue formation were calculated and assessed. Microbiology and histology results were analyzed for significant differences between treatments and among assessment days using one-way analysis of variance and student t-tests. A P value ≤ .05 was considered significant. RESULTS: The WMS effected a bacterial reduction (P ≤ .05) of more than 2.74 ± 0.43 and 1.03 ± 0.22 Log CFU/g in all assessment days compared with baseline before and after debridement, respectively. Percent epithelialization was significantly different between treatments on day 8, only 78.3% and 67.8% for HOCl and saline, respectively (P ≤ .05). No significant differences between treatments were observed for epithelial thickness or granulation tissue formation. CONCLUSION: The combination of debridement and HOCl wound irrigation can significantly reduce MRSA contamination and facilitate the healing process compared to saline irrigation. Clinical studies are needed to confirm these results.

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Implants and Breast Pocket Irrigation: Outcomes of Antibiotic, Antiseptic, and Saline Irrigation

Aesthetic Surgery Journal ◽

10.1093/asj/sjab181 ◽

2021 ◽

Author(s):

Amanda N Awad ◽

Adee J Heiman ◽

Ashit Patel

Keyword(s):

Systematic Review ◽

Hypochlorous Acid ◽

Povidone Iodine ◽

Breast Implant ◽

Capsular Contracture ◽

Saline Irrigation ◽

Concurrent Use ◽

Significant Difference ◽

Poor Outcomes ◽

Reoperation Rates

Abstract Background Breast implant-associated infection and capsular contracture are challenging complications that can result in poor outcomes following implant-based breast surgery. Antimicrobial irrigation of the breast pocket or implant is a widely accepted strategy to prevent these complications, but the literature lacks an evidence-based consensus on the optimal irrigation solution. Objectives The objective of this systematic review is to compare clinical outcomes, specifically capsular contracture, infection, and reoperation rates, associated with the use of antibiotic, antiseptic, and saline irrigation. Methods A systematic review was performed in March 2020 using the following search terms: “breast implant,” “irrigation,” “antibiotic,” “bacitracin,” “antiseptic,” “povidone iodine,” “betadine,” “low concentration chlorhexidine,” and “hypochlorous acid.” Capsular contracture, infection, and reoperation rates were compared using forest plots. Results Out of the 104 articles were screened, 14 met inclusion criteria. There was no significant difference in capsular contracture rates between antibiotic and povidone iodine irrigation, although the data comparing these two groups was limited and confounded by the concurrent use of steroids. Antibiotic irrigation showed a significantly lower rate of capsular contracture compared to saline irrigation and a lower rate of capsular contracture and reoperation compared to no irrigation at all.. Povidone iodine was associated with lower rates of capsular contracture and reoperation compared to saline irrigation but there was no data on infection rates specific to povidone iodine irrigation. Conclusions Our study supports the use of antibiotic or povidone iodine use for breast implant irrigation. Further research is required to better determine which of these two irrigation types is superior.

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