Randomized Comparison of Hypochlorous Acid With 5% Sulfamylon Solution as Topical Therapy Following Skin Grafting

Kevin N. Foster, MD, MBA, FACS; K. J. Richey, BSN, RN; J. S. Champagne, MA, RN; M. R. Matthews, MD, FACS


ePlasty. 2019;19(e16) 

In This Article

Methods and Materials

This study was approved by the hospital institutional review board.

Both male and female patients, older than 18 years, and who required hospitalization were eligible for inclusion into the study. The other inclusion criterion was the presence of burn injuries that required excision and grafting, not exceeding 20% total body surface area (%TBSA).

Exclusion criteria were as follows:

  • Pregnant or lactating females;

  • Individuals with chlorine sensitivity; and

  • Chemical, electrical, and/or frostbite injuries.

Once patients met inclusion and exclusion criteria and successfully completed the informed consent process, they were randomized to either the Vashe group or the control group. Since this was a pilot study, it aimed for 10 evaluable patients in each arm.

Outcomes evaluated in the trial were as follows:

  • Graft viability (as assessed by wound inspection on every second day);

  • The percentage graft take (reepithelialization) on postoperative day 14;

  • Whether or not infections had occurred (as per clinical judgment and, if clinically indicated, culture results);

  • Pain, assessed twice daily, both AM and PM, using the Johns Hopkins visual analog assessment tool (scale 1–10); and

  • The cost of the test and control materials.

Excision and grafting were performed in the standard fashion. Specifically, excision was performed tangentially with a Weck knife and hemostasis attained with epinephrine/thrombin solution and electrocautery. Split-thickness autografts were obtained with a dermatome set at 0.012-in thickness. The autografts were meshed 2:1 and secured into place with fibrin sealant and skin staples.

The grafted areas were dressed with one layer of porous silicone, which was then covered with an 8-ply burn dressing, cut to size. The 8-ply dressing was moistened with the test or control solution intraoperatively and then every 6 to 8 hours or more frequently if deemed necessary to keep the proper level of moisture. Retention dressings were cotton netting. Splints were applied as necessary.

The dressings were to be left undisturbed (except for irrigation) for a total of 5 days' duration.

Data collected included graft take and reepithelialization, incidence of infection, pain (using the Johns Hopkins visual analog scale), cost of materials used, and adverse and serious adverse experiences.