Hypochlorous acid: safe and effective cleansing solution in three neonatal and pediatric wounds of vascular origin

Neonatal and pediatric wounds of vascular origin vary from ulcerated hemangiomas and arteriovenous malformations to ischemic necrosis of extremities. Delicate underlying tissue, propensity to bleed, ischemia causing slough formation and potential risk of cutaneous absorption highlights practitioner’s concern with products application to such wounds. We describe safe and efficacious application of hypochlorous acid(HOCl) to such wounds, fulfilling roles of safe cleanser and non-toxic, non-painful, effective debrider, while contributing to biofilm regression with the antimicrobial preservative.

Ulcerated congenital hemangiomas are challenging wounds as thin epithelium and propensity to bleed with touch require minimal handling. 3 cases of ulcerated hemangiomas are presented. HOCl soaks were applied to cleanse, debride exudate, minimize scrubbing and provide anti-microbial coverage.

Patients were 2, 3 and 4 months old. All tolerated application well, with no subjective pain findings. We also describe 3 neonatal ischemic/gangrene extremity wounds that eventually progressed to partial amputations. Time was taken to salvage as much tissue as possible. HOCl solution was used as the cleansing solution on all wounds.

Adolescent with large thigh arteriovenous malformation(AVM) presented with ulcerated, infected wound. Significant slough was noted yet patient had no tolerance for mechanical scrubbing. He would require significant sedation and potentially operating room for deep debridement. Given his co-morbidities and airway status deep sedation was unadvisable. HOCl soaks were utilized every 6 hrs. to soften exudate, reduce biofilm burden and minimize scrubbing(mechanical/sharp debridement) secondary to concern for profuse bleeding from AVM. After 5 days of this regimen and systemic antibiotics bleeding stopped, exudate was mostly removed and patient was discharged to the outpatient clinic.

Addressing wound bed in pediatric vascular wounds can be challenging. Hypochlorous acid is a safe, non-painful and effective cleanser, debriding agent either solely or in combination with mechanical tools and topical antimicrobial solution that can be utilized in all neonatal/pediatric vascular wounds.