A unique management option for therapeutic treatment of peri-wound underming using hypochlorous acid irrigation and cooled P188 Concentrated Surfactant Gel instillation

Accurate evaluation of peri-wound soft tissue is critical to accomplish wound closure. Inadequate detection of exposed structures or incomplete debridement of biofilm within tunneling often results in wound closure failure.1 Current standards of care include “wound packing” with gauzes or foams, use of sponges for NPWT2 or opening the tunnel with an incision to improve access for treatments.

The potential disadvantage of these techniques is a “foreign body” within the tract and must be “timed” to sequential withdrawal to allow coaption.For relatively “simple” soft tissue undermining limited to 8-10 cm in length and no bone, tendon or surgical hardware/mesh exposure, we explored in 5 patients using daily HOCL irrigation and instillation of cooled Poloxamer 188 concentrated surfactant gel (P188 CSG), which forms micelles around necrotic tissue and acts as a cell membrane stabilizing factor.3-6 HOCL irrigation removes biofilm and decreases wound pH (chronic wounds are typically alkaline and biofilm supportive)7-9, P188 CSF is cooled to take advantage of the reverse thermodynamic qualities of P188 CSF (gel at warm temperatures and thin “liquid like” at cooled temperatures; patients kept in refrigerator). All wounds were managed by family members after being taught the method by a clinic WOCN.

Of the 5 patients, 3 healed the undermining tracts within 3-6 weeks (surgical neck spinal wound, DFU transmetatarsal wound and below knee amputation revision wound) and 2 remained stable without significant change at 4 weeks (elbow bursitis wound and ischial tuberosity wound), necessitating alternative therapies. Photos are demonstrated and further details outlined in poster.Outpatient wound clinic management of chronic soft tissue undermining wounds can be a challenge for both staff and family to accomplish the end point of closure. Accurate undermining assessment is critical as undetected osteomyelitis, non-viable tendon, surgical hardware/mesh and significant tract biofilm impedes closure.

Use of packing and VAC sponge fragments may function as “foreign bodies” impeding closure without accurate withdrawal timing. Use of HOCL irrigation and cooled P188 CSG accomplishes biofilm management, decreased wound pH environment, and circumferential tunnel soft tissue management devoid of foreign body placement. This technique has inherent merit that requires further exploration and research.