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Activated Chlorine Dioxide Solution Can Be Used as a Biocompatible Antiseptic Wound Irrigant

Valente, Jonathan H. MD; Jay, Gregory D. MD, PhD; Zabbo, Christopher P. DO; Reinert, Steven E. MS; Bertsch, Karina MSW

Advances in Skin & Wound Care: January 2014 - Volume 27 - Issue 1 - p 13–19
doi: 10.1097/01.ASW.0000439060.79822.b3
Features: Original Investigations

OBJECTIVE: The purpose of this study was to compare cosmesis at 3 to 4 months and infection in simple lacerations irrigated with normal saline (NS) versus activated chlorine dioxide (CD).

DESIGN: This was a prospective, randomized trial of a convenience sample of patients. This study was approved by the institutional review board and Food and Drug Administration as a physician-sponsored trial (FDA investigational new drug no. 68762).

SETTING: The study was conducted in a large urban, academic emergency department.

PATIENTS: Patients aged 18 to 100 with simple, uncomplicated lacerations requiring repair that were less than 8 hours old were enrolled.

INTERVENTIONS: Patients were randomized to receive either NS or CD wound irrigation.

MAIN OUTCOME MEASURES: Demographics, infection, and cosmesis were analyzed and assessed. Cosmetic outcome was assessed at 3 to 4 months using a visual analog scale (VAS), wound evaluation score (WES), patient VAS (VASPt), and digital imaging VAS by 2 plastic surgeons (VASPlast).

MAIN RESULTS: One hundred ninety-three patients were enrolled. Data analysis was available for 175 cases (86 NS and 89 CD). Wound infection follow-up was obtained in 74.9% of the patients. The 3- to 4-month cosmesis follow-up was 37.7% for VAS/WES, 40.0% for VASPt, and 37.7% for VASPlast. There were no significant differences in demographics, key wound characteristics, infection, adverse reactions, and cosmesis.

CONCLUSION: The authors report the use of a novel antimicrobial irrigation solution. Chlorine dioxide appears to be a safe biologically acceptable antiseptic wound irrigant that does not appear to interfere with cosmetic outcomes.

The objective of this study was to compare cosmesis at 3 to 4 months and infection in simple lacerations irrigated with normal saline versus activated chlorine dioxide

Jonathan H. Valente, MD, is an Associate Professor in the Department of Emergency Medicine at The Alpert Medical School of Brown University and Rhode Island Hospital, and Hasbro Children’s Hospital, Providence, Rhode Island. Gregory D. Jay, MD, PhD, is a Professor in the Department of Emergency Medicine at The Alpert Medical School of Brown University and Rhode Island Hospital in Providence, Rhode Island. He has received grant/research funding from the NIH and AHRQ in the past and is receiving funding from those same organizations currently. He is a consultant/advisor to Covidien (Mansfield, Massachusetts). Christopher P. Zabbo, DO, is the Program Director of the Emergency Medicine Residency at Kent Hospital in Warwick, Rhode Island, and a Clinical Assistant Professor at the University of New England College of Osteopathic Medicine in the Department of Emergency Medicine at Kent Hospital in Warwick, Rhode Island. Steven E. Reinert, MS, is a Research Analyst at Lifespan Information Services in Providence, Rhode Island. Karina Bertsch, MSW, is the Clinical Research Program Administrator at Rhode Island Hospital in Providence.

Acknowledgments: The authors thank the 2 plastic surgeons who reviewed and scored the hard copy digital images: Scott Schmidt, MD (Department of Surgery, The Alpert Medical School of Brown University, Providence, Rhode Island), and Albert Oh, MD (Department of Plastic and Reconstructive Surgery, Children’s National Medical Center, Washington, DC). The authors thank the following research assistant staff who helped enroll patients, performed photography, and coded data for the authors’ analysis: Fenwick Gardiner, Ashley Hughes, Alisha Revotskie, Ashley Razook, and Flor Trespalacios. This study was supported by an unrestricted corporate grant of $42,059 from Frontier Pharmaceutical, Inc (Melville, New York) and by funding from the Department of Emergency Medicine at The Alpert Medical School of Brown University. The study was registered with the Food and Drug Administration (FDA investigational new drug no. 68762) and approved by the Rhode Island Hospital institutional review board. Dr Valente has disclosed that he has received funding from Frontier Pharmaceutical, Inc, for travel related to a conference presentation. Dr Jay has disclosed that he is a consultant/advisor to Covidien. Dr Zabbo, Mr Reinert, and Ms Bertsch have disclosed they have no financial relationships related to this article. The authors have disclosed they will discuss the off-label use of chlorine dioxide use in laceration irrigation. Submitted December 10, 2012; accepted in revised form May 3, 2013.

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