Flow-through Instillation of Hypochlorous Acid in the Treatment of Necrotizing Fasciitis.

INTRODUCTION: Necrotizing fasciitis (NF) is a rare and rapidly progressing bacterial infection of soft tissues. Bacterial toxins cause local tissue damage and necrosis, as well as blunt immune system responses. A self-propagating cycle of bacterial invasion, toxin release and tissue destruction can continue until substantial amounts of tissue become necrotic. Neutralization of bacterial toxins should improve the results. MATERIALS AND METHODS: Pure hypochlorous acid (HOCl) (0.01% w/v) with no sodium hypochlorite impurity in saline pH 4-5, which was recently shown to both eradicate bacteria and neutralize bacterial toxins in vitro, was administered via flowthrough instillation to 6 patients with NF 4-6 times daily as needed. Utilizing a vacuum-assisted closure, 5-10 mL of pure 0.01% HOCl with no sodium hypochlorite impurity was instilled and removed frequently to irrigate the wounds. RESULTS: Of the 6 patients, no deaths or limb amputations occurred. All infected areas healed completely without major complications. CONCLUSION: The toxicity and immune dysfunction caused by bacterial toxins and toxins released from damaged cells may be mitigated by flow-through instillation with saline containing pure 0.01% HOCl with no sodium hypochlorite impurity. Randomized controlled clinical trial research of this relatively simple and inexpensive instillation protocol is suggested for identified cases of NF.

Treatment of Acute Necrotizing Fasciitis Using Negative Pressure Wound Therapy and Adjunctive NeutroPhase Irrigation Under the Foam.

Necrotizing fasciitis is a complication of a bacterial infection that activates the immune system in perifascial planes. This case report highlights initial diagnostic failures that delay early treatment, which causes profoundly negative consequences. Antimicrobial control with abolition of the inciting bacteria does not neutralize the subsequent endopathologic ravages. A new therapeutic technique, which combines negative pressure wound therapy (NPWT) and a pure hypochlorous acid solution 0.01% (NeutroPhase, NovaBay Pharmaceuticals Inc, Emeryville, CA) along with debridement and antibiotics is described in this study. It is believed that the combination of neutralization of the toxins produced by bacteria with NeutroPhase along with the NPWT action of removing exudates is effective in saving the patient.

Transmyocardial Revascularisation by CO2 Laser.

Anatomical channels connecting the left ventricular chamber to the myocardial sinusoids supplying the left ventricle with oxygenated blood in the human heart were described by Dr Wearn in 1933. He microscopically confirmed these communicating vessels or tiny clusters of arteries by gelatin filling. The second type of these channels was located at the end of the vessels almost as though woven into the fabric of the muscular fibres. These irregular shaped blood vessels were called myocardial sinusoids. Three other early investigators described connecting channels. The first was Adrian Christian Thebesius, a Dutch physician in 1708 who described connections from the atrium the coronary veins which were called Thebesian veins. The second was the American physiologist F H Pratt who, in 1898, perfused blood though the ventricle alone in a cat, keeping it alive for more than an hour. Finally, the historical work of R T Grant who in 1926 reported that a congenitally deformed heart in a child had connecting cavities with the surrounding veins and arteries.