Safety of autologous drainage blood reinfusion following total knee arthroplasty prepared with hydrogen peroxide

Hydrogen Peroxide: Its Use in an Extensive Acute Wound to Promote Wound Granulation and Infection Control - Is it Better Than Normal Saline?

Background: Hydrogen peroxide (H₂O₂) is used as a topical antiseptic in contaminated wounds caused by road traffic accidents. It kills bacteria by producing oxidation through local, nascent, free oxygen radicals. It also removes dirt from the wound due to its frothing action. H₂O₂ is synthesized by various cells as an active biochemical agent that affects cell biological behavior through complex chemical reactions. H₂O₂ has also been used as a wound cleaning agent, removing debris, preventing infection, and causing hemostasis due to its exothermic reaction with blood. Despite its widespread use, there is scanty literature on its use to promote granulation tissue formation. Objective: In the orthopaedics literature, studies on H₂O₂ use are very limited and its potential is underestimated. In the present study, we would like to report our protocol of use of H₂O₂ for its tremendous potential for stimulating granulation and early wound healing. Material and Methods: A total of 53 patients with large acute extensive lower limb contaminated wounds reported to the emergency department have been included with and without lower limb fracture. In group A (43 patients) wound management was done using 7% H₂O₂ and group B (10 patients) was treated by only saline dressing as a control group. Results: In the present study, daily dressing by 7% H₂O₂ solution and provide solution gives excellent results compared to the Saline group. Granulation tissue appeared much earlier with a mean SD 6.3 ± 6.8 days in the hydrogen peroxide group as compared to the Saline group where granulation tissue appeared in 9.3 ± 8.4 days. Conclusion: Spontaneous wound healing is a controlled balance between destructive and healing processes. It is mandatory to remove damaged tissue to promote healing by secondary intention and minimize infection. The dynamic effect of H₂O₂ promotes faster healing, stimulates granulation, and minimizes infection by oxidative stress.

Hydrogen Peroxide: A Potential Wound Therapeutic Target?

Hydrogen peroxide (H2O2) is a topical antiseptic used in wound cleaning which kills pathogens through oxidation burst and local oxygen production. H2O2 has been reported to be a reactive biochemical molecule synthesized by various cells that influences biological behavior through multiple mechanisms: alterations of membrane potential, generation of new molecules, and changing intracellular redox balance, which results in activation or inactivation of different signaling transduction pathways. Contrary to the traditional viewpoint that H2O2 probably impairs tissue through its high oxidative property, a proper level of H2O2 is considered an important requirement for normal wound healing. Although the present clinical use of H2O2 is still limited to the elimination of microbial contamination and sometimes hemostasis, better understanding towards the sterilization ability and cell behavior regulatory function of H2O2 within wounds will enhance the potential to exogenously augment and manipulate healing.

A hydrosurgery system (Versajet) with and without hydrogen peroxide solutions for the debridement of subacute and chronic wounds: a comparative study with hydrodebridement

OBJECTIVE

The aim of this study was to evaluate the efficacy of hydrosurgery prepared with or without hydrogen peroxide for the management of subacute and chronic wounds.

METHODS

This is a retrospective study on patients with infected subacute and chronic wounds. The wounds were debrided using hydrosurgery prepared with (the study group) or without hydrogen peroxide before grafting the wound (the control group).

RESULTS

There were 60 patients in the study group and 70 patients in the control group. The hospital stay (mean, 7.83 [SD, 2.16] vs 9.86 [SD, 3.41] days; P < .001) and graft viability (mean, 3 [2-3] vs 2 [2-3]; P = .001) were significantly better in the study group than in the control group. The difference of hemoglobin levels after surgery was also significantly lower in the study group (0.1 [0-0.48] vs 0.45 [0-1]; P = .004).

CONCLUSIONS

Encouraging results were obtained with the use of the hydrosurgery system prepared with hydrogen peroxide for infected subacute and chronic wounds. This method decreased hospital stay and bleeding, thus providing better contact of the skin graft with the wound bed, allowing early rehabilitation. The findings of the authors' study need to be substantiated in large-scale randomized controlled trials.

Results of primary total knee arthroplasty in Jehovah's Witness patients

Total knee arthroplasty can be challenging in Jehovah's Witnesses, as these patients do not accept blood transfusions. We reported our experiences with a special blood management protocol for these patients who underwent total knee arthroplasty. There were 124 self-reported Jehovah's Witnesses who had a mean age of 64 years and who underwent total knee arthroplasties between 1998 and 2009. Mean follow-up was 60 months (range, 24-120 months). Implant survivorship, with revision for aseptic component failure as an end point, was 98%. At the final follow-up, mean Knee Society objective and function score improved to 91 and 81 points, respectively. The authors believe that this blood management protocol was responsible for performing safe and transfusion-free total knee arthroplasties that can ultimately lead to excellent outcomes.

Hydrogen Peroxide – A Party Trick from the Past?

Hydrogen peroxide solutions are found in almost every operating theatre and are used by many surgical specialties, often with little knowledge of their inherent risk. We reviewed the literature and evidence related to the use of hydrogen peroxide in surgery. We found little evidence supporting the use of hydrogen peroxide solutions intraoperatively, a large number of reports of sometimes-fatal oxygen embolism and other evidence of tissue toxicity. We conclude that the use of hydrogen peroxide as an antiseptic has no direct benefit, but is associated with significant risk, and therefore should be reconsidered.