Hydrogen peroxide and wound healing: a theoretical and practical review for hair transplant surgeons

Alkaline hydrogen peroxide solutions: expectorant, pyolytic, mucolytic, haemolytic, oxygen-releasing, and decolorizing effects

The local action of hydrogen peroxide solutions on such dense biological masses, such as pus, mucus, sputum, and blood clots, is influenced not only by the concentration of the hydrogen peroxide but also by the alkalinity of the solution and the temperature of the interaction medium. Increasing the solutions temperature from 24C26C to 45C55C and its alkalinity from pH 7.0 to 8.48.5 enhances the pyolytic, mucolytic, hemolytic, bleaching, and oxygen-releasing activity of hydrogen peroxide solutions. Simple heating achieves the desired level of hyperthermia, while the addition of sodium bicarbonate provides the indicated alkalinity. Hyperthermia, according to the laws of physics, reduces the viscosity of biological masses, increasing their fluidity, permeability to the antiseptic solution, miscibility, and solubility in it. Furthermore, hyperthermia accelerates the rate of chemical, physicochemical, and biochemical processes, according to the Arrhenius law. The elevated temperature of interacting media speeds up the alkaline saponification process of proteins and protein-lipid complexes, which constitute the colloidal basis of biological masses. Additionally, hyperthermia intensifies the enzymatic decomposition of hydrogen peroxide into water and oxygen gas, facilitated by the enzyme catalase present in most biological masses. The released molecular oxygen generates gas bubbles that mimic cold boiling, leading to the explosion of biological masses, transforming them into a fluffy white foam. Oxygen in an alkaline environment oxidizes biological pigments, including hemoglobin and its metabolites of different colors, resulting in their discoloration.

The Hemostatic Efficacy of Hydrogen Peroxide Irrigation to Control Intraoperative Bleeding in Adenoidectomy

Objective

Although adenoidectomy is generally accepted as a safe procedure, intraoperative hemorrhage is still the most common and potentially life-threating complication, especially in pediatric patients. We evaluated the clinical effect of intraoperative hydrogen peroxide irrigation with respect to hemostasis and operation times in pediatric adenoidectomy.

Methods

This was a prospective, randomized, double-blind study to investigate hydrogen peroxide solution in hemostasis in pediatric patients undergoing adenoidectomy. The patient, the surgeon, and the study nurse were blinded to the surgical technique used.

Results

One hundred seventeen (56 males and 61 females) consecutive pediatric patients with a mean age of 5.46±1.19 years were included in the study. There were 58 patients in the hydrogen peroxide group (median age: 6 years, mean age: 5.62±1.28 years) and 59 patients in the control group (median age: 5 years, mean age: 5.31±1.07 years). No significant difference was observed between the two groups with respect to age (p=0.151), gender (p=0.646), or adenoid size (p=0.767). On the other hand, the difference between the groups with respect to operation and hemostasis times was found to be statistically significant (p<0.001 for both). The average operation times were 8.67±0.48 min in the hydrogen peroxide group and 12.30±0.69 min in the control group. The average hemostasis times were 3.67±0.27 min in the hydrogen peroxide group and 5.73±0.31 min in the control group.

Conclusion

Hydrogen peroxide solution can be effectively used in adenoidectomy for reducing intraoperative blood loss and for economic benefits.

Hydrogen peroxide (H2O2): a review of its use in surgery

Hydrogen peroxide has been used in medicine for more than 100 years. It is known in surgery as a highly useful irrigation solution by virtue of both its hemostatic and its antimicrobial effects. Due to its possible negative effect on wound healing and its cytotoxic effect in higher concentrations, there are concerns about the safety of its use. The objective of this paper is to review the safety and beneficial effects of hydrogen peroxide.

Maltodextrin enhances biofilm elimination by electrochemical scaffold

Electrochemical scaffolds (e-scaffolds) continuously generate low concentrations of H2O2 suitable for damaging wound biofilms without damaging host tissue. Nevertheless, retarded diffusion combined with H2O2 degradation can limit the efficacy of this potentially important clinical tool. H2O2 diffusion into biofilms and bacterial cells can be increased by damaging the biofilm structure or by activating membrane transportation channels by exposure to hyperosmotic agents. We hypothesized that e-scaffolds would be more effective against Acinetobacter baumannii and Staphylococcus aureus biofilms in the presence of a hyperosmotic agent. E-scaffolds polarized at -600 mVAg/AgCl were overlaid onto preformed biofilms in media containing various maltodextrin concentrations. E-scaffold alone decreased A. baumannii and S. aureus biofilm cell densities by (3.92 ± 0.15) log and (2.31 ± 0.12) log, respectively. Compared to untreated biofilms, the efficacy of the e-scaffold increased to a maximum (8.27 ± 0.05) log reduction in A. baumannii and (4.71 ± 0.12) log reduction in S. aureus biofilm cell densities upon 10 mM and 30 mM maltodextrin addition, respectively. Overall ~55% decrease in relative biofilm surface coverage was achieved for both species. We conclude that combined treatment with electrochemically generated H2O2 from an e-scaffold and maltodextrin is more effective in decreasing viable biofilm cell density.

Dislocation and infection after revision total hip arthroplasty: comparison between the first and multiply revised total hip arthroplasty

Dislocation and infection are common complications of total hip arthroplasty (THA). This study evaluated the correlation between the number of revision THAs and the incidence of these complications. Data were obtained from 749 revision THAs. Average follow-up was 13.2 ± 5.9 years. Patients were grouped as first, second, third, and fourth or greater revision THA. Dislocation rates (5.68%, 7.69%, 8.33%, and 27.45%) and infection rates (1.35%, 1.92%, 2.5%, and 7.84%) in the first, second, third, and fourth or greater groups, respectively, correlated directly with the revision number and were highest (P < .001) in the fourth or greater group. Dislocation and infection are exponentially correlated with the number of revision THA. From the fourth revision onward, those risks are multiplied.

Evaluation of LHP® (1% hydrogen peroxide) cream versus petrolatum and untreated controls in open wounds in healthy horses: a randomized, blinded control study

Background

Treatment and protection of wounds in horses can be challenging; protecting bandages may be difficult to apply on the proximal extremities and the body. Unprotected wounds carry an increased risk of bacterial contamination and subsequent infection which can lead to delayed wound healing. Topical treatment with antimicrobials is one possibility to prevent bacterial colonization or infection, but the frequent use of antimicrobials ultimately leads to development of bacterial resistance which is an increasing concern in both human and veterinary medicine.

Methods

Standardized wounds were created in 10 Standardbred mares. Three wounds were made in each horse. Two wounds were randomly treated with LHP^® or petrolatum and the third wound served as untreated control. All wounds were assessed daily until complete epithelization. Protocol data were recorded on day 2, 6, 11, 16, 21 and 28. Data included clinical scores for inflammation and healing, photoplanimetry for calculating wound areas and swab cytology to assess bacterial colonization and inflammation. Bacterial cultures were obtained on day 2, 6 and 16.

Results

Mean time to complete healing for LHP^® treated wounds was 32 days (95%CI = 26.9-37.7). Mean time to complete healing for petrolatum and untreated control wounds were 41.6 days (95%CI = 36.2-47.0) and 44.0 days (95%CI = 38.6-49.4) respectively. Wound healing occurred significantly faster in LHP^® wounds compared to both petrolatum (p = 0.0004) and untreated controls (p < 0.0001). There was no significant difference in time for healing between petrolatum and untreated controls. Total scores for bacteria and neutrophils were significantly (p < 0.0001) lower for LHP^® treated wounds compared to petrolatum from day 16 and onwards. Staphylococcus aureus and Streptococcus zooepidemicus were only found in cultures from petrolatum treated wounds and untreated controls.

Conclusions

Treatment with LHP^® reduced bacterial colonization and was associated with earlier complete wound healing. LHP^® cream appears to be safe and effective for topical wound treatment or wound protection.

Cell resilience in species life spans: a link to inflammation?

Species differences in life span have been attributed to cellular survival during various stressors, designated here as 'cell resilience'. In primary fibroblast cultures, cell resilience during exposure to free radicals, hypoglycemia, hyperthermia, and various toxins has shown generally consistent correlations with the species characteristic life spans of birds and mammals. However, the mechanistic links of cell resilience in fibroblast cultures to different species life spans are poorly understood. We propose that certain experimental stressors are relevant to somatic damage in vivo during inflammatory responses of innate immunity, particularly, resistance to reactive oxygen species (ROS), low glucose, and hyperthermia. According to this hypothesis, somatic cell resilience determines species differences in longevity during repeated infections and traumatic injuries in the natural environment. Infections and injury expose local fibroblasts and other cells to ROS generated by macrophages and to local temperature elevations. Systemically, acute phase immune reactions cause hypoglycemia and hyperthermia. We propose that cell resilience to somatic stressors incurred in inflammation is important in the evolution of longevity and that longer-lived species are specifically more resistant to immune-related stressors. This hypothesis further specifies Kirkwood's disposable soma theory. We suggest expanding the battery of stressors and markers used for comparative studies to additional cell types and additional parameters relevant to host defense and to their ecological specificities.

Complications in hair restoration surgery

Hair loss affects more than 1.2 billion people worldwide. As the technology and artistry of hair restoration surgery has improved including natural results, so too has the popularity of this procedure. As with any other surgical procedure, complications may occur and this presents a major challenge for the surgeon and the patient. This article provides an overview of the complications most likely to occur during the pre, intra, and postoperative periods with modern hair transplant surgery (single follicular unit or multifollicular unit) including scalp surgery, and discusses their treatment and most importantly their prevention.