Integration of Telemedicine and Hypochlorous Acid Wound Care: A Promising Approach as Illustrated by Four Case Studies

Case Series

Ann Surg Perioper Care. 2023; 8(2): 1059.

Integration of Telemedicine and Hypochlorous Acid Wound Care: A Promising Approach as Illustrated by Four Case Studies

Hendrik C Roos, MD1*; Mazizi Njokweni2; Themba Donovan3; Tebogo Pamela Sedibe, RN4

1Trifectiv (Pty) Ltd, Stellenbosch, South Africa

2Head podiatrist Leratong Tertiary Hospital, Gauteng, South Africa

3Podiatrist, Leratong Tertiary Hospital, Gauteng, South Africa

4Unjani Clinic, Thulamahashe, South Africa

*Corresponding author: HC Roos Trifectiv (Pty) Ltd, Stellenbosch, South Africa. Email: labs@trifectiv.com

Received: July 26, 2023 Accepted: August 21, 2023 Published: August 28, 2023

Abstract

Telemedicine has revolutionized the healthcare industry, providing patients and healthcare professionals with convenient and efficient ways to access and deliver remote healthcare services. One area where telemedicine has shown tremendous promise is in wound care, and in particular, the use of hypochlorous acid (HOCl) as a therapeutic agent. This article aims to explore the benefits of telemedicine in wound care and delve into the specific advantages of employing non-toxic HOCl solution as therapeutic agent. Through case studies, we propose for the integration of telemedicine and non-toxic HOCl wound care, highlighting its potential to improve patient outcomes, enhance accessibility, and reduce healthcare costs.

Keywords: Telemedicine; non-toxic hypochlorous acid; Trifectiv® Plus Wound & Burn Care; Infection; Inflammation; Conservative debridement; Biofilm; Wound care; Wet-to-moist debridement; Gauze dressing

Introduction

Wound care is a complex and resource-intensive aspect of healthcare that demands timely and appropriate treatment to prevent complications and promote optimal healing. Telemedicine, the use of telecommunication technology to provide remote clinical care, has emerged as a valuable tool in delivering wound care services [1]. Through virtual consultations, telemedicine enables healthcare providers to assess wounds, provide expert guidance, and monitor progress remotely [2].

HOCl, a potent antimicrobial, anti-biofilm, and anti-inflammatory agent, has shown efficacy in wound management [3]. Hypochlorous acid is a naturally occurring molecule that occurs in the white blood cells. It is generated by the human immune system in response to infection and injury and plays a crucial role in the eradication of pathogens. Advances in methods to produce medical grade stable HOCl have contributed to its exposure as a wound care treatment agent. Furthermore, its anti-biofilm and anti-inflammatory effects are central in the treatment of chronic wounds [4]. HOCl has also gained attention due to its efficacy against Multiple Drug Resistant (MDR) pathogens, including MDR fungi, whilst not demonstrating any cytotoxicity [5].

A simplified yet effective dressing protocol was developed to treat most wounds, including wounds suitable for home treatment. The dressing consists of surgical non-woven gauze wetted with HOCl (Trifectiv) and placed on the wounds. In the case of cavity wounds, the wetted gauze is plugged into the cavities. The dressings are retained with a crepe bandage or breathable plaster. In the case of lower limb wounds, elastic stockings compliment the treatment protocol, if there are no circulatory restraints to local compression.

Case Study Presentation

Case 1 (Figure 1)

Patient history: A 68-year-old female patient presented to the podiatry clinic of a tertiary health facility with a large open wound on the dorsum of her right foot and ankle. Three weeks prior to presentation, necrotizing fasciitis with surgical debridement resulted in a non-healing wound. Co-morbidities treated on oral medication included metabolic syndrome, diabetes mellitus Type 2, hypertension, and raised serum cholesterol. As the wound was infected and inflamed and exhibited necrotic material, further debridement had been scheduled, with the possibility of below-knee amputation, due to exposed extensor tendons. Prior to the podiatric consultation, the patient had been dressing the wound daily with non-medicated paraffin gauze retained with a crepe bandage. The wound was malodorous and had a pain severity level of 8/10. The wound was not responding to paraffin gauze dressings.

Wound progression (Figure 1): On examination, a wound extended over the anterior aspect of the right ankle and the dorsum of the right foot, sparing the toes. The edges of the wound were inflamed and covered in purulent exudate. After irrigation with non-toxic hypochlorous acid solution (HOCl) 380 mg/L (available as Trifectiv® Plus Wound & Burn Care), the wound was dressed. The dressing consisted of surgical non-woven gauze wetted with HOCl and retained with a crepe bandage. The patient was instructed on the method of dressing to be done daily at home. Follow-up appointments at the clinic were scheduled at weekly intervals. The patient was given contact details for the clinic and for electronic transfer of photographs of the wound twice per week. Sufficient monitoring of the wound required the transmission of photos of the removed dressing as well. The clinic arranged multi-disciplinary referral for the treatment for her co-morbidities.