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Resource-Limited Environment Plastic Surgery
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Johann A. Jeevaratnam, Charles Anton Fries, Dimitrios Kanakopoulos, Paul J. H. Drake, Lorraine Harry
It is in non-surgical burn treatment that we might benefit most from the often-forgotten heirlooms of early burns management such as the following:Stabilisation of burn escharAntibiotic clysisTopical Mafenide (Sulfamylon)FlamazineFlammaceriumSilverHypochlorite (Dakin’s Solution)
Chemical Warfare Agent Decontamination from Skin *
Published in Brian J. Lukey, James A. Romano, Salem Harry, Chemical Warfare Agents, 2019
Robert P. Chilcott, Brian J. Lukey, Harry F. Slife Jr., Edward D. Clarkson, Charles G. Hurst, Ernest H. Braue Jr.
In World War I, the Allies used bleaching powder (calcium hypochlorite) as the primary decontaminant. This material proved effective at neutralizing sulfur mustard on the ground. Almost 2000 tons of bleaching powder was sent to the Allied Expeditionary Force during the war (Smart, 1997). Another form of hypochlorite used in the war was Dakin’s solution. Dakin’s solution consists of sodium hypochlorite (0.4–0.5%) and boric acid (4%) and was used as a successful field antiseptic. Unfortunately, the solution was unstable and had to be formulated in situ (Vedder, 1925). Because of its oxidative chlorination properties, it was identified as an acceptable way to decontaminate CWAs. Dakin’s solution acts as a solvent on dead cells and hastens the separation of dead from living tissue. This originally was thought to detoxify agent in the skin, but later work showed that this was not the case (Smart, 1997).
Complications of Thermal Injuries
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Mark Cockburn, Edgar J. Pierre, Mark G. McKenney
Dakin’s solution (sodium hypochlorite 0.5% or 0.25% solution) is bactericidal, fungicidal, and virucidal. It is effective against MRSA, methicillin-resistant Staphylococcus epidermidis, and Enterococci [6]. Sodium hypochlorite dissolves clots and may cause bleeding. At concentrations higher than 0.025%, it is toxic to fibroblasts, keratinocytes, and PMNs [11].
Ebselen oxide attenuates mechlorethamine dermatotoxicity in the mouse ear vesicant model
Published in Drug and Chemical Toxicology, 2020
Hemanta C. Rao Tumu, Benedette J. Cuffari, Maria A. Pino, Jerzy Palus, Magdalena Piętka-Ottlik, Blase Billack
There are no specific antidotes currently available for mustard gas exposure. Modified Dakins solution (0.025% sodium hypochlorite) has been used as an irrigating and antiseptic agent during World War I and the Iran–Iraq War (Anderson 2012) but more effective countermeasures are needed. To this end, numerous in vivo studies have evaluated various classes of compounds such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, chelators, povidone-iodine, zinc oxide, capsaicin, and anti-TNFα antibodies for treating vesicant-induced inflammatory responses (Casillas et al. 2000, Dachir et al. 2002, Kenar et al. 2005, Wormser et al. 2005), but each of these have had limitations. More recently, a novel formulation of doxycycline has shown promise in healing dermal wounds caused by NM (Anumolu et al. 2011) and a novel bifunctional anti-inflammatory prodrug (NDH 4338) has been found to reduce vesicant-induced edema and markers of epidermal proliferation (Chang et al.2014, Composto et al.2016). None of these compounds, however, have completely reduced vesication. Therefore, there is an urgent need to identify antidotes to the blistering effects of mustard gas.
Surgical management of giant acne keloidalis nuchae lesions
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Laura I. Galarza, Camille A. Azar, Youssef Al Hmada, Abelardo Medina
For patients No. 1 and No. 2, the post-excisional wounds were left widely open and packed with Dakin’s solution-soaked gauze and secured with ABD pads, kerlix and tubular elastic net (Figures 2(A) and 3(B)). In case No. 3, a partial skin closure with 3-0 vicryl sutures followed by immediate split thickness skin graft (STSG) was performed due to the magnitude of the ablative wound (specimen weight: 815 g) and concerns of inappropriate wound management in outpatient setting (Figure 4).
Prevention and treatment of burn wound infections: the role of topical antimicrobials
Published in Expert Review of Anti-infective Therapy, 2022
Deepak K. Ozhathil, Steven E. Wolf
The primary adverse effect of Dakins’ Solution™ is cytotoxicity to fibroblasts and therefore impairs wound healing, particularly at full-strength and half-strength concentrations. However, studies showed that a dilution of 1/20th strength (0.025%) Dakins’ Solution™ maintains its bactericidal effects, while no longer cytotoxic [73–75]. For this reason, most burn centers utilize dilute Dakins’ Solutions™ of quarter-strength (0.125%) or less. Wilson and colleagues compared the cytotoxic effect of common antimicrobial agents on human-infant derived keratinocyte and dermal fibroblast cultures. They also defined cytotoxicity with a relatively low bar of >15% difference in proliferation compared to baseline culture growth after 3 hours of exposure. Their results showed that 1/20th strength modified Dakins’ Solution™ was still cytotoxic (by their definition) and needs to be further diluted 10-fold to be non-cytotoxic to fibroblasts and 105-fold for keratinocytes [76]. Building upon these findings, Lineaweaver and colleagues found that wounds irrigated with full-strength Dakins’ Solution™ had diminished tensile strength and impaired wound healing compared to controls (no irrigation, irrigated with normal saline and irrigated with 3% hydrogen peroxide). However, they also showed that a concentration of 0.005% (1/100th strength Dakin<apos;>s Solution™) though certainly not cytotoxic, continued to be bactericidal [77]. These findings suggest that sufficient dilution of Dakins’ Solution™ makes it an effective antimicrobial and non-cytotoxic agent. Another rarely reported complication is post-operative bleeding due to dissolution of blood clots. For this reason, some surgeons prefer to use Dakins’ Solution™ before surgical excision to diminish microbial bioburden and use solutions like silver nitrate and mafenide acetate post-operatively, which have longer shelf lives. Other surgeons do not ascribe to this concern and consider modified Dakins’ Solution™ their antimicrobial solution of choice. Summary: Dakins’ Solution™ is an effective broad-spectrum anti-microbial agent, but it is recommended to be diluted to at least 1/20th strength (0.025%) or less to minimize cytotoxicity. In addition, such dilutions are typically made in small batches by the in-house pharmacy for immediate use due to short chemical half-life. That said, the broad-spectrum coverage of sodium hypochlorite makes it an excellent first-line agent for peri-operative irrigation.