title: Flow-through Instillation of Hypochlorous Acid in the Treatment of Necrotizing Fasciitis.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: John R
authors.initials: JR
authors.lastname: Crew
authors.forename: Kerry T
authors.initials: KT
authors.lastname: Thibodeaux
authors.forename: Marcus S
authors.initials: MS
authors.lastname: Speyrer
authors.forename: Anibal R
authors.initials: AR
authors.lastname: Gauto
authors.forename: Timothy
authors.initials: T
authors.lastname: Shiau
authors.forename: Liliana
authors.initials: L
authors.lastname: Pang
authors.forename: Keith
authors.initials: K
authors.lastname: Bley
authors.forename: Dimitri
authors.initials: D
authors.lastname: Debabov
mesh_terms: D000328:Adult; D019115:Fasciitis, Necrotizing / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006997:Hypochlorous Acid / Q000008:administration & dosage*; D007322:Instillation, Drug; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D006997:Hypochlorous Acid