Making Implants and Fat Grafts Safer: Intraoperative Lavage Protocol Using Cams
Anyone performing surgeries (with or without prosthesis) has faced many challenges when trying to overcome the burden of severe infections and/or complications derived from them. Although many protocols have been described and technology has helped us to reduce its impact, there still remain some obstacles that hinder an optimal cleansing solution[i]. Hypochlorous Acid (HOCl) has demonstrated a broad safety profile as well as effectiveness for wound care[ii],[iii], including various skin/mucosal infections and disorders (e.g. seborrheic dermatitis, atopic dermatitis-associated pruritus, acne vulgaris, diabetic foot ulcers, and hypertrophic scars/keloids)[iv],[v]. The scientific basis for its use relies on the Reactive Oxygen Species (ROS) formation by the respiratory burst, which is a natural immune pathway for pathogen destruction[vi]. Neutrophils and other cells of the innate immune system physiologically produce HOCl from H2O2 and Cl- within phagosomes, through the granule enzyme myeloperoxidase[vii].
S-HOCl is different from Bleach!
HOCl molecule is an oxygen-dependent non-dissociated ion of chlorine, very unstable and hyperreactive at different pH; although it is one of the most powerful oxidants and the direct responsible of the microbicidal effect from chlorine-derived compounds[viii]. Recently a scientist[ix] discovered a process to Stabilize (S-HOCl) the molecule, which was patented and named a Cellular Antimicrobial Molecule (CAM) instead of a mere disinfectant (Figure 1).
Methods/Technique
:S-HOCl concentrations at 500 ppm are effective to reach a 99.9% killing of most bacteria, fungus and virus, through exposures as short as 1 minute. Low-concentrated HOCl-based solutions have shown great efficacy to control common flu-like symptoms in viral and bacterial upper airway infections[x],[xi],[xii].
We are proposing the prosthesis pre-wash with a 500-ppm S-HOCl solution 5 minutes prior to its insertion; the pocket could be irrigated with S-HOCl as well. Besides, we add a 100-ppm S-HOCl solution directly to the fat harvesting canister (1/3 of the Lipoaspirate volume). Then, the processed fat graft can be injected without further washing.
Results/Complications
:The current protocol has shown very promising results in terms of safety and infection control after 1 year of implementation. Neither infections, allergies, adverse effects, nor toxicological effects have been reported whatsoever. Still, a large case series, a cohort or even a multicenter clinical trial should be conducted to support our recommendations.
Conclusion
:There is still a lot of confusion about the chlorine species and how they behave within different pH and physiological conditions. S-HOCl was developed to safely kill and control of numerous microorganisms’ growth at physiological conditions. Further studies are needed to support our protocol, which was supported by our experience and the current literature available. Furthermore, CAMs have arisen as a new category of ‘natural’ compounds for the post-antibiotic era.
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[ix] Calderon JL. PATENT: Method of producing and Applications of composition of Hypochlorous Acid. Aquilabs SA Co. United States Patent Publication Application, US2009/0258083A1. Oct 15, 2009.
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