Time for a change in paradigm in clinical wound care: a review of literature and role of acetic acid dressing

Mr  Eric Tan1,2, Dr Wei Lun Wong1,2, Mr Terrence Creagh1,2

1Christchurch Hospital, Christchurch , New Zealand, 2University of Otago, Christchurch, New Zealand

Abstract:

Introduction:The balance between anti-bacterial activity and tissue toxicity with the final impact on wound healing for every antimicrobial agent ever proposed has been raised in literature but difficult to quantify in clinical practice.
Acetic acid (AA) is not commonly used in New Zealand for burn care.
We would like to investigate the medical literature on the role of AA in burn and outline our proposal to address any paucity of information.

Method: A Pubmed search using keywords ‘antimicrobial acetic acid’ and ‘wound’ was performed. 307 articles were produced but after initial review only 17 were suitable for analysis.
Only one randomised study has been conducted comparing AA against saline dressing in 32 patients with better outcome in AA group (P<0.001).

Results: 12 in vitro study were performed with 4 directly on burn wounds. AA is effective at 0.1666% concentration (2015) and determined to be non-cytotoxic at 1% (2017). A single in vitro study (2010) found suprathel-acetic acid matrix having better anti-MRSA and Pseudomonas aeruginosa activity in comparison to silver and suprathel-silver combination.
A 2018 wound consensus described AA as a future promising agent.

Conclusion:Our proposal for a randomised controlled trial comparing AA against silver dressing and saline dressing as control in a single burn unit in New Zealand will be of utmost clinical relevance.


Biography:

Mr Eric Tan is a current fellow in the department of plastic surgery in Christchurch hospital. He has a special interest in evidence based burn practice and has produced educational curriculum for emergency department and junior doctors in UK on burns. He has also chaired sessions on burns in European Burns Association meetings with a special interest in chemical burns.