The Use of Lactated Ringer's Solution as an Adjunct to Enzymatic Debridement for Optimizing Wound pH

The Use of Lactated Ringer's Solution as an Adjunct to Enzymatic Debridement for Optimizing Wound pH

Statement of Clinical Problem: The cost to treat a diabetic foot ulcer for 1 year is ~$22,500.  Collagenase is most effective within a pH range of 6-8. The purpose of this study was to demonstrate the increased rate of debridement by a topical debrider when used with Lactated Ringer's solution (LR), a strong buffer that raises the pH in acidic wounds.

Description of Past Management: In the past, wound products were applied without regard to wound pH. Wound bed preparation involved irrigation with normal saline (weak buffer) and application of a topical product to promote debridement. Wound healing is complex and removal of necrotic tissue is essential, but a rate of debridement related to wound pH has not been widely researched.

Patient Outcomes: Three male patients, (mean age 71.6) with nonhealing (>30days) neuropathic wounds were followed as outpatients. The wound pH of each was <6 prior to substitution of normal saline with Lactated Ringer's solution. Wound pH was maintained between 6-8 by daily Lactated Ringer's irrigation, followed with Collagenase and a gauze dressing. Two patients had complete wound closure within 3 weeks, the 3rd patient within 4 weeks.

Conclusion: Low wound pH can be attributed to excessive endogenous protease activity. The wound pH environment can be altered to a range conducive to optimal healing. Proper usage of Collagenase, can expedite wound closure by the removal of nonviable tissue. Lactated Ringer's  buffers wound pH, which optimizes the action of Collagenase as compared to normal saline. An expeditiously prepared wound bed will promote wound closure or earlier placement of advanced wound therapies.