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Purpose: From 2009 to 2011 there were 112 cases of invasive fungal infections among US military personnel who suffered complex blast injuries in Afghanistan. The hallmark of invasive fungal infections (IFI) is recurring tissue necrosis with further loss of tissue. Initial wound management for these IFI’s was provided via negative pressure wound therapy (NPWT) with silver impregnated reticulated open cell foam (ROCF) dressings. However, at a major military medical center in Bethesda, MD this treatment was not proving effective in reducing the tissue necrosis or fungal growth associated with these wounds. This was evidenced by the visualization of new growths of black mold patches on wound tissue between routine 48-72 hour debridements.
Objective: Orthopedic and trauma surgeons sought out assistance from the WOC nurse to develop a solution that would help eradicate fungal growth and reduce tissue necrosis between debridements.
Outcomes: The recommendation by the WOC was to use NPWT and periodically instill a solution of dilute sodium hypochlorite solution of 0.025% into the wound. This therapy was accomplished by using a commercially available NPWT device capable of instilling chemical solutions directly into the wound. Sodium hypochlorite was chosen based on its antifungal properties. Initial results were very favorable in the first wounds managed using this technique. Mold growth in the wounds between debridements was significantly reduced with the addition of the dilute sodium hypochlorite solution. Anecdotally the surgeons reported significant reductions in tissue necrosis and tissue loss. After the success in the first trials using dilute sodium hypochlorite solution in wounds all successive wounds suspected of IFI were managed in this manner. The practice of using NPWT with the instillation of dilute sodium hypochlorite solution has now become the treatment of choice for military medicine in the management of invasive fungal wound infections.