Flow-through Instillation of Hypochlorous Acid in the Treatment of Necrotizing Fasciitis

Abstract: Introduction. 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.

Materials and 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 flow-through 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. Conclusion. 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.



Necrotizing fasciitis (NF), commonly referred to in nonmedical discourse as “flesh-eating” inflammation, is a rapidly progressing involvement of the fascia and subcutaneous tissues that can subsequently extend to the muscles and skin. Type I NF is classified as a polymicrobial infection, whereas type II NF is classified as a monomicrobial infection.1 Bacterial toxins released during the course of necrotic inflammations produce direct cytotoxic effects on surrounding tissues, while also causing immune system dysfunction and localized immunosuppression. The authors’ new therapy incorporates the use of an instillation vacuum-assisted closure procedure, also known as negative pressure wound therapy (NPWT), with pure 0.01% hypochlorous acid (HOCl) with no sodium hypochlorite—commonly known as bleach—impurity.2 As pure 0.01% HOCl (ie, > 97% relative molar distribution of active chlorine species as HOCl) in a 0.9% saline solution at pH 4-5 has been shown to both rapidly kill bacteria and neutralize bacterial toxins in vitro, clinical administration of pure HOCl with no sodium hypochlorite impurity was recently explored … read more