Since the beginning of my residency till the present day (12 years), I had contact with an enormous amount of patients with ulcers, namely diabetic foot ulcers, arterial ulcers, and venous ulcers. Some of them extremely hard to treat despite the availability of a great amount of dressings.
Diabetic foot ulcer is a challenge to the surgeon. Many factors are involved in its pathophysiology, and it is a major cause of lower limb amputation. According to some data, diabetic foot is responsible for one amputation each 30 seconds. Additionally, 50% of patients submitted to lower limb amputation, will have the contralateral limb amputated in the next 5 years. So... All efforts to reduce this amputation rate are welcome.
That is why many dressings exist and are available for doctors to use. This great amount of dressing materials has only one meaning: there is not an ideal dressing! In the last decades new complex dressing materials are emerging seeking for the ideal one, and pushing the older and classical dressings into the "not indicated" section. One of those victims is Dakin's Solution. But... Is it not effective anymore? Is there no place for it today?
B. Duarte et al. from Hospital de Santo António dos Capuchos, in Lisbon, Portugal, in conjunction with José Neves, my friend and a surgeon with huge experience in diabetic foot, recently published in the International Wound Journal a paper entitled "Dakin's Solution: is there a place for it in the 21st century?". According to the authors, this publication eliminates the myth that topical antiseptics decrease wound healing. In fact, Dakin's Solution with its antimicrobial and debridement capabilities can be of good help in difficult to treat and heavily infected wounds. B. Duarte et al. report a case of a patient with a septic diabetic foot with osteomyelitis, submitted to surgical treatment leaving a 9x9cm ulcer with exposure bone and tendon, resistant to other topical treatments, that had a good evolution with Dakin's Solution dressings. In 6 weeks there was full coverage with granulation tissue (figure).
Dakin's Solution (also called Dakin's fluid or Carrel-Dakin fluid) received its name from Henry Dakin, and was first used during World War I in the pre-antibiotic era to treat infected war wounds. Henry Drysdale Dakin (London, 12 March 1880 - New York, 10 February 1952) was an english chemist who offered his service to the war effort in 1914. In conjunction with the french surgeon Alexis Carrel (Lyons, 28 June 1873 - Paris, 5 November 1944) - Nobel Prize in Physiology or Medicine 1912 - developed the Carrel-Dakin method to treat infected wounds. Identical to what is described in the case report from B. Duarte et al., the Carrel-Dakin method consisted in an intermittent irrigation of the wound with Dakin's Solution, a highly diluted antiseptic consisting of sodium hypochlorite (0.4% to 0.5%) and boric acid (4%). According to the authors "countless limbs and lives were saved because of this solution". If it saved limbs and lives a century ago why it cannot do the same today?
There are international guidelines that do not indicate the use of Dakin's Solution. Although new complex wound materials with healing properties and less side effects than Dakin's Solution are now available, it does not justify the abomination of the classical dressing materials, I think. I agree with the authors when they state that each dressing has advantages as long as it is correctly used and tailored to each patient.
Some years ago a doctor said: "Guidelines are very important mostly to the ones who do not know, because those who know, do extraordinary things outside the guidelines". Seems to me that the case report presented by B. Duarte et al. meets this idea.
Link to PubMed:
Dr. Carlos Eduardo Costa Almeida
General Surgeon