Water is preferable for wound cleaning… but – Why can hydrogen peroxide (H2O2) be useful in some cases?

It is to be recognised that some wounds have a contusion zone consisting of tissue balancing on the edge between being viable (being able to live) and unviable and therefore destined to die off sooner or later. It is preferable to get rid of the unviable tissue as early in the wound healing process as possible as dead and dying tissue provide an outstanding breeding ground for microbes that are adverse to healing. Other wounds have large amounts of slough that proves very hard to remove even if using pressurised water.

Accelerates kill-off of unviable tissue and leaves viable tissue unharmed

Hydrogen peroxide generally has the ability to kill off the unviable tissue which can then be easily removed as soft necrotic slough. Moreover, if used in the 3% concentration recommended for wounds and washed off with water directly subsequent to the foaming process, i.e. within a minute or less, it will not harm the viable tissue.

Before the first application of MPPT, wounds with large amounts of intractable slough and/or a substantial contusion zone can therefore in some instances benefit from the light chemical debridement that H₂O₂ can offer

Body holds natural degrading enzyme preventing build-up

As hydrogen peroxide is being used in the normal physiology of the body, the body itself naturally holds an enzyme that degrades H₂O₂. This prevents the damaging effects on healthy cells and renders it a relatively safe debrider.

Antiseptics

Hydrogen peroxide also falls within the definition of an antiseptic. If for any reason it is considered necessary to use an antiseptic before the application of MPPT, it is strongly advised NOT to choose one that is cytotoxic resulting in the impairment of healing as is the case for e.g. PHMB and its derivatives, Iodine and its derivatives, Silver in the forms used in clinic, and Chlorhexidine.

A better option would be Hydrogen peroxide 3% or 70% Isopropyl alcohol or 70% normal alcohol.

Once MPPT is started, use only water

Once MPPT is being used on the wound, the body’s own immune system starts to select and sustain the microbiota in the wound that is beneficial to the healing process. In order not to interfere with this desirable process, it is recommended only to wash with water between applications.

Contraindications

The use of H2O2 is contraindicated in very deep or large wounds due to risk of gas embolism. Link MHRA update

References:

Drosou A et al. (2003) Antiseptics on Wounds: An Area of Controversy. Wounds. 2003;15(5)

Faria G et al. (2009) Chlorhexidine-induced apoptosis or necrosis in L929 fibroblasts: A role for endoplasmic reticulum stress. Toxicol Appl Pharmacol. 2009 Jan 15;234(2):256-65

Sanchez IR et al. (1988) Chlorhexidine diacetate and povidone-iodine cytotoxicity to canine embryonic fibroblasts and Staphylococcus aureus. Vet Surg. 1988 Jul-Aug;17(4):182-5.

Mohammadi Z (2008) Chlorhexidine gluconate, its properties and applications in endodontics. Iran Endod J. 2008 Winter; 2(4): 113–125