To the Editor.—Kozol et al conclude that the adverse effects of hypochlorites on various cell lines in their wound module argue against the use of Dakin's solution in open wounds. Unfortunately, extrapolations from cell culture or other "wound facsimiles" to the surgical wound are tenuous at best. Both hypochlorite itself, as well as compounds that generate hypochlorous acid (the active species of all hypochlorite microbicidal formulations), have enjoyed long-term clinical popularity principally because of their efficacy and safety.1-3
The apparently contradictory results obtained by Kozol et al may, in part, be explained by the wound module, which bears little similarity to a real wound milieu. The cell culture environment lacks the organic substances (principally proteinaceous components of serum, fibrin, and collagen) of the clinical wound. It is well known that hypochlorites are consumed by organic matter.4,5 The absence of these organic substances in the wound module precludes
BARESE S, CUONO CB. Débridement of Wounds With Dakin's Solution. Arch Surg. 1989;124(1):133. doi:10.1001/archsurg.1989.01410010143029
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