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Vinegar????

Discussion in 'Diabetic Foot & Wound Management' started by grosit01, May 17, 2012.

  1. grosit01

    grosit01 Member


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    Anyone using Vinegar on wounds, pseudomonas infections etc????

    I've had some good results, just wondering what other peoples experiences were???
     
  2. Tom Quinton

    Tom Quinton Member

    Hi Grosit,

    I've never used vinegar on wounds. Why do you use vinegar on wounds? I don't think acid would benefit wound healing?
     
  3. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Silly, irresponsible, unethical ....
     
  4. grosit01

    grosit01 Member

    I have not personally used vineagar/Acetic Acid on wounds, but have closely watched a Doctors dressing regime, on two seperate clients over a 4-6 week period. Both had heavy growths of pseudomonas, and seemed to respond well to the Vinegar/Acetic Acid.
     
  5. grosit01

    grosit01 Member

    ???????????
    Hippocrates in the 5th century BC used vinegar or acetic acid as a wound antiseptic. As a 0.25% to 0.5% solution, it is bactericidal against many Gram-positive and Gram-negative organisms, and is effective in reducing bacterial burden. By convention, it is a popular adjunctive short-term treatment for superficial wound infections with Pseudomonas aeruginosa. Since Pseudomonas spp typically develop quick resistance to many topical and systemic agents, this simple approach, which reduces local pH, can reduce the bacterial burden of this microorganism in the wound. Diluted vinegar soaks for 15 minutes per day are effective and reduce problems of local wound odor if a mixed aerobic-anaerobic flora is present. This approach is effective for critically colonized wounds in the superficial compartment. In a venous leg ulcer study, gauze dressings wetted with acetic acid decreased the number of S aureus isolates and Gram-negative rods.24 Although some in-vitro studies have suggested that acetic acid is cytotoxic, these findings have not borne out in the in-vivo arena using conventional treatment doses.
    ??????????
     
  6. grosit01

    grosit01 Member

    Ok Ill use the term Acetic Acid
     
  7. grosit01

    grosit01 Member

    3.4.2.7 Chemical stress
    Iodine, peroxide, chlorhexidine, alcohols, hypochlorites and acetic acid are commonly used
    antiseptics and cleansing agents. Use of these agents is often responsible for delayed healing, since they are non-selective in their activity and will kill healthy cells as well as bacteria. It is preferable to avoid the prolonged use of these products on a granulating wound. Even their use in infected wounds is somewhat dubious, as research has shown that although they may reduce the surface load of bacteria in an infected wound, they do not penetrate below the surface and therefore have no real effect on the infection in the tissue itself. They may be of use in dilute forms when applied to some chronic wounds and left in place for no more than five minutes and then washed off.
    http://www.dva.gov.au/service_providers/resources/Documents/wdcaremd.pdf

    ????Acetic acid maybe of use????
     
  8. blinda

    blinda MVP

    No, that is not what your source is suggesting at all (See bold and underlined).


    Investigation of Antibacterial and Cytotoxic Effects of Organic Acids Including Ascorbic Acid, Lactic Acid and Acetic Acids on Mammalian Cells

    Abstract from the above study;

    Cytotoxicity to cultured human keratinocytes of topical antimicrobial agents

    From the above study;

    So, whilst acetic acid may be anti-microbial, from just 2 of many studies we see that acetic acid is also cytotoxic to wounds, killing proliferating fibroblasts and keratinocytes, both of which are critical to wound healing.

    Why would you opt for an unproven treatment in terms of detrimental effects over others that have undergone rigorous clinical trials to determine efficacy and more importantly, safety?
     
  9. grosit01

    grosit01 Member

    I'm raising the question, not as a first option treatment, but for chronic/difficult wounds, eg significant PVD where topical treatments are needed to reduce the bacterial burden.

    Im not baseing anything on that document, but that is An Australian Federal Government Document of the DVA stateing that it maybe of use.

    Australian wound association also describes its use with care.

    I'm interested in peoples clinical experiences???

    I have asked 2 GP's, a Vascular Surgeon and a Pod from a Multi-D High Risk Foot clinic who all supported and have used Acetic Acid under certain circumstances.
     
  10. grosit01

    grosit01 Member

    J R Army Med Corps. 1993 Jun;139(2):49-51.

    Acetic acid used for the elimination of Pseudomonas aeruginosa from burn and soft tissue wounds.

    Sloss JM, Cumberland N, Milner SM.


    Source

    Department of Pathology, Queen Elizabeth Military Hospital Woolwich, London.


    Abstract

    Acetic acid was used topically at concentrations of between 0.5% and 5% to eliminate Pseudomonas aeruginosa from the burn wounds or soft tissue wounds of 16 patients. In-vitro studies indicated the susceptibility of P. aeruginosa to acetic acid; all strains exhibited a minimum inhibitory concentration of 2 per cent. P. aeruginosa was eliminated from the wounds of 14 of the 16 patients within two weeks of treatment. Acetic acid was shown to be an inexpensive and efficient agent for the elimination of P. aeruginosa from burn and soft tissue wounds.
     
  11. Tom Quinton

    Tom Quinton Member

    Thanks for the sources grosit. They're interesting.

    Wound care is a slippery topic. I'm not aware of convincing evidence for any topical antibacterial dressing. I tend to find clinicians personal experiences with dressings more misleading than enlightening.

    How have you observed vinegar being used? Was it diluted? Was it sterile? Where was it purchased from? Was it intended for medical use? Is it possible the wounds healed despite vinegar being used and not because of it? Do you use peroxide, chlorhexidine, alcohols or hypochlorites on wounds?
     
  12. grosit01

    grosit01 Member

    I participate in an Ulcer clinic two's day a week, usually seeing 5-8 wounds in a session.

    I wouldnt use Acetic Acid as a dressing persay, rather question its use to cleanse a wound that has swabbed +ve to Pseudo, and due to limited perfusion/diabetes/smoking etc hasn't responded well to tradition interventions.

    My war chest currently consists of Chlorhex, POVI2, NaCl, Inadine, Iodosorb, Intrasite, Intrasite Comformable, Aquacel Ag, Acticoat 7, Medihoney etc for primary dressing.

    The Vinegar/Acetic Acid I've seen used was a Pharmacy preperation labelled 5%. And these were ongoing chronic wounds, one was nice and green and the GP didnt want to repeat Ciprofloxacin, I'm not sure for what reason???

    I've also been told of a Plastic Surgeon using it on an infected skin graft that didnt take???
     
  13. grosit01

    grosit01 Member

    Treatment of superficial pseudomonal infections with citric acid: an effective and economical approach
    B.S. Nagobaa, , S.R. Deshmukha, B.J. Wadher∗, L. Mahabaleshwar†, R.C. Gandhi†, P.B. Kulkarni†, V.A. Mane†, J.S. Deshmukh†
    a Department of Microbiology, M.I.M.S.R. Medical College, Latur, India
    † Department of Surgery, M.I.M.S.R. Medical College, Latur, India
    ∗ Medical Microbiology Research Laboratory, Department of Microbiology, Nagpur University, Nagpur, India
    Received 10 September 1997. Accepted 28 April 1998. Available online 18 May 2004.


    Abstract
    The antibacterial effect of citric acid for antibiotic resistant Pseudomonas aeruginosa was studied. Twenty-five clinical isolates were tested and all were inhibited by 2% citric acid in a broth dilution assay. Topical application of 2–3% citric acid to wounds, for three to seven times, successfully eliminated P. aeruginosa from the site. The use of this agent is therefore recommended as an effective and economical approach to the control of multiple antibiotic resistant strains of P. aeruginosa causing superficial infections.

    http://www.sciencedirect.com/science/article/pii/S0195670198900950
     
  14. grosit01

    grosit01 Member

    Maharashtra Institute of Medical Sciences and Research, Medical College and Hospital, Departments of Microbiology1, Surgery3 and Pharmacology4, Latur, Medical Microbiology Research Lab. Napur University, Nagpur2, India

    Aim: Pseudomonas aeruginosa is a classic opportunistic pathogen with innate resistance to many antibiotics and disinfectants. It is ubiquitous in hospital environment and because of its ability to survive in hospital environment it creates threat to patient’s care.The antibacterial effect of acetic acid against multiple antibiotic resistant strains of Pseudomonas aeruginosa isolated from nosocomial wound infection cases was studied.

    Methods: For this study, seven hospitalized patients with wound infections, not responding to traditional therapy for more than 10 days, were selected. A specimen of pus was collected before application of acetic acid and after completion of treatment (only one reculture was done) and processed for culture study. Seven clinical isolates of P. aeruginosa were studied for in vitro susceptibility to acetic acid and all were found to be inhibited by 3 % acetic acid.
    Results: The pus culture yielded isolation of P. aeruginosa in all seven cases under study. No other bacterium was isolated from these cases; hence they were labeled as pseudomonal wound infections. All isolates were found to be resistant to four or more antibacterial agents but all of them were found to be inhibited by 3% acetic acid in vitro when exposed for 15 minutes or more. Topical application of 3 to 5% acetic acid to wounds for 2 to 12 times successfully eliminated P. aeruginosa from wounds.

    Conclusion: The use of acetic acid is therefore recommended for effective elimination of multiple antibiotic resistant strains of P. aeruginosa from infection site.

    http://www.bioline.org.br/pdf?gm08019
     
  15. jrwadud

    jrwadud Welcome New Poster

    I regularly use vinegar to control pseudomonus infection on wound specially with renal failure patients where u cant use the aminoglycosides to control pseudomonus infection.

    DR. Wadud
     
  16. grosit01

    grosit01 Member

    Thank you, finally some REAL WORLD CLINICAL experiences.
    Cheers for the feedback :)
     
  17. Vinegar?

    Wow.

    That just, like, rubbing salt into the wound!
     
  18. blinda

    blinda MVP

    OK, grosit01,

    A few points to help you;

    A name, as opposed to a handle or pseudonym, would command more respect and replies from the podiatric community. Whilst an appreciation for the necessity of anonymity is warranted in certain circumstances, experience has indicated it is also open to abuse.

    It would also be beneficial, for yourself, to state where you are practising and in which capacity. Clinical governance, that is the standard transparency, responsibility and accountability of podiatric treatment varies from one country to another, along with access to resources. For instance, in the UK, the NICE standard of care for a chronic neuropathic diabetic wound/ulcer (which is the kind of wound you are referring to, as you started this thread in the `Diabetic foot and wound management` section) is to; reduce any non-viable tissue, take a swab for culture of aerobic and/or anaerobic infection, which leads to the prescription of appropriate broad-spectrum antibiotic therapy (not a folk-lore remedy of vinegar, tree bark, spit or any other dark age tx) and offload the wound.

    Incidentally, and further to the scientific evidenced based papers that I posted previously (which demonstrated that vinegar inhibits fibroblast growth) it is also well documented that a moist environment is required for optimal wound healing; see here (for yet another tiresome evidenced based bit of evidence; "yawn" to coin a popular phrase.....) Management of acute and chronic open wounds: the importance of moist environment in optimal wound healing. The full text of this article states "Caustic solutions..... vinegar....should never be applied to the wound". Hmmm. Lemme think why that would be. Acetic acid = moist environment? Nah. You don`t need me to explain the pH balance, I`m sure.

    You also need to be clear in your initial enquiry of clinical experience/advice here. Your opening post on this thread asked
    Now, that post lead us to believe that YOU had personally experienced "some good results" from "using vinegar on wounds". But, you then went on to say;
    In future posts, please be clear on what it is that you are asking for, or offering advice on, by providing the full clinical scenario/picture. This would lead to less frustration on your part and more comprehensive replies from the community.

    Cheers,
    Bel
     
  19. Good eyes!
     
  20. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    I checked with the key people at two of the major wound management clinics here in Melbourne and they expressed absolute horror that anyone would be using it!
     
  21. Catfoot

    Catfoot Well-Known Member

    Last edited: May 27, 2012
  22. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    A few non-authoritative references to it and its use as an agent for bathing hardly constitutes evidence for its use.

    I can not find anyone in the wound management community who uses it. They are all horrified that its being used, especially on the context of the evidence available for other interventions.
     
  23. Catfoot

    Catfoot Well-Known Member

    Craig,
    I am not sure what you mean by a "non-authoritative reference" but :-

    Milner S.M.: Acetic acid to treat Pseudomonas aeruginosa in superficial wounds and burns. Lancet, 340(8810): 61, 1992.

    E.PUGP (1994) Pressure Ulcer Treatment, AHCPR 95-0653

    B.Krasner (1995) Prevention Management Pressure Ulcers

    regards

    Catfoot
     
  24. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Look at the date of them. Wound management has changed more than a bit in the last 20 yrs.
     
  25. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    I just checked some of the recent wound management textbooks we have here. Only one of them (Carville) even mentioned acetic acid or vinegar.

    This is what it said:

     
  26. Erp

    Erp Member

    Dear All,

    As a podiatrist who has worked in a high risk foot clinic for the last 14 years, we have never used vinegar for wound treatments.:rolleyes:

    We have heard of it being used once on an inpatient with a leg ulcer by the Dermatology team but it wasn't for Pseudomonas and the wound nurse quickly redirected them to something more appropriate.

    In Australia, we have the benefit of accessing all the most effective and evidence based treatments for these conditions. If all aspects of wound healing are addressed, we heal most of these wounds. Our main barrier to healing is patient behaviours.

    Although there are many 'alternative' treatments which may be useful in parts of the world where more costly evidence based options are not available, it is often confusing to patients and some practitioners when these are discussed as being effective options in a broader sense.

    Perhaps we need to clarify the goal of the wound treatment as our first consideration: sometimes to treat and prevent infection is the primary goal and healing the wound may be secondary to that.

    Perhaps if you have no other option and you are stuck in a kitchen somewhere...no I won't even go there!

    According to our best evidence, most antimicrobial dressings are very effective against Pseudomonas, including most silver dressings, Medihoney, Iodosorb and topical Flamazine (SSD).

    If you can, that would be the best way to go. It works!

    Best of luck with wound healing.

    Liz Perry
    The Alfred Podiatry Service
    Melbourne, Australia.
     
  27. cwiebelt

    cwiebelt Active Member

    I have heard of Vinegar being used on foot wounds, and i am sure it has some effect.
    however there are more clinically appropiate products available, that are less harmful to tissue that might be trying to heal.

    Chris
     
  28. Catfoot

    Catfoot Well-Known Member

    Craig,
    You are, of course correct as the references are a bit dated.

    Here are some newer ones :-

    Vinegars and Acetic Acid Bacteria. International Symposium; May, 2005; Available at: http://www.vinegars2005.com/images/Vin_2005_book.pdf. Accessed March 9, 2006.

    Entani E, Asai M, Taujihata S, Tsukamoto YK, Ohta M. Antibacterial action of vinegar against food-borne pathogenic bacteria including Escherichia coli 0157:H7. J Food Prot. 1998;61:953–959. [PubMed]

    http://www.woundsresearch.com/article/1586

    The last one is dated 2008.

    There seems to have been much research done on this topic, but opinions seem to be varied as to its efficacy.

    This contrasts sharply with "needling" for which I can find no "authoritative references" yet seems to be growing in popularity among pods. :confused:

    regards

    Catfoot

    Personally, I think the best place for vinegar is on a fish supper.
     
  29. DaVinci

    DaVinci Well-Known Member

    Reading this thread, it strike me:

    1. Vinegar or acetic acid is effective against Pseudomonas aeruginosa

    2. Vinegar or acetic acid is toxic to fibroblasts, so impairs wound healing

    3. There are agents that are effective against Pseudomonas aeruginosa that do not impair wound healing

    4. Based on that how can anyone defend it use?
     
  30. Masterful summation.

    All pathogens are killed at 1500c. That's not to say applying an oxyacetylene torch to a wound is a good thing.
     
  31. Rob Kidd

    Rob Kidd Well-Known Member

    At the end of the day, it seems the only role for vinegar is in the treatment of Pseudomonas infections where there is no broken skin - my ears, for instance! And even then, the concept of an infection without broken skin may be an oxymoron................
     
  32. fishpod

    fishpod Well-Known Member

    domestos kills all known germs\ just a thought.
     
  33. Tony Kapa

    Tony Kapa Member

    Dermatologists recommend diluted vinegar soaks for interdigital pseudomonas infections regularly. diluted 1part to 3 parts water.
     
  34. Free from side effects?

    Do you know what a fibroblast is? :deadhorse:
     
  35. W J Liggins

    W J Liggins Well-Known Member

    Can you please quote the references ie. in which publications 'the dermatologists' state this so that members can check the written evidence and take issue with it if they wish?

    Many thanks

    Bill Liggins
     
  36. andymiles

    andymiles Active Member

  37. Ashleygibbs

    Ashleygibbs Welcome New Poster

    I have never used vinegar for wound healing. But thank you guys for sharing your knowledge. I learned many things from you all here.
     
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