Enzymatic Wound Debridement; Role of Papaya in the Management of Post Cesarean Gaped Wounds
Background: Enzymatic wound debridement is an emerging concept in facilitating the wound healing process. Papaya has de-sloughing, antibacterial and wound healing properties. It has been used in African countries since centuries for different medicinal pur-poses. Apart from anecdotal reports and few studies on chronic ulcers and burns, no planned studies are avai-lable to support its action in postoperative wound infe-ction.
Objectives: To compare efficacy and safety of pap-aya dressing with conventional wound dressing with povidone iodine in post cesarean section gaped wou-nds.
Setting: Gynecology Unit 3, Sir Ganga Ram Hospital Lahore – Pakistan, over a period of six months(June 2012 to Nov 2012).
Study Design: Randomized, qausi experimental stu-dy.
Materials and Methods: The study sample included 60 patients with post cesarean section gaped wounds. The sample was divided into two groups; thirty patients as Group A or the study group received Papaya dressing andrest of thirty patients as Group B or the control group received Povidone iodine dressing. Wounds were thoroughly washed with saline and then mashed unripe papaya was spread over the whole area of wound in the study group and povidone iodine in the control group. Wounds were covered with sterile bandage for at least 48 hours in study group and 24 hours in the control group. The process was repeated till a clean base of wound with healthy granulation tis-sue was achieved suitable for secondary suture. The efficacy parameters studied were the duration of time needed to develop healthy granulation tissue and total duration of hospital stay which were compared bet-ween the two groups. Safety factors studied were the adverse effects of medications used in the study.
Results: Out of 1200 cesarean sections done during study period, sixty (5%) were gaped in the post-opera-tive period. Out of 60, 55 (90%) were emergency and only 5 (10%) were elective cesarean sections. All the sixty patients with postoperative gaped wounds were included in the study, of which 30 patients received Papaya and 30 received Povidone iodine dressing. Time required to induce healthy granulation tissue was significantly shorter in the papaya group as compared to povidone iodine group (3.4 ± 0.4 days versus 7.2 ± 0.2 days).Similarly the duration of hospital stay was also short in the study as compared to control group i.e. 11.6 ± 1.2 days and 16.8 ± 1.4 days respectively. The side effects of medications used in study (papaya and povidone iodine) like local irritation and hyper-sensitivity reactions were minor & not significally different in both groups.
Conclusion: Papaya dressing is effective, safe, widely available and cost effective for wound healing in post-operative infected gaped wounds.
Key words: Papaya, enzymatic wound debridement, povidone iodine, post cesarean.
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