Study Spotlight: Hypochlorous Acid in Skin Graft Salvage & Wound Bed Preparation

In this article, we analyze a 2019 study that focuses on the utility of hypochlorous acid (HOCl) wound therapy in wound bed preparation and skin graft salvage.

This journey explores some of the revolutionary benefits of hypochlorous acid in wound therapy, a non-cytotoxic alternative to traditional wound treatments that effectively combats resistant bacteria and promotes faster healing, demonstrating that HOCl is a superior choice for wound care and skin graft salvage.


In any industry— and particularly in the rapidly evolving field of wound care—the introduction of new, more effective treatments is always noteworthy. One such advancement is the use of hypochlorous acid (HOCl) solution in wound therapy, particularly in wound bed preparation and skin graft salvage¹. This innovative treatment has shown exceptional efficacy in managing contaminated wounds, reducing bacterial load, and promoting healing, all without the cytotoxic side effects associated with traditional therapies such as Dakin's solution¹.

In today's article, we review a 2019 study¹ where researchers investigated the use of hypochlorous acid as an antiseptic solution for preparing the wound bed for skin grafting and salvage. The study focused on four patients with challenging wounds that had been resistant to previous treatments¹.

First, let’s define skin graft salvage.

Skin graft salvage is a process or combination of techniques used in attempt to correct the healing trajectory of a recent skin graft that is showing signs of failing or has experienced complications in healing.

A Brief History of Dakin’s Solution & Hypochlorous Acid

First described by the solution’s namesake—Henry Drysdale Dakin— in 1915, sodium hypochlorite (often referred to as Dakin’s solution) has long been a cornerstone in the treatment of infected or contaminated wounds¹. While it’s effective at eliminating harmful bacteria, it is also cytotoxic, meaning it can cause damage to healthy cells within the wound and surrounding tissues¹. This cytotoxicity often results in pain, inflammation, and skin erythema, limiting the duration and concentration at which Dakin’s solution can be used¹.

Sodium hypochlorite solution shown in a beaker, held by a scientist in a laboratory.

All the while, a similarly effective but safe and non-cytoxic solution called hypochlorous acid (HOCl) had already been discovered by French chemist Antoine Jérôme Balard in 1834. Balard identified HOCl as a distinct chemical entity over 150 years ago, but it wasn’t until recent years that technological advancements have made stable HOCl a possibility. The solution has since been proven to be a highly effective alternative to Dakin’s solution¹.

Unlike Dakin’s solution, hypochlorous acid operates at a physiological pH, making it non-cytotoxic to healthy cells while maintaining strong antibacterial properties similar to sodium hypochlorite¹. This characteristic allows it to be used more liberally and for longer periods, providing a significant advantage in wound management¹.

Study Overview

A 2019 study¹ by scholars Odom et al., explored the utility of hypochlorous acid in preparing wound beds for skin grafting and salvaging failing skin grafts contaminated with bacteria. The study included four patients with chronic, contaminated wounds that had not responded to months of traditional treatments¹. The microbiology of these wounds included highly resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, and Pseudomonas¹.

The treatment involved the application of hypochlorous acid-soaked gauze to the wound bed and skin graft site for 15 minutes, once or twice daily, over a week before surgical closure and for at least one week after skin graft bolster removal¹. Remarkably, all patients showed significant improvement, with no persistent bacterial growth at the time of grafting and complete healing of the skin grafts within two weeks¹. There were no adverse effects such as maceration or skin irritation reported¹.

Hypochlorous acid solution is an effective therapy for wound bed preparation before surgical wound closure, especially in the presence of highly resistant microbiomes. In addition, given its non-cytotoxic properties and physiologic pH, hypochlorous acid solution can be applied directly to a healing skin graft and can effectively salvage graft healing in patients with known bacterial colonization.¹


Key Findings: The Advantages of HOCl as an Alternative Antiseptic

The study highlighted several key advantages of hypochlorous acid over traditional treatments¹:

  1. Non-cytotoxic: Unlike Dakin’s solution, hypochlorous acid does not damage healthy cells, reducing pain and inflammation.
  2. Effective Against Resistant Bacteria: It has shown effectiveness against highly resistant bacteria, which are often challenging to treat with conventional therapies.
  3. Improved Healing: Patients treated with hypochlorous acid had better wound healing outcomes, with no signs of graft loss or persistent infection.

Study Takeaways

The study's compelling results underscore the transformative potential of hypochlorous acid in wound care, particularly for skin graft salvage¹. The ability of HOCl to eradicate resistant bacteria without damaging healthy tissue makes it an invaluable tool in managing contaminated wounds¹.

Patients treated with hypochlorous acid experienced complete skin graft healing, devoid of graft loss or persistent infection, highlighting its efficacy and safety¹.

As a superior alternative to traditional treatments, hypochlorous acid should be considered a cornerstone in modern wound care protocols, offering enhanced outcomes for skin grafts and overall wound management¹. This advancement not only optimizes patient recovery but also represents a significant leap forward in the field of reconstructive surgery and wound care.



  1. Odom, E. B., Mundschenk, M. B., Hard, K., & Buck, D. W. (2019). The utility of hypochlorous acid wound therapy in wound bed preparation and skin graft salvage. Plastic and reconstructive surgery, 143(3), 677e-678e.

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BIHOCL™ PureCleanse™

Advanced care for acute and chronic wounds.

A safe and effective pure hypochlorous acid (HOCl) irrigation, moisturizing and debridement solution formulated to actively cleanse wounds and prepare optimal wound bed healing conditions.

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