Simple and Effective Approach for Wound-Bed Preparation by Topical Citric Acid Application

Background: A wound must progress through serial steps of healing to achieve structural and functional stability. This process is hampered in chronic wounds and wounds with delayed healing. Wound cover through skin grafting or a flap, or spontaneous healing through epithelization, requires healthy granulation tissue. Wound infection inhibits the formation of such tissue. Material and Methods: This study included 24 cases of chronic wounds with large raw areas that did not respond to conventional therapy for more than 3 weeks. Wounds were treated with 2% citric acid ointment with the aim of promoting healthy granulation and appropriate wound bed preparation. Infective agents, their sensitivity, and response to citric acid were studied. Results: Thirty-two bacterial strains were isolated. The most common was Staphylococcus aureus (12, 37.5%), followed by Pseudomonas aeruginosa (8, 25.0%). The majority of isolates were resistant to multiple antibiotics. The study’s endpoint was the appearance of healthy granulation tissue suitable for split-thickness skin grafting or healing by secondary intention. Application of 2% citric acid ointment resulted in the formation of healthy granulation tissue in all cases after 3 to 20 applications. Conclusion: Citric acid ointment (2%) is highly effective in controlling infections and promoting formation of healthy granulation tissue.