Wound dressingsBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7544.777 (Published 30 March 2006) Cite this as: BMJ 2006;332:777
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Simple method to clear flies and smell around lower limb wounds in India
Leakage or discharge is probably the most common symptom of the open wound management and often happens because of the massive injury to the limbs. These wounds can smell unpleasant, often because of infection. A variety of wound dressings may be used to help control an unpleasant smell. Some contain silver, sugar paste and honey, charcoal dressings, antibiotic gels which can reduce the number of bacteria in the wound, and so control the odor. These dressings can often be left in place for a number of days1,2.
We have conducted a study in January 2006 with consent from the patients who suffer open injuries in lower extremities and who needs regular dressings change. Naphthalene balls were placed in 50 patients around the dressed lower extremity wounds (Table 1). They were kept for every 2 hours and then asked to keep 2 hours free. The patients satisfaction, complaints, general acceptance were recorded. All the patients found this method useful, absence of smell and flies around the dressings. No patient had complication throughout the study. The cost of 10 naphthalene balls for the patient is 0.4$.
Naphthalene is a crystalline, aromatic, white, solid hydrocarbon, best known as the primary ingredient of mothballs. Naphthalene is volatile, forming a flammable vapor. Naphthalene is also been found in the Formosan subterranean termite, possibly as a repellant against "ants, poisonous fungi and nematode worms." 3 In a sealed container containing naphthalene pellets, naphthalene vapors build up to levels toxic to both the adult and larval forms of many moths that are destructive to textiles. Other fumigant uses of naphthalene include use in soil as a fumigant pesticide, and in attic spaces to repel animals and insects.
In humans, exposure to large amounts of naphthalene may damage or destroy red blood cells. Humans, particularly children, have developed this condition after ingesting mothballs or deodorant blocks containing naphthalene. Exposure to large amounts of naphthalene may also cause nausea, vomiting, diarrhea, blood in the urine, and jaundice 4and acute exposure causes cataracts in humans, rats, rabbits, and mice3. So far no mortality has been reported from mothball.
The other means of preventing flies are the environmental sanitation, sound proofing methods and installation of insect electrocuting device. Insect electrocuting device (IED) should not be used as the first line in defense against flies. Without appropriate proofing measures, the number of fly visiting premises will not be reduced significantly by IED alone. IED can only be used to kill flies that have accidentally broken through the sound proofing methods employed.
The authors got the idea from the normal day today use of sanitary naphthalene balls. By placing them merely around the wound keeps off the flies and smell around them, prevents spread of infection and thus rendering a beneficiary role in the soaked dressing of open injuries. This study was an observational and is not reported elsewhere in the literature.
To effectively prevent the fly, smell around the lower extremity dressings, low interval exposure to naphthalene, good sanitation, regular dressing change and sound proofing measure are the keys to success.
1. Oxford Textbook of Palliative Care (third edition) Eds. Doyle et al. Oxford University Press, 2004.
2. Handbook of Palliative Care (second edition) Faull et al. Blackwell Publishing, 2005
3. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Monographs on the Evaluation of Carcinogenic Risks to Humans, Some Traditional Herbal Medicines, Some Mycotoxins, Naphthalene and Styrene, Vol. 82 (2002) (p. 367). Retrieved on March 9, 2005.
Table 1 showing the types of patients involved
Gustilo’s Grade II, Gustilo’s Grade IIIa Gustilo’s Grade II, III b,c Degloving injury ( Thigh, knee, leg, ankle foot) Deep friction burns (lower extremity following road traffic accident)
03 09 13 15 10
Competing interests: No competing interests
Around 20 yrs ago, an antiseptic solution known as EUSOL (Edinburgh
University Solution of Lime) and widely used to moisten gauze dressings by
those involved in day to day wound care, was removed from availabilty
following the advice of those involved in largely in vitro studies. Those
like myself involved in the daily care of both clean and dirty wounds
throughout our careers knew that it was cheap and effective contrary to
the advice of the academics. Since then marketed wound care products have
become hugely more expensive but in my view no more effective and often,
in the case of occlusive dressings, an excuse to neglect the ideal of
regular care for most wounds.
What a shame that your ABC of Wound Care in the 1st April edition of
the BMJ, in listing presently available dressings, starts by debunking one
of the simplest dressings, gauze. If gauze does any harm to
epithelialisation, as suggested, it is simply because it is not
remoisturised by those who remove it.
It is unarguable that the biggest influence on the successful outcome
of chronic wounds is the meticulous daily attention of personnel skilled
at cleansing and debriding. Sadly, today's wound care nurses, whilst
usually highly knowledgable in prescribing expensive 'leave in place'
dressings of the type listed in your article, are often unable to properly
debride a necrotic ulcer at the bedside. This sorry clinical situation
will not improve until recommendations for dressings materials come from
working surgeons as much as the physicians and rehabilitationists listed
as editors of this well-meaning series.
Competing interests: No competing interests