Comparison of Effect of pH Modulation on Wound Healing with Topical Application of Citric Acid Versus Superoxide Ions

BACKGROUND: Wound healing is a dynamic process involving tissue repair and regeneration. Nonhealing and chronic wounds are a significant health problem that many patients all over the world are suffering from. Proper wound care is hence very important. Wound dressings have undergone continuous and significant changes over the time period. Optimal dressing should ensure a moist wound bed, help drainage, remove debris, and be anti-allergic and without immunogenicity. OBJECTIVES: The objective of the study is compare the effect of pH modulation on wound healing with topical application of citric acid versus superoxide ions. The aim is to study the efficacy and safety of citric acid versus superoxide ions in the prevention and control of infection and their effect on wound healing in similar wound types. MATERIALS AND METHODS: We conducted randomized, prospective comparative study in a total of 100 patients admitted at Guru Nanak Dev Hospital, attached to Government Medical College, Amritsar. The patients were divided into two groups: Group A where wound management was done using superoxide ions and Group B where citric acid was used. A standard grading was done in terms of a decrease in wound size, an increase in granulation tissue, and a reduction in wound discharge. RESULTS: The wounds treated with citric acid showed an average reduction in wound size of 73.43% by the 14(th) day as compared to 66.52% in the control group. The difference seen in the average reduction of wound size was statistically significant (P = 0.032). The wounds treated by citric acid application showed an average increase in granulation tissue of 56.66% as compared to 50.87% in the wounds treated by superoxide ions. The average hospital stay in patients of Group B was comparatively less than that of patients in Group A. CONCLUSION: Citric acid is safe and effective in all types of wound management and gives better efficacy and faster response as compared to superoxide ions. Citric acid promotes wound healing by the formation of granulation tissue and fibroblast proliferation.