Wound Care
The most severe cases of mpox evolve over weeks to months. Patients
develop multiple necrotic lesions that progress and become secondarily
infected until the immune system reconstitutes sufficiently to clear the
virus. Therefore, in addition to systemic antiviral therapy and rapid
ART, high quality longitudinal wound care provided by a specialist
becomes a critical component of management of the severe mpox patient.
In patients with skin and tissue loss resulting in fat, muscle, or bone
exposure, advanced wound care principles following the DIME method
(Devitalized tissue/Debridement, Infection/Inflammation, Moisture
management, Edge). Addressing devitalized tissue or debridement can be
done with autolytic, enzymatic (collagenase), ultrasonic or
surgical/sharp debridement. The method of debridement that is
appropriate is dependent on the patient’s pain and ability to tolerate
procedures.
Bacterial superinfection is common in these most severe mpox cases. All
suspected infections should be cultured, either with biopsy or using the
Levine technique, prior to initiation of antibiotic therapy. The ulcers
should be cleansed with hypochlorous acid solution, wound cleanser, or
mild soap such as baby shampoo. Other chemical cleansers such as sodium
hypochlorite solutions, chlorhexadine, alcohol containing solutions,
povodine iodine, and hydrogen peroxide should be avoided as they are
cytotoxic with a lower therapeutic index than hypochlorous acid.
Moisture management in the ulcers and periwound skin is also essential
for healing. The base of the wound requires enough moisture to promote
healing without causing maceration of the periwound. A moist wound
environment reduces pain, promotes autolytic debridement, collagen
formation and epithelialization. Scar formation is also reduced.
Moisture can be added to the base of the wound, if needed, by applying
hydrogels, hydropolymer, or hydrocolloid dressings. Excess moisture, or
heavy exudate, can be managed with alginate, hydrofiber, foam, or
superabsorbent dressings.
Despite severe wounds with full thickness necrosis, severe mpox cases
can recover complete tissue regeneration with quality wound care (Figure
3).