Can Zinc Oxide Have An Impact On Wound Healing?
The antibacterial mechanism of zinc oxide was described to be more indirect (mediated via local defense systems) rather than being directly toxic to the bacteria.8 When one applies zinc on wounds, it not only corrects a local zinc deficit but also acts pharmacologically. Getting Results With Zinc Oxide: A Few Case Studies A 47-year-old type 2 diabetic patient presented to the office with a chronic grade 1-A (University of Texas Wound Classification System) ulceration that had been present on and off for over two years. After providing effective pressure relief and debridement, the patient was treated in the office and at home with zinc oxide. Within 14 days, the wound completely closed. A 58-year-old type 2 diabetic presented with a chronic interdigital ulceration that had been present for over a year. The ulceration was present secondary to a contracted digit and neuropathy. The patient’s wound healing was extremely poor from both non-compliance and poorly controlled blood sugar. Given the inflammatory and chronic nature of the wound, we started daily zinc oxide treatments along with regualr wound care. In less than 14 days, the patient had complete epithelialization of the wound (see photos on pages 22 and 25). A 63-year-old vascularly compromised diabetic type 2 patient presented to the office with a severe streptococcus infection throughout his entire left forefoot, resulting in significant skin loss dorsally and plantarly. A year earlier, the patient had a transmetatarsal amputation and a partial fifth ray amputation six months later on the left foot. After the patient had a brief hospital stay along with IV antibiotics, we began zinc oxide treatments immediately. We chose zinc because of its ease of use in the home and its excellent antiinflammatory and drying properties. Despite the patient’s poor vascular status and extremely poor home conditions, the patient used the zinc oxide faithfully and presented regularly for his in-office wound care, resulting in complete healing in a matter of three months. A 51-year-old diabetic patient developed a severe pin tract infection following a routine K-wire removal after a simple digital arthroplasty. The pin tract infection resulted in a cellulitic sausage digit deformity. While in the hospital for IV antibiotics, a minor incision and drainage was performed. After the procedure, daily zinc oxide treatments were started, resulting in complete resolution of the sausage digit deformity. Key Practical Considerations Practically, zinc oxide is an affordable option that even your most non-compliant patients can easily apply at home. By actively facilitating absorption of moisture and odors within the wound, indications for zinc oxide are broad, including: • post-inflammatory skin following surgery; • post-matrixectomy/nail surgery; • draining wounds; • venous/arterial ulcers (with compression); • interdigital wounds (does not cause maceration); • vesicular dermatitis (eczema/tinea pedis); • full thickness wounds; • partial thickness wounds; • heel fissures; and • puncture wounds. There are several commercially available products that have zinc oxide, including Dermagran wound cleanser/hydrogel/moisturizer, zinc paste bandages (Unna boot), Double Guard Skin Guard, Zinc Oxide adhering tape, Derma 50 and many diaper rash ointments. Keep in mind that zinc oxide must be used in conjunction with good overall wound care that includes but is not limited to debridement, compression (venous stasis ulcerations), appropriate offloading, antibiotics and surgical intervention. Final Notes Clinically, zinc oxide keeps wounds moist and clean while facilitating wound healing. After cleansing of the wound with saline (along with indicated debridement), one may apply zinc oxide onto the wound in a thick layer followed by a non-adherent dressing or gauze. Wounds are in constant evolution and though zinc oxide is an excellent and inexpensive tool for your armamentarium, keep in mind that wounds have different needs at different points in time. Dr. Moore is a former University of Texas Diabetic Foot Fellow who currently practices in Somerset, Ky. Dr. Steinberg (pictured) is an Assistant Professor in the Department of Orthopaedics/Podiatry Service at the University of Texas Health Science Center.