Treatment of Wounds with Urea

Sir,?More than fifty cases treated by this method have more than proved its value. This treatment was introduced by Muldavin and Holtzmann (Lancet, 1938, i, p. 549) who cleaned up the wound with a saturated solution of urea, and after removing moisture and necrotic material applied pure urea to the wound itself and zinc cream to the adjacent skin. The wound was then covered with waxed paper and bandaged. In my own series of cases the wounds were simply cleaned with saline, dried, and any large detachable sloughs removed, and liberally sprinkled with pure urea. They were then covered with jaconet, waxed paper or rubber sheeting and bandaged over a piece of wool, or elastoplast applied over sponge rubber, and left for five days. Waxed paper can be made by placing some sheets of stout paper in a flat tin with a piece of paraffin wax in an autoclave, and old motor and cycle tubes are a ready source of rubber which can be sterilized by boiling. Any discharge soaking through dressings is ignored. After five days the dressings are removed. The results have to be seen to be believed. The wound is covered with healthy granulations and necrotic material has usually completely disappeared. The granulations are bathed in a clear reddish-stained serous exudate and pus has disappeared even from wounds which had previously discharged pus freely. Even when pus can be found to have soaked into the dressings the wound itself is clean and apparently practically sterile. In the small proportion of cases in which sloughs or pus remain, the wound is again cleaned with saline and the urea treatment is given for a further five days. No case has required a third treatment. The subsequent treatment depends on the size of the remaining granulating surface. As a rule epithelization has already commenced around the edges. Small wounds may be dusted with boracic powder and allowed to heal under a crust. Larger wounds are covered with elastoplast and allowed to heal underneath it, any discharge being wiped away and ignored. Very large granulating areas can be made to heal quickly by dressing with saline packs for two days, scraping away the granulations, and applying a Thiersch graft after ensuring lisemostasis. In other cases Reverdin grafts may be applied and pushed into the granulations with