Carica papaya fruit in the management of chronic non healing ulcer wounds

Carica papaya fruit in the management of chronic non healing ulcer wounds

Divyata A Vasa , Tapan A Shah, Mukesh S Suvera, Jaimin D Shah, Yagnik N Katara
AMC MET Medical College and Sheth L.G. hospital, Ahmedabad, Ahmedabad, India; AMC MET Medical College and Sheth L.G. hospital,, Ahmedabad, India

Introduction
The concept of using papaya as a debriding agent came from the use of papaya latex as a debriding agent in Ayurvedic practice. Carica papaya contains proteolytic enzymes namely papain and chymopapain in the fruit, latex, leaves, stems, and roots.It contains antioxidants like caffeic acid, myricetin, alphatocopherol and kempferol. Its proteolytic action is marked in acid, alkaline, and neutral solutions and has a digestive power at a wide range of temperatures and pH. This study aims to deduce the role of Carica papaya pulp in the management of chronic non healing ulcer wounds. Method: The study was, open-labeled interventional study carried out for 18 months in the inpatient department of General Surgery at L.G. Hospital. All patients with chronic non-healing ulcer wounds including diabetic foot ulcers, who consented to participate in the study were included. Patients with pre-existing cardiac conditions or immunocompromised states, patients younger than 15years of age, mentally challenged patients and severely anemic (Hb<6gm/dl) patients were excluded.
Detailed history of the enrolled patients was taken and details like age, history of allergies and atopic nature, and any significant past surgical and medical history were noted. Local examination of the wound was done, the presence of slough, type of discharge, and nature of granulation tissue at the base of the wound.
Patients received papaya dressing – placing autoclaved dressing gauze containing well-cleaned, peeled, and quarter sliced, steam disinfected raw papaya on the wound bed which remained in situ for 24 hours. The dressing was removed after 24hours and the condition of the wound was noted. The dressing was continued in both groups till the presence of healthy granulation tissue; serous non–foul smelling discharge; and complete absence of slough at the center of the wound. Number of days for which dressing was required before achieving the end point was noted. Results
The study included 28 patients: 26 males, 2 females from ages 18 to 65 years (mean age 51 years).
The average day on which health granulation appeared was 3rd day (mean 2.8 SD 0.93).
The average end point of therapy was 7th day (mean 7.6, SD 1.7). Mean hemoglobin at the start and end of therapy was 11.10g/dl (SD 2.14) and 10.7g/dl (SD 1.97) respectively, showing relatively less blood loss.
10 (35.7%) of the patients were diabetics.
Patients reacted to the visual analog scale (with 1 being mild bearable and 10 being the severe unbearable pain experienced) with moderate bearable pain (mean 5 SD 1.4).Conclusion:In India, with the average cost of chronic ulcer wound care being USD1956/Patient and per capita income being USD 2191/Person, the financial burden of management of chronic non-healing ulcer wounds is overwhelming. Current management methods include betadine with H2O2, silver-based dressing materials, surgical debridement, enzyme extracts, etc. Dressing with Carica papaya significantly reduces the overall cost burden owing to its easy availability, reduced hospital stay and visits. The overall patient compliance is better owing to the reduced cost of treatment and reduced/no need for surgical debridement following papaya dressing.

Keywords: Carica papaya, chronic, granulation, slough, pain, ulcer