Topical application of Katupila (Securinega leucopyrus) in Dushta Vrana (chronic wound) showing excellent healing effect: A case study.

Securinega leucopyrus (Willd.) Muell. is known as Humari in India, Katupila in Sri Lanka and Spinous fluggea in English. It is a desert climatic plant used topically in paste form for healing of chronic and non-healing wounds. Application of Katupila Kalka (paste) is used commonly in the management of acute as well as chronic wounds in Sri Lanka as a folklore medicine. The aim of this study is to evaluate the role of herbal paste of Katupila in the treatment of Dushta Vrana (chronic wound). It is a single observational innovative case study. A female aged 40 years presented with a non-healing infected wound on her right buttock with a history of 2 months. On examination, there was a rounded wound having black color necrosed tissue and slough with foul smelling, measuring about 3 inch × 3 inch × 1 inch in diameter caused by pyogenic local infection. The routine laboratory investigations were within normal limit except hemoglobin and the swab culture test of the wound bed was reported infection of Staphylococcus aureus. This case study showed effective wound healing by topical application of Katupila paste and sesame oil.

Introduction

Sushruta has described 60 measures for the comprehensive management of Vrana (wound), which includes local as well as the systematic use of different drugs and treatment modalities under a dedicated chapter. In the treatment of Vrana, Sushruta mentioned the Dushta Vrana (chronic wounds), which is difficult to heal.[1] Dushta is one in which there is localization of three Dosha. Vrana, which had a bad odor, has abnormal color, with profuse discharge, intense pain and takes a long period to heal. Dushta Vrana is a long standing ulcer where removing debris enabling drug to reach healthy tissue is more important. In Ayurveda Dushta Vrana are treated effectively by Ghrita and Taila preparations. Among Ghrita - Karpuradi, Manjisthadi and Karanjadi; while in Taila - Jatyadi, Pilu, Durvadi, Asthishrinkala showed effective in wound healing.[2]

Securinega leucopyrus (Willd.) Muell is known as Humari in India, Katupila in Sri Lanka and spinous fluggea in English [Figure 1]. It is a desert climatic plant used topically in paste form for healing of chronic and non-healing wounds. The healing process becomes diminished in chronic wounds due to reduced tissue regeneration, angiogenesis and neurological problem.[3] There are so many research works have been carried out for the management of chronic and non-healing wounds, but still it is a big confront for the medical professionals to deal this problem comprehensively.[456] In search of an effective herbal preparation Katupila paste tried in this case and showed effective in healing of chronic wound. Pharmacognostical study of Katupila powder shows the presence of calcium oxalate crystals, large amount of tannin and oil helpful in the treatment of cuts and wounds.[7]

Figure 1

Shrub Katupila / Humari (

Case Report

A female patient, aged about 40 years, presented with non-healing chronic wound on the right buttock since 2 months in the Outdoor Patient Department (OPD) of Shalya Tantra. Patient was thoroughly examined locally as well as systematically. The local findings revealed a foul smelling deep wound, having fixed and black slough area, around, that is, 3 inch × 3 inch × 1 inch. The culture swab report of the wound was done, and it reported the presence of Staphylococcus aureus infection. All the other laboratory findings were found to be within normal limits except hemoglobin level, which was 8 g %. Patient gave a history that she had taken treatment for wound since last 1 month with dressing by antiseptic solution, but there was no improvement in the wound. No any major systemic disease or surgery reported by the patient.

Diagnosis

This chronic wound was diagnosed as trophic ulcer because the ulcer was located at buttock region having less blood supply and pressure point during sitting posture. This type of ulcer can also be correlated with pressure ulcer.

Intervention

Local dressing of wound by Katupila powder mixed with sesame oil was carried out.

The wound was cleaned with decoction of Panchavalkala. The dried leaf powder of Katupila mixed with sesame oil was applied on wound once daily. The Katupila dressing was continued until complete healing achieved and the result was assessed at regular intervals. Along with local dressing; capsule of hematinic drug composed of vitamin B-12, Ferrous Fumarate, vitamin C and Folic acid was administered orally once a day for 30 days.

Observations

The characteristics of Dushta Vrana like Ativivrita (broad base), Bhairava (ugly look), Putipuyamansa (pus discharge), Durgandha (foul smell), Vedana (pain), Dirghakalanubandhi (chronic) were noted in the wound [Figure 2]. There was deep seated blackish slough at the base of the wound and which was hard to remove initially. The wound was cleaned daily with Panchawalkala Kwatha and then the paste made up of dried leaves powder of Katupila with sesame oil was applied in adequate quantity [Figure 3]. Wound was bandaged after covering with sterilized gauze and cotton pads.

Figure 2

Dushta vrana (infected non-healing wound) at left buttock on 1st day of treatment

Figure 3

After application of Securinega leucopyrus paste

It was noted that the deep seated slough, which was hard to remove, started to dissolve from the base and wound became clean and healthy on 4th day [Figure 4]. The healing was started with the formation of healthy granulation tissue. The margin of wound became bluish showing growing epithelium. The wound started to contract by filling of tissue from the base of wound day by day. The Katupila dressing was continued, and on 21st day, it was observed that wound size was markedly reduced with normal skin coloration at the healed area [Figure 5]. On the 35th day, the wound was healed completely with minimum scar tissue formation [Figure 6]. After completion of a month, the hemoglobin was increased and became 10 g %.

Figure 4

Status of wound on the 4th day of treatment

Figure 5

Wound status on the 21st day after treatment

Figure 6

Complete healed wound with minimum scar on the 35th day

Discussion

According to Acharya Sushruta, among the 60 measures of comprehensive wound management, Kalka (paste) is indicated in cases of chronic wound, which is full of slough, deep seated in muscle and reluctant to heal.[8] The paste performs both the functions of Shodhana (cleansing) and Ropana (healing) in cases of Dushta Vrana. Extracts of the Katupila leaves exhibited a broad spectrum antimicrobial activity, which is an important requirement of wound healing by controlling and reducing the microbial load.[910] In this case, the black slough removed on 4th day without surgical debridement because Katupila has Kashaya Rasa (astringent taste), which exerted Lekhana (scraping) action that helped in removing slough and prepared the wound bed for healing.[11] Wound became clean with healthy granulation on 21st day as Katupila is having the ability to disinfect and destroy the micro-organisms in cases of sores acted as a disinfectant and promoted excellent healing.[12]

Signs and symptoms such as pain, discharge, discoloration, bad odor, etc., are considered due to active involvement of Tridosha. The Tikta Rasa (bitter taste) of the Katupila and Snigdha Guna of sesame oil pacified the vitiated Doshas, rendered relief in pain, discharge which were proven helpful in the healing process of wound.[13] All those properties of drug assisted in cleaning the wound and helped to inhibit the growth of micro-organisms. Another property of Katupila is antioxidant activity due to the presence of some flavanoids and tannins in abundant quantity. Tanin is supposed to be having wound healing property, which helped in wound healing.[14] It acted as scavenger and probably helped to remove free radicals as well as inhibited further generation of free radicals.[1516] Patient was anemic at the first consultation; systemic use of hemainic capsule had also played an important role to increase hemoglobin level and general condition of the patient. Anemia is one of cause for non-healing of wound so improving hemoglobin level by hematanic ultimately promoted wound healing. The hemoglobin in the blood circulation nourishes the newly generated cell.[17] It is supposed to be the systemic effect of Hematinic drug and local effect of Katupila for wound healing.

After application of the Katupila paste the wound became clean and free from slough and foul smell within 3 days. There was a significant increase in granulation tissue showing good healing effect after 15 days. The wound became contacted markedly by 21 days, and complete wound healing was observed by 35 days (5 weeks). After wound healing, there was little formation of scar tissue with noticeable pigmentation. There were no any adverse events noted throughout the treatment and healing occurred uneventfully. The dressing of Katupila in chronic wound is found to be cost-effective, safe, and easy to implement.

Conclusion

This single case study highlighted the topical application of Katupila (S. leucopyrus [Willd.]). Muell paste with sesame oil was found very effective and shown excellent healing effect in a case of chronic and nonhealing wounds.