When is Marathon liquid (sodium hypochlorite) indicated for wound debridement?

Marathon Liquid (Sodium Hypochlorite) for Wound Debridement

Marathon liquid, a stabilized hypochlorous acid solution, is indicated for wound pH management and infection control in chronic wounds, particularly as an adjunct to mechanical debridement in wounds with biofilm or bacterial burden. 1

Primary Indications

Marathon liquid serves as a supplementary antimicrobial agent rather than a primary debridement method. The 2024 Clinical Infectious Diseases guidelines specifically identify stabilized hypochlorous acid for:

• Targeting wound pH of 4-6 to optimize the healing environment 1
• Infection and inflammation control as part of the T.I.M.E. wound bed preparation protocol 1
• Biofilm management, as biofilm can reform within 24-72 hours if left uninhibited 1

Key Properties Supporting Its Use

The evidence supports Marathon liquid based on three critical characteristics:

• Germicidal properties that are well-established for wound pathogens 1
• Non-cytotoxic formulation that avoids chlorine gas or hypochlorite ion formation, distinguishing it from traditional bleach solutions 1
• Favorable effects on cellular migration, specifically promoting fibroblast and keratinocyte movement essential for wound healing 1

Clinical Context and Limitations

Do not use Marathon liquid as a substitute for mechanical debridement. The 2016 IWGDF guidelines emphasize that sharp debridement remains the gold standard for removing slough, necrotic tissue, and callus 1. Marathon liquid functions as an adjunctive cleansing and antimicrobial agent, not a primary debridement tool.

When to Integrate Marathon Liquid:

• After mechanical debridement to reduce bacterial burden and manage biofilm 1
• In wounds with signs of infection including increased exudate, erythema, or odor 1
• For regular wound cleansing when antimicrobial properties are needed beyond simple saline irrigation 1

When NOT to Use:

• As monotherapy for necrotic tissue removal - sharp debridement is required first 1
• In place of standard wound cleansing with clean water or saline for routine non-infected wounds 1
• As a primary antimicrobial dressing - the 2024 IWGDF guidelines recommend against antimicrobial dressings as routine practice for improving wound healing 1

Practical Application Algorithm

1. Perform sharp debridement first to remove necrotic tissue, slough, and callus (unless contraindicated by severe ischemia) 1
2. Assess for infection/biofilm using clinical signs (NERDS/STONES criteria) 1
3. Apply Marathon liquid if infection or biofilm is suspected to achieve pH control and antimicrobial effect 1
4. Follow with appropriate dressing selection based on exudate control, comfort, and cost 1
5. Monitor for biofilm reformation within 24-72 hours and reapply as needed 1

Critical Caveats

The evidence for hypochlorous acid is limited to guideline recommendations rather than high-quality randomized trials. The 2024 Clinical Infectious Diseases guidelines include it in their wound bed preparation protocol, but this represents expert consensus rather than Level 1 evidence 1. Traditional wound cleansing with clean water or saline remains the evidence-based standard for routine wound care 1.

Avoid confusing stabilized hypochlorous acid with traditional sodium hypochlorite (bleach) solutions, which can be cytotoxic and produce harmful chlorine gas 1. Marathon liquid's formulation specifically avoids these complications.