Novel Approach to Dressing Using Vinegar-Soaked Gauze and Grated Papaya in the Management of Pseudomonas-Infected Pressure Ulcers: A Case Report.

Pressure ulcers in chronically immobilized patients often become infected with multidrug-resistant organisms such as Pseudomonas aeruginosa. Management is particularly challenging in low-resource settings where advanced wound care products are unavailable. Natural, inexpensive alternatives, such as vinegar and papaya, have demonstrated antimicrobial and debriding properties, but their combined use has not been formally documented. A 65-year-old male with advanced Parkinsonian disease and a prior cerebrovascular accident, bedridden and dependent for care, presented with multiple Stage III-IV gluteal pressure ulcers. The largest measured approximately 25 × 25 cm with a depth of 2 cm, all with foul odor, greenish discharge, and heavy slough. Pseudomonas aeruginosa infection was confirmed on wound culture. Initial povidone-iodine dressings for one week failed to improve the ulcers. A novel regimen was then introduced: freshly grated unripe papaya was applied directly to the wound bed, followed by sterile gauze soaked in 5% white vinegar. Dressings were performed twice daily initially, then once daily as the wound improved. Within 3 days, odor and green staining had markedly reduced; by day 5, approximately 70% of slough had cleared; and by day 10, the wounds demonstrated a clean, granulating base. Once the ulcers reached an inflamed "angry wound" stage, papaya-vinegar applications were discontinued, and saline dressings were recommended. The patient tolerated the regimen well, reporting only transient burning with vinegar application. Unfortunately, he died at home soon after, unrelated to the ulcers, precluding long-term follow-up. Grated papaya combined with vinegar dressing may provide a low-cost option for managing Pseudomonas-infected pressure ulcers in resource-limited settings. This approach facilitated rapid odor reduction, slough clearance, and granulation when conventional dressings failed, but requires discontinuation once the wound becomes inflamed. Further studies are needed to establish efficacy and safety.