AN OPEN LABEL SINGLE ARM CLINICAL STUDY TO EVALUATE THE EFFICACY OF RAW PAPAYA CRUSH DRESSING IN WOUND BED PREPARATION OF ZAKHME BISTARI (BED SORE / PRESSURE ULCER)
Dr. Shaikh Zaki Ahmad Riyazuddin*, Dr. Akhtar Husain Chaudhary, Dr. Tausif Khan,
Dr. Mujtaba Waqar, Dr. Saima Istayaque
ABSTRACT
Zakhme Bistari (bed sore/pressure ulcer) is a chronic wound commonly associated with prolonged pressure,
immobility and impaired tissue perfusion. Effective wound-bed preparation requires removal of slough and
devitalized tissue, control of microbial burden, maintenance of moisture balance and promotion of healthy
granulation and epithelialization. Raw papaya (Carica papaya Linn.) contains proteolytic enzymes, particularly
papain and chymopapain, which provide a rationale for its use as a biological debridement agent. An open-label,
single-arm clinical study was conducted among patients with Zakhme Bistari selected from the OPD and IPD of
the Department of Ilmul Jarahat. Forty patients were enrolled considering possible dropouts, of whom 30 were
included for statistical analysis. Convenience sampling was used and the study duration was 45 days. Patients
were assessed using subjective parameters including slough/exudate, dead skin, wound length and width, and
inflammation. Objective assessment included detailed history, general physical examination and the Pressure
Ulcer Scale for Healing (PUSH). The PUSH score was calculated based on wound surface area, exudate amount
and wound tissue type. Among the 30 patients analyzed, 18 (60%) were male and 12 (40%) were female. Slough
was absent in 40.0% of patients initially and increased to 83.3% by Visit 6; the improvement was statistically
highly significant at Visits 5 and 6 (p=0.001). Mean wound size decreased progressively from 8.59 ± 6.30 cm² at
baseline to 0.78 ± 0.61 cm² at Visit 6, corresponding to a mean reduction of 91.44%; the reduction was statistically
significant from Visit 1 onward (p=0.009 at Visit 1 and p=0.001 at subsequent visits). The study findings indicate
that raw papaya dressing may be beneficial for wound-bed preparation and healing of Zakhme Bistari, particularly
in reducing slough and wound size and supporting progression toward healthy granulation and epithelialization. Its
potential advantages include simplicity, accessibility and low cost. However, the findings should be interpreted
cautiously because the study was open-label, single-arm, had a limited sample size and used convenience
sampling. Larger controlled and multicentric studies are recommended to establish its efficacy, safety and
comparative effectiveness.
Keywords: Zakhme Bistari; Pressure Ulcer; Bed Sore; Carica papaya; Raw Papaya Dressing; Papain; Chymopapain; Wound Bed Preparation; Debridement; Unani Medicine.
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