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)

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.