Povidone iodine in wound healing: A review of current concepts and practices

A review of advancements in antiseptics for wound care in diabetic and non-diabetic patients

Wounds affect many people and require a considerable annual cost to manage. Wound infections significantly delay the healing process, particularly in individuals with diabetes mellitus, due to impaired immunity and microvascular complications. The use of antiseptics is considered a way to reduce this problem. The study aims to assess the different antiseptic categories frequently employed in wound management, focusing on identifying and understanding their unique features. A comprehensive review of PubMed, Scopus, and EMBASE databases identified key antiseptics, including isopropyl alcohol, chlorhexidine, polyhexanide, octenidine, povidone-iodine, hypochlorous acid, silver-based products, hydrogen peroxide, triclosan, and benzalkonium chloride. These antiseptics exhibit varying efficacies and cytotoxicity profiles, necessitating tailored usage to optimize healing while preventing antimicrobial resistance. The primary indication for antiseptics is the prevention of Surgical Site Infections (SSIs), as recommended by guidelines. For diabetic foot ulcers, the strongest evidence supports the use of hypochlorous acid. There are no universal recommendations for antiseptic use; their application depends on specific circumstances. This review highlights the need for evidence-based, condition-specific antiseptic strategies to address unique patient needs effectively.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01607-7.

Sub-Micrometer Polycaprolactone and Polyethylene Glycol-Based Fiber Mats With Iodine and Its Potential for Wound Healing

This study introduces an innovative approach to developing advanced antimicrobial wound dressings by engineering fiber mats of polycaprolactone (PCL) and polycaprolactone/polyethylene glycol (PCL/PEG) loaded with iodine using solution blow spinning (SBS). The mats exhibited a unique morphology, combining fibers and beads, with average fiber diameters of 570 nm for 12% (w/v) PCL and 470 nm for 1% (w/v) PEG in 12% (w/v) PCL, and bead diameters of 11.34 μm and 10.43 μm, respectively. PEG incorporation rendered the mats hydrophilic and significantly enhanced their swelling capacity, which is essential for wound exudate management. Remarkably, iodine was incorporated at a concentration specifically optimized to achieve its minimum inhibitory concentration (MIC) against a range of microorganisms while preserving the structural integrity and release profile of the mats. While PEG facilitated a higher initial iodine release rate, equilibrium was achieved after 5 days. UV-Vis spectroscopy unveiled the formation of transient iodine complexes with both PCL and PEG, underscoring their functional synergy. Biological assays revealed that PCL/PEG mats loaded with 4.26 mg/mL of iodine (PCL/PEG 3MIC) exhibited potent antimicrobial efficacy against gram-positive and gram-negative bacteria, as well as fungi, alongside significant in vitro wound healing potential. These findings underscore the promise of PCL/PEG iodine-loaded mats as an innovative platform for next-generation antimicrobial wound care, combining effective infection control with enhanced wound healing capabilities.

Addressing the Dressings: Wound Care in Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) wounds are complex and have unique characteristics that complicate dressing selection. Proper wound care assists with wound healing and contributes to improved quality of life. Ideal dressings are comfortable while maintaining a wound-healing environment. Antimicrobial dressings should target dysbiosis and biofilms. Absorptive dressings are needed for control of exudate. Pain control is best achieved with nonadhesive dressings and contact layers. Agents targeting anaerobic bacteria are effective at odor reduction. Surgery may be indicated for management of refractory wounds. Overall, there is a need for increased research and education on both routine and postsurgical wound care in HS.

Infectious Complications After Modified Purse-String Stoma Closure

Purpose: Current society guidelines recommend purse-string closure technique for stoma reversal, which has been shown to reduce but not eliminate the risk of deep surgical site infection (SSI) at the original stoma site, a complication associated with increased morbidity and cost. We studied an adjunctive technique to further reduce the risk of SSI. Methods: A retrospective chart review was conducted on adult patients who underwent stoma reversal between May 2016 - July 2022. Stoma reversal was performed with purse-string closure, and placement of a strip of povidone-iodine soaked non-adherent pad in the remaining two cm opening at the prior stoma site. This pad was taken out on post-operative day one and changed to wet-to-dry saline moistened gauze. Results: 82 patients were identified. The cohort had a median BMI 26.5 [IQR 23.0-31.0] and median age 57.5 [IQR 45.8-67.0]. Mean time from original surgery to reversal was nine months. 59.8% identified as female, 24.4% were currently smoking, 18.3% were had diabetes. The cohort experienced a 11.0% readmission rate and 18.3% rate of stoma site hernia with a mean follow up of 17 17 months. No patient developed an SSI. Conclusion: In this cohort study with known risk factors for SSI, no patients undergoing stoma reversal experienced a post-operative SSI. The adjunctive technique of a povidone-iodine soaked non-adherent pad in addition to purse-string closure should be further examined in conjunction with surgical bundles to reduce the risk of SSI and overall morbidity of stoma reversal surgery.

Concentration of Povidone-Iodine Pocket Irrigation in Implant-Based Breast Surgery: A Scoping Review

BACKGROUND

In implant-based breast surgery, microbial contamination of implant surfaces predisposes complications such as overt periprosthetic infection and has been linked to capsular contracture (CC). Anti-microbial practices, including povidone-iodine (PVP-I) breast pocket irrigation, are routinely employed to minimise these risks. No standardised protocol for using this antiseptic exists, particularly concerning the ideal concentration. This review investigates how PVP-I concentration affects outcomes in these procedures while highlighting research gaps.

METHODS

Using PRISMA-ScR guidelines, a systematic search was conducted across MEDLINE, Embase, Scopus, and PubMed databases from their inception to June 2024. Studies were screened using pre-determined criteria for inclusion. The methodological quality of relevant studies was assessed using the MINORS tool. Data regarding basic characteristics, PVP-I irrigation implementation, and outcomes (primarily periprosthetic infection and CC) were extracted for analysis.

RESULTS

Nine articles, primarily observational studies, and retrospective analyses were included. These mainly focused on breast augmentation with a few including reconstruction. There was considerable heterogeneity in surgical techniques, and reported PVP-I concentrations ranged from 4 to 20%. This was further confounded by frequent mixing of irrigation solution with antibiotics. Although infection and CC rates were frequently reported, most studies did not specify outcome data for patients receiving PVP-I irrigation.

CONCLUSIONS

While PVP-I irrigation is extensively used in implant surgeries, the current evidence base is insufficient to determine the optimal concentration and application techniques. This review underscores the need for further detailed research to establish evidence-based guidelines for PVP-I use, aiming to improve patient care and surgical outcomes in breast surgery.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .

Efficacy of Dialkylcarbamoylchloride (DACC)-Impregnated Dressings in Surgical Wound Management: A Review

Surgical site infections (SSIs) are a significant challenge in postoperative care, leading to increased morbidity, extended hospital stays, and elevated healthcare costs. Traditional antimicrobial dressings, such as those containing silver or iodine, have limitations, including cytotoxicity and the potential for antimicrobial resistance. Dialkylcarbamoyl chloride (DACC)-impregnated dressings offer a novel approach, employing a physical mechanism to bind and remove bacteria without the use of chemical agents, thereby reducing the risk of resistance. This review summarizes current evidence on the efficacy of DACC dressings in preventing SSIs and promoting wound healing. Findings from multiple studies indicate that DACC dressings reduce bacterial burden and SSI rates across various surgical procedures, including cesarean sections and vascular surgeries. Additionally, DACC dressings demonstrate potential in managing hard-to-heal wounds, such as diabetic foot ulcers, by reducing bacterial load and biofilm formation. Furthermore, they present advantages in antimicrobial stewardship and cost-effectiveness by minimizing the need for antibiotics and decreasing overall healthcare expenses. However, the current literature is limited by small sample sizes, methodological weaknesses, heterogeneity in study designs, and a lack of long-term data. Future research should focus on high-quality randomized controlled trials across diverse surgical populations, comprehensive cost-effectiveness analyses, and long-term outcomes to establish the full clinical impact of DACC dressings. With further validation, DACC-impregnated dressings could become a critical tool in sustainable postoperative wound care.

Dilute Povidone-Iodine Irrigation: The Science of Molecular Iodine (I2) Kinetics and Its Antimicrobial Activity

Dilute povidone-iodine (polyvinylpyrrolidone iodine [PVP-I]) irrigation in spine surgery and total joint arthroplasty has seen a rapid and substantial increase in its use during the past decade. Yet, most surgeons do not know the chemistry and biochemistry that explain its efficacy in preventing infections. PVP-I forms a complex with molecular iodine (I2), facilitating the delivery of I2 to the membrane of the infectious organism. Here, PVP-I establishes an equilibrium between complexed and noncomplexed (free) I2 in the aqueous solution. The I2 acts at numerous cellular targets of infecting organisms augmenting its role as a biocidal molecule. The paradoxical increase in the concentration of I2 that occurs with dilution of PVP-I is a result of equilibrium kinetics and is associated with an enhanced antimicrobial activity. Cytotoxicity studies have yielded conflicting results, but most endorse diluted concentrations as being less damaging to tissues. Clinical studies have verified notable reductions in surgical site infections with a 3-minute soak of 0.35% dilute povidone-iodine irrigation. Guidelines from the World Health Organization, Centers for Disease Control and Prevention, and International Consensus Meeting on Musculoskeletal Infection support the use of prophylactic incisional wound irrigation with aqueous PVP-I to reduce and prevent surgical site infections.

Non-antibiotic approaches to mitigating wound infections: Potential for SSRIs and adrenergic antagonists as emerging therapeutics

Bacterial biofilms represent a formidable challenge in the treatment of chronic wounds, largely because of their resistance to conventional antibiotics. The emergence of multidrug-resistant (MDR) bacterial strains exacerbates this issue, necessitating a shift towards exploring alternative therapeutic approaches. In response to this urgent need, there has been a surge in research efforts aimed at identifying effective non-antibiotic treatments. Recently noted among the non-antibiotic options are selective serotonin reuptake inhibitors (SSRIs) and beta-adrenergic (β-AR) antagonists. Both have demonstrated antimicrobial activities and wound-healing properties, which makes them particularly promising potential therapeutics for chronic wounds. This review seeks to comprehensively evaluate the landscape of non-antibiotic strategies for managing wound infections. By analysing the latest research findings and clinical developments, it aims to shed light on emerging therapeutic alternatives. Additionally, the review delves into the potential of repurposing systemic therapeutics for topical application, offering insights into the feasibility and challenges associated with current approaches. We also address the necessity of translating promising preclinical results into tangible clinical benefits.

Electrocatalytic efficiency of carbon nitride supported gold nanoparticle based sensor for iodide and cysteine detection

Extensive investigations are being conducted on gold nanoparticles focusing on their applications in biosensors, laser phototherapy, targeted drug delivery and bioimaging utilizing advanced detection techniques. In this work, an electrochemical sensor was developed based on graphite carbon nitride supported gold nanoparticles. Carbon nitride supported gold nanoparticles (Au-CN) was synthesized by applying a deposition-precipitation route followed by a chemical reduction technique. The composite system was characterized by X-ray diffraction and X-ray photo electron spectroscopy methods. Electron microscopy analysis confirmed the formation of gold nanoparticles within the size range of 5-15 nm on the carbon nitride support. Carbon nitride supported gold based sensor was employed for the electrochemical detection of iodide ion and l-cysteine. The limit of detection and sensitivity of the sensor was attained 8.9 μM and 0.96 μAμM⁻1cm⁻2, respectively, for iodide ion, while 0.48 μM and 5.8 μAμM⁻1cm⁻2, respectively, was achieved for the recognition of cysteine. Furthermore, a paper-based electrochemical device was developed using the Au-CN hybrid system that exhibited promising results in detecting iodide ions, highlighting its potential for economic and portable device applications.

Surface enzyme-polymerization endows Janus hydrogel tough adhesion and regenerative repair in penetrating orocutaneous fistulas

Penetrating orocutaneous or oropharyngeal fistulas (POFs), severe complications following unsuccessful oral or oropharyngeal reconstruction, remain complex clinical challenges due to lack of supportive tissue, contamination with saliva and chewed food, and dynamic oral environment. Here, we present a Janus hydrogel adhesive (JHA) with asymmetric functions on opposite sides fabricated via a facile surface enzyme-initiated polymerization (SEIP) approach, which self-entraps surface water and blood within an in-situ formed hydrogel layer (RL) to effectively bridge biological tissues with a supporting hydrogel (SL), achieving superior wet-adhesion and seamless wound plugging. The tough SL hydrogel interlocked with RL dissipates energy to withstand external mechanical stimuli from continuous oral motions like chewing and swallowing, thus reducing stress-induced damage. In male New Zealand rabbit POF models, the JHA demonstrates strong adhesion and fluid-tight sealing, and maintained firm sealing for over 3 days without any decreased signs under a normal diet. After 12 days, both extraoral cutaneous and mucosal wounds achieved complete closure, with mechanical strengths comparable to normal tissues. Similar therapeutic efficacy was also confirmed in male beagle dog POF models. Thus, the proposed JHA hydrogel shows great potential for deep wound sealing and providing mechanical support to assist healing in penetrating fistulas and other injuries.

Synthesis, physicochemical properties and antimicrobial activity of a di-aminopropionic acid hydrogen tri-iodide coordination compound

OBJECTIVE

The objective of this study is to synthesize and comprehensively characterize a novel iodine-containing coordination compound, di-aminopropionic acid hydrogen tri-iodide. This involves determining its structural, physicochemical, and thermal properties, as well as evaluating its antimicrobial activity against a range of bacterial strains, including multidrug-resistant pathogens. The aim is to explore the potential of this compound as a candidate for developing new antibacterial agents to address the challenge of antibiotic resistance.

RESULTS

An original iodine-containing semiorganic coordination compound was synthesized and characterized. The physicochemical properties were studied via diffraction, FTIR spectroscopy and thermogravimetric/differential scanning calorimetry (TG/DSC). In vitro antimicrobial activity evaluation was performed using two-fold serial dilution method. The obtained results demonstrated efficiency against both gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii) bacteria including MDR strains that cause infectious disease. The results of the antibacterial evaluation revealed that the new iodine coordination compound - di-aminopropionic acid hydrogen tri-iodide possesses high bactericidal properties and exhibits better antimicrobial activity against both susceptible and multidrug-resistant strains than does Lugol solution and ampicillin sodium, which are used as reference drugs.

Povidone-iodine-induced scalp lesions in pediatric neurosurgery patients: a case series

PURPOSE

Povidone-iodine, or Betadine® (Atlantis Consumer Healthcare Inc., Bridgewater, NJ), is a commonly used agent for surgical site preparation. Although commonly used, it carries the risk of skin reactions, and multiple cases of intra-operative contact dermatitis and chemical burns have been reported. However, to our knowledge, there are currently no published cases of povidone-iodine-induced skin lesions in neurosurgical patients.

METHODS

A single-center retrospective chart review was performed to identify patients who developed scalp lesions secondary to chemical toxicity following neurosurgical procedures between October 1, 2021, and June 30, 2024.

RESULTS

Three patients were identified, ranging from 2.5 months to 14 years old. Two were positioned prone and the third in lateral decubitus. All patients' heads were supported by a horseshoe headrest covered with a gel pad and wrapped in a cotton roll. For two patients, Reston™ foam (3M©, St. Paul, MN) was added on the horseshoe. Surgical sites were prepped with isopropyl alcohol, Betadine®, and chlorohexidine. Two patients had their heads intermittently lifted throughout the procedure. Lesions were identified immediately after returning the patient to the supine position in the operating room and steadily improved over the course of one to five months with local wound care.

CONCLUSIONS

Careful preparation of the surgical site is an essential step in the prevention of surgical site infections. However, caution should be exercised during skin preparation to avoid pooling of povidone-iodine around dependent regions. Additional steps, such as scheduled head elevations and pressure dispersion, should be taken to mitigate factors contributing to these lesions.

Involvement of macromolecules in 3D printing for wound healing management: A narrative review

Wound healing comprises four overlapping stages involving complex biochemical and cellular processes. Any lapse in this procedure causes irregular healing, which generates clinical and financial burdens for the health system. Personalized treatment is preferred to overcome the limitations of classical as well as modern methods of wound healing. This review discusses recently developed 3D printing models for personalized treatment with varying degrees of success. It is an effective approach for treating wounds by developing custom dressings tailored to the patient's needs and reducing incidents of infections. Additionally, incorporating natural or synthetic polymers can further enhance their effectiveness. Macromolecular polymers, laminin, cellulose, collagen, gelatin, etc. that make up the bulk of 3D printable bio-inks, have been essential in diverse 3D bioprinting technologies throughout the layered 3D manufacturing processes. The polymers need to be tailored for the specific requirements of printing and effector functions in cancer treatment, dental & oral care, biosensors, and muscle repair. We have explored how 3D printing can be utilized to fasten the process of wound healing at each of the four stages. The benefits as well as the future prospects are also discussed in this article.

Evaluation of two different self-disinfection alginate impression material

OBJECTIVE

This study was conducted to evaluate the antimicrobial efficacy and mechanical properties of two experimental self-disinfecting alginate preparations utilising two different antimicrobial agents; povidone-iodine and silver nanoparticles.

METHODS

Alginate moulds were assigned into three groups. Additives-free control group, povidone-iodine-containing group, and silver nanoparticle-containing group. Discs from each group were obtained and assessed for their antimicrobial activities by the disc diffusion method against Staphylococcus aureus, Escherichia coli, and Candida albicans. For the elastic recovery analysis, each group was divided into 6 samples. Each sample was mixed according to its group specification and subjected to surface detail reproduction and elastic recovery according to ISO 1563:1990 specifications. All data were expressed as mean ± standard deviation for each group at the significance level of P < 0.05.

RESULTS

Results revealed that the experimental self-disinfection alginate possessed broad-spectrum antimicrobial activities against the tested microorganisms, compared to the control group. No statistically significant differences in elastic recovery values between all tested groups (P < 0.05) were observed. For surface detail reproduction, all samples reproduced the 50 μm line.

CONCLUSION

Povidone-iodine as well as silver nanoparticles could be used efficiently for the sanitization of alginate moulds without adverse effects on detail accuracy or elastic recovery of the impression material.

Hypervirulent and carbapenem-resistant Klebsiella pneumoniae: A global public health threat

The evolution of hypervirulent and carbapenem-resistant Klebsiella pneumoniae can be categorized into three main patterns: the evolution of KL1/KL2-hvKp strains into CR-hvKp, the evolution of carbapenem-resistant K. pneumoniae (CRKp) strains into hv-CRKp, and the acquisition of hybrid plasmids carrying carbapenem resistance and virulence genes by classical K. pneumoniae (cKp). These strains are characterized by multi-drug resistance, high virulence, and high infectivity. Currently, there are no effective methods for treating and surveillance this pathogen. In addition, the continuous horizontal transfer and clonal spread of these bacteria under the pressure of hospital antibiotics have led to the emergence of more drug-resistant strains. This review discusses the evolution and distribution characteristics of hypervirulent and carbapenem-resistant K. pneumoniae, the mechanisms of carbapenem resistance and hypervirulence, risk factors for susceptibility, infection syndromes, treatment regimens, real-time surveillance and preventive control measures. It also outlines the resistance mechanisms of antimicrobial drugs used to treat this pathogen, providing insights for developing new drugs, combination therapies, and a "One Health" approach. Narrowing the scope of surveillance but intensifying implementation efforts is a viable solution. Monitoring of strains can be focused primarily on hospitals and urban wastewater treatment plants.

A comprehensive review of the application of 3D-bioprinting in chronic wound management

INTRODUCTION

Chronic wounds require more sophisticated care than standard wound care because they are becoming more severe as a result of diseases like diabetes. By resolving shortcomings in existing methods, 3D-bioprinting offers a viable path toward personalized, mechanically strong, and cell-stimulating wound dressings.

AREAS COVERED

This review highlights the drawbacks of traditional approaches while navigating the difficulties of managing chronic wounds. The conversation revolves around employing natural biomaterials for customized dressings, with a particular emphasis on 3D-bioprinting. A thorough understanding of the uses of 3D-printed dressings in a range of chronic wound scenarios is provided by insights into recent research and patents.

EXPERT OPINION

The expert view recognizes wounds as a historical human ailment and emphasizes the growing difficulties and expenses related to wound treatment. The expert acknowledges that 3D printing is revolutionary, but also points out that it is still in its infancy and has the potential to enhance mass production rather than replace it. The review highlights the benefits of 3D printing for wound dressings by providing instances of smart materials that improve treatment results by stimulating angiogenesis, reducing pain, and targeting particular enzymes. The expert advises taking action to convert the technology's prospective advantages into real benefits for patients, even in the face of resistance to change in the healthcare industry. It is believed that the increasing evidence from in-vivo studies is promising and represents a positive change in the treatment of chronic wounds toward sophisticated 3D-printed dressings.

Combating antimicrobial resistance in osteoarticular infections: Current strategies and future directions

The emergence of antimicrobial resistance (AMR) has profoundly impacted the management of osteoarticular infections (OAIs), presenting significant challenges for healthcare systems worldwide. This review provides a comprehensive overview of the current landscape of AMR in OAIs, emphasizing the necessity for assertive and innovative strategies to combat this escalating health threat. It discusses the evolution of resistance among key pathogens, including ESKAPEE organisms, and the implications for treatment protocols and healthcare outcomes. The importance of antibiotic stewardship programs (ASPs) is highlighted as a core strategy to optimize antibiotic use and mitigate the development of resistance. Additionally, the review explores the potential of pharmacological approaches, including novel antibiotic regimens and combination therapies, alongside surgical interventions and alternative therapies such as bacteriophage-based treatments and probiotics, in managing these complex infections. The role of rapid diagnostic methods in improving treatment accuracy and the critical need for global surveillance to track AMR trends are also examined. By integrating insights from recent literature and expert recommendations, this review underscores the multifaceted approach required to address the challenge of AMR in OAIs effectively. It calls for a concerted effort among clinicians, researchers, and policymakers to foster innovation in treatment strategies, enhance diagnostic capabilities, and implement robust stewardship and surveillance programs. The goal is to adapt to the evolving landscape of OAIs and ensure optimal patient care in the face of rising AMR.

Postoperative Wound Care in Dermatologic Surgery: Update And Narrative Review

Dermatologic surgery is associated with a very low risk of complications. There is no widely accepted, evidence-based protocol with recommendations for postoperative wound care after dermatologic surgery. In this narrative review, we will be discussing the evidence on surgical wound care products and procedures. Overall, we found relatively few studies and, in many cases, a lack of statistically significant differences, possibly because of the low rate of complications. We'll be discussing the evidence on when we should initiate wound care procedures and their frequency, the type of ointment and antiseptics that should be applied, and the type of dressings that should be used. Despite the very few studies available on postoperative wound care following dermatologic surgery, there is sufficient evidence as to not recommend the use of prophylactic topical antibiotics. We also analyze the currently available evidence on surgical wound care in special situations, such as management of skin grafts, partial skin graft donor sites, xenografts/biomembranes, and surgical wounds to the legs.

[Translated article] Postoperative Wound Care in Dermatologic Surgery: Update And Narrative Review

Dermatologic surgery is associated with a very low risk of complications. There is no widely accepted, evidence-based protocol with recommendations for postoperative wound care after dermatologic surgery. In this narrative review, we will be discussing the evidence on surgical wound care products and procedures. Overall, we found relatively few studies and, in many cases, a lack of statistically significant differences, possibly because of the low rate of complications. We'll be discussing the evidence on when we should initiate wound care procedures and their frequency, the type of ointment and antiseptics that should be applied, and the type of dressings that should be used. Despite the very few studies available on postoperative wound care following dermatologic surgery, there is sufficient evidence as to not recommend the use of prophylactic topical antibiotics. We also analyze the currently available evidence on surgical wound care in special situations, such as management of skin grafts, partial skin graft donor sites, xenografts/biomembranes, and surgical wounds to the legs.

Genotyping of oral Candida albicans and Candida tropicalis strains in patients with orofacial clefts undergoing surgical rehabilitation by MALDI-TOF MS: Case-series study

Patients with orofacial clefts are more likely to develop oral fungal diseases due to anatomo-physiological changes and surgical rehabilitation treatment. This case-series study evaluated the genetic diversity and dynamics of oral colonization and spread of C. albicans and C. tropicalis in four patients with orofacial clefts, from the time of hospital admission, perioperative and outpatient follow-up, with specialized physician. Candida biotypes previously identified by CHROMagar Candida and PCR methods were studied by MALDI-TOF MS assays and clustering analyses. Possible correlations with pathogenicity characteristics were observed, including production of hydrolytic exoenzymes and the antifungal sensitivity profiles. Amphotericin B-sensitive and fluconazole-resistant (low frequency) C. tropicalis and C. albicans, including clinically compatible MIC of nystatin, were found in the oral cavity of these patients. Clusters of isolates revealed phenomena of (i) elimination in the operative phase, (ii) maintenance or (iii) acquisition of oral C. tropicalis in the perioperative period and specialized outpatient and medical follow-up. For C. albicans, these phenomena included (i) elimination in the operative phase, (ii) acquisition in the operative phase and propagation from the hospital environment, and (iii) maintenance during hospitalization and operative phase. Amphotericin B and nystatin were shown to be effective in cases of clinical treatment and/or prophylaxis, especially considering the pre-existence of fluconazole-resistant strains. This study confirmed the phenomena of septic maintenance, septic neocolonization and septic elimination involving the opportunistic pathogens. MALDI-TOF MS associated with clustering analysis may assist the monitoring of clinical isolates or groups of epidemiologically important microbial strains in the hospital setting.

Enhanced bactericidal effects of povidone-iodine in the presence of silver ions

The rising prevalence of antibiotic-resistant infections worldwide necessitates the development of innovative antimicrobial systems for effective pathogen control. This study investigates the synergistic bactericidal effects of a combined system comprising povidone-iodine (PVP-I) and silver ions (Ag(I)). The PVP-I/Ag(I) system exhibited enhanced bactericidal activity against four key surrogate bacterial species: two Gram-negative bacteria, Escherichia coli (E. coli) and Pseudomonas aeruginosa (P. aeruginosa), and two Gram-positive bacteria, Staphylococcus aureus (S. aureus) and Bacillus subtilis (B. subtilis). Our experiments revealed that Ag(I) interacts with iodide ions (I-) to form silver iodide (AgI). This reaction promotes the formation of hypoiodous acid (HOI), a more potent bactericidal agent than other reactive iodine species (RIS), by shifting the equilibrium of RIS released from PVP-I. Under representative conditions ([PVP-I]0 = 1 mg/L, [Ag(I)]0 = 5 μM, pH = 7.3), the concentration of HOI in the PVP-I/Ag(I) system was 2.4-3.9 times higher than in the PVP-I system alone, aligning with theoretical predictions. The bactericidal efficacy of the PVP-I/Ag(I) system was influenced by pH variations, affecting HOI formation. This system represents a promising tool for rapid and effective microbial control, potentially enhancing public health outcomes.

Copper-amino acid/Carboxymethyl starch composite for controllable releasing of povidone-iodine

Povidone-iodine is identified as one of the widely applicable antiseptic reagents for treatment of skin infection and wound healing. Controllable releasing of povidone-iodine is extensively required for healing of chronic wounds. The release of povidone-iodine was systematically studied from the composites based on carboxymethyl starch (CMS). Currently, different ratios from copper precursor and L-aspartic acid (L-AA) were interacted with CMS to obtain Cu-L-AA@CMS composites. Increment the percentage of L-AA was reflected in clustering of dense masses from the desirable composite with highly crystalline/stable structural network. Regardless to pH conditions, Cu-L-AA(30%)@CMS composite showed the highest efficiency for controllable release of povidone-iodine, whereas, the release percentages were estimated to be 58%, 32% and 18% at pH 5, 7 and 9, respectively. The kinetic results revealed the impossibility of povidone-iodine releasing via diffusion/erosion for further support of the hypothesis of releasing via swelling process. Moreover, the release of povidone-iodine using column technique showed that the lowest release was estimated at using high rate of 6 mL/min. Besides the biocompatibility and biodegradability of the prepared Cu-L-AA@CMS composites, it showed the superiority for controllable release of povidone-iodine antiseptic reagent to regulate its beneficial effect in curing of the skin.

Phytochemical Profiling and Wound Healing Activity of Gigantochloa apus Liquid Smoke in Mus Musculus

Purpose

Rope bamboo (Gigantochloa apus) is traditionally used for medicinal purposes, and extracts from stem leaves and shoots have been shown to possess antioxidant and anti-inflammatory activity. Thus, this study looked at the potential compounds present in and the usefulness of Rope bamboo liquid smoke preparations in the wound healing process in mice.

Methods

The fingerprinting of the liquid smoke was done by liquid chromatography-mass spectrometry. In-vivo experiments were conducted to observe the diameter and percentage of wound healing in mice for 14 days using topical formulations containing liquid smoke concentrations of 100%, 50%, 25%, positive control and negative control. Statistical analyses were conducted using the Kruskal-Wallis test and Spearman correlation.

Results

The phytochemical fingerprint showed the presence of alkaloids, flavonoids, vitamins, phenols, and lipids. The 100% undiluted liquid smoke accelerated wound healing faster compared to 50% and 25% dilutions. The differences in wound diameters were statistically significant across treatments having a p-value of 0.020 and dose-dependent (p = 0.029).

Conclusion

Liquid smoke acceleration of the wound healing process was dose-dependent compared to controls. This dose-dependency indicates that the wound healing effects were probably due to the anti-inflammatory, antioxidant, and antimicrobial activities of the elucidated constituents of Rope bamboo liquid smoke.

Critical appraisal of the chorioallantoic membrane model for studying angiogenesis in preclinical research

BACKGROUND

Angiogenesis, the biological mechanism by which new blood vessels are generated from existing ones, plays a vital role in growth and development. Effective preclinical screening is necessary for the development of medications that may enhance or inhibit angiogenesis in the setting of different disorders. Traditional in vitro and, in vivo models of angiogenesis are laborious and time-consuming, necessitating advanced infrastructure for embryo culture.

MAIN BODY

A challenge encountered by researchers studying angiogenesis is the lack of appropriate techniques to evaluate the impact of regulators on the angiogenic response. An ideal test should possess reliability, technical simplicity, easy quantifiability, and, most importantly, physiological relevance. The CAM model, leveraging the extraembryonic membrane of the chicken embryo, offers a unique combination of accessibility, low cost, and rapid development, making it an attractive option for angiogenesis assays. This review evaluates the strengths and limitations of the CAM model in the context of its anatomical and physiological properties, and its relevance to human pathophysiological conditions. Its abundant capillary network makes it a common choice for studying angiogenesis. The CAM assay serves as a substitute for animal models and offers a natural setting for developing blood vessels and the many elements involved in the intricate interaction with the host. Despite its advantages, the CAM model's limitations are notable. These include species-specific responses that may not always extrapolate to humans and the ethical considerations of using avian embryos. We discuss methodological adaptations that can mitigate some of these limitations and propose future directions to enhance the translational relevance of this model. This review underscores the CAM model's valuable role in angiogenesis research and aims to guide researchers in optimizing its use for more predictive and robust preclinical studies.

CONCLUSION

The highly vascularized chorioallantoic membrane (CAM) of fertilized chicken eggs is a cost-effective and easily available method for screening angiogenesis, in comparison to other animal models.

Povidone Iodine vs Chlorhexidine Gluconate for Preoperative Skin Antisepsis: A Systematic Review and Meta-analysis of Randomised Controlled Trials

BACKGROUND

Surgical site infection (SSI) remains a challenge in healthcare, contributing to prolonged hospital stays, increased healthcare costs, and adverse patient outcomes, including mortality. Effective preoperative skin disinfection interventions, such as povidone-iodine (PVI) and chlorhexidine (CHG), are widely used but their efficacy remains debated. To address this gap, this meta-analysis aims to evaluate the efficacy of PVI and CHG.

METHOD

We searched PubMed, Embase, and Cochrane databases up to June 2024 to identify studies comparing PVI versus CHG for preoperative skin antisepsis. We calculated odds ratios (ORs) for binary outcomes, with 95% confidence intervals (CIs). A random-effects model was used with statistical significance set at p < 0.05. Data were analysed using R software (version 4.4.0), and heterogeneity was assessed using I2 statistics.

FINDINGS

Sixteen randomised controlled trials (RCTs) were included, involving a total of 13,721 patients, among whom 6,836 (49.8%) received PVI. Compared to CHG, PVI was associated with a non-significant reduction in deep SSI (OR 1.00; 95% CI 0.66 - 1.50; p = 0.994), but an increased risk of overall SSI (OR 1.25; 95% CI 1.06 - 1.48; p = 0.007) and superficial SSI (OR 1.67; 95% CI 1.25 - 2.24; p < 0.001).

CONCLUSION

PVI as preoperative skin antisepsis demonstrated a non-significant reduction in deep SSI compared to CHG but was associated with an increased risk of overall and superficial SSI. Despite these findings, PVI remains an effective option, especially in resource-limited settings. Further research is needed to optimise its use and improve infection prevention strategies in clinical practice.

Understanding innate and adaptive responses during radiation combined burn injuries

The occurrence of incidents involving radiation-combined burn injuries (RCBI) poses a significant risk to public health. Understanding the immunological and physiological responses associated with such injuries is crucial for developing care triage to counter the mortality that occurs due to the synergistic effects of radiation and burn injuries. The core focus of this narrative review lies in unraveling the immune response against RCBI. Langerhans cells, mast cells, keratinocytes, and fibroblasts, which induce innate immunity, have been explored for their response to radiation, burns, and combined injuries. In the case of adaptive immune response, exploring behavioral changes in T regulatory (Treg) cells, T helper cells (Th1, Th2, and Th17), and immunoglobulin results in delayed healing compared to burn and radiation injury. The review also includes the function of complement system components such as neutrophils, acute phase proteins (CRP, C3, and C5), and cytokines for their role in RCBI. Combined insults resulting in a reduction in the cell population of immune cells display variation in response based on radiation doses, burn injury types, and their intrinsic radiosensitivity. The lack of approved countermeasures against RCBI poses a significant challenge. Drug repurposing might help to balance immune cell alteration, resulting in fast recovery and decreasing mortality, which gives it clinical significance for its implication on the site of such incidence. However, the exact immune response in RCBI remains insufficiently explored in pre-clinical and clinical stages, which might be due to the non-availability of in vitro models, standard animal models, or human subjects, warranting further research.

Application of metal-organic framework materials in regenerative medicine

In the past few decades, scaffolds manufactured from composite or hybrid biomaterials of natural or synthetic origin have made great strides in enhancing wound healing and repairing fractures and pathological bone loss. However, the prevailing use of such scaffolds in tissue engineering is accompanied by numerous constraints, including low mechanical stability, poor biological activity, and impaired cell proliferation and differentiation. The performance of scaffolds in wound and bone tissue engineering may be enhanced by some modifications in the synthesis of nanoscale metal-organic framework (nano-MOF) scaffolds. Nano-MOFs have attracted researchers' attention in recent years due to their distinctive features, which include tenability, biocompatibility, good mechanical stability, and ultrahigh surface area. The biological properties of scaffolds are enhanced and tissue regeneration is facilitated by the introduction of nano-MOFs. Moreover, the physicochemical characteristics, drug loading, and ion release capacities of the scaffolds are improved by the nanoscale structure and topological features of nano-MOFs, which also control stem cell differentiation, proliferation, and attachment. This review provides further comprehensive detail about the most recent uses of nano-MOFs in tissue engineering. The distinct characteristics of nano-MOFs are explored in enhancing tissue repair, wound healing, osteoinduction, and bone conductivity. Significant attributes include high antibacterial activity, substantial drug-loading capacity, and the ability to regulate drug release. Finally, this discussion addresses the obstacles, clinical impediments, and considerations encountered in the application of these nanomaterials to diverse scaffolds, tissue-mimicking structures, dressings, fillers, and implants for bone tissue repair and wound healing.

Accelerated wound healing and reduced scar formation induced by D-mannose: a possible role of mannose binding lectin

Wounds are most commonly caused by accidents, surgery and burns, and can be internal or external. Naturally, the wound healing process can take a long time and lead to scarring. In this study we present a technique to shorten wound healing time and prevent or mitigate scarring using D-mannose that is applied directly on the wound. The results showed that the healing time is almost halved compared to treatment with povidone-iodine solution which is an antiseptic widely used in surgery. D-Mannose is neither an antisepsis nor an antibiotic. We propose a posssible mechanism by which D-mannose binds to D-mannose binding lectin and immediately activates the innate immune system that ultimately phagocytizes pathogens and clears the wound of degraded cells and materials, which reduces inflammation and implicitly wound healing time. D-Mannose also intervenes in the coagulation process by binding to fibrinogen, generating a finer and denser fibrin, which visibly reduces collagen scars. Our findings show that applying D-mannose directly on the wound as a powder shortens wound healing time and visibly attenuates scarring. Apart from the unaesthetic appearance, these scars can also cause a certain tissue dysfunction, regardless of the affected organ.

The Effect of Oral Mucosal Disinfection with Povidone-Iodine in Oral and Maxillofacial Surgery

This study enrolled 60 patients aged 28 to 76 years who were oral malignancy undergoing radical surgery for more than 3 hours to assess the disinfection effect of povidone-iodine in oral and maxillofacial surgery which is a clean-contaminated wound. The authors collected and compared the sample from oral mucosa and counted the colony-forming units before disinfection, after disinfection for 10 minutes, 1, 2, 3, and 4 hours. The results showed that the oral bacterial colony-forming units significantly decreased after disinfecting with povidone-iodine and the effect existed for 2 hours and the colony-forming units of 3 hours after disinfection showed statistically significant increase. In oral and maxillofacial surgery, povidone-iodine can effectively disinfect the mouth and maintain a certain period of time. Therefore, to reduce the number of oral mucosa microorganisms, it is recommended to disinfect the oral cavity again after 3 hours.

Antibacterial Iodine-Releasing Coatings of Cross-Linked Poly(N-vinylpyrrolidone) Synthesized by Solvent-Free Initiated Chemical Vapor Deposition

Biomaterial-associated infections caused by bacteria pose a great threat to human health, and therefore, various antibacterial coatings have been developed to control bacterial infections. Povidone iodine (PVP-I) is a broad-spectrum antimicrobial agent without drug resistance to most pathogenic microorganisms and has been widely used in the clinic. However, its applications in the field of coatings are limited due to its strong water solubility. Here, we used initiated Chemical Vapor Deposition (iCVD) technique to synthesize cross-linked poly(N-vinylpyrrolidone-co-ethylene glycol dimethacrylate) (PVE) coatings to firmly immobilize poly(N-vinylpyrrolidone) (PVP) on surfaces. After complexation with iodine, PVE-I coatings exhibited potent bacteria-killing and antifouling activities against Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus in vitro owing to the antibacterial effect of iodine and the hydrophilicity of VP, respectively. The killing and antifouling effects were positively correlated with the VP content. The PVE-I-2 coating displayed excellent anti-infection performance in a rat subcutaneous implantation model in vivo. This study provided a simple method for preparing stable povidone iodine coatings on surfaces via solvent-free iCVD, and combined bacteria-killing and antifouling strategies to fabricate multifunctional antibacterial coatings against bacterial infections on biomaterial surfaces.

Effectiveness of silver and iodine dressings on wound healing: a systematic review and meta-analysis

OBJECTIVE

To evaluate the effects of silver and iodine dressings on healing time, healing rate, exudate amount, pain and anti-infective efficacy.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Databases including PubMed, Cochrane Library, Embase, Web of Science and CINAHL were surveyed up to May 2024.

ELIGIBILITY CRITERIA

Randomised controlled trials comparing silver and iodine dressings on wound healing in humans.

DATA EXTRACTION AND SYNTHESIS

Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Data extraction was done independently by two reviewers, with the risk of bias assessed using the Cochrane tool. Narrative synthesis was performed to evaluate the effects of silver and iodine dressings on healing time, healing rate, pain, exudate amount and anti-infective efficacy. Meta-analysis using Review Manager V.5.4 calculated standardised mean differences for healing time and relative risks for rate to quantify the impacts of the treatments.

RESULTS

17 studies (18 articles) were included. The meta-analysis indicated that silver dressings significantly reduced healing time compared with iodine dressings (SMD=-0.95, 95% CI -1.62 to -0.28, I2=92%, p=0.005, moderate-quality evidence), with no significant difference in enhancing healing rate (RR=1.29, 95% CI 0.90 to 1.85, I2=91%, p=0.16, low-quality evidence). Based on low-quality evidence, for exudate amount (3/17), 66.7% (2/3) of the studies favoured silver dressings over iodine in reducing exudate volume. For pain (7/17), 57.1% (4/7) of the studies reported no significant difference between silver and iodine dressings, while 42.9% (3/7) studies indicated superior pain relief with silver dressings. For anti-infective efficacy (11/13), 54.5% (6/11) of the studies showed equivalence between silver and iodine dressings, while 36.4% (4/11) suggested greater antibacterial efficacy for silver.

CONCLUSION

Silver dressings, demonstrating a comparable healing rate to iodine dressings, significantly reduce healing time, suggesting their potential as a superior adjunct in wound care.

PROSPERO REGISTRATION NUMBER

CRD42020199602.

New Insights Regarding the Use of Relevant Synthetic Compounds in Dentistry

Worldwide, synthetic compounds are used for both in-office and at-home dental care. They are a valuable resource for both prophylactic and curative treatments for various dental problems, such as tooth decay, periodontal diseases, and many more. They are typically preferred due to their broad range of actions and ability to produce targeted, rapid, and long-lasting effects. Using a 0.12% chlorhexidine mouthwash is capable of reducing the plaque index from 47.69% to 2.37% and the bleeding index from 32.93% to 6.28% after just 2 weeks. Mouthwash with 0.1% OCT is also highly effective, as it significantly lowered the median plaque index and salivary bacterial counts in 152 patients in 5 days compared to a control group (p < 0.0001), while also reducing the gingival index (p < 0.001). When povidone-iodine was used as an irrigant during the surgical removal of mandibular third molars in 105 patients, it resulted in notably lower pain scores after 2 days compared to a control group (4.57 ± 0.60 vs. 5.71 ± 0.45). Sodium hypochlorite is excellent for root canal disinfection, as irrigating with 1% NaOCl completely eliminated the bacteria from canals in 65% patients. A 0.05% CPC mouthwash proved effective for perioperative patient care, significantly decreasing gingival bleeding (p < 0.001) and suppressing Streptococcus levels even one week post-surgery. Lastly, a 6% H2O2 paint-on varnish and 6% H2O2 tray formulations successfully bleached the teeth of 40 patients, maintaining a noticeably whiter appearance up to the 6-month follow-up, with significant color differences from the baseline (p < 0.005). Synthetic compounds have a large research base, which also provides a greater awareness of their mechanism of action and potential adverse effects. For a better understanding of how they work, several methods and assays are performed. These are protocolary techniques through which a compound's efficacy and toxicity are established.

Approaches to scarless burn wound healing: application of 3D printed skin substitutes with dual properties of anti-infection and balancing wound hydration levels

BACKGROUND

Severe burn wounds face two primary challenges: dysregulated cellular impairment functions following infection and an unbalanced wound hydration microenvironment leading to excessive inflammation and collagen deposition. These results in hypertrophic scar contraction, causing significant deformity and disability in survivors.

METHODS

A three-dimensional (3D) printed double-layer hydrogel (DLH) was designed and fabricated to address the problem of scar formation after burn injury. DLH was developed using methacrylated silk fibroin (SFMA) and gelatin methacryloyl (GelMA) for the upper layer, and GelMA and hyaluronic acid methacryloyl (HAMA) for the lower layer. To combat infection, copper-epigallocatechin gallate (Cu-EGCG) was incorporated into the lower layer bioink, collectively referred to as DLS. To balance wound hydration levels, HaCaT cells were additionally encapsulated in the upper layer, designed as DLS/c.

FINDINGS

DLH demonstrated suitable porosity, appropriate mechanical properties, and excellent biocompatibility. DLS exhibited potent antimicrobial properties, exerted anti-inflammatory effects by regulating macrophage polarisation, and may enhance angiogenesis through the HIF-1α/VEGF pathway. In the DLS/c group, animal studies showed significant improvements in epidermal formation, barrier function, and epidermal hydration, accompanied by reduced inflammation. In addition, Masson's trichrome and Sirius red staining revealed that the structure and ratio of dermal collagen in DLS/c resembled that of normal skin, indicating considerable potential for scarless wound healing.

INTERPRETATION

This biomimetic matrix shows promise in addressing the challenges of burn wounds and aiming for scarless repair, with benefits such as anti-infection, epidermal hydration, biological induction, and optimised topological properties.

FUNDING

Shown in Acknowledgements.

A novel chlorin derivative Shengtaibufen (STBF) mediated photodynamic therapy combined with iodophor for the treatment of chronic superficial leg wounds infected with methicillin-resistant Staphylococcus aureus: A retrospective clinical study

OBJECTIVE

Chronic wounds are costly and difficult to treat, resulting in morbidity and even mortality in some cases due to a high methicillin-resistant Staphylococcus aureus (MRSA) burden contributing to chronicity. We aimed to observe the antimicrobial activity and healing-promoting effect of a novel photosensitizer Shengtaibufen (STBF)-mediated antibacterial photodynamic therapy (PDT) on MRSA-infected chronic leg ulcers.

PATIENTS AND METHODS

This was a retrospective, comparative, single-center clinical study. A total of 32 patients with chronic lower limb wounds infected with MRSA from January 2022 to December 2023 were finally included in this study by searching the electronic medical records of the dermatology department of Huadong Hospital, including a group of red light combined with iodophor (control+iodophor, n=16, receiving red light once a week for 8 weeks and routine dressing change with iodophor once a day) and a group of STBF-mediated PDT (STBF-PDT) combined with iodophor (STBF-PDT+iodophor, n=16, receiving STBF-PDT and routine dressing change with iodophor once a day). STBF-PDT was performed once a week (1 mg/ml STBF, 1 h incubation, 630 nm red light, 80 J/cm2) for 8 weeks. The primary endpoints included wound clinical signs, wound size, wound-related pain, re-epithelialization score, MRSA load and wound-related quality of life (wound-QoL). Any adverse events were also recorded.

RESULTS

We found that STBF-PDT+iodophor could effectively alleviate clinical infection symptoms, accelerate wound closure, reduce average biological burden and improve wound-QoL without severe adverse events in comparison to the control+iodophor group. The STBF-PDT+iodophor group obtained a mean percentage reduction of 65.22% in wound size (from 18.96±11.18 cm2 to 6.59±7.94 cm2) and excellent re-epithelialization scores, as compared with a decrease of 30.17% (from 19.23±9.80 cm2 to 13.43±9.32 cm2) for the control+iodophor group. Significant differences in wound area were observed at week 6 (p=0.028*) and week 8 (p=0.002**). The bacterial load decreased by 99.86% (from 6.45 × 107±2.69 × 107 to 8.94 × 104±1.92 × 105 CFU/cm2, p<0.0001) in the STBF-PDT+iodophor group and 1.82% (from 6.61 × 107±2.13 × 107 to 6.49 × 107±2.01 × 107 CFU/cm2, p=0.029) in the control+iodophor group. The wound-QoL in STBF-PDT+iodophor group had a 51.62% decrease in overall score (from 29.65±9.33 at the initial to 14.34±5.17 at week 8, p<0.0001) compared to those receiving red light and routine wound care (from 30.73±17.16 to 29.32±15.89 at week 8, p=0.003). Moreover, patients undergoing STBF-PDT+iodophor exhibited great improvements in all domains of wound-QoL (physical, psychological and everyday-life), whereas the control+iodophor group ameliorated in only one field (everyday-life).

CONCLUSION

Our data confirmed that a novel photosensitizer, STBF-mediated PDT, when combined with iodophor, served as a potential modality for MRSA infection and a possible therapy for other drug-resistant microorganisms, and as a promising alternative for chronic cutaneous infectious diseases.

Effects of povidone-iodine wound irrigation on surgical site infection in gastroenterological surgery: A randomized controlled trial

BACKGROUND

The irrigation efficacy of a povidone-iodine solution to prevent surgical site infection is still controversial. We assessed the irrigation effect with a povidone-iodine solution on the incidence of surgical site infection after gastroenterological surgery.

METHODS

This study is a single-center, prospective, randomized, blinded-end point superiority trial for surgical wound irrigation. Patients undergoing gastroenterological surgery were randomly assigned in a 1:1 replacement ratio using computer-generated randomization. Patients were grouped according to their surgical wound treatment into the control group using the normal sterile saline and the povidone-iodine group using 10% povidone-iodine solution after the NS solution. The main finding was 30-day surgical site infections assessed in the full analysis set.

RESULTS

From November 2020 to December 2022, 697 of 894 patients were eligible for the study, among which 347 were in the povidone-iodine group and 350 in the control group. Thirty-day surgical site infections occurred in 100 (14%) patients-54 (16%) in the povidone-iodine group and 46 (13%) in the control group (odds ratio, 1.229; 95% CI, 0.800-1.889; P = .406). Superficial incisional surgical site infections occurred in 30 (9%) and 15 (4%) patients, respectively (odds ratio, 2.154; 95% CI, 1.134-4.090; P = .026). Only 3 patients (1%) in the control group developed adverse skin reactions.

CONCLUSION

This study examined the irrigation efficacy of povidone-iodine for surgical site infection prevention compared to control in gastroenterological surgery. Povidone-iodine wound irrigation has shown no additional beneficial effect on the occurrence of surgical site infections.

Uncovering the Benefits of Povidone Iodine Compared to Other Therapeutic Agents in Wound Infection Prevention and Healing Outcomes: A Scoping Review

Background

The selection of an appropriate chemical solution in wound care reduces the severity of wounds and accelerates the healing process. Povidone-iodine (PV-I), a chemical solution popularly known as an antiseptic, is frequently used in studies of wound care to prevent wound infection and accelerate woud the process of wound healing.

Objective

To identify the latest evidence on the benefits of PV-I in wound infection prevention and healing in all areas.

Methods

This review is a scoping review by Arskey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) is used for reporting. The literature search used databases including PubMed, CINAHL, and search engines such as Scopus. This study was conducted using thematic analysis.

Results

This review yielded 19 out of 2109 studies that were identified in the initial search. Four outcomes comprised 20 sub-outcomes have been identified. Although strong evidence is lacking, PV-I in the form of foam is effective in improving wound healing, shortening healing time, and producing fewer adverse events than hydrocelluers. Moreover, saline and PV-I are effective as skin disinfectants when compared to saline alone in reducing surgical site infection (SSI), and they are also more effective than hypochlorous acid in improving wound healing. Nevertheless, there was no difference between PV-I and hypochlorous acid in the prevention of SSI and bacterial growth. In terms of healing time, silver foam and hyaluronic acid were more favorable than PV-I. Moreover, the use of chlorhexidine to improve SSI and silver dressing to improve hospital stay is more favorable than that of PV-I.

Conclusion

There is limited evidence regarding the effectiveness of wound care outcomes, and the efficacy of PV-I as a surface disinfectant for wound infection prevention remains controversial. Consequently, PV-I is not highly recommended for wound care, and further investigation into the effectiveness of PV-I as a surface disinfectant is required for various types of surgeries.

Silicone Bioadhesive with Shear-Stiffening Effect: Rate-Responsive Adhesion Behavior and Wound Dressing Application

Stimuli-responsive adhesives with on-demand adhesion capabilities are highly advantageous for facilitating wound healing. However, the triggering conditions of stimuli-responsive adhesives are cumbersome, even though some of them are detrimental to the adhesive and adjacent natural tissues. Herein, a novel stimuli-responsive adhesive called shear-stiffening adhesive (SSA) has been created by constructing a poly(diborosiloxane)-based silicone network for the first time, and SSA exhibits a rate-responsive adhesion behavior. Furthermore, we introduced bactericidal factors (PVP-I) into SSA and applied it as a wound dressing to promote the healing of infected wounds. Impressively, the wound dressing not only has excellent biocompatibility and long-term antibacterial properties but also performs well in accelerating wound healing. Therefore, this study provides a new strategy for the synthesis of intelligent adhesives with force rate response, which simplifies the triggering conditions by the force rate. Thus, SSA has great potential to be applied in wound management as an intelligent bioadhesive with on-demand adhesion performance.

Use of intranasal povidone-iodine packing in the management of infectious rhinosinusitis in three cats

Case series summary

Described are three cats diagnosed with rhinosinusitis secondary to Mycobacterium bouchedurhonense, Aspergillus species and Alternaria species, respectively. Medical records were retrospectively reviewed to identify cats with decreased nasal airflow and mucopurulent discharge that failed to improve on antibiotic therapy of 3 months or longer duration. Surgical debridement was followed by nasal packing using 5% povidone-iodine saturated umbilical tape, which was replaced at 24 h postoperatively. At 48 h postoperatively, the rhinotomy site was closed. Systemic therapy continued in the postoperative period. All cases were minimally responsive to previous medical management. History, signalment, clinical signs, diagnostic findings, treatment, and short- and long-term outcomes were retrieved. All cats were middle-aged with outdoor access and had clinical signs that commenced during the summer months. CT revealed turbinate destruction and soft tissue densities within the nasal passages. The otic apparatuses and calvaria were intact in all cats before surgery. A repeat CT examination revealed an improvement of the proliferative tissue identified in preoperative imaging in all cases. All cats achieved successful interruption of nasal discharge and restoration of nasal airflow with follow-up times of up to 16 months postoperatively.

Relevance and novel information

To the authors' knowledge, this is the first report of the use of intranasal povidone-iodine packing in cats for the management of infectious rhinosinusitis. Surgical debridement and intranasal packing in addition to systemic therapy were successful in restoring nasal airflow and resolving nasal discharge in all cats with long-term follow-up.

Management of an elderly patient with retention of a steel nail in the scrotum: a case report

BACKGROUND

The retention of foreign bodies inside the body during ludic/sexual procedures or for traumatism represents one of the causes of visits to accident and emergency departments that often requires surgical removal of the foreign body. However, there are cases where the discovery of such foreign bodies takes place after many years, as in patients that are slightly compromised from a neuro-sociological point of view.

CASE PRESENTATION

A 76-year-old male presented to an outpatient urological examination due to an increase in scrotal volume. At the ultrasound check, an acoustic interference from a solid object was detected, for which computed tomography was requested. The computed tomography scan revealed the presence of an elongated metal body in the perineum. The removal of the foreign body in the operating theatre was then scheduled. A 10 cm long stainless-steel nail located within an abscessed foreign body granuloma was identified and removed via a scrotal access. Four days later, a new surgical toilet was performed due to minimal necrosis of the skin flaps. The patient then performed three more dressings in the operating theatre during the following week. Healing took place by secondary intention until a perfect healing of the surgical wound was obtained.

CONCLUSIONS

Removal of foreign bodies from the perineum in case of infection can be challenging. Careful attention and postoperative dressings are crucial for the success of the case.

Electrospray Nano-Micro Composite Sodium Alginate Microspheres with Shape-Adaptive, Antibacterial, and Angiogenic Abilities for Infected Wound Healing

Nonhealing infectious wounds, characterized by bacterial colonization, wound microenvironment destruction, and shape complexity, present an intractable problem in clinical practice. Inspired by LEGOs, building-block toys that can be assembled into desired shapes, we proposed the use of electrospray nano-micro composite sodium alginate (SA) microspheres with antibacterial and angiogenic properties to fill irregularly shaped wounds instantly. Specifically, porous poly(lactic-co-glycolic acid) (PLGA) microspheres (MSs) encapsulating basic fibroblast growth factor (bFGF) were produced by a water-in-oil-in-water double-emulsion method. Then, bFGF@MSs were blended with the SA solution containing ZIF-8 nanoparticles. The resultant solution was electrosprayed to obtain nano-micro composite microspheres (bFGF@MS/ZIF-8@SAMSs). The composite MSs' size could be regulated by PLGA MS mass proportion and electrospray voltage. Moreover, bFGF, a potent angiogenic agent, and ZIF-8, bactericidal nanoparticles, were found to release from bFGF@MS/ZIF-8@SAMSs in a controlled and sustainable manner, which promoted cell proliferation, migration, and tube formation and killed bacteria. Through experimentation on rat models, bFGF@MS/ZIF-8@SAMSs were revealed to adapt to wound shapes and accelerate infected wound healing because of the synergistic effects of antibacterial and angiogenic abilities. In summation, this study developed a feasible approach to prepare bioactive nano-micro MSs as building blocks that can fill irregularly shaped infected wounds and improve healing.

Nasal instillation of povidone-iodine ameliorates ongoing mucosal inflammation in a pre-sensitized murine model of Der p1-induced allergic rhinitis

BACKGROUND

Interleukin (IL)-33, when cleaved into smaller fragments by proteases, becomes hyperactive, contributing to allergic inflammation. Povidone-iodine (PVP-I) is an iodine-based compound that exhibits antimicrobial properties and inhibits proteases. This study aimed to investigate whether PVP-I treatment inhibits IL-33 cleavage, improves allergic rhinitis (AR) symptoms, and suppresses allergic inflammation in a mouse model.

METHODS

In vitro experiments using full-length recombinant human IL-33 and allergens, including house dust mites or Dermatophagoides pteronyssinus 1, were conducted using western blotting. Fifty BALB/c mice were divided into five groups: control (CON), AR with phosphate-buffered saline treatment (AR), PVP-I treatment (AR + PVP), trans-epoxysuccinyl-L-leucylamido(4-guanidino)butane (E64) treatment (AR + E64), and dexamethasone treatment (AR + Dexa). Nasal symptom scores, including rubbing and sneezing, were measured. The cytokine levels in the nasal lavage fluid (NLF) and the concentration of immunoglobulins in the blood serum were assessed. Nasal mucosa from each group was used for reverse transcriptase-polymerase chain reaction (RT-PCR) and histological analyses were conducted.

RESULTS

PVP-I treatment reduced nasal symptoms, suppressed allergic inflammation, and decreased the levels of IL-33, IL-5, and IL-13 in the NLF and total immunoglobulin E (IgE) and specific IgE in the serum. Histopathological analysis revealed a reduction in the number of eosinophils and goblet cells in the nasal mucosa of the AR + PVP group when compared to the AR group. RT-PCR and immunofluorescence staining confirmed the downregulation of genes and proteins associated with allergic inflammation.

CONCLUSIONS

These findings suggest that nasal irrigation with PVP-I may be a promising therapeutic option for managing AR by inhibiting IL-33 activation and suppressing allergic inflammation.

Preventing Bacterial Contamination of Breast Implants Using Infection Mitigation Techniques: An In Vitro Study

BACKGROUND

Bacterial contamination of implants has been linked to biofilm formation and subsequent infection, capsular contracture, and breast implant-associated anaplastic large cell lymphoma. Reducing contamination during implant insertion should therefore reduce biofilm formation disease sequelae.

OBJECTIVES

The aim of this study was to compare levels of contamination between preventative techniques.

METHODS

A model to simulate the passage of implants through a skin incision was designed that utilized a sterile textured polyvinyl plastic sheet contaminated with Staphylococcus epidermidis. In the first stage of the polyvinyl contamination model, implants were subject to infection-mitigation techniques and passed through the incision, then placed onto horse blood agar plates and incubated for 24 hours. In the second stage of the study the same contamination was applied to human abdominal wall specimens. A 5 cm incision was made through skin and fat, then implants were passed through and levels of contamination were measured as described.

RESULTS

Smooth implants grew a mean of 95 colony-forming units (CFUs; approximately 1 CFU/cm2) and textured implants grew 86 CFUs (also approximately 1 CFU/cm2). CFU counts were analyzed by the Mann-Whitney U-test which showed no significant difference between implant types (P < .05); independent-sample t-tests showed a significant difference. The dependent-variable techniques were then compared as groups by one-way analysis of variance, which also showed a significant reduction compared with the control group (P < .01).

CONCLUSIONS

This in vitro study has shown the effectiveness of antiseptic rinse and skin/implant barrier techniques for reducing bacterial contamination of breast implants at the time of insertion.

Thymol, a Monoterpenoid within Polymeric Iodophor Formulations and Their Antimicrobial Activities

Antimicrobial resistance (AMR) poses an emanating threat to humanity's future. The effectiveness of commonly used antibiotics against microbial infections is declining at an alarming rate. As a result, morbidity and mortality rates are soaring, particularly among immunocompromised populations. Exploring alternative solutions, such as medicinal plants and iodine, shows promise in combating resistant pathogens. Such antimicrobials could effectively inhibit microbial proliferation through synergistic combinations. In our study, we prepared a formulation consisting of Aloe barbadensis Miller (AV), Thymol, iodine (I2), and polyvinylpyrrolidone (PVP). Various analytical methods including SEM/EDS, UV-vis, Raman, FTIR, and XRD were carried out to verify the purity, composition, and morphology of AV-PVP-Thymol-I2. We evaluated the inhibitory effects of this formulation against 10 selected reference strains using impregnated sterile discs, surgical sutures, gauze bandages, surgical face masks, and KN95 masks. The antimicrobial properties of AV-PVP-Thymol-I2 were assessed through disc diffusion methods against 10 reference strains in comparison with two common antibiotics. The 25-month-old formulation exhibited slightly lower inhibitory zones, indicating changes in the sustained-iodine-release reservoir. Our findings confirm AV-PVP-Thymol-I2 as a potent antifungal and antibacterial agent against the reference strains, demonstrating particularly strong inhibitory action on surgical sutures, cotton bandages, and face masks. These results enable the potential use of the formulation AV-PVP-Thymol-I2 as a promising antimicrobial agent against wound infections and as a spray-on contact-killing agent.

Enhancement of in vitro antibacterial activity and bioactivity of iodine-loaded titanium by micro-scale regulation using mixed-acid treatment

Postoperative infection and subsequent device loss are serious complications in the use of titanium dental implants and plates for jawbone reconstruction. We have previously reported that NaOH-CaCl2 -thermal-ICl3 -treated titanium (NaCaThIo) has a nano-scale surface and exhibits antibacterial activity against Staphylococcus aureus. The present study examined the surface properties of mixed-acid treated and then iodine-treated titanium (MA-NaCaThIo), and evaluated oral antibacterial activity and cytotoxicity compared with the results obtained with NaCaThIo. MA-NaCaThIo formed a surface layer with a nano-scale network structure having microscale irregularities, and both the thickness of the surface layer (1.49 ± 0.16 μm) and the average surface roughness (0.35 ± 0.03 μm) were significantly higher than those of NaCaThIo. Furthermore, MA-NaCaThIo maintained high hydrophilicity with a contact angle of 7.5 ± 1.7° even after 4 weeks, as well as improved apatite formation, iodine ion release, and antibacterial activity against Prevotella intermedia compared to NaCaThIo. Cell culture test revealed that MA-NaCaThIo exhibited no cytotoxicity against MG-63 and Vero cells, while increased cell proliferation, ALP activity and mineralization of MG-63 compared to NaCaThIo. This treated titanium is expected to be useful for the development of next-generation titanium devices having both bone-bonding and antibacterial properties.

Tear cytokine levels are reduced in patients treated with intravitreal injections

PURPOSE

To investigate cytokine levels in the tear fluid of patients receiving serial intravitreal injections (IVI) with anti-vascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD).

METHODS

Concentrations of six cytokines (IFN-γ, IL-1β, IL-6, IL-8, TNF and VEGF) in tears of patients receiving anti-VEGF in one eye were assayed using multiplex cytometric bead array. The fellow untreated eye served as control. Tear sampling was performed on a single occasion at a minimum of four weeks after IVI. Patients underwent a pre-IVI antisepsis protocol with povidone-iodine.

RESULTS

Tear fluid from thirty patients with a mean age of 78.8 years (range 58-90) was assayed. Subjects received a median of 43.5 (range 22-106) IVI in one eye. The median level of IFN-γ was 0.33 (interquartile range (IQR) 0.22-0.52) pg/mg of total protein in injected eyes versus 0.41 (IQR 0.21-1.05) pg/mg in fellow eyes (p = 0.017). For TNF, a median level of 0.12 (IQR 0.08-0.18) pg/mg of total protein was found in injected eyes versus 0.14 (IQR 0.07-0.33) pg/mg of total protein in fellow eyes (p = 0.019). There were no differences between injected and fellow eyes regarding the levels of IL-1β, IL-6, IL-8 and VEGF.

CONCLUSION

Tear fluid in eyes receiving serial IVI with anti-VEGF and preoperative povidone-iodine antisepsis constitutes lower levels of the pro-inflammatory cytokines IFN-γ and TNF compared to fellow eyes. This provides biochemical support of previous findings of reduced signs of inflammation and healthier tear film parameters in patients treated with serial IVI.

A Wound-Healing Effect of Nanoemulgel of Kangkung (Ipomoea Reptans, Poir) Leaf Extract in STZ Diabetic Rats

Context

The chronic diabetes mellitus (DM) condition may lead to diabetic wounds that increase morbidity in patients. Ipomoea reptans Poir leaves have been widely reported to possess anti-diabetic activity due to their flavonoid contents. To enhance drug penetration, a nanoemulgel preparation was formulated.

Aims

This study aimed to evaluate the activity of nanoemulgel preparations of Ipomoea reptans Poir leaf extract on diabetic and non-diabetic wound-healing using male Wistar rats.

Settings and Design

This research was an experimental study with a post-test only control group design.

Materials and Methods

The rats (n = 32) were randomly divided into two groups: diabetic (induced by 40 mg/kg BW STZ) and non-diabetic model. Each model consisted of four groups: normal, positive control, I. reptans leaf extract (IRLE), and nanoemulgel of I. reptans leaf extract (NIRLE). All the animals studied were shaved from the back, and a 2.5 × 0.5 cm full-thickness excision wound was made. IRLE and NIRLE were administered daily and observed for the wound-healing process.

Statistical Analysis Used

The one-way analysis of variance with the Tukey post-hoc test was used for the statistical analysis.

Results

A NIRLE formulation has been developed to produce a preparation that meets the physical requirements. IRLE and NIRLE possessed wound-healing activity in normal and diabetic rat models. However, the wound-healing process in diabetic rats treated with NIRLE was faster than those with IRLE.

Conclusions

NIRLE increased the activity of wound-healing effect of I. reptans leaves on diabetic rats in comparison with the extract form.

Small animal patient preoperative preparation: a review of common antiseptics, comparison studies, and resistance

This review aims to describe commonly used antiseptics in veterinary medicine including their mechanism of action, spectrum of activity, potential adverse effects, and application techniques. Additionally, it provides a review of the veterinary literature comparing antiseptics, a discussion of effectiveness and efficacy studies, and the potential for increased resistance to biocides and antimicrobials. This review concludes that appropriate selection and use is necessary to prevent the occurrence of surgical site infections, adverse effects, and potential for increasing resistance to antimicrobials. Continued research is needed to fill gaps in the current knowledge such as optimal preparation procedures for various surgical sites, standardization of efficacy and effectiveness testing, and the clinical impact of decreased susceptibility to chlorhexidine and other antiseptics.

Effect of Poly(Vinyl Pyrrolidone) on Iodine Release from Acrylate-Endcapped Urethane-Based Poly(Ethylene Glycol) Hydrogels as Antibacterial Wound Dressing

Infections are still a major cause of morbidity in burn wounds. Although silver has been used strongly in past centuries as an anti-bacterial, it can lead to allergic reactions, bacterial resistance, and delayed wound healing. Iodine-based antibacterials are becoming an interesting alternative. In this work, the effect of complexation with poly(vinyl pyrrolidone) (PVP) and poly(ethylene oxide) (PEO)-based polymers is explored by using different acrylate-endcapped urethane-based poly(ethylene glycol) (AUP) polymers, varying the molar mass (MM) of the poly(ethylene glycol) (PEG) backbone, with possible addition of PVP. The higher MM AUP outperforms the swelling potential of commercial wound dressings such as Kaltostat, Aquacel Ag, and Hydrosorb and all MM show superior mechanical properties. The addition of iodine to the polymers is compared to Iso-Betadine Tulle (IBT). Interestingly, the addition of PVP does not lead to increased iodine complexation compared to the blank AUP polymers, while all have a prolonged iodine release compared to the IBT, which leads to a burst release. The observed prolonged release also leads to larger inhibition zones during antibacterial tests. Complexing iodine in AUP polymers with or without PVP leads to antimicrobial wound dressings which may hold potential for future application to treat infected wounds.

Development, characterization, and evaluation of a simple polymicrobial colony biofilm model for testing of antimicrobial wound dressings

Chronic wound infections are generally of polymicrobial nature with aerobic and anaerobic bacteria, as well as fungi frequently observed in them. Wound treatment involves a series of steps, including debridement of the wound, flushing, and often the use of multiple wound dressings many of which are antimicrobial. Yet, many wound dressings are tested versus single species of planktonic microbes, which fails to mirror the real-life presence of biofilms.

AIMS

Simple biofilm models are the first step to testing of any antimicrobial and wound dressing; therefore, the aim of this study was to develop and validate a simple polymicrobial colony biofilm wound model comprised of Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans on RPMI-1640 agar. The model was then used to evaluate the topical disinfectant chlorohexidine and four commercially available wound dressings using the polymicrobial model. The model used was as a starting point to mimic debridement in clinical care of wounds and the effectiveness of wound dressings evaluated afterwards.

METHODS AND RESULTS

Planktonic assessment using AATCC100-2004 demonstrated that all antimicrobial wound dressings reduced the planktonic microbial burden below the limit of detection; however, when challenged with polymicrobial colony biofilms, silver wound dressings showed limited effectiveness (1-2 log CFU reductions). In contrast, a single iodine releasing wound dressing showed potent antibiofilm activity reducing all species CFUs below the limit of detection (>6-10 log) depending on the species. A disrupted biofilm model challenge was performed to represent the debridement of a wound and wound silver-based wound dressings were found to be marginally more effective than in whole colony biofilm challenges while the iodine containing wound dressing reduced microbial recovery below the limit of detection.

CONCLUSIONS

In this model, silver dressings were ineffective versus the whole colony biofilms but showed some recovery of activity versus the disrupted colony biofilm. The iodine wound dressing reduced the viability of all species below the level of detection. This suggests that mode of action of wound dressing should be considered for the type of biofilm challenge as should the clinical use, e.g. debridement.

Impact of (nano ZnO/multi-wall CNTs) prepared by arc discharge method on the removal efficiency of stable iodine 127I and radioactive iodine 131I from water

Radioactive iodine isotopes especially 131I are used for diagnosis and treatment of different types of cancer diseases. Due to the leak of radioactive iodine into the patient's urine in turn, the wastewater would be contaminated, so it is worth preparing a novel adsorption green material to remove the radioactive iodine from wastewater efficiently. The removal of 127I and 131I contaminants from aqueous solution is a problem of interest. Therefore, this work presents a new study for removing the stable iodine 127I- and radioactive iodine 131I from aqueous solutions by using the novel nano adsorbent (Nano ZnO/MWCNTs) which is synthesized by the arc discharge method. It is an economic method for treating contaminated water from undesired dissolved iodine isotopes. The optimal conditions for maximum removal are (5 mg/100 ml) as optimum dose with shacking (200 rpm) for contact time of (60 min), at (25 °C) in an acidic medium of (pH = 5). After the adsorption process, the solution is filtrated and the residual iodide (127I-) is measured at a maximum UV wavelength absorbance of 225 nm. The maximum adsorption capacity is (15.25 mg/g); therefore the prepared nano adsorbent (Nano ZnO/MWCNTs) is suitable for treating polluted water from low iodide concentrations. The adsorption mechanism of 127I- on to the surface of (Nano ZnO/MWCNTs) is multilayer physical adsorption according to Freundlich isotherm model and obeys the Pseudo-first order kinetic model. According to Temkin isotherm model the adsorption is exothermic. The removal efficiency of Nano ZnO/MWCNTs for stable iodine (127I-) from aqueous solutions has reached 97.23%, 89.75%, and 64.78% in case of initial concentrations; 0.1843 ppm, 0.5014 ppm and 1.0331 ppm, respectively. For the prepared radio iodine (131I-) solution of radioactivity (20 µCi), the dose of nano adsorbent was (10 mg/100 ml) and the contact time was (60 min) at (pH = 5) with shacking (200 rpm) at (25 °C). The filtration process was done by using a syringe filter of a pore size (450 nm) after 2 days to equilibrate. The removal efficiency reached (34.16%) after the first cycle of treatment and the percentage of residual radio iodine was (65.86%). The removal efficiency reached (94.76%) after five cycles of treatment and the percentage of residual radio iodine was (5.24%). This last percentage was less than (42.15%) which produces due to the natural decay during 10 days.