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Franken J, Mikler J. Reactive skin decontamination lotion (RSDL) safety with clinical antiseptics and hemostatic agents. Toxicol Lett 2024; 395:11-16. [PMID: 38484828 DOI: 10.1016/j.toxlet.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/21/2024]
Abstract
Reactive skin decontamination lotion (RSDL) is a Health Canada approved product used by the Canadian Armed Forces for removal and inactivation of toxic chemicals on skin. Although it is considered very safe when used as directed, questions have been raised regarding whether topical RSDL in the medical setting will react exothermically with antiseptic compounds on the casualty's epidermis that could result in thermal burns. Benchtop experiments were conducted to investigate reactivity of RSDL with various antiseptic compounds or hemostatic agents. Temperature changes were closely monitored in three different volume ratios, 1:10, 1:1, and 10:1 over a time course of 16 minutes. Chlorine based bleaches versus RSDL were included as a positive control and were the only combination that exhibited a significant exothermic reaction capable of causing minor thermal burns. RSDL was also evaluated with antiseptic solution applied to swine epidermal tissue without observation of visual irritation; then in lacerated skeletal muscle tissue which resulted in no measured temperature change. The conclusion of this study is that antiseptics and hemostatic agents can be used as required on a patient decontaminated with RSDL as no exothermic reaction will occur.
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Affiliation(s)
- Jessica Franken
- Defence Research and Development Canada - Suffield Research Centre, Department of National Defence, Suffield, Alberta, Canada.
| | - John Mikler
- Defence Research and Development Canada - Suffield Research Centre, Department of National Defence, Suffield, Alberta, Canada
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Alexander P L, Jonathan R, Gunnar K, Johan P E J. Amino acid buffered hypochlorite facilitates debridement of porcine infected burn wounds. Burns 2023; 49:1363-1371. [PMID: 36543728 DOI: 10.1016/j.burns.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/21/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Removal of necrotic tissue is a vital step in the treatment of full-thickness burn wounds, with surgical debridement being the most effective method. Since minor burn wounds are typically treated on an outpatient basis where surgical capabilities can be limited there is a need for alternative treatment options. In this study we aim to evaluate the use of amino acid buffered hypochlorite (AABH) as a chemical enhancement for wound debridement in a porcine infected burn wound model. METHOD A total of 60 full-thickness burn wounds, 3 cm in diameter, were created on four pigs using a standardized burn device. The wounds were inoculated with 107 colony-forming units (CFU) of S. aureus. The experimental groups included wounds debrided with a plastic curette, wounds debrided after pretreatment with AABH, and control wounds wiped with gauze. Wounds were treated twice per week for three weeks. Debridement, healing, and infection parameters were evaluated over time. RESULTS After one week, but not after two and three weeks, the curette and AABH groups had higher debrided weights compared to control (p < 0.05). Percentage of wound area adequately cleared from necrotic tissue was higher in the AABH-group compared to the curette-group and control, after one week. The earliest healing was measured in the AABH group after two weeks (5 % of wounds), which also had the most healed wounds after three weeks (55 %). In both the AABH and the curette groups, bacterial load had fallen below 105 CFU/g after two weeks. No CFU were detectable in the AABH group after three weeks. The AABH-group was also the easiest to debride. CONCLUSION Our results indicate that AABH facilitates wound debridement and could be a helpful addition to an effective treatment modality for removal of necrotic tissue in full-thickness burns.
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Affiliation(s)
- Larsson Alexander P
- Laboratory for Experimental Plastic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden; Department of Hand Surgery, Plastic Surgery, and Burns, Linköping University Hospital, SE-581 85, Linköping, Sweden; Department of Reconstructive Plastic Surgery, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
| | - Rakar Jonathan
- Laboratory for Experimental Plastic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden; Center for Disaster Medicine and Traumatology, and Department of Biomedical and Clinical Sciences, Linköping University, SE-583 30, Linköping, Sweden
| | - Kratz Gunnar
- Laboratory for Experimental Plastic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden; Department of Hand Surgery, Plastic Surgery, and Burns, Linköping University Hospital, SE-581 85, Linköping, Sweden
| | - Junker Johan P E
- Laboratory for Experimental Plastic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden; Center for Disaster Medicine and Traumatology, and Department of Biomedical and Clinical Sciences, Linköping University, SE-583 30, Linköping, Sweden
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Bota O, Taqatqeh F, Bönke F, Nowotny J, Matschke K, Bienger K, Dragu A. The role of negative pressure wound therapy with instillation and dwell time in the treatment of deep sternal wound infections-A retrospective cohort study. Health Sci Rep 2023; 6:e1430. [PMID: 37465238 PMCID: PMC10350553 DOI: 10.1002/hsr2.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
Background and Aims Negative pressure wound therapy (NPWT) has gained a central role in the treatment of deep sternal wound infections (DSWIs) after median thoracotomy. Our study aims at proving the safety of using NPWT with instillation and dwell time (NPWTi-d) in the treatment of DSWI. Methods We retrospectively evaluated the patients who were treated at our institution between March 2018 and November 2021 for DSWI after radical sternectomy using NPWT or NPWTi-d. The NPWTi-d was applied to start the first postoperative day using 75 mmHg negative pressure for 3 h, followed by instillation of sodium hypochlorite <0.08% with a 3-min dwell time. Results The NPWTi-d group showed a shorter length of stay (29.39 ± 12.09 vs. 39.54 ± 17.07 days; p = 0.049), a shorter elapsed time between the debridement and the flap coverage (7.18 ± 4.27 vs. 11.86 ± 7.7 days; p = 0.003) and less operative or nonoperative dressing changes (1.73 ± 1.14 vs. 2.68 ± 56; p < 0.001). The in-hospital mortality was 8.2%, with no significant differences between the two groups (p = 1). Conclusion NPWTi-d can be safely employed in the treatment of DSWI. Further prospective randomized studies need to establish the role of NPWTi-d in the control of infection and biofilm as well as in wound healing.
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Affiliation(s)
- Olimpiu Bota
- Faculty of Medicine Carl Gustav CarusUniversity Center for Orthopedics, Trauma and Plastic SurgeryDresdenGermany
| | - Feras Taqatqeh
- Faculty of Medicine Carl Gustav CarusUniversity Center for Orthopedics, Trauma and Plastic SurgeryDresdenGermany
| | - Florian Bönke
- Faculty of Medicine Carl Gustav CarusUniversity Center for Orthopedics, Trauma and Plastic SurgeryDresdenGermany
| | - Jörg Nowotny
- Faculty of Medicine Carl Gustav CarusUniversity Center for Orthopedics, Trauma and Plastic SurgeryDresdenGermany
| | - Klaus Matschke
- Department of Cardiac SurgeryUniversity Heart Center DresdenDresdenGermany
| | - Kevin Bienger
- Faculty of Medicine Carl Gustav CarusUniversity Center for Orthopedics, Trauma and Plastic SurgeryDresdenGermany
| | - Adrian Dragu
- Faculty of Medicine Carl Gustav CarusUniversity Center for Orthopedics, Trauma and Plastic SurgeryDresdenGermany
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Use of Adjunct Antiseptic Agents in Periprosthetic Joint Infections. J Am Acad Orthop Surg 2021; 29:e1151-e1158. [PMID: 34520439 DOI: 10.5435/jaaos-d-21-00154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/05/2021] [Indexed: 02/01/2023] Open
Abstract
Periprosthetic joint infection is a leading cause for failure of contemporary total hip arthroplasty and total knee arthroplasty projected to nearly double in the next decade and reach an economic burden of $1.85 billion in the United Sates by 2030. Although multiple treatments for periprosthetic joint infection have been described, a thorough débridement and joint lavage to decrease bacterial bioburden and to remove biofilm remains a critical component of treatment. Various adjunct antiseptic agents such as chlorhexidine, povidone-iodine, hydrogen peroxide, acetic acid, and chlorine compounds are currently in off-label use in this capacity. Each antiseptic agent, however, has a distinct mechanism of action and targets different organisms, and some combinations of agents may lead to tissue toxicity. In this review, currently available adjunct antiseptic washes will be described in detail based on their mechanism of action and the evidence for their use will be reviewed. Furthermore, this review puts forward an evidence-based treatment algorithm based on the specific causative organism.
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Abstract
Palliative wound care is a philosophy of wound management that prioritizes comfort over healing and attends to the emotional distress these wounds can cause. Intervention strategies focus on management of symptoms such as pain, odor, bleeding, and exudate. Historic treatments such as honey, chlorine, and vinegar have gained renewed interest, and although well suited to the palliative setting, there is an increasing amount of research exploring their efficacy in other contexts. The lived experience of patients and caregivers facing these wounds is often stressful and isolating, and any treatment plan must address these issues along with the physical aspects of care.
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Epps MT, Langsdon S, Pels TK, Lee TM, Thurston T, Brzezienski MA. Antimicrobial Irrigation and Technique during Breast Augmentation: Survey of Current Practice. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2310. [PMID: 31592371 PMCID: PMC6756664 DOI: 10.1097/gox.0000000000002310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 04/24/2019] [Indexed: 11/25/2022]
Abstract
Breast augmentation is among the most common procedures performed in the United States. Though bacterial contamination of breast prostheses is associated with adverse sequelae, there are no universally accepted guidelines and limited best practice recommendations for antimicrobial breast pocket irrigation. We designed a survey to identify pocket irrigation preferences and antimicrobial techniques during implant-based breast augmentation among American Society of Plastic Surgeons (ASPS) members. METHODS In January 2018, a random cohort of 2,488 ASPS members was surveyed. Questions queried breast pocket irrigation methods and surgical techniques including implant placement, incision location, and implant soaking agents. An extensive literature review of breast pocket irrigation practices was completed and used as a basis for the survey. RESULTS The survey response rate was above the ASPS average at 16% (n = 407). Respondents preferred an inframammary incision (90%) and submuscular implant placement (92%). Triple antibiotic solution (TAS) and TAS + Betadine ± Bacitracin were preferred by 61% and Betadine variants by 11%. Preferred dwell times stratified to 30 seconds (39%), 1 minute (18%), 2-5 minutes (21%), and >5 minutes (22%). Among those employing a TAS variant, 53% preferred a suboptimal dwell time of ≤1 minute. Prostheses were soaked in TAS (42%), TAS + Betadine ± Bacitracin (15%), a Betadine variant (12%), or other (31%). CONCLUSIONS Periprosthetic bacterial contamination leads to comorbidity following breast augmentation. Our results reveal significant variability regarding breast pocket irrigation techniques among ASPS members during cosmetic breast augmentation. These data suggest the need for best practice guidelines regarding breast pocket irrigation and implant soaking agents.
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Affiliation(s)
- Mathew T. Epps
- From the Department of Plastic and Reconstructive Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tenn
| | - Sarah Langsdon
- University of Tennessee College of Medicine, Memphis, Tenn
| | - Taylor K. Pels
- From the Department of Plastic and Reconstructive Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tenn
| | - Tara M. Lee
- From the Department of Plastic and Reconstructive Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tenn
| | - Todd Thurston
- From the Department of Plastic and Reconstructive Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tenn
| | - Mark A. Brzezienski
- From the Department of Plastic and Reconstructive Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tenn
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The downside of antimicrobial agents for wound healing. Eur J Clin Microbiol Infect Dis 2018; 38:39-54. [DOI: 10.1007/s10096-018-3393-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/26/2018] [Indexed: 02/01/2023]
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Mangum LC, Franklin NA, Garcia GR, Akers KS, Wenke JC. Rapid degradation and non-selectivity of Dakin's solution prevents effectiveness in contaminated musculoskeletal wound models. Injury 2018; 49:1763-1773. [PMID: 30104015 DOI: 10.1016/j.injury.2018.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/04/2018] [Accepted: 08/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dakin's solution (buffered sodium hypochlorite) has been used as a topical adjunct for the treatment of invasive fungal infections in trauma patients. Prudent use of Dakin's solution (DS) for complex musculoskeletal wound management implies balancing antimicrobial efficacy and human tissue toxicity, but little empirical evidence exists to inform clinical practice. To identify potentially efficacious DS concentrations and application methods, we conducted two animal studies to evaluate the ability of DS to reduce bacterial burden in small and large animal models of contaminated musculoskeletal wounds. METHODS An established rat (Rattus norvegicus) contaminated femoral defect model was employed to evaluate the antimicrobial efficacy of DS as a topical adjunctive treatment for Staphylococcus aureus infection. A range of clinically-relevant DS concentrations (0.00025%-0.125%) were tested, both with and without periodic replenishment during treatment. Next, an established goat (Capra hircus) musculoskeletal wound model, consisting of a Pseudomonas aeruginosa contaminated proximal tibia cortical defect, muscle crush, and thermal injury, was utilized to evaluate the antimicrobial efficacy of dilute DS (0.0025% and 0.025%) as a surgical irrigant solution. In situ reactive chlorine concentrations were monitored throughout each treatment using an automated iodometric titration approach. RESULTS In a rat wound model, DS treatment did not significantly reduce S. aureus bioburden after 14 days as compared to saline control. Two treatment groups (0.01% single application and 0.025% multiple application) exhibited significantly higher bacterial burden than control. In a goat musculoskeletal wound model, neither 0.0025% nor 0.025% DS significantly altered P. aeruginosa bioburden immediately following treatment or at 48 h post-treatment. Overall, DS applied to exposed soft tissue exhibited rapid degradation, e.g., 0.125% DS degraded 32% after 5 s progressing to 86% degradation after 15 min following single application. CONCLUSIONS We did not observe evidence of a therapeutic benefit following Dakin's solution treatment for any tested concentration or application method in two contaminated musculoskeletal wound models. Despite confirmation of robust bactericidal activity in vitro, our findings suggest DS at current clinically-used concentrations does not kill tissue surface-attached bacteria, nor does it necessarily cause host tissue toxicity that exacerbates infection in the setting of complex musculoskeletal injury.
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Affiliation(s)
- Lee C Mangum
- Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA.
| | - Nathan A Franklin
- Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA; Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Gerardo R Garcia
- Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Kevin S Akers
- Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA; Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Joseph C Wenke
- Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA
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Pierson RC, Scott NP, Briscoe KE, Haas DM. A review of post-caesarean infectious morbidity: how to prevent and treat. J OBSTET GYNAECOL 2018; 38:591-597. [DOI: 10.1080/01443615.2017.1394281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Rebecca C. Pierson
- Department of Obstetrics, Gynecology, and Women’s Health, University of Louisville, Louisville, KY, USA
| | - Nicole P. Scott
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA
| | - Kristin E. Briscoe
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - David M. Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA
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Aurora A, Beasy A, Rizzo JA, Chung KK. The Use of a Silver–Nylon Dressing During Evacuation of Military Burn Casualties. J Burn Care Res 2017; 39:593-597. [DOI: 10.1093/jbcr/irx026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Amit Aurora
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, Texas
| | - Alexander Beasy
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, Texas
| | - Julie A Rizzo
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryl
| | - Kevin K Chung
- Uniformed Services University of the Health Sciences, Bethesda, Maryl
- Brooke Army Medical Center, JBSA, Fort Sam Houston, Texas
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Commercial and Homemade Extremely Dilute Hypochlorous Acid Solutions Are Bactericidal Against Staphylococcus aureus and Escherichia coli In Vitro. J Equine Vet Sci 2015. [DOI: 10.1016/j.jevs.2014.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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