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Langen S, Lötscher P, Prost J, Bovet C, Vögelin E, Surke C. A prospective study to analyse the concentration of octenidine in hand wounds after disinfection by LC-MS/MS. Int Wound J 2023; 21:e14425. [PMID: 37846874 PMCID: PMC10828719 DOI: 10.1111/iwj.14425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/18/2023] Open
Abstract
Toxic reactions can appear after pressurised flushing of soft tissue with octenidine (OCT) containing disinfectants. Their use for surgical disinfection could complicate the diagnosis of possible contamination. In patients with open lacerations of their hand's subcutaneous tissue samples were taken before and after surgical disinfection with Octenisept® and analysed by ultra-high-performance liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). In 16 out of 20 tissue samples, OCT was detected after disinfection (lower limit of quantification (LLOQ)=10 pg/mL/mg). The concentration of OCT was below the LLOQ, estimation of mean of 0.6 pg/mL/mg (0.22-0.98 pg/mL/mg, 95%-CI) before disinfection and mean of 179.4 pg/mL/mg (13.35-432.0 pg/mL/mg, 95%-CI) after disinfection. This study shows that the disinfection of open wounds with Octenisept® leads to a quantifiable concentration of OCT in open wounds. In cases of suspected OCT-mediated toxic reaction, the use of antiseptics containing OCT should be avoided.
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Affiliation(s)
- Susanne Langen
- Department of Plastic and Hand Surgery, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Patrick Lötscher
- Department of Plastic and Hand Surgery, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Jean‐Christophe Prost
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Cédric Bovet
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Esther Vögelin
- Department of Plastic and Hand Surgery, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Carsten Surke
- Department of Plastic and Hand Surgery, InselspitalBern University Hospital, University of BernBernSwitzerland
- Arcademy StockholmStockholmSweden
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Beschastnov VV, Egorikhina MN, Tulupov AA, Pogodin IE, Orlinskaya NY, Antoshina VV, Shirokova IY, Ryabkov MG. Immobilization of Bacteriophages in Ex Tempore Hydrogel for the Treatment of Burn Wound Infection. Gels 2023; 9:625. [PMID: 37623080 PMCID: PMC10453372 DOI: 10.3390/gels9080625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
The resistance of bacteria to antibiotics is a major problem for anti-bacterial therapy. This problem may be solved by using bacteriophages-viruses that can attack and destroy bacteria, including antibiotic-resistant ones. In this article, the authors compared the efficacy of topical bacteriophage therapy and systemic antibiotic therapy in the treatment of wound infections caused by ESKAPE pathogens in patients with limited (less than 5% of the body surface) full-thickness burns. Patients in the study group (n = 30) were treated with PVA-based hydrogel dressings saturated ex tempore with a bacteriophage suspension characterized by its lytic activity against the bacteria colonizing the wound. Patients in the control group (n = 30) were treated using etiotropic systemic antibiotic therapy, and the wounds were covered with gauze bandages soaked in an aqueous solution of povidone-iodine. An assessment of the decrease in the level of bacterial contamination of the recipient wounds in both groups was conducted after 7 days, and after that, free skin grafting was performed. On day 14 after free skin grafting, patients in both groups underwent incisional biopsy. The study group demonstrated an increase in the indices of proliferative activity (Ki-67), and angiogenesis (CD-31, VEGF) in the area of engraftment of the split-thickness skin grafts. The results indicate that PVA-based hydrogel wound dressings can be used as bacteriophage carriers for local antimicrobial therapy ahead of free skin grafting.
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Affiliation(s)
| | | | | | | | | | | | | | - Maksim G. Ryabkov
- University Clinic, Privolzhsky Research Medical University, Nizhny Novgorod 603155, Russia; (V.V.B.); (M.N.E.); (A.A.T.); (I.E.P.); (N.Y.O.); (V.V.A.); (I.Y.S.)
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Wiegand C, Eberlein T, Andriessen A. Antibacterial activity of polihexanide formulations in a co-culture of HaCaT keratinocytes and Staphylococcus aureus and at different pH levels. Wound Repair Regen 2017; 25:423-431. [PMID: 28370821 DOI: 10.1111/wrr.12528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/31/2017] [Indexed: 11/27/2022]
Abstract
Complex stalled wounds feature an alkaline milieu that favors tissue destruction and microbial growth. The presence of bacteria in turn perpetuates the inflammatory response. However, only limited knowledge exists of pH dependency on the antibacterial efficacy of polyhexamethylene biguanide (PHMB) or the influence of surfactants or delivery vehicle used in antiseptic formulations. So far, PHMB alone has been shown to protect the keratinocytes from bacterial damage in such a co-culture system as well as exhibiting increased antimicrobial activity at higher pH values. Here, the interaction of PHMB with the surfactants macrogolum and undecylenamidopropyl betaine that are most commonly used as additives in antiseptics and rinsing solutions such as Lavasept and Prontosan has been explored in addition to the PHMB-containing biocellulose dressing Suprasorb X + PHMB. Undecylenamidopropyl betaine was found to lower the antimicrobial activity of polihexanide in the co-culture system, while macrogolum and the biocellulose increased polihexanide efficiency to reduce Staphylococcus aureus especially in the presence of serum. The increasing antibacterial efficacy of PHMB with rising pH was not altered by undecylenamidopropyl betaine, macrogolum, or the biocellulose. The results suggest that application of PHMB with macrogolum or by delivery through a biocellulose dressing might be advantageous for management of wound infections.
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Affiliation(s)
- Cornelia Wiegand
- Department of Dermatology, University Hospital Center Jena, Jena, Germany
| | | | - Anneke Andriessen
- Malden & UMC St Radboud, Andriessen Consultants, Nijmegen, The Netherlands
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Kaiser S, Kramer M, Thiel C. [Severe complications after non-intended usage of octenidine dihydrochloride. A case series with four dogs]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2015; 43:291-298. [PMID: 26353826 DOI: 10.15654/tpk-150029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Case series of four dogs in which extensive bite wounds had been treated using octenidine dihydrochloride (Octenivet® or Octenisept®) flushing. The dogs subsequently developed severe local complications. MATERIAL AND METHODS Retrospective evaluation of clinical symptoms, diagnostics, therapy and course of the disease. RESULTS In four dogs, severe necrosis and persistent edematous changes of the treated area developed after the application of octenidine dihydrochloride. The clinical course was comparable to complications described previously in human medicine. Therapy was protracted and complicated by secondary wound infection. CONCLUSION AND CLINICAL RELEVANCE Irrigation of deep wounds, particularly bite wounds, using octenidine dihydrochloride without drainage may lead to persistent edematous changes, inflammatory reactions and necrosis. The inappropriate application of octenidine dihydrochloride for wound irrigation should be avoided in veterinary medicine.
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Affiliation(s)
- S Kaiser
- Dr. Susanne Kaiser, Klinikum Veterinärmedizin, Klinik für Kleintiere (Chirurgie), der Justus-Liebig-Universität Gießen, Frankfurter Straße 108, 35392 Gießen, E-Mail:
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Röhner E, Hoff P, Winkler T, von Roth P, Seeger JB, Perka C, Matziolis G. Polyhexanide and hydrogen peroxide inhibit proteoglycan synthesis of human chondrocytes. J Histotechnol 2013; 34:35-39. [PMID: 21731121 PMCID: PMC3093610 DOI: 10.1179/014788811x12949268296121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The use of local antiseptics is a common method in septic joint surgery. We tested polyhexanide and hydrogen peroxide, two of the most frequently used antiseptics with high efficacy and low toxicity. The purpose of this study was to evaluate the effects of both antiseptics on the extracellular cartilaginous matrix synthesis of human chondrocytes. Chondrocytes were isolated from donated human knee joints, embedded in alginate beads, and incubated for 10 and 30 minutes with polyhexanide (0.04%), hydrogen peroxide (3%), or phosphate-buffered saline (PBS) for control. Cartilaginous matrix production was quantified through light microscopic analysis of Alcian blue staining. Cell number and morphology were detected by histological analysis. Chondrocytes showed a decreased intensity of blue colouring after antiseptic treatment versus PBS. In contrast to that, neither the cell number per view field nor the cell morphology differed between the groups. Polyhexanide has more toxic potential than hydrogen peroxide. Based on the fact that the cell number and morphology was not altered by the substances at the examined concentrations, the lower intensity of Alcian blue staining of treated chondrocytes indicates a decreased cartilage-specific matrix synthesis by polyhexanide more than by hydrogen peroxide and control.
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Röhner E, Hoff P, Pfitzner T, Seeger JB, Buttgereit F, Perka C, Matziolis G. Limited Use of Antiseptics in Septic Surgery. J INVEST SURG 2012; 25:311-6. [DOI: 10.3109/08941939.2011.648718] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tiemann AH, Hofmann GO. Wound irrigation within the surgical treatment of osteomyelitis. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2012; 1:Doc08. [PMID: 26504692 PMCID: PMC4582480 DOI: 10.3205/iprs000008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The basic treatment of osteomyelitis remains even today the surgical debridement in combination with a wound irrigation by lavage systems. Next to a comprehensive knowledge of the surgical techniques a profound knowledge of the lavage systems, the rinsing solutions used and the philosophies of revision programs are a must. In this article the typical hardware of modern lavage systems is analysed, their advantages and disadvantages are pointed out. In addition we investigate the value of common antiseptic wound irrigation solutions for their use in osteomyelitis therapy. Finally the two basic philosophies of wound revision and irrigation in the course of osteomyelitis therapy are presented and discussed.
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Affiliation(s)
- A H Tiemann
- BG-Kliniken Bergmannstrost, Klinik für Unfall- und Wiederherstellungschirurgie, Abteilung für Septische und Rekonstruktive Chirurgie, Halle, Germany
| | - G O Hofmann
- BG-Kliniken Bergmannstrost, Klinik für Unfall- und Wiederherstellungschirurgie, Halle, Germany ; Friedrich-Schiller-Universität Jena, Kliniken für Unfall-, Hand- und Wiederherstellungschirurgie, Jena, Germany
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Franz T, Vögelin E. Aseptic tissue necrosis and chronic inflammation after irrigation of penetrating hand wounds using Octenisept®. J Hand Surg Eur Vol 2012; 37:61-4. [PMID: 21816890 DOI: 10.1177/1753193411414353] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Penetrating hand wounds are common and these are managed by thorough debridement. However, stab wounds without evidence of divided structures are often treated with irrigation using antiseptic substances, antibiotic therapy, and immobilization. Octenisept® (Schülke & Mayr Ltd) is a widely used antiseptic agent for disinfection of acute or chronic wounds. It has a broad spectrum of antiseptic efficacy and has become an antiseptic of first choice in many hospitals. Within a few months, four patients presented to us with chronic inflammation and severe tissue necrosis after irrigation of penetrating hand wounds with Octenisept®. Repeated surgery and debridement was required in all patients. Wound healing was prolonged and patients had persisting oedema. Penetrating hand wounds must not be irrigated with Octenisept®.
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Affiliation(s)
- T Franz
- Department of Plastic and Hand Surgery, Inselspital Berne, University Hospital, Berne, Switzerland.
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Röhner E, Kolar P, Seeger JB, Arnholdt J, Thiele K, Perka C, Matziolis G. Toxicity of antiseptics against chondrocytes: what is best for the cartilage in septic joint surgery? INTERNATIONAL ORTHOPAEDICS 2011; 35:1719-23. [PMID: 21240607 PMCID: PMC3193958 DOI: 10.1007/s00264-010-1178-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 11/20/2010] [Accepted: 11/20/2010] [Indexed: 11/30/2022]
Abstract
In septic joint surgery, the most frequently used antiseptics are polyhexanide, hydrogen peroxide and taurolidine. The aim of this study was to examine the effects of these antiseptics on viability of human chondrocytes. Our hypothesis was that antiseptics and supplemental irrigation with sodium chloride lavage are less toxic on human chondrocytes than treatment with antiseptics only. Primary human chondrocytes were isolated and cultured from six donated human knee joints. Polyhexanide, hydrogen peroxide or taurolidine were added to the cultures. Toxicity analysis was performed by visualisation of cell structure using light microscopy and LDH activity. The determination of vital cells and total cell numbers of chondrocytes treated with antiseptics partly followed by irrigation with sodium chloride solution was performed by using Casy Cell-Counter. Light microscopic data revealed a defect in cell structure after addition of antiseptics. We showed a significant increase of LDH enzyme activity after the treatment with polyhexanide or taurolidine. After treatment with antiseptics followed by sodium chloride solution a significant increase of vital and total cell numbers resulted in comparison with the chondrocytes that were only treated with antiseptics. The data show that treatment with polyhexanid, hydrogen peroxide or taurolidine induces cell death of human chondroctes in vitro. The application of sodium chloride solution after the treatment with polyhexanide and hydrogen peroxide possibly has a protective effect on chondrocyte viability.
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Affiliation(s)
- Eric Röhner
- Department of Traumatology and Orthopaedics, Charité - Universitätsmedizin, Berlin, Germany.
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11
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Röhner E, Seeger JB, Hoff P, Pfitzner T, Preininger B, Andreas K, Buttgereit F, Perka C, Matziolis G. Preferred use of polyhexanide in orthopedic surgery. Orthopedics 2011; 34:e664-8. [PMID: 21956063 DOI: 10.3928/01477447-20110826-10] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In orthopedic and trauma surgery, the most frequently used antiseptic is polyhexanide. Its favored application is based on prepossessing tissue compatibility in contrast to various antiseptics and a high antimicrobiological effect. Recent studies showed toxic effects of this antiseptic on human chondrocytes. The aim of this study was to further analyze the toxic and apoptotic effects of polyhexanide on primary human chondrocytes. The hypothesis of this study was that polyhexanide induces apoptosis on human chondrocytes. Primary human chondrocytes were isolated and cultured from human donors with osteoarthritis of the knee who underwent total arthroplasty and had no indication of infection. Polyhexanide at a standard concentration of 0.04% was added to the monolayer cultures. Early and late apoptotic cells were analyzed by flow cytometric detection of annexin V, active caspases, and 7AAD, and by fluorescence microscopy using annexin V and propidium iodide staining. Flow cytometric analysis demonstrated an increase of annexin V and active caspases expression of human chondrocytes after incubation with polyhexanide. Fluorescence microscopy demonstrated a high number of annexin V positive and propidium iodide negative early apoptotic cells. The data show that polyhexanide promotes apoptosis on primary human chondrocytes in vitro, which may indicate the use of polyhexanide in septic joint surgery.
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Affiliation(s)
- Eric Röhner
- Department of Traumatology and Orthopedics, Charité – Universitätsmedizin, Berlin, Germany.
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Röhner E, Seeger JB, Hoff P, Dähn-Wollenberg S, Perka C, Matziolis G. Toxicity of polyhexanide and hydrogen peroxide on human chondrocytes in vitro. Orthopedics 2011; 34:e290-4. [PMID: 21717992 DOI: 10.3928/01477447-20110526-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The treatment of acute joint infections has an important impact on long-term outcome and remains an unsolved problem. The most frequent bacteria are staphylococci, streptococci, and gram-negative bacteria. In septic surgery, polyhexanide and hydrogen peroxide are the most frequently used local antiseptics. The aim of this study was to examine the hypothesis that antiseptics induce cell death of human chondrocytes after a short incubation time.Human chondrocytes were treated with different concentrations of polyhexanide and hydrogen peroxide. Toxicity analysis was determined by visualization of cell structure using light microscopy, lactate dehydrogenase release, and determination of living and total cell numbers after addition of polyhexanide and hydrogen peroxide. Light microscopic data revealed a defect cell structure after addition of both antiseptics. Lactate dehydrogenase activity showed a significant increase of enzyme expression after a short incubation with polyhexanide. The determination of vital chondrocytes showed a significant decrease of vital and total cell numbers after addition with polyhexanide and hydrogen peroxide.Both antiseptic solutions induce significant cell death of human chondrocytes after a short incubation time. Polyhexanide possibly has more toxic potential than hydrogen peroxide against human chondrocytes after an application >15 minutes. Therefore, both substances should only be applied for a short time (<15 minutes) and the joint irrigated to wash out the antiseptic substance prior to wound closure.
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Affiliation(s)
- Eric Röhner
- Department of Traumatology and Orthopedics, and Dr Hoff is from the Department of Rheumatology and Clinical Immunology, Charité--Universitätsmedizin, Berlin, Germany.
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Marquardt C, Matuschek E, Bölke E, Gerber PA, Peiper M, V Seydlitz-Kurzbach J, Buhren BA, van Griensven M, Budach W, Hassan M, Kukova G, Mota R, Höfer D, Orth K, Fleischmann W. Evaluation of the tissue toxicity of antiseptics by the hen's egg test on the chorioallantoic membrane (HETCAM). Eur J Med Res 2010; 15:204-9. [PMID: 20562059 PMCID: PMC3352009 DOI: 10.1186/2047-783x-15-5-204] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Antiseptics are frequently used for the prophylaxis and treatment of local infections of chronic wounds. Whereas local antiseptics in general have a positive effect on wound healing an uncritical use may impair wound healing due to toxic side effects. Objective We sought to assess the vascular irritation potential of different antiseptic solutions and ointments commonly used for short and long term application as a measure of tissue toxicity. Method The vascular irritation was evaluated by the hen's egg test (HET) on the chorioallantoic membrane (CAM). The effects on the vessels of a mucous membrane were directly assessed by stereomicroscopic observation in vivo. Results Severe CAM irritation was observed after short-term applications of 1% octenidin-2HCl (Octeni sept™), 72% isopropanol (Cutasept™), 0.35% chloroxylenol (Dettol™) and 10% PVP-I ointment (Betaisodona™). Medium irritations were observed for 10% PVP-I solution (Betaisodona™), 3% lysosomal PVP-I ointment (Repithel™), 1.8% cadexomer-iodine ointment (Iodosorb™) and 1% cadexomer-iodine pellets (Iodosorb™). Finally, slight irritations were observed for 1% PVP-I solution (Betaisodona™), 0.1% polyhexanid plus betain (Prontosan™) and 1% silver-sulfadiazine ointment (Flammazine™), whereas 0.04% polyhexanid solution (Lavanid™), washings from sterile maggots of Lucilia sericata and filtrated enzymes from Clostridium histolyticum (Iruxol-N™) showed no effects of irritation. In the long-term approaches, no vascular irritations were found for polyhexanid, washings from Lucilia sericata and enzyme filtrations from Clostridium histolyticum. Conclusion The vascular injuries caused by the studied antiseptics are an indirect indicator of their tissue toxicity. Strikingly, even therapeutic substances, which have been regarded as safe in their application for the treatment of chronic wounds in clinical studies, showed severe irritations on the CAM. We suggest that agents with no or low irritation potential on the CAM should be preferred in the clinical practice in order to obtain optimal results.
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Affiliation(s)
- C Marquardt
- Department of General and Visceral Surgery, Klinikum Ludwigsburg, Germany
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Abstract
PURPOSE Local skin antiseptics are the standard of care for chronic and non-healing wounds. However, little is known about their potential toxic properties. This study investigates the impact of three commercially available and widely used antiseptics on vitality and proliferation of human cutaneous cells. MATERIAL AND METHODS Three antiseptics, Lavasept (PHMB), Octenisept (octenidine) and Betaisodona (PVP-iodine) were tested for their cytotoxic effects towards HaCaT cells, primary human keratinocytes and fibroblasts using MTT assay and BrDU ELISA. RESULTS Lavasept showed only slight to moderate toxic effects on cellular vitality and proliferation. Ocentisept and Betaisodona induced severe reduction of cell vitality (p<0.05) to 0% surviving fibroblasts at 7.5% (Betaisodona) and 12.5% Octenisept, respectively. Furthermore, poliferative activity was reduced to 0% in keratinocytes at 7.5% concentration of Betaisodona and Ocentisept. CONCLUSION This study shows that frequently used wound- and skin antiseptics show severe cytotoxic effects towards cutaneous cells. Furthermore, antimicrobial efficacy and toxic properties must be included in the clinical decision process for optimal therapy of chronic wounds. The PHMB solution Lavasept showed best results regarding toxicity in this study.
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Bischofberger AS, Fürst A, Auer J, Lischer C. Surgical management of complete diaphyseal third metacarpal and metatarsal bone fractures: clinical outcome in 10 mature horses and 11 foals. Equine Vet J 2009; 41:465-73. [PMID: 19642407 DOI: 10.2746/042516409x389388] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Osteosynthesis of third metacarpal (McIII) and third metatarsal (MtIII) bone fractures in horses is a surgical challenge and complications surrounding the repair are common. Retrospective studies evaluating surgical repair, complications and outcome are necessary to increase knowledge and improve success of long bone fracture repair in the horse. OBJECTIVES To evaluate clinical findings, surgical repair, post operative complications and outcome of 10 mature horses and 11 foals with McIII or MtIII fractures that were treated with open reduction and internal fixation (ORIF). METHODS Medical records were reviewed and follow-up information obtained by means of radiographs and/or telephone questionnaire. RESULTS Survival was achieved in 62% of the horses (3 mature/10 foals). On long-term evaluation (> 6 months) 11 horses (2 mature/9 foals) were fit for their intended activity, one mature horse had a chronic low grade lameness, and one foal was lost to follow-up because it was sold. The main fracture types were simple transverse (333%) or simple oblique (28.6%) and 71.4% of the fractures were open, 3 Type I (one mature/2 foals) and 12 type II (7 mature/5 foals). The preoperative assessment revealed inadequate emergency treatment in 10 horses (5 mature/5 foals; 47.6%). Survival rate of horses with open fractures was 12.5% (1/8) in mature and 85.7% (6/7) in foals. Post operative incisional infection (4 mature, 3 foals) was only managed successfully in 2 foals. Fracture instability related to inadequate fracture fixation technique occurred in 4 horses (all mature) and was always associated with unsuccessful outcome. CONCLUSIONS Age, bodyweight and infection are strongly associated with outcome in treatment of complete McIII/MtIII fractures. CLINICAL RELEVANCE Rigid fixation using plates and screws can be successful in treatment of closed or open, complete diaphyseal McIII/MtIII fractures in mature horses and foals. Instable fixation, infection and a bodyweight > 320 kg are major risk factors for unsuccessful outcome.
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Affiliation(s)
- A S Bischofberger
- University Veterinary Teaching Hospital of Camden, Faculty of Veterinary Science, University of Sydney, Camden, New South Wales, Australia
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Hirsch T, Koerber A, Jacobsen F, Dissemond J, Steinau HU, Gatermann S, Al-Benna S, Kesting M, Seipp HM, Steinstraesser L. Evaluation of toxic side effects of clinically used skin antiseptics in vitro. J Surg Res 2009; 164:344-50. [PMID: 19726054 DOI: 10.1016/j.jss.2009.04.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 03/25/2009] [Accepted: 04/01/2009] [Indexed: 12/01/2022]
Abstract
BACKGROUND Skin antiseptics are widely used in health-care worldwide. However, there is a need to determine cytotoxicity of these medications on wounds. The aim of this study was to evaluate cytotoxic effects of five clinically used antiseptics on human skin cells. MATERIAL AND METHODS Five clinically used skin antiseptics (Prontosan, Lavasept, Braunol, Octenisept, and Betaisodona) were tested. The minimal inhibitory concentration was determined against Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, and Escherichia coli). The cytotoxic effects on primary keratinocytes, fibroblasts, and a HaCaT cell line were determined (MTT-assay and BrdU-ELISA) at a wide range of concentrations. RESULTS The agents tested showed effective antibacterial properties (Octenisept, Lavasept, and Prontosan showed higher efficacy than Braunol and Betaisodona) and different degrees of cytotoxicity. Lavasept and Prontosan demonstrated less toxicity on primary human fibroblasts and keratinocytes, whereas Octenisept, Betaisodona, and Braunol showed a significant (P<0.05) decrease in cell viability to 0% on keratinocytes at concentrations of 4%, 7.5%, and 12.5%, and on fibroblasts at 7.5% and 10%, respectively. CONCLUSION Due to the cytotoxic effect of some antiseptics on human skin cells, it is advised that health care professionals balance the cytotoxicity of the medication, their antiseptic properties, and the severity of colonization when selecting a wound care antiseptic. In this study, Lavasept and Prontosan showed best result regarding antibacterial efficacy and cell toxicity.
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Affiliation(s)
- Tobias Hirsch
- Department of Plastic Surgery, Ruhr University Bochum, Bochum, Germany
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Ryssel H, Kloeters O, Germann G, Schäfer T, Wiedemann G, Oehlbauer M. The antimicrobial effect of acetic acid--an alternative to common local antiseptics? Burns 2009; 35:695-700. [PMID: 19286325 DOI: 10.1016/j.burns.2008.11.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 11/17/2008] [Indexed: 10/21/2022]
Abstract
Acetic acid has been commonly used in medicine for more than 6000 years for the disinfection of wounds and especially as an antiseptic agent in the treatment and prophylaxis of the plague. The main goal of this study was to prove the suitability of acetic acid, in low concentration of 3%, as a local antiseptic agent, especially for use in salvage procedures in problematic infections caused by organisms such as Proteus vulgaris, Acinetobacter baumannii or Pseudomonas aeruginosa. This study was designed to compare the in vitro antimicrobial effect of acetic acid with those of common local antiseptics such as povidone-iodine 11% (Betaisodona), polyhexanide 0.04% (Lavasept), mafenide 5% and chlohexidine gluconate 1.5% cetrimide 15% (Hibicet). Former studies suggest the bactericidal effect of acetic acid, but these data are very heterogeneous; therefore, a standardised in vitro study was conducted. To cover the typical bacterial spectrum of a burn unit, the following Gram-negative and Gram-positive bacterial strains were tested: Escherichia coli, P. vulgaris, P. aeruginosa, A. baumannii, Enterococcus faecalis, Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA) and beta-haemolytic Streptococcus group A and B. The tests showed excellent bactericidal effect of acetic acid, particularly with problematic Gram-negative bacteria such as P. vulgaris, P. aeruginosa and A. baumannii. The microbiological spectrum of acetic acid is wide, even when tested at a low concentration of 3%. In comparison to our currently used antiseptic solutions, it showed similar - in some bacteria, even better - bactericidal properties. An evaluation of the clinical value of topical application of acetic acid is currently underway. It can be concluded that acetic acid in a concentration of 3% has excellent bactericidal effect and, therefore, seems to be suitable as a local antiseptic agent, but further clinical studies are necessary.
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Affiliation(s)
- H Ryssel
- Department of Hand, Plastic and Reconstructive Surgery and Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.
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Timmers MS, Graafland N, Bernards AT, Nelissen RGHH, van Dissel JT, Jukema GN. Negative pressure wound treatment with polyvinyl alcohol foam and polyhexanide antiseptic solution instillation in posttraumatic osteomyelitis. Wound Repair Regen 2009; 17:278-86. [DOI: 10.1111/j.1524-475x.2009.00458.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Daeschlein G, Assadian O, Bruck JC, Meinl C, Kramer A, Koch S. Feasibility and clinical applicability of polihexanide for treatment of second-degree burn wounds. Skin Pharmacol Physiol 2007; 20:292-6. [PMID: 17717425 DOI: 10.1159/000107577] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 05/10/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Due to a partial rejection of mesh split-thickness skin grafts (mesh grafts) after application of povidone-iodine and silver nitrate and due to its better in vitro tolerance, polihexanide was investigated as an alternative and its applicability in the treatment of second-degree burn wounds. METHODS In 4 patients with poorly healing decubitus ulcers the mesh grafts were each divided into three areas which were pre-treated with either undiluted povidone-iodine solution, 1% silver nitrate solution or 0.04% polihexanide solution. After 7 days of application the wound areas were compared clinically and histologically. Thereafter 14 patients (average extent of burns 28% TBSA) were treated in the same way. RESULTS Clinically and histologically the mesh grafts treated with polihexanide showed by far the best re-epithelialization compared with the deep tissue necrosis and marked fibrin discharge observed for application of povidone-iodine and silver nitrate. The second-degree burn wounds treated with polihexanide epithelialized without any further débridement after an average of 10 days with remarkable freedom from pain. Compared with silver nitrate treatment, no fibrin film was observed on the wound. CONCLUSION Polihexanide proved clinically and histologically superior to povidone-iodine and silver nitrate. For the treatment of second-degree burns, which cannot primarily be covered by plastic surgery, polihexanide is suitable because in addition to its antiseptic efficacy it does not inhibit the re-epithelialization process.
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Affiliation(s)
- G Daeschlein
- Institute of Hygiene and Environmental Medicine, Ernst Moritz Arndt University, Greifswald, Germany
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Lauber S, Schulte TL, Götze C, Steinbeck J, Bottner F. Acute compartment syndrome following intramedullary pulse lavage and débridement for osteomyelitis of the tibia. Arch Orthop Trauma Surg 2005; 125:564-6. [PMID: 16151822 DOI: 10.1007/s00402-005-0005-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Indexed: 11/25/2022]
Abstract
The implantation of gentamicin loaded polymethylmethacrylate (PMMA) beats and other local antibiotic carriers is a common practice in the treatment of chronic osteomyelitis as is the use of local jet lavage débridement. This article presents the case of a patient with chronic osteomyelitis of the tibia, who had no complication after débridement, intramedullary reaming and pulse lavage without tourniquet but sustained a compartment syndrome 2 weeks later during a second procedure in which an intraoperative tourniquet and pulse lavage were combined.
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Affiliation(s)
- S Lauber
- Department of Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Str. 33, 48149 Münster, Germany.
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Abstract
BACKGROUND Peritonitis is the established term for infective inflammation of the peritoneum, whereas serositis generally refers to aseptic inflammation of a serous cavity, including the peritoneum. Serositis may be metabolic, viral, autoimmune, drug induced, genetic, allergic or granulomatous, or due to chemical antiseptics. CASES In our gynecological department, 4 patients had peritonitis and ascites after laparotomy. CONCLUSION Based on the investigation, we think that the solution used for peritoneal lavage (0.1% octenidine dihydrochloride and 2% phenoxyethanol) played a role in the tissue toxicity that caused chemical serositis with effusion.
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Affiliation(s)
- Petronella Hupuczi
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
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