Christian Willy1, Catharina Scheuermann-Poley2, Marcus Stichling2, Thomas von Stein3, Axel Kramer4. 1. Klinik für Unfallchirurgie, Orthopädie, septisch-rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum septische Defektwunden, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland. christianwilly@bundeswehr.org. 2. Klinik für Unfallchirurgie, Orthopädie, septisch-rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum septische Defektwunden, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland. 3. Abteilung für Septische und Rekonstruktive Chirurgie, BG Unfallklinik Murnau, Prof.-Küntscher-Straße 8, 82418, Murnau, Deutschland. 4. Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Walter-Rathenau-Straße 49A, 17475, Greifswald, Deutschland.
Abstract
INTRODUCTION: Despite the use of modern antibiotics as well as complex perioperative, intraoperative and postoperative prophylactic measures, the rate of surgical site infections (SSI) could not be significantly reduced. The introduction of biocompatible antiseptic drugs with a high microbiocidal effect provided a successful alternative for infection prevention and therapy, particularly in a time of increasing occurrence of multi-drug resistant pathogens. Hence, questions about the risk-benefit ratio of antiseptic wound irrigation solutions, the prophylactic use of wound irrigation solutions for the reduction of SSI and the effect of negative pressure wound therapy combined with instillation (NPWTi) need to be answered. METHOD: Against the background of our own experiences with the use of antiseptic wound irrigation solutions, a literature analysis (e.g. computer-supported MEDLINE, EMBASE and Cochrane database research as of April 2017) was performed. RESULTS: Antiseptic fluids can be used both prophylactically and therapeutically, in acute and chronic, clean, contaminated and infected wounds to reduce the posttraumatic and postoperative wound infection rates. The antiseptic solutions that are commonly used in orthopedic and trauma surgery (e.g. PVP-iodine, octenidine, polyhexanide, sodium hypochlorite/hypochlorous acid and acetic acid), have in common that no development of resistance has so far been shown and that when the contraindications are taken into account, the antiseptic effect can develop without any clinically significant local and systemic side effects. As a rule the biocompatibility index is higher than 1 for the substances mentioned. In addition, they show an antiseptic effect against biofilms and multi-drug resistant pathogens. These antiseptic solutions can also be used for NPWTi with some limitations for octenidine. CONCLUSION: As the basic equipment in trauma surgery, a selection of three different antiseptic wound irrigation solutions for the reduction of the rates of posttraumatic and SSI can be recommended. The use of antiseptics should be reviewed on an ongoing basis in the daily clinical routine and particular attention should be paid to unwanted effects in the course of the healing process. After application of 7-14 days, the indications for continuing the use of the antiseptic solutions must be carefully re-evaluated.
INTRODUCTION: Despite the use of modern antibiotics as well as complex perioperative, intraoperative and postoperative prophylactic measures, the rate of surgical site infections (SSI) could not be significantly reduced. The introduction of biocompatible antiseptic drugs with a high microbiocidal effect provided a successful alternative for infection prevention and therapy, particularly in a time of increasing occurrence of multi-drug resistant pathogens. Hence, questions about the risk-benefit ratio of antiseptic wound irrigation solutions, the prophylactic use of wound irrigation solutions for the reduction of SSI and the effect of negative pressure wound therapy combined with instillation (NPWTi) need to be answered. METHOD: Against the background of our own experiences with the use of antiseptic wound irrigation solutions, a literature analysis (e.g. computer-supported MEDLINE, EMBASE and Cochrane database research as of April 2017) was performed. RESULTS: Antiseptic fluids can be used both prophylactically and therapeutically, in acute and chronic, clean, contaminated and infected wounds to reduce the posttraumatic and postoperative wound infection rates. The antiseptic solutions that are commonly used in orthopedic and trauma surgery (e.g. PVP-iodine, octenidine, polyhexanide, sodium hypochlorite/hypochlorous acid and acetic acid), have in common that no development of resistance has so far been shown and that when the contraindications are taken into account, the antiseptic effect can develop without any clinically significant local and systemic side effects. As a rule the biocompatibility index is higher than 1 for the substances mentioned. In addition, they show an antiseptic effect against biofilms and multi-drug resistant pathogens. These antiseptic solutions can also be used for NPWTi with some limitations for octenidine. CONCLUSION: As the basic equipment in trauma surgery, a selection of three different antiseptic wound irrigation solutions for the reduction of the rates of posttraumatic and SSI can be recommended. The use of antiseptics should be reviewed on an ongoing basis in the daily clinical routine and particular attention should be paid to unwanted effects in the course of the healing process. After application of 7-14 days, the indications for continuing the use of the antiseptic solutions must be carefully re-evaluated.
Authors: Suhas V Abhyankar; Veena Venkatesh; Savita Karnad; K P Kulkarni; Manpreet Juneja; Bheem Singh Nanda; T Saifulla Journal: J Indian Med Assoc Date: 2009-12
Authors: Duane R Hospenthal; Clinton K Murray; Romney C Andersen; Jeffrey P Blice; Jason H Calhoun; Leopoldo C Cancio; Kevin K Chung; Nicholas G Conger; Helen K Crouch; Laurie C D'Avignon; James R Dunne; James R Ficke; Robert G Hale; David K Hayes; Erwin F Hirsch; Joseph R Hsu; Donald H Jenkins; John J Keeling; R Russell Martin; Leon E Moores; Kyle Petersen; Jeffrey R Saffle; Joseph S Solomkin; Sybil A Tasker; Alex B Valadka; Andrew R Wiesen; Glenn W Wortmann; John B Holcomb Journal: J Trauma Date: 2008-03
Authors: Ricardo Becerro de Bengoa Vallejo; Marta Elena Losa Iglesias; Luis Alou Cervera; David Sevillano Fernández; José Prieto Prieto Journal: J Am Acad Dermatol Date: 2010-11-26 Impact factor: 11.527
Authors: Romana Klasinc; Lee Ann Augustin; Harald Below; Romy Baguhl; Ojan Assadian; Elisabeth Presterl; Axel Kramer Journal: Int Wound J Date: 2017-11-24 Impact factor: 3.315
Authors: Omri Maayan; Christopher Babu; Miguel E Tusa Lavieri; Jason Chua; Paul J Christos; Theodore H Schwartz Journal: Acta Neurochir (Wien) Date: 2022-01-14 Impact factor: 2.816
Authors: Paul J Kim; Christopher E Attinger; Thomas Constantine; Brett D Crist; Elizabeth Faust; Christoph R Hirche; Lawrence A Lavery; Valerie J Messina; Norihiko Ohura; Laurie J Punch; Garrett A Wirth; Ibby Younis; Luc Téot Journal: Int Wound J Date: 2019-10-30 Impact factor: 3.315