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Advanced wound care with stable, super-oxidized water: A look at how combination therapy can optimize wound healing
... The treatment has also been used successfully for abdominal wounds with exposed polypropylene or biological mesh. 27 It is important to emphasize that negative-pressure wound therapy with instillation should not be used as a substitute for appropriate medical and surgical care. ...
... 44,45 Microcyn and Dermacyn have been used effectively and safely as the solution of choice for negative-pressure wound therapy with instillation. 27 Although the above solutions received the highest level of consensus, other instillation solutions have been used by the expert panel, notably 0.25% and 1% diluted acetic acid, diluted iodine, and 0.125% sodium hypochlorite (Dakin's solution). Furthermore, antibiotics alone, as well as cocktails utilizing antibiotics mixed with local anesthetics (1%, 2% lidocaine plain), have been used to address painful wounds. ...
Negative pressure wound therapy with instillation (NPWTi) is increasingly utilized as an adjunct therapy for a wide variety of wounds. Despite its growing popularity, there is a paucity of evidence and lack of guidance to provide effective use of this therapy.
A panel of experts was convened to provide guidance regarding the appropriate use of NPWTi. This included a face-to face meeting where the available evidence was discussed as well as individual clinical experience with this therapy was shared. Follow-up communication amongst the panelists continued until consensus was achieved. The final consensus recommendations were derived through >80% agreement amongst the panelists.
Nine consensus statements were generated that address the appropriate use of NPWTi. The question of clinical effectiveness of NPWTi was not directly addressed by this consensus panel.
This document serves as preliminary guidelines until more robust evidence emerges that will support or modify these consensus recommendations.
Therapeutic, V.
... 43 ECA technology was pioneered in Russia in the 1970s where ECA solutions have been used extensively for over 30 years, for drinking water disinfection, swimming pool disinfection, as the general disinfectant in hospitals, as wound irrigants, as nebulised inhalant sprays and many other infection control applications with no apparent harmful effects. [44][45][46][47][48] Since the 1970s, several generations of FEM have been developed, with the FEM-3 being one of the more recent. 45,46 Production of ECA solutions with consistent quality and properties was techni-j o u r n a l o f d e n t i s t r y 3 8 ( 2 0 1 0 ) 9 3 0 -9 4 0 cally difficult prior to the advent of FEM-3 technology. ...
... 8 There are few quantitative scientific publications outside of Russia that have investigated potential health effects of ECA solutions, although they have been used extensively for over 30 years with no reported harmful effects. [44][45][46][47][48] In the present study, oral keratinocyte monolayers of TR146 cells were selected as a preliminary model for assessing the biocompatibility of Ecasol because their survival rate is high and they have been shown to be suitable for cytotoxicity testing if reproducibility is a prerequisite. [60][61][62] Furthermore, keratinocytes are the first cells to be exposed to potential irritants in vivo. ...
We previously showed that residual treatment of dental chair unit (DCU) supply water using the electrochemically-activated solution Trustwater Ecasol™ (2.5 ppm) provided an effective long-term solution to the problem of dental unit waterline (DUWL) biofilm resulting in DUWL output water quality consistently superior to potable water.
To investigate the cytoxicity of Ecasol using cultured keratinocyte monolayers and reconstituted human oral epithelial (RHE) tissue and to extend the study of Ecasol's effectiveness in maintaining the microbiological quality of DUWL output water.
TR146 human keratinocyte monolayers and RHE tissues were exposed to Ecasol (2.5-100 ppm) for 1h periods after removal of growth medium and washing with phosphate-buffered saline (PBS). Experiments were repeated using Ecasol that had been exposed for 30 min to 1-2mg/mL bovine serum albumin (BSA), equivalent to protein concentrations in saliva. To quantitatively determine cytotoxic effects on monolayers following Ecasol exposure, the Alamar Blue proliferation assay (assesses cell viability) and the Trypan Blue exclusion assay (assesses plasma membrane integrity), were used. Cytotoxicity effects on RHE tissues were assessed by the Alamar Blue assay and by histopathology.
Ecasol at >5.0 ppm resulted in significant (P<0.001) cytotoxicity to keratinocyte monolayers following a 1h exposure. These effects, however, were completely negated by BSA pretreatment of Ecasol. No cytotoxicity was observed in the more complex RHE tissue at any of the Ecasol concentrations tested. In a 60-week study of 10 DCUs, tested weekly, the average density of aerobic heterotrophic bacteria in Ecasol-treated (2.5 ppm) DCU supply water was <1cfu/mL and in DUWL output water was 6.5cfu/mL.
Ecasol present as a residual disinfectant in DUWL output water is very unlikely to have adverse effects on human oral tissues at levels effective in maintaining DUWL output water quality at better than potable standard water quality.
... En heridas crónicas infectadas, la irrigación con hipoclorito es bien tolerada por los pacientes 37 , incluso en combinación con la terapia de presión negativa 19,38 . ...
INTRODUCCIÓN En el año 2002, el Grupo Nacional para el Estudio y Asesoramiento en Úlceras por Presión y Heridas Crónicas (GNEAUPP) elaboró la prime-ra edición sobre recomendaciones de antisépticos en heridas crónicas 1 , documento que fue elemento clave para apoyarnos en nuestra práctica asistencial diaria. Han pasado ya 20 años desde aquella edición y este ar-tículo, síntesis del documento técnico n.º VIII del GNEAUPP, pretende continuar la labor realizada por aquel entonces actualizando algunos detalles y añadiendo nuevas herramientas terapéuticas para prevenir o luchar frente a uno de los factores más importantes que impiden que ci-catrice una herida: los problemas relacionados con los microorganismos, clásicamente la infección y, ahora, también el impacto de los biofilms. En este artículo se habla sobre antimicrobianos en heridas crónicas, incluyendo a los que basan su mecanismo de acción en una acción quí-mica o bioquímica, es decir, los antisépticos, pero también se tratan algunos aspectos de los antibióticos que se continúan usando en la prác-tica clínica y, como mínimo, siguen siendo objeto de debate y contro-versia, como, por ejemplo, los antibióticos tópicos y, más actualmente, otros agentes con potenciales propiedades antibiofilm. No se incluyen otros productos con capacidad antimicrobiana en los que su mecanismo de acción sería físico o electrocéutico. Hoy en día existen diversos factores que han propiciado que existan microorganismos cada vez más resistentes a los antibióticos actuales, y el descubrimiento de nuevas generaciones de antibióticos es costoso y difí-cil, por eso a nivel mundial se realizan campañas de uso racional de los antibióticos. Uno de los problemas de esta estrategia es que, a menudo, se obvian recomendaciones sobre el uso de antisépticos, que pueden ser unos buenos aliados para evitar el uso de antibióticos en heridas o mediante su uso concomitante para luchar contra los microorganismos. Recomendaciones del uso de antimicrobianos en heridas crónicas ABSTRACT This article, based on GNEAUPP Technical Paper No. VIII, updates some concepts related to antimicrobials and adds new therapeutic tools to prevent and fight against one of the most important factors that prevent wound healing: problems related to microorganisms, classically infection and now also the impact of biofilms. The GNEAUPP's own evidence grading system is used, which classifies the strength of the recommendation as high, moderate or low. The antimicrobials analyzed in terms of their mode of action, commercial presentation, recommendations for use, contraindications and effectiveness on biofilm are: alcohol, chlorhexidine, sodium hypochlorite, octenidine, silver and iodophors. Also the effects of the so-called antibiofilm agents, although most of them have been performed in vitro. Finally, a series of recommendations are made to researchers to generate new evidence related to antimicrobials and their clinical applicability. Crónicas acreditada por el GNEAUPP. Referente de heridas del ABS Ernest Lluch de Figueres. *Autor para correspondencia. Correo electrónico: pepe.verdu@ua.es (José Verdú Soriano). Recibido el 28 de febrero de 2022; aceptado el 28 de febrero de 2022. RESUMEN En este artículo, basado en el documento técnico n.º VIII del GNEAUPP, se actualizan algunos conceptos relacionados con los antimicrobianos y se añaden nuevas herramientas terapéuticas para prevenir y luchar frente a uno de los factores más importantes que impiden que cicatrice una herida: los problemas relacionados con los microorganismos, clásicamente la infección y, ahora, también el impacto de los biofilms. Se asume el sistema propio del GNEAUPP de gradación de la evidencia, que clasifica la fuerza de la recomendación en alta, moderada o baja. Los antimicrobianos analizados mediante su modo de actuación, presentación comercial, recomendaciones de uso, contraindicaciones y efectividad sobre el biofilm son: el alcohol, la clorhexidina, el hipoclorito sódico, la octenidina, la plata y los yodóforos. También los efectos de los llamados agentes antibiofilm, aunque la mayoría se han realizado in vitro. Para finalizar, se realizan una serie de recomendaciones dirigidas a los investigadores para generar nuevas evidencias relacionadas con los antimicrobianos y su aplicabilidad clínica.
PALABRAS CLAVE: Antibacterianos, antiinfecciosos, biopelículas, infección de heridas.
... En heridas crónicas infectadas la irrigación con hipoclorito es bien tolerada por los pacientes (37), incluso en combinación con la terapia de presión negativa (19,38). ...
Hoy en día existen diversos factores que han propiciado que existan
microorganismos cada vez más resistentes a los antibióticos actuales, y el descubrimiento de nuevas generaciones de antibióticos es costosa y difícil, por eso a nivel mundial se realizan campañas de uso racional de los antibióticos.
Uno de los problemas de esta estrategia es que, a menudo, se obvian
recomendaciones sobre el uso de antisépticos, que pueden ser unos buenos aliados para evitar el uso de antibióticos en heridas o mediante su usoconcomitante para luchar contra los microorganismos.
A pesar de tener los antisépticos muy a mano y de uso muy extendido en nuestra práctica clínica, existe un déficit de estudios de calidad sobre su eficacia o estándares de laboratorio/resultados que permitan sacar conclusiones en igualdad de condiciones, puesto que se comparan diversos antisépticos en diferentes concentraciones y situaciones.
También existen intereses comerciales con la intención de situar unos productos por encima de otros, algunas veces sin contar con evidencia que lo sustente.
En este documento técnico se utilizan documentos de consenso y revisiones realizadas por Cochrane que, como bien sabemos, tiene unos criterios muy estrictos que la mayoría de veces muestran que no hay evidencia de peso para recomendar algunos antimicrobianos respecto a otras intervenciones. Es necesario realizar estudios robustos, que generen evidencia sobre la efectividad de su uso en la prevención y tratamiento de las infecciones.
Intentamos ofrecer una pincelada sobre las recomendaciones de uso de antibióticos y antisépticos, algunos de los cuales aún no están plenamente implantados en España, pero que las últimas guías de consenso recomiendan, y también recomendaciones que desaconsejan el uso de algunos antisépticos que sí tienen su uso muy extendido en España.
... J Evolution Med Dent Sci / eISSN -2278-4802, pISSN -2278-4748 / Vol. 10 / Issue 37 / Sept. 13,2021 Page 3221 ...
BACKGROUND Wounds and their management are important in the practice of surgery. Super oxidised solution is a recent concept in wound management. It is an aqueous solution which is electrochemically processed which is non-toxic, non-irrigating and is having a neutral pH. Povidone iodine is the most common topical wound care product used in surgical practice. Both are affordable solutions for the patients. There are very few studies comparing the efficacy. In this study, we wanted to compare the efficacy of super oxidised solution and povidone iodine in the management of lower limb ulcers. METHODS A prospective study was conducted on 100 patients who were randomized into two groups. Group A was treated with super oxidized solution and Group B were treated with povidone iodine. Assessments of wounds were done on various days (1, 3, 5, 7, 9, 12, 15, 18, 21). Various outcomes of data were analysed using statistical analysis. RESULTS The average percentage reduction in wound size on day 21 was 47 % in Group A compared to 24 % in Group B. Early appearance of granulation tissue, disinfection, decrease in wound size, and less duration of hospital stay was achieved in Group A. CONCLUSIONS The results were more favourable towards super oxidised solution than povidone iodine. In this comparative study, super oxidized solution had faster efficacy and wound healing in patients than povidone iodine. KEY WORDS Super Oxidized Solution, Ulcer, Povidone Iodine.
... 15,16 There have been isolated reports of its use in healing of diabetic foot ulcers, abscess cavities, surgical wounds and various other types of ulcers. 17 Further, this solution has been used in management of chest wall infections and reportedly reduced the time of healing in a significant manner. 18 Several studies have shown the efficacy of the superoxidised solutions and its wide range of applications on several types of wounds. ...
Background: Diabetic foot ulcer is a one of the major challenging problem to every surgeon in day to day practice. Superoxidised solution is an effective concept in the wound management. The present study was aimed to compare the efficacy of dressings with superoxidised solution versus povidine iodine in the management of infected diabetic ulcers.Methods: This is a randomized controlled study conducted over a period of one year. In our study, total of 60 patients presenting with infected diabetic ulcers are included. Patients were randomly divided into two groups of 30 each, group A (Topical superoxidised solution dressing) and group B (Topical povidine iodine dressing). Wound was observed for decrease in size of the ulcer, granulation, tissue quality and discharge from the wound at the end of each week for two weeks.Results: In the present study, 76.67% of patients in group A and B were males and the male to female ratio was 3.2:1. The mean age in group A was 55.90±14.27 years compared to 51.50±13.18 years in group B. The mean initial ulcer area in group A was 3882±1890 mm2 compared to 3992±2000 mm2 in group B. The mean post treatment final area in group A was significantly low (1607±862 mm2) compared to group B (2351±1240 mm2; p=0.009) and the comparison of mean change in ulcer area was significantly high in group A compared to group B (2215±1060 mm2 vs 1641±856 mm2; p=0.024). The mean percentage reduction in ulcer area among patients with group A was significantly high (58.90±5.21 percent vs. 40.90±8.76 percent; p=0.024). The commonest organism isolated in group A was Escherichia coli (26.67%) and in group B, it was staphylococcus. The culture was positive in 26% of the patients in group A compared to 50% in group B (p=0.063).Conclusions: Overall, topical superoxidised solution dressing for diabetic foot ulcer accelerated the healing process resulting in faster recovery through reduction in ulcer area compared to topical povidine iodine dressing.
... The vast majority of the publications on negative-pressure wound therapy with instillation with antiseptics are small case studies, case series, and expert opinion using various antiseptic and antibiotic solutions. 5,7,8,11 There is a paucity of robust studies examining the outcomes of negative-pressure wound therapy with instillation, and inconsistency as to the optimal solution choice. Nevertheless, there is a clear bias toward the use of antiseptics. ...
Background:
Negative-pressure wound therapy with instillation is an adjunctive treatment that uses periodic instillation of a solution and negative pressure for a wide diversity of wounds. A variety of solutions have been reported, with topical antiseptics as the most frequently chosen option. The objective of this study was to compare the outcomes of normal saline versus an antiseptic solution for negative-pressure wound therapy with instillation for the adjunctive treatment of infected wounds.
Methods:
This was a prospective, randomized, effectiveness study comparing 0.9% normal saline versus 0.1% polyhexanide plus 0.1% betaine for the adjunctive treatment of infected wounds that required hospital admission and operative débridement. One hundred twenty-three patients were eligible, with 100 patients randomized for the intention-to-treat analysis and 83 patients for the per-protocol analysis. The surrogate outcomes measured were number of operative visits, length of hospital stay, time to final surgical procedure, proportion of closed or covered wounds, and proportion of wounds that remained closed or covered at the 30-day follow-up.
Results:
There were no statistically significant differences in the demographic profiles in the two cohorts except for a larger proportion of male patients (p = 0.004). There was no statistically significant difference in the surrogate outcomes with the exception of the time to final surgical procedure favoring normal saline (p = 0.038).
Conclusion:
The authors' results suggest that 0.9% normal saline may be as effective as an antiseptic (0.1% polyhexanide plus 0.1% betaine) for negative-pressure wound therapy with instillation for the adjunctive inpatient management of infected wounds.
Clinical question/level of evidence:
Therapeutic, II.
... Similarly, the global efficacy evaluation also confirms the superiority of Oxum (Microcyn Superoxidized solution) over Povidone iodine as good to excellent efficacy response was recorded in relatively more number of patients in Oxum treated Group as compared to Povidone-iodine treated Group. Wolvos TA 15 used Microcyn Superoxidized solution to treat 26 patients with various wound types that included 9 patients with post-operative wound. In these patients, the ...
... However, NPWT/NPWTi is neither considered a replacement for thorough or repeated debridement nor recommended for use on untreated wounds, but rather as an adjunct therapy (2,18,19). Examples of solutions that have been previously reported to be effective in conjunction with NPWTi in patients are as follows: antibiotic solutions (6,20); 0·5% silver nitrate solution (21); Microcyn ® skin and wound cleanser (0·003% hypochlorous acid, 0·004% sodium hypochlorite and 0·023% sodium chloride, pH7·4; Oculus Innovative Sciences, Petaluma, CA) (22); taurolidine solution (23) and Lavasept ® solution (0·04-0·2% PHMB; BBraun Medical Inc.) (24)(25)(26)(27)(28)(29)(30). Among these clinical reports, instillation (soak/dwell time) varied from 8 to 30 minutes with 1-6 hours negative pressure per cycle. ...
Negative pressure wound therapy with instillation (NPWTi) is increasingly used as an adjunct therapy for a wide variety of infected wounds. However, the effect of NPWTi on mature biofilm in wounds has not been determined. This study assessed the effects of NPWTi using saline or various antimicrobial solutions on mature Pseudomonas aeruginosa biofilm using an ex vivo porcine skin explant biofilm model. Treatment consisted of six cycles with 10-minute exposure to instillation solution followed by 4 hours of negative pressure at -125 mm Hg over a 24-hour period. NPWTi using saline reduced bacterial levels by 1-log (logarithmic) of 7-log total colony-forming units (CFUs). In contrast, instillation of 1% povidone iodine (2-log), L-solution (3-log), 0·05% chlorhexidine gluconate (3-log), 0·1% polyhexamethylene biguanide (4-log), 0·2% polydiallyldimethylammonium chloride (4-log) and 10% povidone iodine (5-log), all significantly reduced (P < 0·001) total CFUs. Scanning electron micrographs showed disrupted exopolymeric matrix of biofilms and damaged bacterial cells that correlated with CFU levels. Compared with previous studies assessing microbicidal effects of topical antimicrobial dressings on biofilms cultured on porcine skin explants, these ex vivo model data suggest that NPWTi with delivery of active antimicrobial agents enhances the reduction of CFUs by increasing destruction and removal of biofilm bacteria. These results must be confirmed in human studies.
... Microcyn ® Skin and Wound Cleanser (Oculus Innovative Sciences, Petaluma, CA) with preservatives is an FDA cleared topical wound irrigation solution that has been used successfully with NPWT with instillation (109,110). It has demonstrated effectiveness by reducing multiple microorganisms including MRSA, VRE, Pseudomonas, and Candida. ...
Over the last decade Vacuum Assisted Closure® (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.® Therapy and V.A.C. Instill® with either GranuFoam™ or GranuFoam Silver™ Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C.® Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.® Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.® Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies.
... Dressing with super-oxide solution is not a very old topic of discussion and lately a good number of efforts have been made to evaluate the effectiveness of this approach in wound healing. There have been isolated reports of its use in healing of diabetic foot ulcers, abscess cavities, surgical wounds and various other types of ulcers [9]. The use of super oxidized aqueous solution for jet lavage debridement has been found to be as safe and effective as saline [10]. ...
Aims: This study was undertaken to evaluate the role of super-oxide solution in wound healing.
At the same time an effort was made to compare the efficacy and outcomes of super-oxide
solution dressings and those with povidone iodine solution. Methods: 100 Patients in age
group of 6 to 65 yrs with different types of wounds were randomized in two different groups of 50 each. Patients of group A were treated by dressing with super-oxide solution whereas those belonging to group B with povidone-iodine solution. The prospective analysis of results was done and compared in each group. Results: Decrease in surface area of wounds at the ends of 1st , 2nd , 3rd and 4th weeks was more in group A when compared to group B and this was statistically significant ( p values0.005, 0.002, < 0.001 and 0.001 respectively ). No report of discontinuation in either of the groups was reported. Allergic reactions were found in one patient of group A and 2 patients in group B. The occurrence of infection in primarily sterile cases was lesser (15%) in group A than in group B (36%). Persisting infection at the end of 1st, 2nd, 3rd and 4th weeks of dressings was lower in patients of group A in comparison to group B patients.
Conclusion: The outcome of this study supports the concept of wound healing with
super oxide solution, a novel and effective mode of treatment. The efficacy of super-oxide
solution in different types of wounds was found to be superior than the conventional method of treatment with povidone iodine.
... The clinical evidence for the use of ECAS a is largely based on small-scale case studies, but it has shown promise in reducing bacterial infections in burn wounds [112], for the treatment of refractory chronic ulcers [109], as well as synergistic necrotising infections [113], and a neutralised ECAS is now commercially available specifically for the treatment of wounds (Dermacyn, Oculus Innovative Sciences, Petaluma, CA, USA [114]). Neutral ECAS a have been shown to significantly increase healing rates and reduce pain levels in recalcitrant venous leg ulcers [115,116], improve healing outcomes in diabetic foot ulcers [47,117,118], shown potential applications in advanced wound care in combination with negative pressure therapy [119] and have been shown to be more effective than povidoneiodine in treating diabetic foot ulcers [120]. Moreover, a recent randomised controlled trial using a daily instillation of pH-neutralised ECAS a within wound dressings for the management of wide postsurgical lesions of the diabetic foot found it to significantly improve healing rates, while significantly reducing the bacterial load (compared to the control treatment, povidone-iodine) with no reported adverse effects [121]. ...
Due to the limitations associated with the use of existing biocidal agents, there is a need to explore new methods of disinfection to help maintain effective bioburden control, especially within the healthcare environment. The transformation of low mineral salt solutions into an activated metastable state, by electrochemical unipolar action, produces a solution containing a variety of oxidants, including hypochlorous acid, free chlorine and free radicals, known to possess antimicrobial properties. Electrochemically activated solutions (ECAS) have been shown to have broad-spectrum antimicrobial activity, and have the potential to be widely adopted within the healthcare environment due to low-cost raw material requirements and ease of production (either remotely or in situ). Numerous studies have found ECAS to be highly efficacious, as both a novel environmental decontaminant and a topical treatment agent (with low accompanying toxicity), but they are still not in widespread use, particularly within the healthcare environment. This review provides an overview of the scientific evidence for the mode of action, antimicrobial spectrum and potential healthcare-related applications of ECAS, providing an insight into these novel yet seldom utilised biocides.
Aim: To describe the indication and technique of microbiological wound investigation in treating infected or colonised wounds with or without multi-drug resistant microorganisms (MDROs). The clinical symptoms and criteria of locally or systemically infected wounds are summarized and described. Method: An interdisciplinary consensus of microbiological wound diagnosis was elaborated between representatives of different medical specialities. Moreover, some perspectives on future wound diagnostics were presented. Results: The panel agreed on ten clinical signs, situations and symptoms, which give the indication for further microbiological wound investigation: formation of pus, clinical signs or suspicion of an infection, suspicion or presence of a surgical site infection, localised progredient infection with or without systemic involvement (e.g. joint empyema, phlegmone), gangrene formation and necrotising fasciitis, ulcerative neoplasia, burn wounds with > 15% thermally injured surface area, exacerbation of dermatological disorders, localised wound infection without sign of systemic involvement after 3 days treatment with antiseptics without obvious clinical improvement, and chronic skin lesion with indication to screen for MDROs. The panel agreed that no indication for microbiological investigation is given in acute wounds without signs of infection and uncomplicated superficial wounds. Today, the gold standard for microbiological investigation is processing tissue biopsies in the laboratory. However, in many instances it may be easier and more rapid to perform a wound swab. If swabs are obtained, the Essener circle or the Levine technique shall be applied. Wound swabs, however, are the method of choice in screening for wound colonisation with MDROs. Additionally, information is summarised pertaining to transport and processing of microbiological wound specimens Also, potential applicability of future wound diagnostic methods based on genomic, metabolomic and proteomic approach are discussed. Conclusion: Beside a full understanding of all clinical symptoms and clinical experience of wound experts the correct microbiological wound investigation will be the basis for a succesfull management of infected wounds.
Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment.
Background:
Diabetic foot ulceration remains a major challenge is one of the most expensive and a leading cause of major and minor among patients with a diabetic foot ulcer. Hence the purpose of this review emphases on potential molecular markers involved in diabetic ulcer physiology, the efficacy of different types of dressing materials, therapy and newer therapeutic approach like nanoparticles for the of diabetic foot ulcer.
Methods:
We conducted a systematic literature reviews search by using Pubmed and other web search. The researchers collect the quality evidence of diabetic foot ulcer biomolecules and treatments and summarized and compared and the strength of the study.
Results:
The present investigation suggested that impaired wound healing in diabetic patients is influence of several factors. All the advanced therapies and foot ulcer dressing materials are not suitable for all types of diabetic foot ulcers, more prospective follow up and in vivo and in vitro study is needed to give certain conclusion. Several critical wound biomolecules are identified and need to investigate in diabetic foot ulcers. Application of biocompatible nanoparticles holds a promising approach for designing dressing materials for the treatment of diabetic foot ulcer.
Conclusion:
Understanding the cellular and molecular events and identifying the appropriate treatment strategies for different foot ulcer grades will reduce recurrence of foot ulcer and lower limb amputation.
Soft tissue losses from acute or chronic trauma are a challenge for surgeons. To explore a method to expedite granulation tissue formation in preparation for a split-thickness skin graft (STSG), the medical records of 3 patients - 2 adult men with wounds related to trauma injury and 1 infant with necrotizing fasciitis, all infected with Pseudomonas aeruginosa - were reviewed. All wounds were surgically debrided and managed by applying gauze soaked in 50% glucose followed by continuous negative pressure wound therapy (NPWT) before definitive skin grafting. NPWT pressure was applied at -80 mm Hg for the 2 adult males (ages 39 and 25 years) and -50 mm Hg for the 7-month-old male infant. The dressings were changed every 2 to 3 days. No adverse events occurred, and wounds were successfully closed with a STSG after an average of 7 days. In 1 case, NPWT was able to help affix dressings in a difficult-to-dress area (genital region). The combination of hypertonic glucose and hand-made, gauze-based NPWT was found to be safe, well-tolerated, and effective in preparing the wound bed for grafting. Prospective, randomized, controlled clinical studies are needed to compare the safety, effectiveness, and efficacy of this method to other treatment approaches for P. aeruginosa-infected wounds.
Wounds expose a patient to serious hazards like wound infection, tissue destruction, disfiguring and disabling scars. Use of superoxidised solution (oxum) in infected wounds, ulcers, diabetic wounds, abcesses, burns reduced morbidity and hospital stay with its early wound healing effect. To evaluate the effect of superoxidised water (Oxum) V/s povidone iodine (Betadine) on similar types of wounds. We retrospectively analysed the records of two hundred patients with different types of wounds who attended Department of Surgery, Guru Nanak Dev Hospital/Govt. Medical College, Amritsar from January 2008 to January 2009. The patients were divided into two groups. Group A where topical management and dressing was done using oxum and group B where topical management and dressing was done using betadine. A standard grading in terms of percentage decrease in wound size, periwound oedema/erythema, pus discharge and percentage increase in granulation, fibrin and epithelisation was noted in various types of wounds in both groups. Oxum treated wounds showed reduction in inflammation and their healing earlier than betadine group. Oxum application was safe having no pain and allergic manifestation.
This randomized, prospective, multicenter, open-label study was designed to test whether a topical, electrolyzed, superoxidized solution (Microcyn Rx) is a safe and effective treatment for mildly infected diabetic foot ulcers.
Sixty-seven patients with ulcers were randomized into three groups. Patients with wounds irrigated with Microcyn Rx alone were compared with patients treated with oral levofloxacin plus normal saline wound irrigation and with patients treated with oral levofloxacin plus Microcyn Rx wound irrigation. Patients were evaluated on day 3, at the end of treatment on day 10 (visit 3), and 14 days after completion of therapy for test of cure (visit 4).
In the intention-to-treat sample at visit 3, the clinical success rate was higher in the Microcyn Rx alone group (75.0%) than in the saline plus levofloxacin group (57.1%) or in the Microcyn Rx plus levofloxacin group (64.0%). Results at visit 4 were similar. In the clinically evaluable population, the clinical success rate at visit 3 (end of treatment) for patients treated with Microcyn Rx alone was 77.8% versus 61.1% for the levofloxacin group. The clinical success rate at visit 4 (test of cure) for patients treated with Microcyn Rx alone was 93.3% versus 56.3% for levofloxacin plus saline-treated patients. This study was not statistically powered, but the high clinical success rate (93.3%) and the P value (P = .033) suggest that the difference is meaningfully positive for Microcyn Rx-treated patients.
Microcyn Rx is safe and at least as effective as oral levofloxacin for mild diabetic foot infections.
The purpose of this study was to examine the influence of the fluid dynamics of syringe irrigation on the efficacy of wound cleansing and the infection rate of experimental wounds. The pressure experienced by a surface following wound irrigation was directly proportional to the pressure within the syringe and the size of the needle. High pressure syringe irrigation effectively removed bacteria from the surface of the wound. This reduction in the wound bacterial count resulted in a decrease in the infection rate of tissues. Low pressure irrigation with an asepto syringe did not significantly cleanse the wound of its bacterial contaminants and had no demonstrable clinical merit. On the basis of these studies, high pressure syringe irrigation is being employed routinely in our emergency department for the care of traumatic wounds.
We tested the antimicrobial activity of superoxidized water against methicillin-sensitive Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, Serratia marcescens, Escherichia coli, Pseudomonas aeruginosa and Burkholderia cepacia. The number of bacteria was reduced below detection limit following incubation in superoxidized water for 10 s. The bactericidal activity of superoxidized water was similar to that of 80% ethanol, but superior to that of 0.1% chlorhexidine and 0.02% povidone iodine. We conclude that superoxidized water is a low cost but powerful disinfectant.
The literature suggests that the amount of pressure used in irrigation is the key variable to achieve effective wound cleansing. Pressures of 1 psi or less have been found to be of little clinical value for wound cleansing. Although surface bacterial counts are reduced by irrigation in general, the literature indicates that higher pressures are more effective. Surface debris, such as loose necrotic tissue and wound exudate, has been shown to be most effectively removed using pressures between 5 and 10 psi. Irrigation pressures above 10 psi protect the wound from gross infections. Inconsistencies in reporting output and impact pressures, described previously, create confusion in performing a meta-analysis of research results. Future research examining the efficacy of pulsed lavage must demonstrate consistency in reporting impact pressures at the tissue's surface. Research comparing the efficacy of continuous or intermittent (pulsed) lavage procedures has produced less clear results. The results of one study suggest that both methods are effective at removing surface bacteria when using pressures of 10 to 15 psi, whereas another study suggests that continuous irrigation is more effective than pulsed irrigation at removing bacteria at 25 psi. Clearly, additional research is needed that compares the effects of pulsed and continuous irrigation at a variety of pressure levels, before suggesting a preferred method. Until there is definitive evidence, it may be advisable to eliminate the use of the phrase 'high-pressure irrigation' when referring to pulsed lavage because 'pulsed lavage' refers only to the application of an intermittent stream of fluid regardless of the pressure level. Research comparing the effectiveness of whirlpool and pulsed lavage on wound cleansing is scant. Two studies suggest that pulsed lavage following whirlpool agitation is more effective at removing bacteria than lavage alone. In a recent study, however, pulsed lavage was found to be more effective than whirlpool in promoting wound healing. Additional clinical studies comparing the effects of pulsed lavage and whirlpool on wound cleansing and healing are needed. Recognizing the progressive financial restrictions facing the clinician, future comparisons should also include cost analyses of the 2 methods. Total costs per incident, number of treatments required to achieve wound closure, and per-treatment costs should be included. Pulsed lavage appears to be a safe method for wound cleansing. Research has demonstrated no evidence of bacteremia following lavage applications, regardless of pressure. Concerns that 'high-pressure' (output pressure of 70 psi) lavage may disseminate contaminants to surrounding tissues appear to be unwarranted, but more research needs to be conducted in order to confidently apply pulsed lavage to all types of wounds at all stages of the healing process. Until more convincing controlled studies are performed, establishing safe levels of irrigation pressure in wound cleansing, Rodeheaver's suggestion needs to be heeded: continue to use the AHCPR guideline of irrigation pressures between 4 and 15 psi.
Microbial bioburden in both acute and chronic wounds is an important factor in wound healing. Consequently, the reduction of bioburden to host-manageable levels, as well as the elimination of certain virulent forms of wound pathogens (regardless of their number), has become a goal of the wound care professional. A prospective, controlled clinical study using accepted sampling methods was conducted to compare the use of an antimicrobial wound cleanser (0.057% sodium hypochlorite in an isotonic saline solution) to normal saline on the reduction of bioburden and wound size. During the 2-month study, 100% of the wounds cleansed with the antimicrobial wound cleanser (n = 9) demonstrated aerobic bioburden reduction from baseline in a range from 1 to 4 logs per wound, while 56% of the wounds cleansed with normal saline (n = 9) showed an increase in aerobic bioburden levels. The proportion of wounds exhibiting a reduction in wound size was higher in the antimicrobial wound cleanser group than in the saline group. Further research to increase understanding of the relationship between wound bioburden, healing, and cleansing agents is needed.