povidone-iodine and Leg-Ulcer

The antimicrobial efficacy of antiseptics used in wound management is tested in vitro under standardised conditions according to DIN EN 13727, with albumin and sheep erythrocytes used as organic challenge. However, these testing conditions do not adequately simulate the wound bed environment. Thus, the aim of this study was to compare the efficacy of different antiseptics such as octenidine dihydrochloride (OCT), chlorhexidine digluconate (CHX), polyhexamethylene biguanide (PHMB), and povidone-iodine under challenge with human wound exudate instead of standardised organic load in an in vitro setting according to DIN EN 13727. Moreover, protein contents, pH, and temperature were compared with standardised testing conditions. The tested antiseptic agents were reduced to different extents based on their bactericidal efficacy, when challenged with human wound exudate compared with standardised conditions. Overall, 0.10% OCT showed the highest effects reaching full efficacy after 30 seconds. CHX and PHMB were the least efficient. Next to the protein content, other components of wound exudate, such as the microflora, seem to influence the efficacy of antiseptics. In summary, the optimisation of in vitro testing conditions in future applications, to more adequately simulate the wound bed environment, will allow a more realistic picture on the potential performance of antiseptics in clinical practice.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Biguanides; Chlorhexidine; Exudates and Transudates; Female; Humans; Imines; Leg Ulcer; Male; Microbial Sensitivity Tests; Middle Aged; Povidone-Iodine; Pyridines; Tissue Culture Techniques

chronic leg ulcers cause a prolonged hospital stay with devastating effects on the patients. Several modifiable factors are taken care of to reduce the duration of stay. A further measure to hasten wound bed preparation pre-grafting and to hasten graft healing post-grafting is with negative pressure dressing.. sixty-two patients were placed in two groups of 31 cases each. The wound beds were prepared with negative pressure apparatus locally adapted with suction machine for group A and with conventional gauze dressing using 5% povidone iodine soaks for group B. Grafted wound was also dressed similarly for the respective groups. Grafts were inspected on the 5. the mean hospital stay pre-grafting and post-grafting were 12.2 (±8.64) days and 13.6 (±2.03) days respectively for the negative pressure dressing and 28.8 (±30.9) days and 21.8 (±21.97) days respectively for the traditional dressing group. These differences with p values of 0.038 for the pre-grafting stay and 0.006 for the post-grafting stay were statistically significant. The patients managed with negative pressure dressing also recorded greater satisfaction with the process and the outcome.. negative pressure dressing contributes significantly to reducing the length of hospital stay in chronic leg ulcers both in wound bed preparation and in graft healing resulting to better patient satisfaction than in patients treated with conventional gauze dressing and 5% povidone iodine soaks.

Topics: Anti-Infective Agents, Local; Bandages; Female; Humans; Leg Ulcer; Length of Stay; Male; Negative-Pressure Wound Therapy; Patient Satisfaction; Povidone-Iodine; Prospective Studies; Skin Transplantation; Wound Healing

Topics: Chronic Disease; Humans; Leg Ulcer; Peptide Hydrolases; Povidone-Iodine; Protease Inhibitors; Venous Insufficiency; Wound Healing

Some of the views contrasting the beneficial and toxic effects of antimicrobials upon wound healing remain controversial.. To assess the clinical relevance of histological findings following antimicrobial applications on chronic leg ulcers.. The present study was performed in three parallel groups of 17 patients suffering from at least 2 similar chronic leg ulcers. Clinical planimetric assessments were performed before and after 3 and 6 weeks of treatment using hydrocolloid dressings. In addition, 1 ulcer in each patient received applications of povidone-iodine (PVP-I), silver sulfadiazine or chlorhexidine digluconate. Histological examinations were made at inclusion and after the 6-week therapy. Time to healing was also recorded.. At entry in the study, fibroblasts, macrophages, neutrophils and vessels were abundant in the ulcers. In addition, focal necrotizing vasculitis was related to the microbiological load. Compared to the control lesions, both the healing rate and time to healing of the leg ulcers showed a modest improvement at the sites receiving silver sulfadiazine (2-7%) or chlorhexidine digluconate (-1 to 5%). By contrast, PVP-I increased significantly the healing rate (4-18%, p < 0.01), and time to healing was reduced by 2-9 weeks (p < 0.01). The 3 antimicrobials decreased the bacterial density, and the vascular margination and migration of inflammatory cells, thus abating the vasculitic changes. PVP-I applications did not alter the microvessels and did not significantly reduce the density in dendrocytes and fibroblasts. By contrast, both silver sulfadiazine and chorhexidine digluconate appeared to alter the superficial microsvasculature including the dendrocyte population.. Although topical antimicrobials may apparently achieve almost similar activity on the bacterial load inside chronic leg ulcers, the toxicity upon host cells was different among these agents. PVP-I appeared to be an efficient compound in these respects exhibiting a positive and relevant clinical effect.

Topics: Anti-Infective Agents, Local; Chlorhexidine; Humans; Leg Ulcer; Middle Aged; Povidone-Iodine; Silver Sulfadiazine; Wound Healing

In chronic wounds (ulcus cruris) of lymphedematous patients (n = 25) opportunistic infections caused by gram-negative rods and methicillin-resistant Staphylococcus aureus can be detected in 35% of cases. The healing of the wound takes a long time, which is the reason why the patients are taught how to manage the wound care. Local antibiotics must be avoided. The elimination of the wound infections is the first step of the complex decongestive physiotherapy. The infection aggravates the lymphostasis and makes the complaints of the patients (inflammation, pain, odor) more unacceptable, the systemic infections (erysipelas, lymphadenopathy, fever) more probable and the costs of the treatment higher. Betadine solution and ointment were used locally. The clinical and bacteriological efficacy of povidone-iodine has been validated. Excellent local tolerability has also been observed. The opinion of the patients was registered on a visual analog scale and statistically analyzed. No development of resistance has been noted. For local treatment, Betadine proved to be an effective preparation tolerable for a long time in the treatment of chronic wounds.

Topics: Adult; Anti-Infective Agents, Local; Chronic Disease; Female; Humans; Leg Ulcer; Lymphedema; Male; Middle Aged; Povidone-Iodine; Skin Diseases, Bacterial; Staphylococcal Skin Infections; Staphylococcus aureus

2 patients with leg ulcers got worse after the application of a compound mixture of sugar and povidone-iodine (sugar/PI compound). Because they had been suffering from stasis dermatitis, symptoms of contact dermatitis were ambiguous. Patch tests showed positive reactions to 10% povidone-iodine in water and 5% potassium iodide in water, with no response to sugar. They were also tested with sugar/PI compound, containing 3% povidone-iodine, resulting in another positive reaction. They improved after the application of sugar/PI compound was discontinued. Contact dermatitis from topical agents should be considered as more probable than angry back syndrome in cases of leg ulcer.

Topics: Aged; Aged, 80 and over; Dermatitis, Contact; Drug Combinations; Female; Humans; Leg Ulcer; Middle Aged; Patch Tests; Povidone; Povidone-Iodine; Sucrose

Topics: Adult; Aged; Anti-Infective Agents, Local; Bandages; Chronic Disease; Drug Therapy, Combination; Female; Gelatin Sponge, Absorbable; Humans; Leg Ulcer; Male; Ointments; Povidone; Povidone-Iodine; Powders; Varicose Ulcer

Topics: Drug Therapy; Humans; Iodine; Leg Ulcer; Ointments; Povidone; Povidone-Iodine; Skin Ulcer