povidone-iodine and Necrosis

The definition for the diabetic foot is infection, ulceration or destruction of deep tissues of the foot associated with neuropathy or peripheral vascular disease in the lower extremity of people with diabetes. Non-diabetic patients may suffer the same risks when neuropathy and arteriopathy are present. Knowing that 85% of amputations are preceded by foot ulcers, prevention is primordial. At the onset of an ulcer, immediate treatment must be undertaken and preferably by an interdisciplinary team. Delayed healing and increased risk of infection are often due to an associated vascular disease. While the array of dressings is expansive there is no «gold standard» treatment or «miracle dressing» described for foot ulcers. The management consists of wound analysis, debridement, woundcare and especially offloading.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Bandages; Combined Modality Therapy; Debridement; Diabetic Angiopathies; Diabetic Foot; Diabetic Neuropathies; Humans; Necrosis; Povidone-Iodine; Wound Infection

Dead tissue, in the form of slough and necrosis, can, if present in a wound, delay healing and promote infection. Debridement describes any method by which such materials are removed and, as a consequence, the potential to achieve wound healing enhanced. In this article, the first of two, the author discusses the history of debridement, cell death, the nature of necrotic tissue and a variety of debridement techniques. All methods of debridement have associated risks and benefits and while this article examines its clinical application there are also legal and professional issues to consider particularly in relation to conservative sharp debridement. These issues will be addressed in the second article.

Topics: Anti-Infective Agents, Local; Apoptosis; Bandages; Borates; Debridement; Humans; Hydrogen Peroxide; Necrosis; Povidone-Iodine; Risk Factors; Sodium Hypochlorite; Treatment Outcome; Wound Healing; Wounds and Injuries

In the years before 1981, the mortality of acute necrotizing pancreatitis was about 70%. By better timing of surgery and intra- as well as postoperative rinsing with povidone-iodine mortality could be lowered to 50%. Leaving the peritoneal cavity open enables easy surgical access to further septic complications. In 10 patients with conservative closure of the abdominal wall five patients died. In seven patients whose abdominal wall was left open and the pancreatic space packed, with the possibility of endoscopic removal of further necroses, only one patient died.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents, Local; Child; Child, Preschool; Female; Humans; Male; Mediastinoscopy; Middle Aged; Necrosis; Pancreas; Pancreatitis; Postoperative Complications; Povidone; Povidone-Iodine; Tampons, Surgical

Antiseptics are used for the cleansing of acute or chronic wounds to eliminate micro-organisms from the wound bed. However, they have effects on the skin cells.. To determine the effects of hexetidine, povidone-iodine (PI), undecylenamidopropyl-betaine/polyhexanide (UBP), chlorhexidine, disodium eosin and hydrogen peroxide on human skin fibroblasts.. CCD-1064Sk cells were treated with hexetidine, PI, UBP, chlorhexidine, disodium eosin or hydrogen peroxide. Spectrophotometry was used to measure cell viability and flow cytometry was used to study apoptosis and necrosis after the treatment. In vitro wound scratch assays were performed to determine the gap closure.. All antiseptics significantly reduced the viability of human skin fibroblasts compared with controls. The percentage wound closure was lower with hexetidine, PI and UBP. The scratch assay could not be measured after treatments with chlorhexidine, disodium eosin or hydrogen peroxide, owing to their cytotoxicity. The apoptosis/necrosis experiments evidenced a significant reduction in viable cells compared with controls. An increased percentage of apoptotic cells was observed after treatment with all antiseptics. Compared with controls, the percentage of necrotic cells was significantly increased with all antiseptics except for hexetidine.. The proliferation, migration and viability of human skin fibroblasts are reduced by treatment with hexetidine, PI, UBP, chlorhexidine, disodium eosin and hydrogen peroxide.

Topics: Anti-Infective Agents, Local; Chlorhexidine; Eosine Yellowish-(YS); Fibroblasts; Hexetidine; Humans; Hydrogen Peroxide; Necrosis; Povidone-Iodine

Topics: Aged; Anti-Infective Agents, Local; Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Myiasis; Neck; Necrosis; Povidone-Iodine; Therapeutic Irrigation; Ulcer

Two drug formulations of povidone-iodine (PVP-I)--an aqueous PVP-I solution (Betaisodona) and a liposomal PVP-I formulation--were tested for their virucidal activity and cytotoxicity in cell culture. As to the virudical activity against influenza A virus, herpes simplex virus type 1, adenovirus type 8 and human rhinovirus type 14, the liposomal formulation of PVP-I proved to be approximately as active as the aqueous one. Half maximum cytotoxic PVP-I concentrations were 0.01-0.07% for aqueous PVP-I and 0.03-0.27% for the liposomal PVP-I formulation (XTT reduction assay EZ4U). The detection of lactate dehydrogenase (LDH) release, DNA fragmentation (ELISA) and DNA strand breakage (TUNEL assay) after 24 h exposure of human embryonic lung fibroblasts to PVP-I revealed that necrosis predominates in cells treated with aqueous 0.08-0.32% PVP-I solutions, whereas apoptosis was the predominant type of cell death in cells treated with equivalent concentrations of liposomal PVP-I formulation. The favorable virucidal efficiency together with the preferred apoptotic route of cell death makes the liposomal PVP-I formulation a promising candidate for topical use in prevention and treatment of infections of the eye and the upper respiratory tract.

Topics: Adenoviridae; Administration, Topical; Animals; Antiviral Agents; Apoptosis; Cells, Cultured; Chlorocebus aethiops; Cricetinae; Dogs; Herpesvirus 1, Human; Humans; In Situ Nick-End Labeling; Influenza A virus; Iodophors; L-Lactate Dehydrogenase; Liposomes; Lung; Necrosis; Povidone-Iodine; Rabbits; Rhinovirus

Four cows and a calf with non-suppurative limb cellulitis were observed subsequently to suffer skin necrosis and sloughing in the affected limbs, either on or distal to the metacarpus or metatarsus. In comparison with six cows with suppurative Corynebacterium pyogenes limb cellulitis, topical therapy or the cases with skin necrosis and sloughing was adequate and the prognosis was good, when compared with the rigorous systemic therapy applied to the cows with suppurative cellulitis, some of which died. The skin necrosis and sloughing resulting from limb cellulitis seemed to be encouraged by the paucity of tissue between the skin and the bone, by the poor vascularity of the area, and by the causative bacteria.

Topics: Administration, Topical; Animals; Cattle; Cattle Diseases; Cellulitis; Debridement; Extremities; Female; Necrosis; Ointments; Povidone-Iodine; Prognosis; Skin; Tetracycline; Treatment Outcome