povidone-iodine and Spinal-Cord-Injuries

To compare a hydrogel dressing with a conservative topical wound-care regimen (gauze with povidone-iodine) for the treatment of pressure ulcers.. A prospective study comprising 27 (24 male and three female) spinal-cord injury patients with a total of 49 pressure ulcers. Wounds were randomised into a treatment group (n=25) or control group (n=24). The primary outcome measure was the rate of wound healing (cm2/days).. Healing rates in the treatment group were higher than in the control group, although this was not statistically significant. Some 84% of the wounds in the treatment group and 54% in the control group epithelialised, which was statistically significant (p=0.04). The mean healing time in the treatment group was 48 days compared with 45 days for the controls.. Our results suggest that hydrogel occlusive wound dressings facilitate healing by promoting more rapid epithelialisation of pressure ulcers, when compared with conservative wound care.

Topics: Administration, Cutaneous; Adolescent; Adult; Bandages; Bandages, Hydrocolloid; Female; Hemoglobins; Humans; Lymphocyte Count; Male; Middle Aged; Povidone-Iodine; Pressure Ulcer; Serum Albumin; Severity of Illness Index; Skin Care; Spinal Cord Injuries; Time Factors; Treatment Outcome; Wound Healing

Analysis of the clinical case of a male aged 30 years, presenting with T6 complete paraplegia in 1991, demonstrated the existence of aggravating factors for disuse osteoporosis of spinal cord injury, possibly leading to bone density values below the fracture threshold with the risk of spontaneous fractures. This patient was admitted to hospital for multiple pressure sores requiring prolonged local dressings before and after plastic surgery performed in July 1995. In January 1996, following exercise, he developed a fracture of the femoral diaphysis with a cystic demineralized appearance of the bone. The etiologic work-up demonstrated hyperthyroidism due to iatrogenic iodine overload secondary to Betadine. A review of the literature revealed numerous cases of thyroid dysfunction secondary to iatrogenic iodine saturation. This case justifies regular surveillance of thyroid function tests during prolonged treatment with Betadine and identification of patients with a clinical predisposition.

Topics: Administration, Topical; Adult; Anti-Infective Agents, Local; Bone Density; Femoral Fractures; Fracture Fixation, Intramedullary; Humans; Hyperthyroidism; Iatrogenic Disease; Male; Osteoporosis; Paraplegia; Povidone-Iodine; Pressure Ulcer; Spinal Cord Injuries

In pressure sore wounds after spinal cord injury, methicillin-resistant Staphylococcus aureus can be detected in 2% of the cases. The elimination of the germ is the aim of the treatment. Pressure sore wounds are an often found complication after spinal cord injury. For local treatment five commercially available antiseptics for the skin and mucous membrane were tested in vitro. The method used is a modified qualitative and quantitative suspension test. The antiseptics were tested without and with addition of 5% albumin in order to simulate the conditions of the wound in vivo. The results show a superior efficacy of the povidone-iodine preparations. Betadine, probably due to the higher concentration, is more efficacious than Braunol; chlorhexidine is sufficiently efficacious without the addition of albumin. These results still have to be confirmed by in vivo studies.

Topics: Anti-Infective Agents, Local; Biguanides; Chamomile; Chlorhexidine; Escherichia coli; Escherichia coli Infections; Flavonoids; Humans; Imines; Iodophors; Methicillin Resistance; Oils, Volatile; Plants, Medicinal; Povidone-Iodine; Pressure Ulcer; Pseudomonas aeruginosa; Pseudomonas Infections; Pyridines; Quaternary Ammonium Compounds; Serum Albumin; Skin; Spinal Cord Injuries; Staphylococcal Infections; Staphylococcus aureus

Povidone-iodine (PVP-I) has a wide range of activity against bacteria. The author's clinical experience has indicated that it can be used successfully as a topical agent in the treatment of decubital ulcer in patients with spinal cord injury. To date, 110 patients have been treated with Betadine solution and ointment, topically applied at daily intervals. Of these, 70 patients had decubitus ulcers involving the sacral and trochanter region; 20 were chronic ulcers which cleared up well. Another 20 required rotation grafting procedure. Primary healing was achieved in all patients (1-4).

Topics: Administration, Topical; Adolescent; Adult; Child; Humans; Middle Aged; Povidone; Povidone-Iodine; Pressure Ulcer; Spinal Cord Injuries; Wound Infection

Male patients with spinal cord injury are frequently colonized with P. aeruginosa and K. pneumoniae on the perineum. Regular bathing with bar soap has not influenced this colonization. We have attempted to remove these bacteria using antiseptic agents. The number of P. aeruginosa, K. pneumoniae and total aerobic bacteria on the perineum and the penile shaft was determined before and after cleaning with bar soap, chlorhexidine, povidone-iodine and pHresh. Povidone-iodine and chlorhexidine had no advantage over bar soap or pHresh in the removal of P. aeruginosa or K. pneumoniae from the perineum of patients with spinal cord injury.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Carbanilides; Chlorhexidine; Humans; Hydrogen-Ion Concentration; Klebsiella pneumoniae; Male; Middle Aged; Penis; Perineum; Povidone-Iodine; Pseudomonas aeruginosa; Random Allocation; Soaps; Spinal Cord Injuries