povidone-iodine and Varicose-Ulcer

The treatment of venous leg ulcers is often inadequate, because of incorrect diagnosis, overuse of systemic antibiotics and inadequate use of compression therapy. Stasis dermatitis related to chronic venous insufficiency accompanied by infected superficial ulcers must be differentiated from erysipelas, cellulitis and contact eczema.. To assess the effectiveness of (1) topical povidone-iodine with and (2) without compression bandages, (3) to compare the efficacy of systemic antibiotics and topical antimicrobial agents to prevent the progression of superficial skin ulcers.. 63 patients presenting ulcerated stasis dermatitis due to deep venous refluxes were included in the study. The clinical stage of all patients was homogeneous determined by clinical, aetiological, anatomical and pathological classification. They were examined by taking a bacteriological swab from their ulcer area. Compression bandages were used in a total of 42 patients. Twenty-one patients with superficial infected (Staphylococcus aureus) ulcers were treated locally with povidone-iodine (Betadine), and 21 patients were treated with systemic antibiotics (amoxicillin). Twenty-one patients were treated locally with Betadine but did not use compression. The end point was the time of ulcus healing. The healing process of the ulcers was related to the impact of bacterial colonization and clinical signs of infection.. Compression increases the ulcer healing rate compared with no compression. Using the same local povidone-iodine (Betadine) treatment with compression bandages is more effective (82%) for ulcus healing than without compression therapy (62%). The healing rate of ulcers treated with systemic antibiotics was not significantly better (85%) than that of the Betadine group. Using systemic antibiotics, the relapse rate of superficial bacterial infections (impetigo, folliculitis) was significantly higher (32%) than in patients with local disinfection (11%).. Compression is essential in the mobilization of the interstitial lymphatic fluid from the region of stasis dermatitis. Topical disinfection and appropriate wound dressings are important to prevent wound infection. Systemic antibiotics are necessary only in systemic infections (fever, lymphangitis, lymphadenopathy, erysipelas).

Topics: Aged; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bandages; Chronic Disease; Humans; Middle Aged; Povidone-Iodine; Prospective Studies; Quality Control; Recurrence; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Varicose Ulcer; Wound Healing; Wound Infection

Results of an open randomized study of staged treatment of 94 patients suffering from varicose veins of the lower extremities with open infected trophic ulcers of the shank were analyzed. All the patients were divided into 3 groups depending on the treatment variant. Based on this study, clinical efficacy of early correction of upper vertical venous-venous reflux is substantiated. Efficacy of CO(2) laser application for sanation of trophic venous ulcers and practical importance of their auto-venous plastic reconstruction are demonstrated. Thus, up-to-date technologies provide differential treatment in patients with trophic venous ulcers.

Topics: Anti-Infective Agents, Local; Bacteria; Bacterial Infections; Bandages; Humans; Laser Therapy; Patient Selection; Povidone-Iodine; Skin Transplantation; Treatment Outcome; Varicose Ulcer; Varicose Veins

Recent reports in the literature have indicated that dextranomer (Debrisan; Adcock-Ingram) is an effective cleansing agent for the secreting wound. To evaluate its possible use in the initial cleansing of the infected secreting stasis ulcer, 100 patients were incorporated in a single-blind randomized trial. The mean cleansing time for the Debrisan-treated ulcers was 5,9 days, compared with 15,4 days for the control group receiving standard treatment. The average healing time for ulcers treated with Debrisan and left to heal spontaneously was 4,4 weeks compared with 5,32 weeks for the controls. Debrisan, furthermore, decreased the amount of local tissue oedema and alleviated local pain in the majority of patients. It is feasible to use Debrisan for outpatient treatment and without additional staff in a busy clinic. The cost of Debrisan therapy appeared to be reasonable. A hydrophilic cleansing agent such as Debrisan has a definite place in the early treatment of the secreting infected post-phlebitic stasis ulcer.

Topics: Chlorohydrins; Clinical Trials as Topic; Debridement; Dextrans; Edema; Epichlorohydrin; Female; Granulation Tissue; Humans; Male; Pain; Phlebitis; Povidone-Iodine; Random Allocation; Time Factors; Varicose Ulcer; Wound Healing

Iodine-based products are antibacterial. The small iodine molecular size is ideally suited to treat surface critical colonisation. Inadine is a 10% povidone iodine dressing with the equivalent of 1% available iodine that is easily extracted from the viscose backing by serum or exudate. The use of hydrophilic polyethylene glycol tulle dressing delivery vehicle allows the dressing to be easily removed by irrigation with potable water or saline. In this study, we developed a short online survey completed by 23 wound-care key opinion leaders from the nursing, medical and podiatry professions. A computerised modified Delphi technique was used to achieve 80% consensus on 11 statements related to the utility and everyday topical wound-care use of this product.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Attitude of Health Personnel; Consensus; Female; Health Personnel; Humans; Male; Middle Aged; Occlusive Dressings; Povidone-Iodine; Varicose Ulcer; Wound Healing

Wound healing represents a dynamic process of increasing scientific interest, especially with the detection of the different growth factors. Economic aspects are also of importance in the investigation of substances used for wound healing. In Germany 25% of all patients (ca. 1 million) with severe chronic venous insufficiency have crural ulcers. The influence of bacterial infection of crural ulcers is controversial. There is no doubt that the quantity of bacteria is of importance. Local antibiotic treatment is difficult, as most of the substances used are known to inhibit wound healing. In vivo and in vitro investigations showed, that chiniofon-containing antiseptic has a bacteriostatic function. Additionally it was shown, using cultures of fibroblasts, that chiniofon-containing antiseptic does not inhibit the growth of fibroblasts, whereas PVP-iodine solution, a widely used antiseptic, clearly reduces the growth of fibroblasts. The good clinical results in the treatment of acute and chronic radiation damage indicate that chiniofon-containing antiseptic may have antiflammatory activity.

Topics: Administration, Topical; Adult; Aged; Animals; Breast Neoplasms; Cell Division; DNA Replication; Dose-Response Relationship, Drug; Female; Humans; In Vitro Techniques; L Cells; Male; Mice; Microbial Sensitivity Tests; Middle Aged; Mouth Mucosa; Otorhinolaryngologic Neoplasms; Povidone-Iodine; Radiodermatitis; Skin; Stomatitis; Superinfection; Varicose Ulcer; Wound Healing

The success of venous leg ulcer treatment can be evaluated by various parameters like wound area reduction in square millimeters, percent reduction of ulcer size, reduction of wound radius, and time of wound closure. Which one is the most reliable parameter if different treatment forms (i.e. various ointments) are to be compared? The best parameter for the evaluation of the speed at which chronic ulcers heal was the daily wound radius reduction, calculated from the wound area by planimetry. Under a standardized treatment (polyvidoniodine ointment, pressure bandaging) the daily ulcer radius fell on the average by 0.24 mm indicating a continuous growth of skin tissue from the wound circumference. Conversely, the daily wound area reduction in mm2 or in percent was difficult to interpret due to the parabolic shape of the area reduction curve. Here the following characteristics were noted: Large wounds displayed a relatively quick reduction of the wound area and at the same time a slow percental wound diminution. Small wounds, on the other hand, displayed a relatively slow reduction of the wound area and at the same time a relatively quick percent wound diminution. The period of time during which a wound became completely closed was equally unsuited for the assessment of therapeutic success because large ulcers healed slower than smaller ones. We conclude from these results that reduction of the wound radius should be used as the most reliable parameter for the evaluation of venous leg ulcer healing.

Topics: Adult; Aged; Aged, 80 and over; Bandages; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Povidone-Iodine; Varicose Ulcer; Wound Healing

In an open comparative study, 40 patients suffering from pyoderma, combustion (1st and 2nd degrees), leg ulcer, or inflammatory white atrophy were treated with a topical preparation containing either polyvinyl pyrrolidone iodine or neomycin. Both preparations were well-tolerated. There was no local hypersensibility. With regard to the therapeutic effect, we did not observe any differences between the two groups of patients. We discuss the properties, modes of action, and contraindications, as well as the possible systemic influences of topically applied PVP iodine.

Topics: Administration, Topical; Adolescent; Adult; Aged; Atrophy; Burns; Female; Humans; Male; Middle Aged; Neomycin; Povidone; Povidone-Iodine; Pyoderma; Skin; Skin Diseases, Infectious; Varicose Ulcer; Wound Infection

A clinical study was conducted over a 2 year period to assess the effect of four different treatments on the healing of venous leg ulcers. The treatments consisted of standard local applications of povidone-iodine or normal saline, with and without electrode therapy. At weekly intervals, ulcer areas were measured using a newly developed technique. This allowed time-to-heal data to be analysed. A comparison of the four treatments revealed a highly significant retarding effect on ulcer healing by the povidone-iodine plus electrode treatment. There were no statistical differences for comparisons made between povidone-iodine alone and normal saline alone or for normal saline with and without electrode. Covariates were considered in the analyses. Patient sex and initial ulcer area were identified as significant factors in ulcer's time-to-heal (P less than 0.05), while patient's smoking habits, age and ulcer's initial total organism count had no influence.

Topics: Aged; Chronic Disease; Combined Modality Therapy; Electric Stimulation; Female; Humans; Male; Povidone-Iodine; Prognosis; Varicose Ulcer

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