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Wound cleansing agents are routine in wound care and preoperative preparation. Antiseptic activity intends to prevent contaminating microbes from establishing an infection while also raising concerns of cytotoxicity and delayed wound healing. We evaluated the cytotoxicity of five clinically used wound cleaning agents (saline, povidone iodine, Dove® and Dial® soaps, and chlorhexidine gluconate [CHG]) using both an ex vivo and in vivo human skin xenograft mouse model, in contrast to classical in vitro models that lack the structural and compositional heterogeneity of human skin. We further established an ex vivo wound contamination model inoculated with ~100 cells of Pseudomonas aeruginosa or Staphylococcus aureus to evaluate antimicrobial efficacy. Scanning electron microscopy and confocal microscopy were used to evaluate phenotypic and spatial characteristics of bacterial cells in wound tissue. CHG significantly reduced metabolic activity of the skin explants, while all treatments except saline affected local cellular viability. CHG cytotoxicity persisted and progressed over 14 days, impairing wound healing in vivo. Within the contamination model, CHG treatment resulted in a significant reduction of P. aeruginosa wound surface counts at 24 h post‐treatment. However, this effect was transient and serial application of CHG had no effect on both P. aeruginosa or S. aureus microbial growth. Microscopy revealed that viable cells of P. aeruginosa reside deep within wound tissue post‐CHG application, likely serving as a reservoir to re‐populate the tissue to a high bioburden. We reveal concerning cytotoxicity and limited antimicrobial activity of CHG in human skin using clinically relevant models, with the ability to resolve spatial localization and temporal dynamics of tissue viability and microbial growth. [ABSTRACT FROM AUTHOR]

Presence of bacteria in wounds can delay healing. Addition of a regularly instilled topical solution over the wound during negative‐pressure wound therapy (NPWT) may reduce bioburden levels compared with standard NPWT alone. We performed a prospective, randomised, multi‐centre, post‐market trial to compare effects of NPWT with instillation and dwell of polyhexamethylene biguanide solution vs NPWT without instillation therapy in wounds requiring operative debridement. Results showed a significantly greater mean decrease in total bacterial counts from time of initial surgical debridement to first dressing change in NPWT plus instillation (n = 69) subjects compared with standard NPWT (n = 63) subjects (−0.18 vs 0.6 log10 CFU/g, respectively). There was no significant difference between the groups in the primary endpoint of required inpatient operating room debridements after initial debridement. Time to readiness for wound closure/coverage, proportion of wounds closed, and incidence of wound complications were similar. NPWT subjects had 3.1 times the risk of re‐hospitalisation compared with NPWT plus instillation subjects. This study provides a basis for exploring research options to understand the impact of NPWT with instillation on wound healing. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to compare different wound‐rinsing solutions to determine differences in the efficiency and to evaluate three different in vitro models for wound cleansing. Different wound‐rinsing solutions (physiological saline solution, ringer lactate solution for wound irrigation, water and a solution containing polihexanide and the surfactant undecylenamidopropyl‐betain) were applied on standardised test models (one‐ and three‐chamber model, flow‐cell method and a biofilm model), each challenged with three different standardised wound test soils. In the one‐chamber model saline showed a better effect on decontaminating proteins than the ringer lactate solution. In the flow‐cell method, water performed better than physiological saline solution, whereas ringer lactate solution demonstrated the lowest cleansing effect. No obvious superiority between the two electrolyte‐containing solutions was detectable in the biofilm model. Unfortunately, it was not possible to assess the protein decontamination qualities of the surfactant‐containing solution because of the interference with the protein measurement. The flow‐cell method was able to detect differences between different rinse solutions because it works at constant flow mechanics, imitating a wound‐rinsing procedure. The three‐chamber and the less‐pronounced modified one‐chamber method as well as the biofilm model had generated inhomogeneous results. [ABSTRACT FROM AUTHOR]

We describe our experience with a novel foam dressing architecture in tandem with negative pressure wound therapy and instillation ( NPWTi-d) for removing viscous wound exudate and infectious materials. A retrospective review was conducted of the outcomes of 21 patients who received NPWTi-d using a reticulated open cell foam instillation dressing with through holes ( ROCF-CC) designed to facilitate the removal of thick wound exudate and infectious materials. NPWTi-d with ROCF-CC was used to treat large complex chronic wounds with viscous wound exudate that contained substantial areas of devitalised tissue. Debridement was performed as appropriate or available. NPWTi-d with ROCF-CC assisted in loosening, solubilising and detaching viscous exudate, dry fibrin, wet slough and other infectious materials. Percent surface area of black non-viable tissue and yellow fibrinous slough was reduced to ≤ 10% in 18/21 (85·7%) and 12/21 (57·1%) wounds, respectively, after an average of 1-3 applications (3-9 days) of NPWTi-d with ROCF-CC. Preliminary evidence suggests that adjunctive use of NPWTi-d with ROCF-CC may help clean large, complex wounds when complete surgical debridement is not possible or appropriate and/or when areas of slough and non-viable tissue remain present on the wound surface. [ABSTRACT FROM AUTHOR]

A new method (V.A.C. ULTA™ Therapy System, KCI USA, Inc., San Antonio, TX) combines the benefits of negative pressure wound therapy ( NPWT; V.A.C.® Therapy, KCI USA, Inc.) with regulated, periodic instillation of user-selected topical wound solutions (V.A.C. VeraFlo™ Therapy, KCI USA, Inc.). In simulated wound model studies comparing solution distribution using NPWT with and without a soak phase, the instillation soak phase allowed for uniform solution distribution across the wound bed, whereas continuous (no soak) irrigation resulted in uneven coverage. Additional in vitro work illustrated that bacterial particle aerosolisation during wound cleansing was significantly decreased using NPWT with instillation ( NPWTi) versus commercially available low-pressure wound cleansers ( P < 0·05). In porcine studies, NPWT with saline instillation induced 43% more granulation tissue versus NPWT ( P < 0·05) and was as effective at wound cleansing as pulsed lavage. These studies have demonstrated that NPWTi may be an effective wound management therapy that provides both wound cleansing and NPWT benefits. [ABSTRACT FROM AUTHOR]

Atiyeh BS, Dibo SA, Hayek SN. Wound cleansing, topical antiseptics and wound healing. Quality of care is a critical requirement for wound healing and ‘good’ care of wounds has been synonymous with topical prevention and management of microbial contamination. Topical antiseptics are antimicrobial agents that kill, inhibit or reduce the number of microorganisms and are thought to be essential for wounds infection control. However, they have long and commonly been used on wounds to prevent or treat infection, the merits of antiseptic fluid irrigation have received little scientific study. Unlike antibiotics that act selectively on a specific target, antiseptics have multiple targets and a broader spectrum of activity, which include bacteria, fungi, viruses, protozoa and even prions. Although certain skin and wound cleansers are designed as topical solutions with varying degrees of antimicrobial activity, concerns have been raised. Wound cleansers may affect normal human cells and may be antimitotic adversely affecting normal tissue repair. Repeated and excessive treatment of wounds with antiseptics without proper indications may have negative outcomes or promote a microenvironment similar to those found in chronic wounds. However, when applied at the proper times and concentrations, some classes of antiseptics may provide a tool for the clinician to drive the wound bed in desired directions. The present review summarises the various antiseptics in use and their negative impact on the wound healing mechanisms. It is clear that the role of antiseptics on wounds and their role in wound care management need to be reconsidered. [ABSTRACT FROM AUTHOR]

Since commercialisation almost 20 years ago, negative pressure wound therapy ( NPWT; V.A.C.® Therapy; KCI USA, Inc., San Antonio, TX) has been used to treat a wide variety of wound types and continues to evolve as research expands understanding of the mechanisms of action that enable this adjunct therapy to facilitate wound closure. In 2010, the educational International Surgical Wound Forum ( ISWF) was created to facilitate discussion among experts from all over the world regarding modern wound treatment challenges and techniques. This is the first of two supplements, which are based on the 2012 and 2013 ISWF presentations and demonstrate the evolution of the role of NPWT in wound care. This first supplement provides an overview of current health care challenges and clinical practice and reviews evidence and experience using NPWT with instillation, which combines NPWT with computer-controlled delivery and removal of topical solutions and suspensions to cleanse and/or treat wounds. [ABSTRACT FROM AUTHOR]