Wound? We learn to disinfect first, even as children. It is less well known that disinfectants and antiseptics not only kill bacteria, but also damage the normal skin flora, leukocytes and fibroblasts involved in wound healing. Therefore, there is no good reason for disinfection without a wound or during normal wound healing. Colonization with bacteria in the region of the gluteal fold and anus is unavoidable and not harmful. Only in the case of infection, i.e. pathogenic bacterial growth in the wound, can antiseptics be useful in justified individual cases. Today, the skin flora is better referred to as the microbiome. The term "flora", after the Roman goddess of flowers and youth, refers to the plant kingdom, to which bacteria do not belong.
"Thoroughly rinse the wound daily (several times)". - This is the most commonly reported recommendation for wound care. What does science say?
A 2012 Cochrane analysis found different types of wound irrigation (tap water vs boiled water vs saline vs no irrigation) were equivalent.
The Robert Koch Institute (RKI) nevertheless comments as follows: "Every rinsing fluid must be sterile. Tap water is not free of microorganisms. Only sterile solutions may be used to rinse wounds."
What the RKI says is the law.
Nevertheless, I feel I can comment on these opinions:
Improve water quality: The German Society for Hospital Hygiene (DGKH) says on the subject of tap water: "When using terminal sterile filters at the water outlet, drinking water ... can achieve the necessary microbiological purity. However, these filters should be changed daily...".
Suitable filters are available as disposable products or in rental systems with included reprocessing. The best solution is a terminal system as a handpiece at the shower. This seems to me to be a recommendable and practicable solution.
It is not necessary to "clean" the wound. However, once or twice a day we would recommend showering off secretion residues, loose hairs and exfoliated horny scales of the skin in the fold of the buttocks.
New in wound treatment are stabilized aqueous preparations of NaOCl/HOCl. They combine very good efficacy against almost all types of pathogens including resistant problem germs with very good tolerability. It is the only antiseptic permitted in the treatment of severe infections in the abdominal cavity. and central nervous system. NaOCl/HOCl is therefore already referred to as the new gold standard in wound treatment.
Representatives of this group are, for example, the products Veriforte™ med, Granudacyn®, Lavanox-Serag® and Microdacyn®, which are available as wound gel, irrigation solution and wound spray.
Pros:
Octenidine (Octenisept®) is effective against bacteria, fungi and, to a limited extent, viruses. It is well tolerated and does not normally sting the wound; a slight feeling of warmth occurs. It has no adverse effects on wound healing. Due to its slightly viscous consistency, it is well suited as a lubricant for shaving.
Precautions for use:
In the case of wound irrigation, the preparation must not be introduced or injected into the tissue under pressure.
In Germany,chlorhexidine is mainly used in dentistry as a solution for mouth rinsing. A further, recognized application in England and the USA is the use before operations to reduce wound infections.
It has a broad spectrum of activity against gram-positive and gram-negative bacteria and yeasts. Allergic reactions and an influence on connective tissue and skin cells have been described.
I would consider the so-called decolonisation to be suitable for preventing inflammations in connection with risk situations (travel, exam preparation, etc.) at Pilonidal Sinus . Due to the approval status, the treatment would have to be classified as an off-label therapy. In case of a permanent treatment, negative effects would probably predominate.
There is currently no guideline recommendation on chlorhexidine.
Chlorhexidine wash lotion is available in Germany only to healthcare professionals as Skinsan Scrub N™. Via European distributors Desinclor Chlorhexidine Antiseptic Soap 0.8% offered. In the USA, preparations containing chlorhexidine are available without prescription. In an Australian study, decolonisation by washing with chlorhexidine was significantly more effective in preventing wound healing problems than taking antibiotics in tablet form.
As an ingredient of Bepanthen Antiseptic Wound Cream, chlorhexidine is approved for the treatment of superficial wounds. In individual cases, its use may be justified in the case of wound healing disorders that cannot be influenced in any other way.
Wound irrigation with chlorhexidine probably impedes healing more than it helps and is not recommended.
PVP - Iodine is a broadly effective antiseptic against bacteria and bacterial spores, viruses and fungi, for which no significant gaps in efficacy or resistance are known (Review paper on iodine in wound treatment).
Elemental iodine is not soluble in water and is toxic to tissues. Povidone iodine (PVP iodine, polyvinylpyrrolidone iodine), on the other hand, is water-soluble and tissue-compatible and continuously releases small amounts of iodine. The substance is available over the counter as a solution and ointment.
Most surgeons report good experiences with PVP iodine ointment, also to support delayed wound healing in the area of the gluteal fold. The positive effects seem to outweigh the experimentally found inhibition of connective tissue cells (fibroblasts) and cells of the immune system. Numerous clinical studies have shown that iodine-containing antiseptics have a positive effect on the healing rate and healing time of chronic wounds.
Caution is advisable in the case of large wound areas through which large quantities of iodine could enter the organism, as well as in patients with previous heart, kidney or thyroid diseases. Allergies can also occur occasionally, very rarely reaching anaphylactic shock(1)(2).
Not every wound should be disinfected with iodine. We use PVP iodine for complex mixed colonization of delayed healing, strong smelling or exuding wounds .
Please note that the brown color stains the laundry.
Iodine should no longer be considered an old-fashioned antiseptic.... Perhaps its greatest strength is that bacteria have not found a way to develop resistance even after 150 years of use in humans.
Rose A. Cooper (2007), University of Wales, Centre of biomedical sciences, Cardiff
Dr. Bernhard Hofer and Florian Liebl
Specialists in Visceral Surgery and Proctology - PartG mbB
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