Aseptic tissue necrosis and chronic inflammation after irrigation of penetrating hand wounds using Octenisept^®

Abstract

Penetrating hand wounds are common and these are managed by thorough debridement. However, stab wounds without evidence of divided structures are often treated with irrigation using antiseptic substances, antibiotic therapy, and immobilization. Octenisept® (Schülke & Mayr Ltd) is a widely used antiseptic agent for disinfection of acute or chronic wounds. It has a broad spectrum of antiseptic efficacy and has become an antiseptic of first choice in many hospitals. Within a few months, four patients presented to us with chronic inflammation and severe tissue necrosis after irrigation of penetrating hand wounds with Octenisept®. Repeated surgery and debridement was required in all patients. Wound healing was prolonged and patients had persisting oedema. Penetrating hand wounds must not be irrigated with Octenisept®.

A comparison of the irritant and allergenic properties of antiseptics

“…Wound healing was prolonged and the patients had persisting oedema. The conclusion of the authors was that penetrating hand wounds must not be irrigated with Octenisept ® [19]. It has not been decided whether this side effect was associated (or not) to the combined presence of octenidine and phenoxyethanol but it has to be emphasized that it has never been related to phenoxyethanol when used alone [20].…”

“…It has been demonstrated that chlorhexidine induced cytotoxicity and genotoxicity on macrophages in vitro [18]. A very particular side effect of octenidine, which does not primarily concern superficial skin infections, has been recently described [19]. It refers to aseptic tissue necrosis and chronic inflammation after irrigation of penetrating hand wounds using Octenisept ® .…”

Eradication of MRSA skull base osteitis by combined treatment with antibiotics and sinonasal irrigation with sodium hypochlorite

“…As a consequence, irrigation of penetrating wounds using Octenisept Ò resulted in aseptic tissue necrosis [19][20][21]. Besides, in vitro results indicate significantly reduced cell viability after octenidine treatment [11].…”

“…In vitro studies have shown that Dermacyn Ò has a higher effectiveness than a 0.1 % CHX or 0.02 % PVP-I [28]. Hypochlorite has a distinct effectiveness in colonized wounds with S. aureus [21] and chronic wounds had a better outcome after treatment by Dermacyn Ò than by PVP-I [29][30][31]. In comparison to the cytotoxic H 2 O 2 [32], the microbiocidal concentration of OCl -does not inhibit the proliferation of fibroblasts [33].…”

The Effect of Antiseptics on Adipose-Derived Stem Cells

“…However, serositis after peritoneal lavage, severe subcutaneous edema with fatty tissue necrosis in pediatric patients, and chronic soft tissue inflammation combined with tissue necrosis of the hand have been reported with its use (23–27). As a result, the manufacturer issued a warning for the use of Octenisept® for the irrigation of deep wounds with high force.…”