Classification of Wounds at Risk and Their Antimicrobial Treatment with Polihexanide: A Practice-Oriented Expert Recommendation

Dissemond, Joachim; Assadian, Ojan; Gerber, Veronika; Kingsley, Andrew; Krämer, Axel; Leaper, David; Mosti, Giovanni; Piatkowski, Andrzej; Riepe, G.; Risse, Alexander; Romanelli, Marco; Strohal, Robert; Traber, Jürg; Vasel-Biergans, A.; Wild, T. Cameron; Eberlein, Thomas

doi:10.1159/000327210

Cited by 71 publications

(62 citation statements)

References 39 publications

(28 reference statements)

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“…Another important aspect of modern antisepsis is the improvement of treatment options for chronic wounds. Standardized procedures aiming to improve chronic wound healing need to be assessed based on clinical criteria and the practicability of their implementation [4]. …”

Section: The Impact Of Preoperative Skin Antisepsis On the Preventionmentioning

confidence: 99%

“…Accordingly, chronic wounds in pets were completely healed by TTP in combination with polihexanide (PHMB) or octenidine dihydrochloride, whereas healing could not be achieved with surgical treatment or with antisepsis alone [51]. Thus, depending on the clinical assessment and grading of the lesions concerned [4], TTP is a new option for the treatment of chronic wounds [36]. …”

Section: Future Challenges To Improving Skin Antisepsismentioning

confidence: 99%

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New Strategies for Preoperative Skin Antisepsis

Ulmer

Lademann

Patzelt

et al. 2014

Skin Pharmacol Physiol

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During the past decades, encouraging progress has been made in the prevention of surgical site infections (SSI). However, as SSI still occur today, strategic prevention measures such as standardized skin antisepsis must be implemented and rigorously promoted. Recent discoveries in skin physiology necessitate the development of novel antiseptic agents and procedures in order to ameliorate their efficacy. In particular, alternate target structures in the skin need to be taken into consideration for the development of the next generation of antiseptics. Recent investigations have shown that a high number of microorganisms are located within and in the close vicinity of the hair follicles. This suggests that these structures are an important reservoir of bacterial growth and activity in human skin. To date, it has not been fully elucidated to what extent conventional liquid antiseptics sufficiently target the hair follicle-related microbial population. Modern technologies such as tissue-tolerable plasma (TTP) have been tested for their potential antiseptic efficiency by reducing the bacterial load in the skin and in the hair follicles. First experiments using liposomes to deliver antiseptics into the hair follicles have been evaluated for their potential clinical application. The present review evaluates these two innovative methods for their efficacy and applicability in preoperative skin antiseptics.

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Section: The Impact Of Preoperative Skin Antisepsis On the Preventionmentioning

confidence: 99%

Section: Future Challenges To Improving Skin Antisepsismentioning

confidence: 99%

New Strategies for Preoperative Skin Antisepsis

Ulmer

Lademann

Patzelt

et al. 2014

Skin Pharmacol Physiol

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“…Schultz 6 CFU per gram tissue) no clinically manifest infection could be diagnosed by an experienced investigator [43]. The Wounds At Risk Score is a purely clinical decision-making tool for the use of antiseptics that determines the probability of wound infection on the basis of risk factors [44].…”

Section: Infection Controlmentioning

confidence: 99%

Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Klein

Schreml

Dolderer

et al. 2013

J Deutsche Derma Gesell

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SummaryThe number of patients suffering from chronic wound healing disorders in Germany alone is estimated to be 2.5-4 million. Therapy related expenses reach 5-8 billion Euros annually. This number is partially caused by costly dressing changes due to non-standardized approaches and the application of non-evidence-based topical wound therapies. The purpose of this paper is to elucidate a straightforward principle for the management of chronic wounds, and to review the available evidence for the particular therapy options. The T.I.M.E.-principle (Tissue management, Inflammation and infection control, Moisture balance, Epithelial [edge] advancement) was chosen as a systematic strategy for wound bed preparation. Literature was retrieved from the PubMed and Cochrane Library databases and subjected to selective analysis.Topical wound management should be carried out according to a standardized principle and should further be synchronized to the phases of wound healing. Despite the broad implementation of these products in clinical practice, often no benefit exists in the rate of healing, when evaluated in meta-analyses or systematic reviews. This insufficient evidence is additionally limited by varying study designs. In case of non-superiority, the results suggest to prefer relatively inexpensive wound dressings over expensive alternatives. Arbitrary endpoints to prove the effectiveness of wound dressings, contribute to the random use of such therapies. Defining rational endpoints for future studies as well as the deployment of structured therapy strategies will be essential for the economical and evidence-based management of chronic wounds.

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“…[43]. Eine rein klinische Entscheidungshilfe für den Einsatz von Antiseptika bietet der Wounds-at-Risk-Score welcher anhand von Risikofaktoren die Wahrscheinlichkeit einer Wundinfektion ermittelt [44].…”

Section: Pathophysiologie Chronischer Wundenunclassified

“…Umgekehrt verhält es sich mit Octenidinlösungen, welche mit 1,73-2,11 relativ hohe BI-Werte aufweisen, über deren unerwünschte Arzneimittelwirkungen mit Ödembildung und Gewebsnekrosen bei Anwendung unter Druck oder Verbleib in Wundhöhlen bereits wiederholt in "Rote-Hand-Briefen" informiert wurde [49,51]. Polyhexanidlösungen gelten bezüglich ihrer Gewebetoxizität und ihrer Kontaktsensibilisierung als risikoarm [44,52,53].…”

Section: Pathophysiologie Chronischer Wundenunclassified