Search

Importance: Peceleganan spray is a novel topical antimicrobial agent targeted for the treatment of skin wound infections. However, its efficacy and safety remain unclear., Objective: To assess the safety and efficacy of peceleganan spray for the treatment of wound infections., Design, Setting, and Participants: This multicenter, open-label, phase 3 randomized clinical trial recruited and followed up 570 adult patients diagnosed with secondary open wound infections from 37 hospitals in China from August 23, 2021, to July 16, 2022., Interventions: Patients were randomized to 2 groups with a 2:1 allocation. One group received treatment with 2% peceleganan spray (n = 381) and the other with 1% silver sulfadiazine (SSD) cream (n = 189)., Main Outcomes and Measures: The primary efficacy outcome was the clinical efficacy rate (the number of patients fulfilling the criteria for efficacy of the number of patients receiving the treatment) on the first day following the end of treatment (day 8). The secondary outcomes included the clinical efficacy rate on day 5 and the bacterial clearance rate (cases achieving negative bacteria cultures after treatment of all cases with positive bacteria cultures before treatment) on days 5 and 8. The safety outcomes included patients' vital signs, physical examination results, electrocardiographic findings, blood test results, and adverse reactions., Results: Among the 570 patients randomized to 1 of the 2 groups, 375 (98.4%) in the 2% peceleganan treatment group and 183 (96.8%) in the 1% SSD control group completed the trial (n = 558). Of these, 361 (64.7%) were men, and the mean (SD) age was 48.6 (15.3) years. The demographic characteristics were similar between groups. On day 8, clinical efficacy was achieved by 339 patients (90.4%) in the treatment group and 144 (78.7%) in the control group (P < .001). On day 5, clinical efficacy was achieved by 222 patients (59.2%) in the treatment group and 90 (49.2%) in the control group (P = .03). On day 8, bacterial clearance was achieved by 80 of 334 patients (24.0%) in the treatment group and in 75 of 163 (46.0%) in the control group (P < .001). On day 5, bacterial clearance was achieved by 55 of 334 patients (16.5%) in the treatment group and 50 of 163 (30.7%) in the control group (P < .001). The adverse events related to the application of peceleganan spray and SSD cream were similar., Conclusions and Relevance: This randomized clinical trial found that peceleganan spray is a safe topical antimicrobial agent with a satisfactory clinical efficacy rate for the treatment of skin wound infections, while the effectiveness of bacterial clearance remains uncertain., Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2100047202.

Objective: Antiseptics are widely used in wound management to prevent or treat wound infections, and have been shown to have antibiofilm efficacy. The objective of this study was to assess the effectiveness of a polyhexamethylene biguanide (PHMB)-containing wound cleansing and irrigation solution on model biofilm of pathogens known to cause wound infections compared with a number of other antimicrobial wound cleansing and irrigation solutions., Method: Staphylococcus aureus and Pseudomonas aeruginosa single-species biofilms were cultured using microtitre plate and Centers for Disease Control and Prevention (CDC) biofilm reactor methods. Following a 24-hour incubation period, the biofilms were rinsed to remove planktonic microorganisms and then challenged with wound cleansing and irrigation solutions. Following incubation of the biofilms with a variety of concentrations of the test solutions (50%, 75% or 100%) for 20, 30, 40, 50 or 60 minutes, remaining viable organisms from the treated biofilms were quantified., Results: The six antimicrobial wound cleansing and irrigation solutions used were all effective in eradicating Staphylococcus aureus biofilm bacteria in both test models. However, the results were more variable for the more tolerant Pseudomonas aeruginosa biofilm. Only one of the six solutions (sea salt and oxychlorite/NaOCl-containing solution) was able to eradicate Pseudomonas aeruginosa biofilm using the microtitre plate assay. Of the six solutions, three (a solution containing PHMB and poloxamer 188 surfactant, a solution containing hypochlorous acid (HOCl) and a solution containing NaOCl/HOCl) showed increasing levels of eradication of Pseudomonas aeruginosa biofilm microorganisms with increasing concentration and exposure time. Using the CDC biofilm reactor model, all six cleansing and irrigation solutions, except for the solution containing HOCl, were able to eradicate Pseudomonas aeruginosa biofilms such that no viable microorganisms were recovered., Conclusion: This study demonstrated that a PHMB-containing wound cleansing and irrigation solution was as effective as other antimicrobial wound irrigation solutions for antibiofilm efficacy. Together with the low toxicity, good safety profile and absence of any reported acquisition of bacterial resistance to PHMB, the antibiofilm effectiveness data support the alignment of this cleansing and irrigation solution with antimicrobial stewardship (AMS) strategies.

Local wound infections are a multidisciplinary challenge which should be diagnosed as early as possible and adequately treated. In addition to a stagnation of wound healing, it is in particular the threat of development into systemic infections and even sepsis that represent feared, potentially life-threatening complications. This topic has a particularly high and multidisciplinary significance in the treatment of patients with chronic wounds. Until now, there were no generally accepted criteria for the diagnostics. The newly developed and validated TILI score, as a supplement to vital signs and serological values, enables rapid objectification of local wound infections. In addition, the W.A.R. score can be used to identify patients with an increased risk of infections. With these easy to use tools, the indications for antiseptic wound treatment can be assessed individually, quickly and without problems. For many patients with chronic wounds, polihexanide is then the wound antiseptic of first choice. However, the indications for wound antiseptics should be critically reviewed after a treatment duration of 14 days at the latest., (© 2021. The Author(s).)

Objective: The purpose of this study was to investigate the antimicrobial efficacy of a novel activated zinc solution against meticillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa after one hour, and to evaluate any untoward effect of the solution on local wound tissue at 24 hours after solution exposure in a pig wound model., Method: A pathogen-free, commercially raised, Yorkshire-cross female pig was acquired 12 days prior to the procedure. Within one week prior to the procedure, a small loopful of test bacteria, Pseudomonas aeruginosa (pig-isolate) and MRSA (ATCC-6538), were streaked and cultured on a non-selective agar. Full-thickness wounds (n=24) were created and evenly divided into three groups: control wounds (exposed to bacteria but untreated, n=8); wounds treated with Compound 1 (n=8), and wounds treated with Compound 2 (n=8). All wounds were dressed and monitored for one hour and 24 hours., Results: After one hour, the wounds treated with Compound 1 and Compound 2 had a mean recoverable total bacteria of 2.8 log colony forming units (CFUs) and 3.5 logCFUs, respectively. After one hour, the wounds treated with Compound 1 and Compound 2 had a mean recoverable MRSA of 2.3 logCFUs and 1.6 logCFUs, respectively (p=0.009). After one hour, the wounds treated with Compound 1 and Compound 2 had a mean recoverable Pseudomonas aeruginosa of 0.3 logCFUs and 0.0 logCFUs, respectively (p=0.000). After 24 hours of exposure to Compound 1 and Compound 2, there was no statistically significant increased necrosis (p=0.12, p=0.31, respectively) or neutrophilic infiltrate (Compound 2, p=0.12) when compared with control wounds., Conclusion: The novel activated-zinc compound used in this study demonstrated a 99.5-99.9% reduction in total bacteria, a 99.9-99.98% reduction in MRSA, and 100% eradication of Pseudomonas aeruginosa one hour after exposure. This novel solution may provide another significant tool to treat and/or prevent wound infections.

Objective: To compare the effectiveness of antiseptic solutions to that of non-antiseptic solutions in reducing wound infection rate, reducing bacterial load and improving wound healing., Method: We searched PubMed MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), ProQuest Medical Database and medRxiv for randomised controlled trials (RCTs) comparing antiseptic solutions with non-antiseptic solutions in simple, uncomplicated acute traumatic wounds. Qualitative data synthesis was employed. Risk of bias was assessed and GRADE assessment was used to evaluate quality of evidence., Results: In this systematic review, four studies with a total of 875 participants were included, of which two studies showed a significant reduction of wound infection rate using povidone-iodine (p=0.001 and p=0.03). The use of non-antiseptic solutions significantly increased bacterial load on acute traumatic wounds (p=0.0001). The quality of evidence was very low. No studies reported on wound healing outcome., Conclusion: No robust conclusions can be implemented in clinical practice. Future studies are needed to compare the use of antiseptic and non-antiseptic solutions in acute traumatic wounds.

A variety of dressings is available for the treatment of partial-thickness wounds, but none has strong evidence supporting their beneficial effect on healing. This may be due to variation in the type and depth of wounds in clinical studies. The aim of this study was to use a standardized porcine wound model to compare three dressings commonly used in burn centers for partial-thickness burns. Partial-thickness scalds were made on the flanks of pigs. Wounds were treated with silver sulfadiazine (SSD, flammazine), a hydrofiber dressing, or glycerol-preserved allogeneic (pig) skin. The healing process was monitored for 8 weeks. Macroscopic parameters were the itching behavior, the cosmetic appearance of the scars, and contraction. Microscopic parameters were the inflammatory response, myofibroblast influx, and the numbers of nerves. All wounds were closed on day 14 and wound infection did not occur. Treatment with SSD resulted in significantly more wound contraction compared to treatment with glycerol-preserved pig skin. Animals treated with SSD suffered more from itching (scratching) during the first 2 weeks after wounding. The number of nerves in healing wounds of these animals was significantly higher compared to wounds treated with hydrofiber dressing or allogeneic skin. In our standardized porcine partial-thickness wound model, treatment with SSD resulted in less favorable wound healing. Compared to treatment with glycerol-preserved allogeneic skin, SSD resulted in more contraction., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Wound infection is an important complicating factor in the wound healing process, and infections can be even more complex and difficult to manage in the case of wounds with biofilms. Silver has been used to treat infected wounds for a long time now, and the strength of the product depends on the number of Ag ions, where the greater the number of ions, the higher and faster the reactivity is. Ag Oxysalts technology-used in 3M Kerracontact Ag dressing-has three times more ions than standard silver dressings. The technology also does not show the typical disadvantages of silver, such as cytotoxicity and systemic toxicity. This article discusses the use of Ag Oxysalts technology for infected wounds and presents case studies to support the efficacy of this product in promoting wound healing.

Objective: To evaluate the effectiveness of a new treatment method in healing superficial infected wounds compared with surgical debridement with chlorhexidine solution., Method: In this animal model, two wounds were created on the back of 10 male adult rabbits. Wounds treated by Method 1 were debrided using 0.02% chlorhexidine aqueous solution and an antibiotic topical ointment. Wounds treated by Method 2 wounds were treated using a newly developed device which enabled visual monitoring of the wound as it was treated with various pharmacological solutions (including antiseptic, antiseptic oxidant and an osmotically active agent) specifically formulated for each wound healing stage. Wound area size (using digital planimetry) and time taken to clean the wound were recorded, and biopsies were taken, at the beginning of the study and at various timepoints throughout., Result: It was observed that both wound cleaning and wound healing were accelerated by treatment with method 2 compared with method 1 (by 43.8% and 36.7%, respectively). There were also a significantly smaller number of complications in these wounds [p=0.0044] due to the positive ratios of neutrophils and fibroblasts in the wound cavities (from the third to the fourteenth day after wound modelling)., Conclusion: Wounds treated with the new device in method 2 had a shorter wound healing time than wounds treated with a traditional method. The automated influx-outflow of solutions removed any fragments of necrotic tissue from the wound surface. Wounds were able to be monitored without the need to remove dressings. The transparent, airtight film, which allowed for wound monitoring without the need to remove dressings, meant that suturing was not required. This resulted in no complications in the wounds treated by this new method.

Objective: This study sought to estimate the effect of a liquid octenidine dihydrochloride (OCT)-impregnated gauze dressing in the treatment of meticillin-resistant Staphylococcus aureus (MRSA) biofilm-infected wounds., Method: In this animal study, a six-millimetre punch full-thickness wound on each mouse back was inoculated with MRSA suspension, and then covered with a Tegaderm (3M Health Care, US) dressing for an established biofilm model. Animals were divided into three groups for topical application: control group (treated with phosphate-buffered saline, PBS); mupirocin group (treated with 2% mupirocin); and OCT group (treated with OCT). All applications were administrated once 24 hours post-wounding. The bioburden was determined by counting colony-forming units (cfus) and the biofilm architecture was viewed using fluorescent staining and scanning electron microscopy (SEM) on day two. The tissue repair was evaluated histologically and the related genes were detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR) on day 15., Results: The results suggested OCT accelerated healing and reduced by >3.6 log cfu/g bacterial counts on the wounds relative to the PBS-treated control (p<0.05). Histological analysis showed OCT-treated tissue exhibited lower burden of the inflammatory cells, more mature collagen fibres and well-defined epithelialisation. LIVE/DEAD fluorescent staining and SEM confirmed OCT induced a substantial destruction to biofilm structure. RT-qPCR further demonstrated that OCT therapy could inhibit the expression of MRSA and its biofilm genes by nearly 100% (p<0.05)., Conclusion: This investigation provides a rare in vivo experimental basis for OCT improvement on MRSA-infected wound healing and the superior efficacy implies OCT topical application may represent an ideal choice to address established bacterial biofilm in hard-to-heal wounds.

Background: Infection is the leading cause of death after thermal injury. Optimal prevention and treatment of burn wound infection is enabled by an in-depth understanding of burn wound treatment modalities not only from a technical standpoint, but also from the standpoint of the clinical context in which these modalities were originally developed. Methods: A review of the historical literature on the topical antimicrobial care of burn wounds was performed. Results: As our understanding of post-burn infection evolved, and as new products were developed for the prevention of post-burn wound infection, major advances in post-burn survival occurred. Ultimately, improvements in anesthetic, surgical, and critical care management have permitted early excision and grafting of the burn wound, decreasing but not eliminating the importance of topical antimicrobial care, and shifting much of the burden of wound infection prevention to the post-operative period. Conclusions: The development of effective topical antimicrobial agents for wound care was, arguably, the single most important advance in the care of the burn patient. Still, many gaps in our ability to treat complicated burn wounds remain. Fungal infection is an unusual but daunting challenge. Patients with impaired wound healing and those with advanced age or medical comorbidities may not benefit from early excision, and the benefits of early excision may not be available in austere or remote locations. For these reasons, research on optimal topical treatment continues.

Significance: Biofilms in vivo are small densely packed aggregations of microbes that are highly resistant to host immune responses and treatment. They attach to each other and to nearby surfaces. Biofilms are difficult to study and identify in a clinical setting as their quantification necessitates the use of advanced microscopy techniques such as confocal laser scanning microscopy. Nonetheless, it is likely that biofilms contribute to the pathophysiology of chronic skin wounds. Reducing, removing, or preventing biofilms is thus a logical approach to help clinicians heal chronic wounds. Recent Advances: Wound care products have demonstrated varying degrees of efficacy in destroying biofilms in in vitro and preclinical models, as well as in some clinical studies. Critical Issues: Controlled studies exploring the beneficial role of biofilm eradication and its relationship to healing in patients with chronic wounds are limited. This review aims to discuss the mode of action and clinical significance of currently available antibiofilm products, including surfactants, dressings, and others, with a focus on levels of evidence for efficacy in disrupting biofilms and ability to improve wound healing outcomes. Future Directions: Few available products have good evidence to support antibiofilm activity and wound healing benefits. Novel therapeutic strategies are on the horizon. More high-quality clinical studies are needed. The development of noninvasive techniques to quantify biofilms will facilitate increased ease of research about biofilms in wounds and how to combat them.

Objective: A score to identify local wound infections was developed by a panel of experts from seven European countries. The Therapeutic Index for Local Infections (TILI) score was designed for health professionals who are not specialised in wound care. This study was carried out to test the validity of the TILI score in everyday practice., Method: Content validity was analysed by means of evaluation by a panel of experts, individually and face-to-face, followed by a European multicentred, retrospective, observational study. Participating clinicians sent anonymised copies of completed TILI scores for patients with leg ulcers along with a photograph of the wound for analysis by two blinded reviewers. Concordance (Kappa index) and convergent criterion validity (sensitivity, specificity, accuracy, Youden's J Index and receiver operator characteristic (ROC) or area under the curve (AUC) curve) were calculated to construct validity and reliability., Results: A total of 307 patients with leg ulcers from seven institutions in five European countries were included in this retrospective analysis. It was shown that the diagnosis of local wound infection could be documented well with five of the six clinical criteria included in the TILI score. By summing up these facultative criteria in comparison with any direct criteria that may be present, there would have been an indication for local antiseptic wound therapy in 22% of patients examined., Conclusions: The results show that the TILI score is concordant with the expert assessment of patients and with good diagnostic characteristics. Thus, the easy-to-use TILI score can now be used in the daily routine practice of health professionals to diagnose local wound infections.

Hard-to-heal wounds are a major public health problem that incur high economic costs. A major source of morbidity, they can have an overwhelming impact on patients, caregivers and society. In contrast to acute wound healing, which follows an 'orderly and timely reparative process', the healing of hard-to-heal wounds is delayed because the usual biological progression is interrupted. This article discusses hard-to-heal wounds, the impact they have on patients and healthcare systems, and how biofilms and other factors affect the wound-healing process. Controlling and preventing infection is of utmost importance for normal wound healing. Rational use of anti-infectious agents is crucial and is particularly relevant in the context of rising healthcare costs. Knowledge of the complex relationship between hard-to-heal wounds, biofilm formation and wound healing is vital for efficient management of hard-to-heal wounds.

Case Report: A 72-year-old woman with a nontraumatic spinal cord injury developed eschar on her lower right back. An underlying abscess was identified, which upon surgical debridement left a large wound extending down to the hip bone. In addition, the hip suffered from chronic osteomyelitis and was exposed at the bottom of the wound. The wound was initially treated for 5 weeks with Manuka honey but deteriorated further. Next, micropore particle technology (MPPT) was used. It cleared the wound of necrotic tissue based on autolytic debridement and removed the soft tissue infection; over a 3-month period, the wound reduced 50% in volume. Treatment approach was changed to polyhexamethylene biguanide (PHMB) and was applied as a gel once every second day to the wound. After 6 days, it was observed to cause tissue degeneration, disruption of the structure of the exposed bone, and the appearance of froth coming through the hip bone. A pain syndrome developed and the use of PHMB was terminated on day 10. After a wash-out period, the use of MPPT was reinitiated. Over the following 8 months, MPPT continued to control the infectious debris coming from the hip bone and promote healing without affecting the bone or causing side effects., Conclusions: It is generally assumed that the cytotoxic properties of antiseptics seen in cell culture experiments do not occur on wounds. The present case shows these cytotoxic properties are expressed on wounds, and they do disrupt tissues and tissue regeneration.

Dialkylcarbamoylchloride (DACC)-coated cotton acetate dressing works directly through hydrophobic interaction to reduce the number of bacteria without the risk of resistance. It is easy to use and therefore expected to improve patient's compliance. This study aimed to assess the clinical efficacy of DACC-coated cotton acetate dressing compared to a combination of normal saline dressing and 2% mupirocin ointment. A single-blind controlled trial was conducted and included 14 infected epidermolysis bullosa (EB) wounds which were divided into two groups. Group I received DACC-coated cotton acetate dressing, and Group II received the combination of normal saline dressing and 2% mupirocin ointment. Study results showed that the average time required for complete wound closure was 8.6 and 11.1 days in Groups I and II, respectively (p = .014), which was statistically significant. Both groups showed complete bacterial elimination on Day 3 based on negative Gram stain results and on Day 6 based on clearance of clinical manifestations (p = 1.000). This is a novel study in EB-infected wounds, which shows that DACC-coated cotton acetate dressing promotes faster wound closure and is as effective as the combination of normal saline dressing and 2% mupirocin ointment in eliminating bacterial infection., (© 2019 Wiley Periodicals, Inc.)

Biofilms are prevalent in non-healing chronic wounds and implicated in delayed healing. Tolerance to antimicrobial treatments and the host's immune system leave clinicians with limited interventions against biofilm populations. It is therefore essential that effective treatments be rigorously tested and demonstrate an impact on biofilm across multiple experimental models to guide clinical investigations and protocols. Cadexomer iodine has previously been shown to be effective against biofilm in various in vitro models, against methicillin-resistant Staphylococcus aureus biofilm in mouse wounds, and clinically in diabetic foot ulcers complicated by biofilm. Similarities between porcine and human skin make the pig a favoured model for cutaneous wound studies. Two antiseptic dressings and a gauze control were assessed against mature biofilm grown on ex vivo pig skin and in a pig wound model. Significant reductions in biofilm were observed following treatment with cadexomer iodine across both biofilm models. In contrast, silver carboxymethylcellulose dressings had minimal impact on biofilm in the models, with similar results to the control in the ex vivo model. Microscopy and histopathology indicate that the depth of organisms in wound tissue may impact treatment effectiveness. Further work on the promising biofilm efficacy of cadexomer iodine is needed to determine optimal treatment durations against biofilm., (© 2019 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Background and Aim: Silver has been widely used as a topical antimicrobial agent in burn wound care. In a previous study, we demonstrated the introduction of nano-silver particles to porcine small intestinal submucosa (NS-PSIS) led to significant enhancement in antibacterial property in repairing contaminated abdominal defect. In this study, we explored the efficacy of NS-PSIS in the treatment of Pseudomonas aeruginosa-infected partial-thickness burn wounds., Methods: 48 male Sprague-Dawley rats were divided into four groups of equal number. Standardized and reproducible Pseudomonas aeruginosa-infected partial-thickness thermal burns wound model were created using these rats. NS-PSIS, PSIS (porcine small intestinal submucosa) or lipido-colloid dressingss (Urgotul™) were tested for 14days to assess their ability to heal the rats' burn wounds. Control group was without any treatment after the establishment of infected burn-wound. The wound contraction rate, animal body weight change, histological examination, and the quantification of IL-6 and C-reactive protein (CRP) were measured to evaluate the healing effects., Results: NS-PSIS significantly promoted wound healing and recovered the normal growth of rats. There were significantly lower expression levels of pro-inflammatory cytokine (IL-6) and CRP in NS-PSIS group as compared with the PSIS or Urgotul group in the treatment of infected partial-thickness burn wounds. Histological exams revealed significant less inflammatory cells infiltrating, more re-epithelization and neovascularization in NS-PSIS group. There were also less inflammatory cells infiltrations in the major organs in NS-PSIS group., Conclusions: Nano-silver modified porcine small intestinal submucosa (NS-PSIS) can be used as a biological derivative dressing for the treatment of infected partial-thickness burn wounds., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

Objective: To determine the antibacterial activity of Pakistani Beri honey in patients with infected wounds in comparison with silver sulfadiazine., Method: Inpatients with infected wounds at a tertiary care hospital were divided in to three equal-sized treatment groups. In Group A, patients were treated with non-Gamma irradiated Beri honey. In Group B, Gamma irradiated Beri honey was used, and in Group C silver sulfadiazine was used. Treatment was for a period of four weeks. Pus swabs were taken at day zero and weeks one and four of treatment. Bacteria were identified using the analytical profile index system API 20E, 20NE and API Staph and antimicrobial susceptibility was done as per the Clinical and Laboratory Standards Institute 2010 guidelines., Results: A total of 90 patients with wounds (n=90) took part in the trial. Out of 90 wounds, 47% were post-traumatic and 37% were postoperative. Overall, average length, width and depth of Group A patients' wounds were significantly reduced (p<0.0001). Out of 144 pus swabs; 99 and 45 were Gram-negative rods and Gram-positive cocci, respectively. Among these Pseudomonas aeruginosa (n=25) and Staphylococcus aureus (n=38) were the major pathogens. Interestingly, bacterial load gradually decreased from baseline to week four due to non-Gamma irradiated Beri honey. Moreover, both the Gram-negative rods and Gram-positive cocci displayed 100% resistance to commonly used antibiotics; the most effective drugs were carbapenem and vancomycin., Conclusion: Pakistani Beri honey could be used as an alternative therapeutic option for the management of infected wounds.

Although partial thickness burns are the most frequently reported burn injuries, there is no consensus on the optimal treatment. The objective of this study was to compare the clinical effectiveness and scar quality of Flaminal® Forte to silver sulfadiazine (Flamazine®) in the treatment of partial thickness burns. In this two-arm open label multicenter randomized controlled trial, adult patients with acute partial thickness burns and an affected total body surface area of less than 30% were randomized between Flaminal® Forte and Flamazine® and followed for 12 months. Dressing changes in the Flamazine® group were performed daily, and in the Flaminal® group during the first 3 days post burn and thereafter every other day until complete wound healing or surgery. Forty-one patients were randomly allocated to Flaminal® Forte and 48 patients to Flamazine®. The primary outcome was time to wound healing, which did not differ between the groups: median 18 days with Flaminal® Forte (range 8-49 days) versus 16 days with Flamazine® (range 7-48 days; p = 0.24). Regarding the secondary outcomes during hospital admission, there were no statistically significant differences between the groups concerning need for surgery, pain scores, pruritus, or pain-related and anticipatory anxiety. More patients in the Flaminal® group developed wound colonization (78% versus 32%, p < 0.001), but the treatment groups did not differ regarding the incidence of local infections and use of systemic antibiotics. In terms of scar quality, no statistically significant differences between both treatment groups were found regarding subjective scar assessment (Patient and Observer Scar Assessment Scale (POSAS)), scar melanin and pigmentation (DermaSpectrometer®), and scar elasticity and maximal extension (Cutometer®) during 12 month postburn. In conclusion, time to wound healing did not differ, but the use of Flaminal® Forte seemed favorable because less dressing changes are needed which lowers the burden of wound care., (© 2019 The Authors. Wound Repair and Regeneration published by Wiley Periodicals, Inc. on behalf of by the Wound Healing Society.)

The aim of the present study was to explore the therapeutic efficacy of microemulsion-based delivery of histidine-capped silver nanoparticles in eradicating Klebsiella pneumoniae-induced burn wound infection. The developed microemulsion was characterized on the basis of differential light scattering, phase separation, refractive index, and specific conductance. Emulgel was prepared and characterized on the basis of thixotropy, texture, differential scanning calorimetry, and release kinetics. Emulgel was further evaluated in skin irritation and in vivo studies, namely full-thickness K. pneumoniae-induced burn wound infection treatment via topical route. Efficacy of treatment was evaluated in terms of bacterial load, histopathology, wound contraction, and other infection markers. The developed emulgel provided significant in vivo antibacterial activity of histidine-capped silver nanoparticle preparations via topical route and resulted in reduction in bacterial load, wound contraction, and enhanced skin healing as well as decrement of inflammatory markers such as malondialdehyde, myeloperoxidase, and reactive nitrogen intermediate compared to untreated animals. The present study encourages the further employment of histidine-capped silver nanoparticles along with microemulsion-based drug delivery system in combating antibiotic-resistant topical infections.

The aim of this systematic review with meta-analysis was to compare the effect of Silver Sulfadiazine (SSD) with other new dressings, with or without silver, on healing and infection prevention in burns. The electronic search was carried out in the electronic databases of Pubmed, ScienceDirect, Lilacs and BVS. The articles included were randomized clinical trials about burn treatment with SSD, which evaluated the healing and infection of burn wounds in humans. The exclusion criteria included articles, editorials and letters published in the form of abstracts, unpublished reports and case series, cross-sectional, observational experimental studies, and the use of sulfadiazine for other types of wounds. The search identified 873 references, and 24 studies were included in accordance with the eligibility criteria. The results showed a statistically favorable difference related to the time of healing for silver dressings (p<0.0001; MD 3.83; 95% CI 2.03-5.62) and dressings without silver (p<0.007; MD 2.9; 95% CI 0.81-5.00) in comparison with SSD. The rate of infection showed no difference in the group treated with SSD compared with the group treated with dressings containing silver (p>0.05). The rate of infection was significantly higher in the SSD group compared with the group treated with dressings without silver (p<0.005; MD 25.29% and MD 12.97%). Considering the clinical trials conducted up to the present time, the authors concluded that new dressings with and without silver show better results than SSD for wound healing, and burns treated with dressings without silver are less likely to become infected than burns with SSD. No differences between SSD and new silver materials were observed in relation to infection prevention., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

The use of topical antimicrobials is beneficial for infection control in wound care because wound infection is the major cause of delayed healing. The advantages of topical over systemic antimicrobials include a higher concentration at the target site, fewer systemic adverse effects, and a lower incidence of antimicrobial resistance. Nowadays, topical antimicrobials are divided into three groups: disinfectants, antiseptics, and antibiotics. Only antiseptics and antibiotics can be applied to living skin; therefore, this review will focus only on these groups. The advantages of each topical antimicrobial are well established; however, their disadvantages remain prominent. It is widely known that antiseptics show higher cytotoxicity and a broader spectrum of activity than antibiotics, whereas antibiotics show a higher probability of bacterial resistance development. However, there are still many adverse effects, resulting from each topical antimicrobial. This review aims to summarize the possible adverse effects of commonly used antiseptics (biguanide, silver, iodine, chlorine compounds, and other antiseptics), antibiotics (bacitracin, mafenide, mupirocin, neomycin, and silver sulfadiazine), and natural antimicrobials (curcumin and honey). Moreover, the antimicrobials that should be avoided in particular populations are also summarized in this review in order to increase awareness for antimicrobial selection in those populations.

Topical antimicrobials are widely used to control wound bioburden and facilitate wound healing; however, the fine balance between antimicrobial efficacy and non-toxicity must be achieved. This study evaluated whether an anti-biofilm silver-containing wound dressing interfered with the normal healing process in non-contaminated deep partial thickness wounds. In an in-vivo porcine wound model using 2 pigs, 96 wounds were randomly assigned to 1 of 3 dressing groups: anti-biofilm silver Hydrofiber dressing (test), silver Hydrofiber dressing (control), or polyurethane film dressing (control). Wounds were investigated for 8 days, and wound biopsies (n = 4) were taken from each dressing group, per animal, on days 2, 4, 6, and 8 after wounding and evaluated using light microscopy. No statistically significant differences were observed in the rate of reepithelialisation, white blood cell infiltration, angiogenesis, or granulation tissue formation following application of the anti-biofilm silver Hydrofiber dressing versus the 2 control dressings. Overall, epithelial thickness was similar between groups. Some differences in infiltration of specific cell types were observed between groups. There were no signs of tissue necrosis, fibrosis, or fatty infiltration in any group. An anti-biofilm silver Hydrofiber wound dressing did not cause any notable interference with normal healing processes., (© 2018 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

As antibiotic resistance increases and antimicrobial options diminish, there is a pressing need to identify and develop new and/or alternative (non-antimicrobial-based) wound therapies. The authors describe the implications of antibiotic resistance on their current wound treatment paradigms and review the most promising non-antibiotic-based antimicrobial agents currently in research and development, with a focus on preclinical and human studies of therapeutic bacteriophages, antimicrobial peptides, cold plasma treatment, photodynamic therapy, honey, silver, and bioelectric dressings.

Infections in burn patients are still the principal cause of complications in burn injuries. The aim of this study is to assess a new strategy for burn wound management in view of infection prevention and treatment in the experience of the Burn Treatment Center in Siemianowice Śląskie. The applied methodology involved the analysis of patient records describing the hospital's epidemiological situation between 2014 and 2016. The analysis also included the use and cost of antibiotics, silver-containing dressings, and other antiseptics relative to the number of sepsis cases, including those caused by Pseudomonas aeruginosa, as well as the mortality ratio. The total costs of prevention and treatment of infections were reduced, while the use of silver-containing dressings and antiseptics increased. The number of patients with sepsis decreased, including cases caused by P. aeruginosa, and the mortality ratio was reduced. Introducing a strategy for burn wound-oriented infection prevention and treatment in burn patients provides a number of benefits. It is also cost-effective. Using locally applied active dressings and antiseptics can be a welcome choice for often-unnecessary antibiotic therapy of a suspected or existing burn wound infection., (© 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Objective: The aim of our study was to examine the antimicrobial potential of eight selected, commercially available wound dressings containing different antimicrobial agents: silver, chlorhexidine acetate, povidone-iodine, and manuka honey., Method: The materials were tested against four reference strains of bacteria: Staphylococcus aureus (PCM 2051), Staphylococcus epidermidis (PCM 2118), Pseudomonas aeruginosa (ATCC 27853), and Escherichia coli (K12), using the disc diffusion-like method and a time-killing assay., Results: For both experiments, the highest activity against all four tested strains of bacteria was observed in the case of Mepilex Ag, which contains silver as an antibacterial agent. Incubation for four hours of a 10x10mm 2 piece of this material in 10ml cells suspension (concentration: 10 9 -10 10 CFU/ml) resulted in complete elimination of bacteria of all four strains tested. The same results were obtained for a povidone-iodine containing dressing, Inadine, though its activity was lower in the disc diffusion assay. Silvercel, Aquacel Ag and Melgisorb Ag, which also contain silver, also exhibited a satisfactory level of activity. In the case of Aquacel Ag, 24 hours' incubation resulted in complete elimination of the cells of both Gram-negative bacteria, Escherichia coli and Pseudomonas aeruginosa.The Escherichia coli cells were killed after only four hours' treatment. High effectiveness against Escherichia coli was also demonstrated for Silvercel. However, 24 hours' includation was required for complete elimination of the cells of this bacteria strain. High activity against all tested bacteria, but only in the disc diffusion assay, was observed for Algivon, which contains manuka honey. The Medisorb Silver Pad, containing silver, and Bactigras, which contains chlorhexidine acetate, revealed much lower antimicrobial activity, particularly noticeable in the time-killing assay. In addition, we also tested the anti-staphylococcal activity of a biopolymer material impregnated with lysostaphin. Results revealed that its activity against Staphylococcus aureus was comparable to the most active wound dressings impregnated with silver or inadine., Conclusion: Some important differences in the antimicrobial potential of investigated materials have been found. The presented results could be of interest to clinicians managing wounds.

A large proportion of community wound care consists of managing chronic wounds. Given the increasingly complex patient comorbidities, early identification and treatment of wound infection can impact greatly not only on wound healing but also on the patient physically, psychologically and socially. Identifying wound infection can be challenging for clinicians, particularly in the chronic wound where infection may not always present itself as it does in acute wounds. The management of infected wounds can be complicated. Managing multiple symptoms and recognising these as being due to infection is not always straightforward and relies on the practitioner's knowledge and skills. An understanding of more commonly used antimicrobial treatments and when to employ these is paramount in enabling the practitioner to provide care that is effective, evidence based and cost efficient.

Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment., (© 2017 S. Karger AG, Basel.)

The objective of this prospective, non-randomised study was to evaluate the performance of an antibacterial foam dressing containing methylene blue and gentian violet (Hydrofera Blue Classic dressing ® ) for the management of chronic wounds with local infection. Patients in this study were ≥18 years of age (n = 29), and each had at least one chronic wound ≥1 cm 2 in size that showed signs of localised infection or critical colonisation but with good potential for healing based on clinical assessment. To all of these wounds, the dressing was applied and changed three times per week over the 4-week study period. The primary endpoints of the study were: (i) changes in wound surface area measurement, (ii) changes in Pressure Ulcer Scale for Healing (PUSH) scores, (iii) changes in percent surface area of devitalised tissue (i.e., yellow slough or other necrotic tissue) and (iv) changes in clinical signs associated with localised wound infection/critical colonisation. Participants were evaluated at presentation (week 0 = baseline), week 2 and at week 4 (end of the study). The 29 patients completed the study, and at week 4, the following wound improvements were observed: (i) baseline mean wound surface area was significantly reduced by 42·5%, from 21·4 to 12·3 cm 2 at week 4 (P = 0·005); (ii) baseline mean PUSH score decreased significantly from 13·3 to 10·7 at week 4 (P < 0·001); (iii) baseline mean wound coverage by devitalised tissue (%) was significantly reduced, from 52·6 % to 11·4% at week 4 (P < 0·001) and (iv) the mean UPPER and LOWER wound infection scores were reduced from 3·6 at baseline to 0·9 at week 4 (75%; P < 0.001). These results indicate that the Hydrofera Blue Classic dressing was effective at managing these chronic wounds and helped them progress onto a healing trajectory., (© 2017 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

General Purpose: To provide information on the use of topical antimicrobial agents for the treatment of chronic wounds., Target Audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care., Learning Objectives/outcomes: After participating in this educational activity, the participant should be better able to:1. Examine features of wounds and wound healing as well as the purpose of specific antimicrobial agents.2. Identify potential therapeutic and adverse effects of specific topical antimicrobial agents for the treatment of chronic wounds., Abstract: Bacteria can delay or prevent healing in the surface compartment of a chronic wound or invade the deep and surrounding structures. This article focuses on the superficial compartment and the appropriate use of topical antimicrobial therapies. The authors have reviewed the published evidence for the last 5 years (2012-2017) and extrapolated findings to clinical practice with critical appraisal and synthesis of the recent literature with expert opinion, patient-centered concerns, and healthcare systems perspectives. Summary evidence tables for commonly used topical antimicrobials are included.

Non-healing wounds are a significant burden to healthcare systems, where it is estimated that 4-5% of the adult population has a problem wound at any one time ( Guest et al, 2017 ). It is suggested that infection is the most frequent complication in non-healing wounds where it can prolong patient treatment times and increase resource use ( Gottrup et al, 2013 ). Wound infection develops as a result of an imbalance between the patient's immune system and the conditions in the wound, which subsequently can promote bacterial proliferation ( Wounds UK, 2013 ). It can impact on the patient by delaying wound healing, increasing the risk of amputation and life-threatening conditions, and reducing quality of life. The use of antibiotics to treat wound infections has decreased due to the increased risk of antibiotic resistance ( Swanson et al, 2014 ). As a result alternative strategies for preventing and managing wound infection have been adopted, including wound debridement and the use of topical antiseptic/antimicrobial agents.

Objective: The aim of this study was to investigate the bacterial bioburden in experimental in vitro wounds during the application of conventional negative pressure wound therapy (NPWT), with and without antimicrobial dressings (polyhexanide, silver), against NPWT instillation of octenidine., Method: Experimental wounds produced in an in vitro porcine wound model were homogenously contaminated with bacterial suspension and treated with NPWT and different options. Group A: non-antimicrobial polyurethane foam dressing; group B: antimicrobial polyurethane foam dressing containing silver; group C: antimicrobial gauze dressing containing polyhexanide; group D: non-antimicrobial polyurethane foam dressing intermittently irrigated with octenidine; group E: negative control (non-antimicrobial polyurethane foam dressing without NPWT). Standard biopsies were harvested after 24 and 28 hours., Results: This study demonstrated that the use of NPWT with intermitted instillation of octenidine (group D) or application of silver-based polyurethane foam dressings (group B) is significantly superior against Staphylococcus aureus colonisation in experimental wounds compared with non-antimicrobial polyurethane foam dressing (group A) after 48 hours. Surprisingly, the polyhexanide-based dressing (group C) used in this model showed no statistical significant effect compared with the control group (group E) after 24 or 48 hours of treatment., Conclusion: Both intermitted instillation of octenidine and silver-based dressings in standard NPWT were significantly superior compared with non-antimicrobial polyurethane foam dressings or PHMB coated gauze dressing after 48 hours.

Objective: Inhibiting bacterial biofilms is of major significance for proper wound healing. The choice of the dressing material plays a key role, as bacteria can live in dressings and keep reinfecting the wound. This study examines the effectiveness of a colloidal silver gel (Ag-gel) wound dressing in inhibiting the growth of bacteria in a mouse wound model., Method: Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii and two different meticillin-resistant Staphylococcus aureus (MRSA) strains were examined. Bacteria were measured in vitro on the dressing, and in vivo studies were carried out to analyses both the dressing and the infected tissue., Results: Using colony-forming unit (CFU) assays, over 7 logs of inhibition (100%) were found for Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii for the Ag-gel dressing when compared with the control dressing. In vivo, complete inhibition was observered for the three most common bacteria on the Ag-gel dressing and the tissue under that dressing. These results were confirmed by an in vivo live imaging system. However, with MRSA strains, only 2-3 logs of inhibition were recorded., Conclusion: The Ag-gel was effective in preventing biofilm infections caused by both Gram-negative and Gram-positive bacteria.

Introduction: Initial therapy of severe burns in specialized burn trauma centers is a challenging task faced by the treating multi-professional and interdisciplinary team. A lack of consistent operating procedures and varying structural conditions was recently demonstrated in preliminary data of our group. These results raised the question on how specific treatment measures in acute burn care are met in the absence of standardized guidelines., Material and Methods: A specific questionnaire containing 57 multiple-choice questions was sent to all 22 major burn centers in Germany, Austria and Switzerland. The survey included standards of airway management and ventilation, fluid management and circulation, body temperature monitoring and management, topical burn wound treatment and a microbiological surveillance. Additionally, the distribution of standardized course systems was covered., Results: 17 out of 22 questionnaires (77%) were returned completed. Regarding volume resuscitation, results showed a similar approach in estimating initial fluid while discrepancies persisted in the use of colloidal fluid and human albumin. Elective tracheostomy and the need for bronchoscopy with suspected inhalation injury were the most controversial issues revealed by the survey. Topical treatment of burned body surface also followed different principles regarding the use of synthetic epidermal skin substitutes or enzymatic wound debridement. Less discrepancy was found in basic diagnostic measures, body temperature management, estimation of the extent of burns and microbiological surveillance., Conclusion: While many burn-related issues are clearly not questionable and managed in a similar way in most participating facilities, we were able to show that the most contentious issues in burn trauma management involve initial volume resuscitation, management of inhalation trauma and topical burn wound treatment. Further research is required to address these topics and evaluate a potential superiority of a regime in order to increase the level of evidence., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Reactive oxygen species (ROS) is a novel therapeutic strategy for topical or local application to wounds, mucosa or internal structures where there may be heavy bacterial bioburden with biofilm and chronic inflammation. Bacterial biofilms are a significant problem in clinical settings owing to their increased tolerance towards conventionally prescribed antibiotics and their propensity for selection of further antibacterial resistance. There is therefore a pressing need for the development of alternative therapeutic strategies that can improve antibiotic efficacy towards biofilms. ROS has been successful in treating chronic wounds and in clearing multidrug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), and carbapenemase-producing isolates from wounds and vascular line sites. There is significant antifungal activity of ROS against planktonic and biofilm forms. Nebulised ROS has been evaluated in limited subjects to assess reductions in bioburden in chronically colonised respiratory tracts. The antibiofilm activity of ROS could have great implications for the treatment of a variety of persistent respiratory conditions. Use of ROS on internal prosthetic devices shows promise. A variety of novel delivery mechanisms are being developed to apply ROS activity to different anatomical sites., (Copyright © 2017 International Society for Chemotherapy of Infection and Cancer. All rights reserved.)

Evidence from animal studies and trials suggests that honey may accelerate wound healing. The objective of this review was to assess the effects of honey compared with silver dressings on the healing of burn wounds. Relevant databases for randomized controlled trials (RCTs) of honey compared with silver sulfadiazine (SSD) were searched. The quality of the selected trials was assessed using the Cochrane Risk of Bias Assessment Tool. The primary endpoints considered were wound healing time and the number of infected wounds rendered sterile. Nine RCTs met the inclusion criteria. Based on moderate quality evidence there was a statistically significant difference between the two groups, favoring honey in healing time (MD -5.76days, 95% CI -8.14 to -3.39) and the proportions of infected wounds rendered sterile (RR 2.59; 95% CI 1.58-2.88). The available evidence suggests that honey dressings promote better wound healing than silver sulfadiazine for burns., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Antiseptics, with a broader spectrum of antimicrobial efficacy, lower risk of antibiotic resistance development, and minimal collateral damage to host tissues, are important alternatives to control the bioburden in wounds. Povidone iodine (PVP-I), in use for several decades, has the broadest spectrum of activity, a persistent antimicrobial effect, an ability to penetrate biofilms, and a lack of acquired or cross-resistance. It demonstrates good skin tolerance and low cytotoxicity. However, some reports on PVP-I have raised concerns over allergy, ineffective penetration, and toxic effects on host cells. The majority of these concerns are based on in vitro or rodent wound studies with diverse study designs and outcomes; these results may not be directly applicable in the clinical reality in humans. In this paper, we discuss the efficacy and safety of PVP-I and outline its place in wound healing in Asia, based on an appraisal of recent literature and clinical practice across the region., (© 2017 S. Karger AG, Basel.)

Mafenide acetate is an antimicrobial agent used to decrease the bacterial load for burn wounds. The 5% solution is more commonly used yet double the cost of its 2.5% counterpart. This study aims to evaluate outcomes and cost associated with the use of 2.5 vs 5% mafenide acetate formulation in the adult burn population. Adult patients (≥18 years) receiving 2.5% mafenide acetate during an 11-month period between 2014 and 2015, corresponding to a policy change in favor of the use of 2.5% mafenide acetate, were queried. Historical controls, patients receiving 5% mafenide acetate, were also reviewed during an 11-month period between 2013 and 2014. A retrospective review was performed comparing wound infection rate, bacteremia, sepsis, pneumonia, duration of mafenide therapy, length of hospital stay, mortality, and cost. A total of 54 and 65 patients received 2.5 and 5% mafenide acetate, respectively. There was no difference in wound infection, bacteremia, sepsis, pneumonia, duration of treatment, and mortality between the two groups. No adverse events occurred in either group directly related to mafenide. Candida and Staph species were the two most common isolates in the 2.5% group, whereas Pseudomonas and Staph species were the most common in the 5% arm. The mean cost of 2.5% mafenide therapy was $1494.92 compared with $3741.39 for 5% mafenide acetate. The 2.5% concentration demonstrates to be an equally efficacious and cost-effective alternative to the 5% concentration. Burn centers should consider the use of the more dilute preparation for burn wound infection prophylaxis as it may reduce the cost without compromising patient safety.

Sepsis is a severe generalised infection caused usually by pathogenic bacteria. It is often the cause of hospitalization and death in patients treated in intensive care and other hospital wards. Latest research brought to better understanding of patomechanisms, took place significant development of therapy heading to improvement of general patients condition treated as a basis and additionally supported by local therapy. The aim of the study was to evaluate the possibility of using the solution Decasan in the comprehensive treatment of patients necrosis of soft tissues., Material and Methods: The study included 192 patients (W/M 103/89; average -aged 53.35 ± 5.36 years). According to the classification of septic states (Chicago, 1991), patients were divided into three groups: first - patients to the local form of the infection, the second - with Systemic Inflammatory Response Syndrome (SIRS), which lasted up to 72 hours and the third - patients with various forms of sepsis, SIRS in which lasted 72 hours., Results: As a result of our studies carried out in patients where the wound was made decontamination solution Decasanu, received: pain reduction, decrease tissue swelling, early debridement of the wound and the appearance in the wound granulation, to reduce delays wound healing. Proposed algorithms treatment of various forms of sepsis, pointed out the essential elements, ie.: a comprehensive approach to the treatment of infection by early surgical intervention, intensive supportive therapy (fluid resuscitation), antibiotic therapy directed to microorganisms that cause infections and topical antiseptics therapy (solution Decasanu)., Conclusions: The preparation antiseptic Decasan can be safely used for disinfection of skin, mucous membranes and wounds in the foci of infections caused by bacteria, fungi and protozoa.

Chronic wounds represent a large and growing segment of health care and add considerably to human suffering and economic burden as populations age. More effective materials, especially those promoting ease of use and economy, are needed to treat this increasing number of patients. A case series conducted at a European outpatient tertiary wound centre used a novel surfactant-based biomaterial dressing containing 1% silver sulphadiazine on 226 chronic wound patients with various aetiologies. Eighty-eight patients had been undergoing standard of care treatment at the facility, while the remainder (n = 138) began treatment with the surfactant-based biomaterial dressing on enrollment. A total of 73% of the first group healed or showed improvement, with 60% healing by a median of 17 weeks after beginning treatment, and 86% of the group of new enrollees healed or showed improvement, with 73% healing within a median of 12 weeks of beginning treatment with the new product. Patient and clinician reports showed improved compliance, reduced pain and a favourable side-effect profile. Limited economic analysis showed markedly reduced treatment costs compared with standard of care. Further research is recommended., (© 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Zorflex is a new type of antimicrobial dressing composed of 100% activated carbon cloth. It attracts and binds bacteria to its surface, enabling them to be safely removed at dressing change. It has no reported toxic effects and can be used on either a short-or long-term basis. This article describes 4 case studies in which patients with recalcitrant chronic venous leg ulcers that were prone to recurrent infection were treated with the activated carbon cloth dressing. All of the wounds had failed to respond to antimicrobial dressings containing silver, iodine or polyhexamethylene biguanide (PHMB), and were heavily exuding and painful. In all cases, the signs of infection reduced significantly within 4 weeks, resulting in good patient outcomes.

The potential impact of biofilm on healing in acute and chronic wounds is one of the most controversial current issues in wound care. A significant amount of laboratory-based research has been carried out on this topic, however, in 2013 the European Wound Management Association (EWMA) pointed out the lack of guidance for managing biofilms in clinical practice and solicited the need for guidelines and further clinical research. In response to this challenge, the Italian Nursing Wound Healing Society (AISLeC) initiated a project which aimed to achieve consensus among a multidisciplinary and multiprofessional international panel of experts to identify what could be considered part of 'good clinical practice' with respect to the recognition and management of biofilms in acute and chronic wounds. The group followed a systematic approach, developed by the GRADE working group, to define relevant questions and clinical recommendations raised in clinical practice. An independent librarian retrieved and screened approximately 2000 pertinent published papers to produce tables of levels of evidence. After a smaller focus group had a multistep structured discussion, and a formal voting process had been completed, ten therapeutic interventions were identified as being strongly recommendable for clinical practice, while another four recommendations were graded as being 'weak'. The panel subsequently formulated a preliminary statement (although with a weak grade of agreement): 'provided that other causes that prevent optimal wound healing have been ruled out, chronic wounds are chronically infected'. All members of the panel agreed that there is a paucity of reliable, well-conducted clinical trials which have produced clear evidence related to the effects of biofilm presence. In the meantime it was agreed that expert-based guidelines were needed to be developed for the recognition and management of biofilms in wounds and for the best design of future clinical trials. This is a fundamental and urgent task for both laboratory-based scientists and clinicians.

Objective: To evaluate the performance and safety of Mepilex Transfer Ag (MTAg) in the treatment of infected diabetic foot ulcers (DFU)., Method: Patients with locally infected DFU were treated with the test dressing for up to 4 weeks, with a further 12 weeks of follow-up in a non-comparative study. Changes to wound infection and wound size as well as the condition of the peri-wound skin from baseline were assessed. Wound pain during dressing change was measured using a visual analogue scale (VAS). The investigators and patients documented their opinions on their overall experience of the test dressing and on key performance parameters., Results: Following treatment with the test dressing, the signs and symptoms of local wound infection present in the target DFU were substantially reduced compared with baseline. Following the posttreatment evaluation, the majority of the DFU exhibited no signs of infection. and mean wound size was reduced by 50%. Wound size also continued to steadily decrease during follow-up. At the end of treatment five DFUs were completely healed and a further six healed by the end of the follow-up period. Concomitantly, over the course of the study, wound exudate levels were reduced and there was a significant improvement in the condition of the peri-wound area. Wound pain at dressing change was low throughout; generally patients felt no anxiety during the dressing change procedure. The patients considered it a comfortable dressing that remained in place and allowed ease of movement during wear. The investigating clinicians were highly satisfied with the overall performance, especially with respect to its ease of application and removal, conformability and flexibility., Conclusion: This study has demonstrated the potential of the dressing to provide topical antimicrobial activity directly to an infected DFU, suggesting prompt treatment of an infected DFU with this topical antimicrobial could aid wound complications., Declaration of Interest: The authors have no conflict of interest to declare.

This ulcer was so painful that the young patient concerned was unable to tolerate antimicrobial dressings and compression therapy. A treatment regimen including octenilin Wound Gel helped reduce the pain, giving the patient more control over her life. The wound healed after 6 months.

A traumatic wound colonised with MRSA failed to respond to topical antimicrobial dressings. Following the combined use of octenilin Wound Gel and octenilin Wound Irrigation Solution, the MRSA was removed in 4 weeks, the necrotic tissue was debrided and the wound started healing.

In this case, the necrotic tissue was so hard it was not possible to categorise the ulcer. Octenilin products were able to debride the necrotic tissue, so that the wound depth could be determined. After 4 weeks, the wound was covered with granulation tissue, improving the patient's quality of life.

This patient presented with a painful, malodorous, infected wound on his right leg, which was also his main heroin injection site. Following treatment with octenilin Wound Irrigation Solution and a superabsorbent dressing, within 3 weeks all of the symptoms of infection and non-healing had gone.

The concept of wound bed preparation can be implemented using the TIME paradigm. Chronic wounds are mostly characterised by prolonged inflammation and increased bioburden. Removal of wound biofilm and devitalised tissue, which is an ideal environment for bacterial growth, can help address the I in TIME. Wound cleansing aims to remove contaminants, debris, dressing remnants and superficial slough from the wound. Some wound cleansers contain surfactants, which reduce the surface tension of a liquid, enabling it to spread further over a surface. This article describes how these solutions can be used to debride the wound surface without damaging healthy cells.