Antiseptics on Wounds

8/11/2019 Antiseptics on Wounds

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Antiseptics on Wounds: An Area of Controversy

Anna Drosou, MD, Anna Falabella, MD, Robert S. Kirsner, MD

Wounds 15(5):149-166, 2003. 2003 Health Management u!l"#at"ons, $n#.

osted 06%11%2003

Abstract and Introduction

Abstract

&nt"se't"#s hae long and #ommonl !een used on *ounds to '+eent o+ t+eat "ne#t"on.Ho*ee+, #"t"ng #toto"#"t data, man autho+s hae ad"sed aga"nst the"+ use on o'en *ounds.h"s a+t"#le d"s#usses ant"se't"#s and the"+ use on o'en *ounds, as *ell +e"e*s +eleant an"malstud"es and #l"n"#al t+"als eam"n"ng the ee#ts o #ommonl used ant"se't"#s, "n#lud"ng "od"ne#om'ounds ('o"done "od"ne and #adeome+ "od"ne), #hlo+he"d"ne, hd+ogen 'e+o"de, a#et"#

a#"d, and s"le+ #om'ounds. h"s a+t"#le eam"nes the"+ ee#ts on *ound heal"ng and+ee'"thel"/at"on and the"+ e"#a# on +edu#"ng !a#te+"al num!e+ "n *ounds and "n#"den#e o*ound "ne#t"ons. he autho+s ound des'"te #toto"#t data, most ant"se't"#s hae not !eensho*n to #lea+l "m'ede heal"ng, es'e#"all ne*e+ o+mulat"ons l"e #adeome+ "od"ne (*h"#hs'eeds heal"ng) and noel s"le+ del"e+ sstems. hese #om'ounds a''ea+ to !e +elat"elsae and e"#"ent "n '+eent"ng "ne#t"on "n human *ounds. "en th"s +e"e*, the +ole oant"se't"#s on *ounds and the"+ +ole "n *ound #a+e management should !e +e#ons"de+ed.

Introduction

&nt"se't"#s a+e agents that dest+o o+ "nh"!"t the g+o*th and deelo'ment o m"#+oo+gan"sms "no+ on l""ng t"ssue. nl"e ant"!"ot"#s that a#t sele#t"el on a s'e#""# ta+get, ant"se't"#s haemult"'le ta+gets and a !+oade+ s'e#t+um o a#t""t, *h"#h "n#lude !a#te+"a, ung", "+uses,'+oto/oa, and een '+"ons.1,2ee+al ant"se't"# #atego+"es e"st, "n#lud"ng al#ohols (ethanol),an"l"des (t+"#lo#a+!an), !"guan"des (#hlo+he"d"ne), !"s'henols (t+"#losan), #hlo+"ne #om'ounds,"od"ne #om'ounds, s"le+ #om'ounds, 'e+ogens, and uate+na+ ammon"um #om'ounds. 1he most #ommonl used '+odu#ts "n #l"n"#al '+a#t"#e toda "n#lude 'o"done "od"ne,#hlo+he"d"ne, al#ohol, a#etate, hd+ogen 'e+o"de, !o+"# a#"d, s"le+ n"t+ate, s"le+ sulad"a/"ne,and sod"um h'o#hlo+"te.

&nt"se't"# uses and "nd"#at"ons a+. ee+al ant"se't"# agents ma"nl o#us on #leans"ng "nta#ts"n and a+e used o+ '+e''"ng 'at"ents '+eo'e+at"el and '+"o+ to "nt+amus#ula+ "n7e#t"ons o+enous 'un#tu+es, '+e- and 'osto'e+at"e s#+u!!"ng "n the o'e+at"ng +oom, and hand *ash"ng! med"#al 'e+sonnel. ome also #onta"n dete+gents, *h"#h +ende+ them too ha+sh o+ use onnon"nta#t s"n.3he useulness o ant"se't"#s on "nta#t s"n "s *ell esta!l"shed and !+oadl

a##e'ted. Ho*ee+, the use o ant"se't"#s as '+o'hla#t"# ant"-"ne#t"e agents o+ o'en *ounds,su#h as la#e+at"ons, a!+as"ons, !u+ns, and #h+on"# ul#e+s, has !een an a+ea o "ntense#ont+oe+s o+ see+al ea+s.

*o o"#"al gu"del"nes hae !een +eleased +e#entl #on#e+n"ng ant"se't"# use on *ounds.o"done "od"ne has !een 8ood and +ug &dm"n"st+at"on (8&)-a''+oed o+ sho+t-te+mt+eatment o su'e+"#"al and a#ute *ounds.4he statement "n#ludes that 'o"done "od"ne hasnot !een ound to e"the+ '+omote o+ "nh"!"t *ound heal"ng. n the othe+ hand, gu"del"nes o+ thet+eatment o '+essu+e ul#e+s ! the e'a+tment o Health and Human e+"#es st+ongld"s#ou+age the use o ant"se't"#s and '+omote the use o no+mal sal"ne o+ #leans"ng '+essu+eul#e+s.5

$n #l"n"#al '+a#t"#e, ant"se't"#s a+e !+oadl used o+ !oth "nta#t s"n and *ounds, although

#on#e+ns a+e +a"sed !ased u'on the"+ ee#t on human #ells and *ound heal"ng. '"n"ons a+e#onl"#t"ng. ome autho+s st+ongl d"sa''+oe the use o ant"se't"#s "n o'en *ounds. 6-;n the


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othe+ hand, othe+s !el"ee ant"se't"#s hae a +ole "n *ound #a+e, and the"+ use ma ao+ *oundheal"ng #l"n"#all.9,10

Reasons to Use Antiseptics on Wounds

he ma"n +at"onale o+ us"ng ant"se't"#s on o'en *ounds "s '+eent"on and t+eatment o "ne#t"on

and, the+eo+e, "n#+eased +ate o the heal"ng '+o#ess. $t "s esta!l"shed that "ne#t"ons ma delaheal"ng, #ause a"lu+e o heal"ng, and een #ause *ound dete+"o+at"on. 11M"#+o!"al 'athogensdela *ound heal"ng th+ough see+al d"e+ent me#han"sms, su#h as 'e+s"stent '+odu#t"on o"nlammato+ med"ato+s, meta!ol"# *astes, and to"ns, and ma"ntenan#e o the a#t"ated stateo neut+o'h"ls, *h"#h '+odu#e #tolt"# en/mes and +ee ogen +ad"#als. 12h"s '+olonged"nlammato+ +es'onse #ont+"!utes to host "n7u+ and delas heal"ng. Mo+eoe+, !a#te+"a#om'ete *"th host #ells o+ nut+"ents and ogen ne#essa+ o+ *ound heal"ng. 13Wound"ne#t"on #an also lead to t"ssue h'o"a, +ende+ the g+anulat"on t"ssue hemo++hag"# and +ag"le,+edu#e "!+o!last num!e+ and #ollagen '+odu#t"on, and damage +ee'"thel"/at"on.


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& ma"n #on#e+n o+ #l"n"#"ans '+"o+ to a''l"ng a to'"#al agent on an o'en *ound "s saet.&gents that a+e #toto"# o+ #ause dela "n *ound heal"ng a+e used *"th +ese+at"on. hest+ongest a+gument aga"nst the use o ant"se't"#s on *ounds "s that ant"se't"#s hae !eenound, '+"ma+"l us"ng in-vitromodels, to !e #toto"# to #ells essent"al to the *ound heal"ng'+o#ess, su#h as "!+o!lasts, e+at"no#tes, and leuo#tes.29-31Ho*ee+, th"s #toto"#"ta''ea+s to !e #on#ent+at"on de'endent, as see+al ant"se't"#s "n lo* #on#ent+at"ons a+e not

#toto"#, although the +eta"n the"+ ant"!a#te+"al a#t""t in vitro.2


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+aett, et al.,39stud"ed the ee#t o one-'e+#ent A-$ solut"on "n the '+eent"on o "ne#t"on "nsutu+ed la#e+at"ons "n 395 'at"ents. he"+ data suggest that use o one-'e+#ent A-$ solut"on'+"o+ to sutu+"ng +edu#es the "n#"den#e o *ound "ne#t"on.

$n a +e#ent stud40on #l"n"#all non"ne#ted enous leg ul#e+s, the #om!"nat"on o A-$ *"thhd+o#ollo"d d+ess"ng *as sho*n to +edu#e !a#te+"al #lum's, neut+o'h"l"# as#ul"t"s, and

'hago#t"# "n"lt+at"on and "n#+ease the heal"ng +ate "n #om'a+"son to the hd+o#ollo"d d+ess"ngalone.

ne o the most #"ted stud"es "s the one #ondu#ted ! A"l7anto 41"n su+g"#al *ounds "n 294'ed"at+"# 'at"ents. He ound that a "e-'e+#ent A-$ ae+osol, *h"#h #onta"ned some e#"'"ents(gl#e+ol, #"t+ate-'hos'hate !ue+, 'oloethlated nonl'henol), "n#+eased the "ne#t"on +ate.$n o+de+ to e'la"n these +esults, he used the #ellst"# method, *h"#h #ons"sts o 'la#"ng a#ellulose s'onge "ns"de a s"l"#one-+u!!e+ tu!e !et*een the *ound edges. Wound eudate "llsthe s'onge, and #ells m"g+ate "nto the s'onge. He ound that the "e-'e+#ent ae+osol #aused'+onoun#ed leuo#te m"g+at"on, a "e-'e+#ent solut"on *"thout e#"'"ents #aused sl"ghte+"nh"!"t"on, *h"le the one-'e+#ent solut"on *as '+a#t"#all no d"e+ent to the #ont+ol (sal"ne).u!seuentl, s'+a"ng *ounds *"th a one-'e+#ent A-$ solut"on had no ee#t on *oundheal"ng *h"le "t s"gn""#antl de#+eased "ne#t"on +ate. $nte+est"ngl, 'o"done "od"ne has !een

ound to hae "n#+eased !a#te+"#"dal a#t""t "n lo*e+ #on#ent+at"ons. 42

=one+sel, some stud"es hae not #on"+med those '+e"ousl ment"oned +esults. A-$soa"ng *as not ound to s"gn""#antl de#+ease !a#te+"al #ounts "n a#ute, t+aumat"#,#ontam"nated *ounds that +eu"+ed de!+"dement, *h"le sal"ne soa"ng #aused "n#+eased #ounts.A-$ solut"on *as not ound to !e an ee#t"e su!st"tute to *ound #lean"ng and de!+"dement. 43

Ho*ee+, A-$ "++"gat"on has !een sho*n to !e ee#t"e "n see+al othe+ stud"es, 44-46so "t "s noto!"ous " the la# o ee#t o A-$ "n th"s stud should !e att+"!uted to the ant"se't"# "tsel o+ tothe method used. $n anothe+ stud *"th "ne#ted #h+on"# '+essu+e ul#e+s, A-$ solut"on *asound to +edu#e !a#te+"al leels !ut *as no mo+e ee#t"e than sal"ne. 4oose-s"nned an"mals (m"#e, +a!!"ts,gu"nea '"gs) heal ma"nl th+ough #ont+a#t"on, *h"le the '+"ma+ me#han"sm o heal"ng "n t"ght-s"nned an"mals ('"gs) "s e'"thel"/at"on, and heal"ng "n t"ght-s"nned an"mals mo+e #losel+esem!les the human heal"ng +es'onse.50$t should !e em'has"/ed that none o the an"malstud"es eam"ned the ee#t o 'o"done "od"ne "n #h+on"# *ound models, as an an"mal modeleu"alent to human #h+on"# *ounds does not e"st. @+"el, "n some stud"es 'o"done "od"ne*as ound to #ause no "nh"!"t"on on *ound +e-e'"thel"/at"on, 51,52*h"le "n othe+s "t +eta+ded

heal"ng.

53

&s a+ as the tens"le st+ength o the *ound "s #on#e+ned, A-$ has !een +e'o+ted to#ause "n#+ease,54+edu#t"on,56hae no ee#t,55and #ause e"the+ +edu#t"on o+ no ee#tde'end"ng on the assessment t"me.29$t has also !een ound to hae no ee#t on #ollagen 56and
http://www.medscape.com/content/2003/00/45/63/456300/456300_tab.html#Table%202.http://www.medscape.com/content/2003/00/45/63/456300/456300_tab.html#Table%202.


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g+anulat"on t"ssue '+odu#t"on o+ nons"gn""#ant +edu#t"on.5


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the stud *as to eam"ne the saet o #adeome+ "od"ne *"th +ega+d to deelo'ment osens"t""t.


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"m"la+l, "n anothe+ #l"n"#al stud "n human !l"ste+ *ounds #ontam"nated *"th Staphylococcusaureus,hd+ogen 'e+o"de *as ound not to +eta+d the heal"ng !ut ne"the+ d"d "t de#+ease!a#te+"al load.;2

$n #on#lus"on, hd+ogen 'e+o"de a''ea+s not to negat"el "nluen#e *ound heal"ng, !ut "t "salso "nee#t"e "n +edu#"ng the !a#te+"al #ount. Ho*ee+, "t ma !e useul as a #hem"#al

de!+"d"ng agent. he &me+"#an Med"#al &sso#"at"on #on#luded that the ee+es#en#e ohd+ogen 'e+o"de m"ght '+o"de some me#han"#al !ene"t "n loosen"ng de!+"s and ne#+ot"#t"ssue o the *ound.13

Acetic Acid

et"# a#"d "s +euentl used "n *ounds as a 0.25-'e+#ent o+ 0.5-'e+#ent solut"on. $t "s!a#te+"#"dal aga"nst man +am-'os"t"e and +am-negat"e o+gan"sms, es'e#"allPseudomonas aeruginosa.Bo dela o +ee'"thel"/at"on has !een ound "n an"mal and humanmodels.52&lthough one stud ound that a#et"# a#"d "n"t"all delaed +ee'"thel"/at"on, ate+ thee"ghth da, th"s ee#t d"d not 'e+s"st. $n the same stud, "t *as not sho*n to "nluen#e tens"le*ound st+ength.29$n t*o human un#ont+olled stud"es, a#et"# a#"d *as ound to !e !ene"#"al "n

*ounds "ne#ted *"th Pseudomonas aeruginosa.;3,;4

$n a stud *"th 'at"ents *"th enous legul#e+s,;5gau/e d+ess"ngs *etted *"th a#et"# a#"d *e+e sho*n to ee#t"el de#+ease thenum!e+ o Staphylococcus aureusand +am-negat"e +ods. seudomonas *as not +edu#eds"gn""#antl.

&lthough see+al in-vitrostud"es ound a#et"# a#"d to !e #toto"#,31,;6the in-vivostud"es do not#on"+m these "nd"ngs. he autho+s !el"ee that a#et"# a#"d #an #ont"nue !e"ng used to'"#all "n#ontam"nated *ounds *he+e an agent "s needed "n o+de+ to el"m"nate the #han#es o "ne#t"on(a!le 4).

C!lor!e&idine

=hlo+he"d"ne has !een #ommonl used "n d"s"ne#tant and ant"se't"# solut"ons. =hlo+he"d"neant"se't"# solut"ons a+e used ma"nl "n u+olog, gne#olog, dent"st+, and "n the t+eatment o*ounds. $t "s h"ghl !a#te+"#"dal.

ee+al an"mal stud"es hae tested the e"#a# and saet o #hlo+he"d"ne on *ounds (a!le5). $t has !een ound to hae m"ld "nh"!"to+ ee#ts on *ound heal"ng "n gu"nea '"gs. ;


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"le+ #om'ounds hae *"del !een used as *ound ant"se't"#s, ma"nl "n !u+ns. "le+sulad"a/"ne () and s"le+ n"t+ate (&gB3) a+e among the most #ommonl used. "le+sulad"a/"ne "s the most !+oadl used t+eatment o+ the '+eent"on o "ne#t"on "n 'at"ents *"th!u+n *ounds.95,96=om!"nat"ons o *"th #e+"um n"t+ate 9"e*"se, B"edne+, et al.,5


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that #ont+"!ute to the ma"ntenan#e o an o't"mal mo"st en"+onment ma !e mo+e a''+o'+"ate asdel"e+ sstems o ant"se't"#s than the #u++ent ones, s"n#e mo"st en"+onments +esult "n !oth"n#+eased *ound heal"ng +ate and enhan#ement o ant"m"#+o!"al 'enet+at"on to *ounds.

&nt"se't"#s need not !e om"tted +om the the+a'eut"# a+mamenta+"um o *ound #a+e. $n 'at"entsand *ound t'es *"th h"gh +"s o "ne#t"on, ant"se't"#s ma !e used to '+eent *ound "ne#t"on

that *ould hae delete+"ous ee#ts on *ound heal"ng. &nt"se't"#s '+esent adantages oe+to'"#al ant"!"ot"#s, s"n#e the do not #ause the eme+gen#e o d+ug-+es"stant !a#te+"a and hae!+oade+ ant"m"#+o!"al s'e#t+um and lo*e+ sens"t"/at"on +ates.

$n #on#lus"on, ate+ +e"e* o the l"te+atu+e, most ant"se't"#s, es'e#"all ne*e+ o+mulat"ons,a''ea+ to !e +elat"el sae and e"#"ent "n '+eent"ng "ne#t"on "n human *ounds. headantages o ant"se't"#s on *ounds ma out*e"gh 'oss"!le d"sadantages, and the"+ 'os"t"on"n *ound #a+e management should !e +e#ons"de+ed.

)ables

)able *. $o%idone iodine

Aut!or Wound )(pe Species

+umbero

Wounds)reated ControlComparator Eect on 'ealing

Eect onInection

@ennett, etal.10


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hae !a#te+"alg+o*th ate+?$ a''l"#at"ons. 42K and33K o+ the@$%$ and

?%?a''l"#at"ong+ou's, ' O0.001)

e+on"mus,et al.51

a+t"alth"#ness

"gs 600*ounds("n 4an"mals,300 o+ea#hg+ou')

Bo t+eatment Bo "nluen#e (4.55das needed o+50K o *ounds to+ee'"thel"al"/e *"th'ha+mad"ne 9-12K $ solut"ons. 4.6 o+ #ont+ol,+elat"e +ate o

heal"ng P1KCnons"gn""#antd"e+en#e)

B%&

+aett, etal.39

utu+edla#e+at"ons

Humans 395 Bo t+eatment (all*ounds *e+e "n"t"all"++"gated *"th sal"ne)

B%& e#+ease (1K+ate o 'u+ulent*ounds and5.4


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al.53 #ont+ol, 10$)

das o+ #om'lete+ee'"thel"/at"ons.


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#ounts ate+ 24h+ s.


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#ont+ol g+ou',' O 0.001)

A"l7ando41 u+g"#al Humans 294 al"ne Bo ee#t (#ellmo+'hologs"m"la+ to sal"ne-

"m'eded #ont+ol)

e#+ease(2.6K "ne#t"on+ate *"th 1K $

solut"on ate+a''ende#toms. ;.5K at the#ont+ol g+ou'Cho*ee+, 19K"ne#t"on +ate*"th 5K $solut"on s. ;Kat the #ont+olg+ou')

)able -. Cade&omer iodine

Aut!orWound)(pe Species

+umber oWounds)reated Control Eect on 'ealing

Eect onInection

&'el"st,et al.


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Hollo*a, etal.amme et,al.6;

8ullth"#ness

"gs 36 (12 =$, 12#adeome+, 12sal"ne)

=adeome+and al"ne

$n#+ease ("n#+ease"n+ee'"thel"al"/at"on6 and 9 das ate+t+eatment, ' O0.05)

B%&

>audansa,et al.69

Aenousul#e+s

Humans 60 (30 =$, 30#ont+ol)

tanda+dt+eatment(#leans"ng*"th d"lute

hd+ogen'e+o"de and#oe+"ng *"tha /"n# 'asted+ess"ng)

$n#+ease (


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al.;1 H, 10;#ont+ol)

(21 'tdeelo'ed"ne#t"ons. 26 othe #ont+olg+ou')

>eden,et al.;2

@l"ste+ *ounds(#ontam"nated)

Humans 144 (24oluntee+s*"th 3*ounds'e+o+ea+m)

Bot+eatment,t+"'leant"!"ot"#

Bo ee#t (14.3das o+ heal"ngs. 13.2 and 9.4"n the not+eatment andt+"'le ant"!"ot"#g+ou')

Bo ee#t(6.< log S.aureus#ounts s.


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humansC 1;.6 s.19.5 "n ull-th"#ness *ounds"n +ats,nons"gn""#antd"e+en#e)

Hansson,et al.;5

Aenousul#e+s

Humans 45 &lum"numa#etota+t+ateC'otass"um'e+manganateC#hlo+am"ne

B%& e#+ease(a#et"# a#"d0.25K +edu#ed!oth S. aureusand +am-negat"e +ods,pO 0.002 andpO 0.03.seudomonas,+oteus, S.epidermidis,and S.

hemolyticus*e+e nots"gn""#antl+edu#ed,pJ0.05)

loss, etal.;4

@u+ns o+sot t"ssue*ounds

Humans 16 B%& B%& e#+ease(el"m"nated P.aeruginosa#ounts "n 14out o 16'at"ent *"th"n 2*ees)

h"ll"'s,et al.;3

u'e+"#"al Humans 20 (10a#et"#a#"d, 10#ont+ol)

=hlo+he"d"ne o+h'o#hlo+"te

B%& e#+ease(mean g+o*thell +om 4.1 to0.< ate+ < dass. 3.3 to 3.4 "nthe #ont+olg+ou')

)able 0. C!lor!e&idine

Aut!or Wound )(pe Species

+umber oWounds)reated ControlComparator

Eect on'ealing

Eect onInection

@+ennan,et al.91

8ull th"#ness Dats 540 (45an"mals *"th 4*ounds ea#h,o+ ea#hg+ou':#hlo+he"d"ne,sal"ne,#hlo+am"ne )

al"ne, #hlo+am"ne Bo ee#t (nod"e+en#e+om sal"ne on#ollagen'+odu#t"onand onh"stolog"#eam"nat"on)

B%&

=+oss"ll, etal.94

&''end"#e#tom*ounds

Humans 2;; (9""ngstone,et al.104

+at"ngate+ !u+n"n7u+

Humans 52 (19 s"le+n"t+ate, 1;neom#"n P!a#"t+a#"n,

15 +"nge+Qsla#tate)

D"nge+Qs la#tate,Beom#"n 'lus!a#"t+a#"n

B%& e#+ease(16K g+ata"lu+e,mostl due

to "ne#t"on,s. 33K and53K o+to'"#alant"!"ot"#sandD"nge+Qsla#tateg+ou's, ' E0.02C 1 outo 3"ne#t"on#ases o

eme+gen#eo ant"!"ot"#-+es"stant!a#te+"a atthe s"le+n"t+ateg+ou' s. 6out o 6 and4 out o ;o+ the othe+g+ou's, ' O0.05)

B"edne+, etal.5


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25K oth"#ness o theg+anulat"onlae+ *"th&gB3solut"on "n

#om'a+"son to#ont+ol)

lson, et al.106

a+t"alth"#ness

"gs


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6. @+o*n =, V"tell" U&. & +e"e* o to'"#al agents o+ *ounds and methods o *ound"ng. *ermatol Surg +ncol1993C19:, >ae+ U&, Hans!+ough U8. he #toto"# ee#ts o #ommonl used to'"#alant"m"#+o!"al agents on human "!+o!lasts and e+at"no#tes. * "rauma 1991C31(6):, 8+an/en >. =an ant"m"#+o!"als !e ee#t"e *"thout

"m'a"+"ng *ound heal"ngR he ealuat"on o a #adeome+ "od"ne o"ntment. +)%S1994C6(6):1;4-93.


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34. og , &mes7o @, +oeng , et al. & +andom"/ed t+"al #om'a+"ng #adeome+ "od"ne andstanda+d t+eatment "n the out'at"ent management o #h+on"# enous ul#e+s. /rit Med *19;3C109:, a+doe D. he ee#t o #ommonl used ant"se't"#s on *oundheal"ng. Plast Reconstr Surg19


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60. Ho' , +and D, tahl-@al"ss =, 8"t/ma+t"n D. he ee#t o !etad"ne #+eam s.s"ladene #+eam on +ee'"thel"al"/at"on "n un"ne#ted e'e+"mental *ounds. Proc /urnssoc1991C23:166.

61. Do!"ns , a => U+, >e* D&. & mult"a+"ate anals"s o a#to+s ae#t"ng *ound heal"ngt"me. ermatol Surg +ncol19;4C10:219-22.

62. e o# M, an de+ Me+*e &, *a+ts =. & #om'a+at"e stud o 'o"done "od"ne

#+eam and s"le+ sulad"a/"ne "n the to'"#al t+eatment o !u+ns. $n: el*n (ed).+o#eed"ngs o he 8"+st &s"an%a#""# =ong+ess o Med"#"ne e+"#es. >ondon, :Doal o#"et o Med"#"ne e+"#es, 199;:65-ee @N, +a"no+ 8, hoden WD. o'"#al a''l"#at"on o 'o"done-"od"ne "n themanagement o de#u!"tus and stas"s ul#e+s. * m $eriatr Soc 19. =hem"#al and m"#+o!"olog"# #ha+a#te+"st"#s and to"#"t o 'o"done "od"nesolut"ons.m * Surg19;6C151:400-5.

6o!o &V, 8e+nade/ D, unda+a B. et"# a#"d "n the t+eatment o su'e+"#"al

*ounds "ne#ted ! Pseudomonas aeruginosa. 3ancet196;C1:11-3.


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;4. loss UM, =um!e+land B, M"lne+ M. et"# a#"d used o+ the el"m"nat"on oPseudomonas aeruginosa+om !u+n and sot t"ssue *ounds. * R rmy Med Corps1993C139(2):49-51.

;5. Hansson =, 8ae+gemann U. he ee#t o ant"se't"# solut"ons on m"#+oo+gan"sms "nenous leg ul#e+s.cta erm 6enereol1995C"nea*eae+ W, M#Mo++"s , ou# , Ho*a+d D. =ellula+ and !a#te+"al to"#"t"es o

to'"#al ant"m"#+o!"als. Plast Reconstr Surg19;5Cansdo*n &@, am'son @, >au'atta+aasem , Autt""+o7ana &. "le+ a"dsheal"ng "n the ste+"le s"n *ound: 'e+"mental stud"es "n the la!o+ato+ +at. /r *ermatol199


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109. @+ennan , >ea'e+ U. he ee#t o ant"se't"#s on the heal"ng *ound: & studus"ng the +a!!"t ea+ #ham!e+. /r * Surg19;5C

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Antiseptics on Wounds