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 ha(e long and #ommonl) !een used on *ounds to '+e(ent o+ t+eat "n,e#t"on.
Ho*e(e+, #"t"ng #)toto-"#"t) data, man) autho+s ha(e 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 +ele(ant an"mal
stud"es and #l"n"#al t+"als e-am"n"ng the e,,e#ts o, #ommonl) used ant"se't"#s, "n#lud"ng "od"ne
#om'ounds ('o("done "od"ne and #ade-ome+ "od"ne), #hlo+he-"d"ne, h)d+ogen 'e+o-"de, a#et"#
a#"d, and s"l(e+ #om'ounds. .h"s a+t"#le e-am"nes the"+ e,,e#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 "n,e#t"ons. .he autho+s ,ound des'"te #)toto-"#t) data, most ant"se't"#s ha(e not !een
sho*n to #lea+l) "m'ede heal"ng, es'e#"all) ne*e+ ,o+mulat"ons l"0e #ade-ome+ "od"ne (*h"#h
s'eeds heal"ng) and no(el s"l(e+ del"(e+) s)stems. .hese #om'ounds a''ea+ to !e +elat"(el)
sa,e and e,,"#"ent "n '+e(ent"ng "n,e#t"on "n human *ounds. 1"(en th"s +e("e*, the +ole o,
ant"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 de(elo'ment o, m"#+oo+gan"sms "n
o+ on l"("ng t"ssue. 2nl"0e ant"!"ot"#s that a#t sele#t"(el) on a s'e#","# ta+get, ant"se't"#s ha(e
mult"'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 e(en '+"ons.
31,24
5e(e+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"l(e+ #om'ounds, 'e+o-)gens, and 6uate+na+) ammon"um #om'ounds.
314

.he 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, h)d+ogen 'e+o-"de, !o+"# a#"d, s"l(e+ n"t+ate, s"l(e+ sul,ad"a/"ne,
and sod"um h)'o#hlo+"te.
&nt"se't"# uses and "nd"#at"ons (a+). 5e(e+al ant"se't"# agents ma"nl) ,o#us on #leans"ng "nta#t
s0"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. 5ome also #onta"n dete+gents, *h"#h +ende+ them too ha+sh ,o+ use on
non"nta#t s0"n.
334
.he use,ulness o, ant"se't"#s on "nta#t s0"n "s *ell esta!l"shed and !+oadl)
a##e'ted. Ho*e(e+, the use o, ant"se't"#s as '+o'h)la#t"# ant"-"n,e#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+o(e+s) ,o+ se(e+al )ea+s.
.*o o,,"#"al gu"del"nes ha(e !een +eleased +e#entl) #on#e+n"ng ant"se't"# use on *ounds.
o("done "od"ne has !een 8ood and 9+ug &dm"n"st+at"on (89&)-a''+o(ed ,o+ sho+t-te+m
t+eatment o, su'e+,"#"al and a#ute *ounds.
344
.he statement "n#ludes that 'o("done "od"ne has
not !een ,ound to e"the+ '+omote o+ "nh"!"t *ound heal"ng. :n the othe+ hand, gu"del"nes ,o+ the
t+eatment o, '+essu+e ul#e+s !) the 25 9e'a+tment o, Health and Human 5e+("#es st+ongl)
d"s#ou+age the use o, ant"se't"#s and '+omote the use o, no+mal sal"ne ,o+ #leans"ng '+essu+e
ul#e+s.
354
$n #l"n"#al '+a#t"#e, ant"se't"#s a+e !+oadl) used ,o+ !oth "nta#t s0"n and *ounds, although
#on#e+ns a+e +a"sed !ased u'on the"+ e,,e#t on human #ells and *ound heal"ng. :'"n"ons a+e
#on,l"#t"ng. 5ome autho+s st+ongl) d"sa''+o(e the use o, ant"se't"#s "n o'en *ounds.
36-;4
:n the
othe+ hand, othe+s !el"e(e ant"se't"#s ha(e a +ole "n *ound #a+e, and the"+ use ma) ,a(o+ *ound
heal"ng #l"n"#all).
39,104
Reasons to Use Antiseptics on Wounds
.he ma"n +at"onale ,o+ us"ng ant"se't"#s on o'en *ounds "s '+e(ent"on and t+eatment o, "n,e#t"on
and, the+e,o+e, "n#+eased +ate o, the heal"ng '+o#ess. $t "s esta!l"shed that "n,e#t"ons ma) dela)
heal"ng, #ause ,a"lu+e o, heal"ng, and e(en #ause *ound dete+"o+at"on.
3114
M"#+o!"al 'athogens
dela) *ound heal"ng th+ough se(e+al d",,e+ent me#han"sms, su#h as 'e+s"stent '+odu#t"on o,
"n,lammato+) med"ato+s, meta!ol"# *astes, and to-"ns, and ma"ntenan#e o, the a#t"(ated state
o, neut+o'h"ls, *h"#h '+odu#e #)tol)t"# en/)mes and ,+ee o-)gen +ad"#als.
3124
.h"s '+olonged
"n,lammato+) +es'onse #ont+"!utes to host "n7u+) and dela)s heal"ng. Mo+eo(e+, !a#te+"a
#om'ete *"th host #ells ,o+ nut+"ents and o-)gen ne#essa+) ,o+ *ound heal"ng.
3134
Wound
"n,e#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.
3<,14-164

=onse6uentl), although #+eat"on o, an o't"mal en("+onment ,o+ the *ound heal"ng '+o#ess "s
#u++entl) the '+"ma+) o!7e#t"(e o, *ound #a+e, add+ess"ng "n,e#t"on st"ll 'la)s a #+"t"#al +ole "n
*ound management.
9es'"te the un"(e+sal a##e'tan#e o, the det+"mental +ole o, "n,e#t"on on *ound heal"ng, the e-a#t
s"gn","#an#e o, "n#+eased !a#te+"al load on *ounds "s st"ll an a+ea o, de!ate. &ll #h+on"# *ounds
a+e #olon"/ed !) !a#te+"a 'o'ulat"on, and "t "s 0no*n #olon"/ed *ounds #an heal.
31<,1;4
Ho*e(e+,
"n add"t"on to #l"n"#al "n,e#t"on, "t seems that !a#te+"al num!e+ a!o(e a #+"t"#al #on#ent+at"on #an
de#+ease the *ound heal"ng +ate and ma) ha(e delete+"ous e,,e#ts on the *ound heal"ng
'+o#ess. .he +ole o, !a#te+"a "n the #h+on"#"t) o, nonheal"ng *ounds "s unde+ "n(est"gat"on.
>"0el), a state o, !a#te+"al #ontam"nat"on that #an '+odu#e su!#l"n"#al t"ssue damage e-"sts.
3194

.h"s ma) !e #aused !) shea+ num!e+ o+ !) othe+ '+o'e+t"es o, the !a#te+"al '+o#ess. $n#+eased
!a#te+"al num!e+s "n '+essu+e ul#e+s ha(e !een "m'l"#ated as s"gn","#ant 'a+t"#"'ants o, #h+on"#
ul#e+at"on.
3204
5e(e+al stud"es ha(e demonst+ated that !a#te+"al num!e+ a!o(e 105 o+ 106
o+gan"sms 'e+ g+am #an #ause lo#al d"sease to s0"n o+ #an dela) *ound heal"ng.
321-244

?uant","#at"on o, !a#te+"a *"th"n *ounds "s not the sole '+ed"#to+ o, the +"s0 o, "n,e#t"on, s"n#e
se(e+al "nd"("dual"/ed ,a#to+s, su#h as '+esen#e o, ,o+e"gn mate+"al and #on#om"tant d"seases,
#an de#+ease the a!"l"t) o, the hosts to de,end themsel(es. Mo+eo(e+, the natu+e o, the *ound
and the ("+ulen#e o, m"#+o!es "n(ol(ed a+e "m'o+tant.
3254
$n add"t"on to use o, ant"se't"#s to
+edu#e !a#te+"al load o, a *ound, se(e+al othe+ a''+oa#hes ha(e !een de(elo'ed, "n#lud"ng
de!+"dement, #leans"ng and 'ulsat"ng 7et la(age ,o+ +emo(al o, the de("tal"/ed t"ssue, and
a''l"#at"on o, to'"#al ant"!"ot"#s.
&nothe+ a+gument ,o+ the use o, ant"se't"#s on *ounds to '+e(ent *ound "n,e#t"on "s that
ant"se't"#s ma) !e '+e,e+a!le to to'"#al ant"!"ot"#s *"th +ega+d to de(elo'ment o, !a#te+"al
+es"stan#e. &nt"!"ot"# +es"stan#e o, s0"n *ound ,lo+a has eme+ged as a s"gn","#ant '+o!lem, and
measu+es to '+e(ent "t should !e ta0en.
3264
1ene+all), ant"se't"#s a"m at el"m"nat"ng all
'athogen"# !a#te+"a o, the *ound, *h"le ant"!"ot"#s a+e e,,e#t"(e onl) to #e+ta"n !a#te+"a that a+e
sens"t"(e to them. &lthough +es"stan#e to*a+d ant"se't"#s has !een +e'o+ted, "t "s to a
s"gn","#antl) lesse+ deg+ee than +e'o+ted *"th ant"!"ot"# usage.
31;4
&##o+d"ng to M#9onnell, et al.,
some a#6u"+ed me#han"sms o, +es"stan#e (es'e#"all) to hea() metals) a+e #l"n"#all) s"gn","#ant,
!ut "n most #ases the +esults ha(e !een s'e#ulat"(e.
314
Mo+eo(e+, de(elo'ment o, +es"stan#e
aga"nst 'o("done "od"ne, *h"#h "s the most #ommonl) used ant"se't"# toda), does not e-"st.
32<4

a)ne, et al., state that the sens"!le use o, ant"se't"#s #ould hel' de#+ease the usage o,
ant"!"ot"#s, '+ese+("ng the"+ ad(antage ,o+ #l"n"#all) #+"t"#al s"tuat"ons.
32;4
&nt"se't"#s a+e also #ons"de+ed su'e+"o+ to to'"#al ant"!"ot"#s *hen the"+ +ates o, #aus"ng #onta#t
sens"t"/at"on a+e #om'a+ed. &m"nogl)#os"des, es'e#"all) neom)#"n, ha(e a mu#h h"ghe+
sens"t"/at"on +ate #om'a+ed to 'o("done "od"ne.
334
Mo+eo(e+, 'at"ents alle+g"# to one ant"!"ot"#
ma) a#6u"+e #+oss-alle+g) to othe+ ant"!"ot"#s, as *ell. .he sens"t"/at"on +ate to 'o("done "od"ne,
the most #ommonl) used ant"se't"#, has !een ,ound to !e onl) 0.<3 'e+#ent.
334
Arguments Against Antiseptics
& ma"n #on#e+n ,o+ #l"n"#"ans '+"o+ to a''l)"ng a to'"#al agent on an o'en *ound "s sa,et).
&gents that a+e #)toto-"# o+ #ause dela) "n *ound heal"ng a+e used *"th +ese+(at"on. .he
st+ongest a+gument aga"nst the use o, ant"se't"#s on *ounds "s that ant"se't"#s ha(e !een
,ound, '+"ma+"l) us"ng in-vitro models, to !e #)toto-"# to #ells essent"al to the *ound heal"ng
'+o#ess, su#h as ,"!+o!lasts, 0e+at"no#)tes, and leu0o#)tes.
329-314
Ho*e(e+, th"s #)toto-"#"t)
a''ea+s to !e #on#ent+at"on de'endent, as se(e+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.
32<4
5"n#e the in-vitro +esults a+e
not al*a)s '+ed"#t"(e o, *hat ma) ha''en in vivo, nume+ous stud"es ha(e !een #ondu#ted on
an"mal and human models. .he +esults o, these stud"es a+e #on,l"#t"ng and *"ll !e '+esented
late+ "n the a+t"#le.
& se#ond +eason aga"nst the use o, ant"se't"#s on o'en *ounds, as ,"+st stated !) 8lem"ng "n
1919,
3324
"s that ant"se't"#s a+e not as e,,e#t"(e aga"nst !a#te+"a that +es"de "n *ounds as the) a+e
aga"nst !a#te+"a in vitro. .he '+esen#e o, e-udate, se+um, o+ !lood seems to de#+ease the"+
a#t"("t). Ho*e(e+, "n '+a#t"#e, se(e+al !a#te+"olog"#al stud"es ha(e sho*n that ant"se't"#s #an
de#+ease !a#te+"al #ounts *"th"n *ounds.
333,344
$n o+de+ to d+a* #on#lus"ons +ega+d"ng the a''+o'+"ateness and use,ulness o, ant"se't"# use on
*ounds, the autho+s ha(e #hosen to +e("e* the +esults o, an"mal and human stud"es o, the most
#ommon ant"se't"#s used #u++entl).
Iodine Compounds
5"n#e the ,"+st d"s#o(e+) o, the natu+al element "od"ne "n 1;11 !) the #hem"st @e+na+d =ou+to"s,
"od"ne and "ts #om'ounds ha(e !een !+oadl) used ,o+ '+e(ent"on o, "n,e#t"on and t+eatment o,
*ounds.
3354
Ho*e(e+, mole#ula+ "od"ne #an !e (e+) to-"# ,o+ t"ssues, so ,o+mulat"ons #om'osed
!) #om!"nat"on o, "od"ne *"th a #a++"e+ that de#+eases "od"ne a(a"la!"l"t) *e+e de(elo'ed.
o("done "od"ne (A-$) +esults ,+om the #om!"nat"on o, mole#ula+ "od"ne and
'ol)("n)l')++ol"done. o("done "od"ne "s a(a"la!le "n se(e+al ,o+ms (solut"on, #+eam, o"ntment,
s#+u!). .he s#+u! ,o+m #onta"ns dete+gent and should !e used onl) on "nta#t s0"n. =ade-ome+
"od"ne #ons"sts o, s'he+"#al h)d+o'h"l"# !eads o, #ade-ome+-sta+#h, *h"#h #onta"n "od"ne, "s
h"ghl) a!so+!ent, and +eleases "od"ne slo*l) "n the *ound a+ea. $t "s a(a"la!le as an o"ntment
and as a d+ess"ng. Bume+ous stud"es ha(e !een #ondu#ted "n o+de+ to dete+m"ne the sa,et) and
e,,"#a#) o, "od"ne #om'ounds on *ound heal"ng.
Eects o Iodine Compounds on t!e "acterial #oad o Wounds
$o%idone iodine. 5e(e+al an"mal stud"es ha(e e-am"ned the e,,e#ts o, 'o("done "od"ne on the
!a#te+"al load o, *ounds (.a!le 1). .hese +esults ha(e not '+o(en the e,,"#a#) o, 'o("done
"od"neC ho*e(e+, the +esults o, nume+ous #l"n"#al t+"als sho* that "t "s e,,e#t"(e "n +edu#"ng the
!a#te+"al load o, *ounds. Dodehea(e+, et al.,
3364
stud"ed the !a#te+"#"dal a#t"("t) o, 'o("done
"od"ne solut"on "n #ontam"nated *ounds "n Ha+tle) gu"nea '"gs and the 'otent"al the+a'eut"#
!ene,"t. &lthough the) ,ound that "t #an s"gn","#antl) +edu#e !a#te+"al load 10 m"nutes a,te+ the
a''l"#at"on o, the ant"se't"#, th"s e,,e#t d"d not 'e+s"st. 8ou+ da)s a,te+ a s"ngle A-$
a''l"#at"on, the+e *as no de#+eased +ate o, "n,e#t"on o+ de#+eased !a#te+"a num!e+. &nothe+
stud)
33<4
that e(aluated #ontam"nated 12-hou+ old la#e+at"ons "n a gu"nea '"g model ,a"led to ,"nd
an) de#+ease o, *ound !a#te+"al #ounts a,te+ "++"gat"on *"th A-$ "n #om'a+"son to no+mal
sal"ne. Ho*e(e+, the autho+s ment"on that th"s ma) !e due to the ,o+mat"on o, a '+ote"na#eous
*ound #oagulum and 'o"nt out that e(en 'a+ente+al ant"m"#+o!"als a+e "ne,,e#t"(e "n '+e(ent"ng
"n,e#t"on "n an"mal models ", adm"n"ste+ed alone mo+e than th+ee hou+s a,te+ *ound"ng.
Ho*e(e+, most o, the human t+"als 'e+,o+med '+o(e the e,,"#a#) o, 'o("done "od"ne "n #l"n"#al
s"tuat"ons. 1eo+g"ade, et al.,
33;4
a''l"ed A-$ o"ntment on !u+n *ounds "n 50 'at"ents and
sho*ed that #ont+ol o, !a#te+"al g+o*th *as e,,e#t"(e. .he+e *as not a #ont+ol g+ou' "n th"s
stud)C ho*e(e+, the #ont+ol o, !a#te+"al g+o*th sho*ed a s"gn","#ant #o++elat"on to the ,+e6uen#)
o, A-$ a''l"#at"on.
1+a(ett, et al.,
3394
stud"ed the e,,e#t o, one-'e+#ent A-$ solut"on "n the '+e(ent"on o, "n,e#t"on "n
sutu+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 "n,e#t"on.
$n a +e#ent stud)
3404
on #l"n"#all) non"n,e#ted (enous leg ul#e+s, the #om!"nat"on o, A-$ *"th
h)d+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 h)d+o#ollo"d d+ess"ng
alone.
:ne o, the most #"ted stud"es "s the one #ondu#ted !) A"l7anto
3414
"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 !u,,e+, 'ol)o-)eth)lated non)l'henol), "n#+eased the "n,e#t"on +ate.
$n o+de+ to e-'la"n these +esults, he used the #ellst"# method, *h"#h #ons"sts o, 'la#"ng a
#ellulose s'onge "ns"de a s"l"#one-+u!!e+ tu!e !et*een the *ound edges. Wound e-udate ,"lls
the s'onge, and #ells m"g+ate "nto the s'onge. He ,ound that the ,"(e-'e+#ent ae+osol #aused
'+onoun#ed leu0o#)te m"g+at"on, a ,"(e-'e+#ent solut"on *"thout e-#"'"ents #aused sl"ghte+
"nh"!"t"on, *h"le the one-'e+#ent solut"on *as '+a#t"#all) no d",,e+ent to the #ont+ol (sal"ne).
5u!se6uentl), s'+a)"ng *ounds *"th a one-'e+#ent A-$ solut"on had no e,,e#t on *ound
heal"ng *h"le "t s"gn","#antl) de#+eased "n,e#t"on +ate. $nte+est"ngl), 'o("done "od"ne has !een
,ound to ha(e "n#+eased !a#te+"#"dal a#t"("t) "n lo*e+ #on#ent+at"ons.
3424
=on(e+sel), some stud"es ha(e not #on,"+med those '+e("ousl) ment"oned +esults. A-$
soa0"ng *as not ,ound to s"gn","#antl) de#+ease !a#te+"al #ounts "n a#ute, t+aumat"#,
#ontam"nated *ounds that +e6u"+ed de!+"dement, *h"le sal"ne soa0"ng #aused "n#+eased #ounts.
A-$ solut"on *as not ,ound to !e an e,,e#t"(e su!st"tute to *ound #lean"ng and de!+"dement.
3434
Ho*e(e+, A-$ "++"gat"on has !een sho*n to !e e,,e#t"(e "n se(e+al othe+ stud"es,
344-464
so "t "s not
o!("ous ", the la#0 o, e,,e#t o, A-$ "n th"s stud) should !e att+"!uted to the ant"se't"# "tsel, o+ to
the method used. $n anothe+ stud) *"th "n,e#ted #h+on"# '+essu+e ul#e+s, A-$ solut"on *as
,ound to +edu#e !a#te+"al le(els !ut *as no mo+e e,,e#t"(e than sal"ne.
34<4
Cade&omer iodine. .he e,,"#a#) o, #ade-ome+ "od"ne has !een sho*n "n !oth an"mal and
human models (.a!le 2). Me+t/, et al.,
34;4
e-am"ned the e,,e#t o, #ade-ome+ "od"ne d+ess"ng on
'a+t"al-th"#0ness *ounds "n s'e#","# 'athogen-,+ee '"gs #ontam"nated *"th o+ *"thout meth"#"ll"n-
+es"stant Staphylococcus aureus (MD5&). &''l"ed da"l), #ade-ome+ "od"ne *as ,ound to
s"gn","#antl) +edu#e MD5& and total !a#te+"a "n the *ounds "n #om'a+"son to no t+eatment
#ont+ol and (eh"#le (#ade-ome+) at all t"me 'o"nts stud"ed (1, 2, and 3 da)s a,te+ "no#ulat"on).
.he +edu#t"on *as most '+onoun#ed at da) 3.
$n an un#ont+olled small stud) se+"es (n E 19), 9an"elsen, et al.,
3494
used #ade-ome+ "od"ne "n
ul#e+s #olon"/ed *"th Pseudomonas aeruginosa and ,ound negat"(e #ultu+es "n 65 'e+#ent and
<5 'e+#ent o, 'at"ents a,te+ 1 and 12 *ee0s o, t+eatment, +es'e#t"(el).
Eects o Iodine Compounds on t!e Wound 'ealing $rocess
$o%idone iodine. >"te+atu+e +ega+d"ng the e,,e#t o, 'o("done "od"ne on *ound heal"ng "n an"mal
*ound models "s #on,l"#t"ng. Deasons ,o+ th"s d"s#+e'an#) ma) !e d",,e+en#es "n the 'a+amete+s
o, *ound heal"ng e(aluated, the (a+"et) o, assessment t"mes, "od"ne #on#ent+at"ons and #ont+ol
g+ou's, and the d"(e+s"t) o, an"mal *ound models ('a+t"al th"#0ness, ,ull th"#0ness, !u+n
*ounds, "s#hem"# *ounds, et#.). .he t)'e o, an"mal used a''ea+s to !e o, "m'o+tan#e, as
d",,e+ent an"mals sho* d",,e+ent heal"ng +es'onses. >oose-s0"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-
s0"nned an"mals ('"gs) "s e'"thel"/at"on, and heal"ng "n t"ght-s0"nned an"mals mo+e #losel)
+esem!les the human heal"ng +es'onse.
3504
$t should !e em'has"/ed that none o, the an"mal
stud"es e-am"ned the e,,e#t o, 'o("done "od"ne "n #h+on"# *ound models, as an an"mal model
e6u"(alent to human #h+on"# *ounds does not e-"st. @+"e,l), "n some stud"es 'o("done "od"ne
*as ,ound to #ause no "nh"!"t"on on *ound +e-e'"thel"/at"on,
351,524
*h"le "n othe+s "t +eta+ded
heal"ng.
3534
&s ,a+ as the tens"le st+ength o, the *ound "s #on#e+ned, A-$ has !een +e'o+ted to
#ause "n#+ease,
3544
+edu#t"on,
3564
ha(e no e,,e#t,
3554
and #ause e"the+ +edu#t"on o+ no e,,e#t
de'end"ng on the assessment t"me.
3294
$t has also !een ,ound to ha(e no e,,e#t on #ollagen
3564
and
g+anulat"on t"ssue '+odu#t"on o+ nons"gn","#ant +edu#t"on.
35<4
Mo+eo(e+, "t has !een sho*n to
"n#+ease +e(as#ula+"/at"on.
3534
$n anothe+ stud) measu+"ng the #o+neal to-"#"t) o, ant"se't"#s,
'o("done "od"ne *as ,ound to !e nonto-"# "n +a!!"t #o+neas.
35;4
=l"n"#al stud"es e(aluat"ng the "n,luen#e o, A-$ "n *ound heal"ng a+e nume+ous. Most o, them
ha(e sho*n no de#+ease o, the *ound heal"ng +ate ,+om the use o, 'o("done "od"ne. .he
a,o+ement"oned stud) !) A"l7anto
3414
,ound no e,,e#t on *ound heal"ng *hen a one-'e+#ent
solut"on "s used. B"edne+
3594
+e("e*ed the #)toto-"#"t) o, A-$ and #on#luded that Fthe no+mal
#ou+se o, *ound heal"ng (su#t"on !l"ste+
3604
) as *ell as the d"stu+!ed one (Mohs the+a')
3614
and
!u+ns
3624
) "s not negat"(el) "n,luen#ed !) A-$.F
"G+a+d-8+an#h"mont, et al.,
3404
e-am"ned the e,,e#t o, A-$ "n #om!"nat"on *"th h)d+o#ollo"d
d+ess"ng on (enous leg ul#e+s. .he #ont+ol g+ou' *as t+eated *"th #om'+ess"on h)d+o#ollo"d
d+ess"ngs alone. 2s"ng 'lan"met+"# e(aluat"on, the) sho*ed that the +ate o, leg ul#e+ heal"ng
*as a##ele+ated "n the A-$-t+eated g+ou' "n #om'a+"son to #ont+ol, es'e#"all) the ,"+st ,ou+
*ee0s o, t+eatment.
>ee, et al., "n a non#ont+olled stud) ,ound +edu#t"on o, "n,e#t"on and '+omot"on o, heal"ng "n
'at"ents *"th long-stand"ng (6 months to 16 )ea+s) de#u!"tus and stas"s ul#e+at"ons.
3634
Hnutson, et al.,
3644
+e'o+ted the"+ ,"(e-)ea+ e-'e+"en#e and #on#luded that the #om!"nat"on o,
suga+ and A-$ enhan#ed heal"ng o, !u+ns, *ounds, and ul#e+s and +edu#ed the +e6u"+ements
,o+ s0"n g+a,t"ng, ant"!"ot"#s, and the hos'"tal #osts. Ho*e(e+, the) do not ment"on *hat
Fstanda+d #a+eF the#ont+ol g+ou' +e#e"(edC ne"the+ "s "t #lea+ ", th"s "m'+o(ement "s due to A-$,
to suga+, o+ to the #om!"nat"on.
Ma)e+, et al.,
394
+e("e*ed the in-vivo stud"es e-am"n"ng the e,,e#ts o, the (a+"ous A-$
,o+mulat"ons on *ound heal"ng. .he) +e'o+ted ,"(e human stud"es us"ng A-$ solut"on, th+ee
*"th A-$ o"ntment, and th+ee *"th A-$ #+eam. $n all these stud"es, A-$ *as not ,ound to
negat"(el) "n,luen#e *ound heal"ng "n #om'a+"son to the #ont+ol g+ou' o+ to othe+ t+eatments.
@u+n *ounds a+e, "n man) *a)s, d",,e+ent than the othe+ a#ute *ounds, and the) ha(e a h"ghe+
+"s0 o, "n,e#t"on that not onl) #an dela) *ound heal"ng !ut also #an #ause a s"gn","#ant +"s0 ,o+
the 'at"entIs l",e. 5teen
3654
+e("e*ed the use o, A-$ "n the t+eatment o, !u+ns. &,te+ +e("e*"ng in-
vitro an"mal and human stud"es, he #on#luded that A-$ has #on#ent+at"on-de'endent
#)toto-"#"t). .he h"ghe+ the #om'le-"t) o, the s)stem stud"ed (in-vivo J ex-vivo J in-vitro stud"es)
the less dete#ta!le the e,,e#ts a+e. He d"d not e-#lude the 'oss"!"l"t) that A-$ ma) #ause
sl"ght +eta+dat"on "n *ound heal"ng !ut !el"e(ed the !ene,"ts o, the m"#+o!"#"dal e,,e#ts o, A-$
should not !e "gno+ed. 5"n#e la+ge a+eas usuall) need to !e t+eated "n !u+n 'at"ents, +"s0s o,
s)stem"# to-"#"t) o, "n#+eased A-$ a!so+'t"on *e+e +e("e*ed, as *ell.
8o+ se(e+al mo+e +e("e*s o, A-$ use on *ounds, see +e,e+en#es 9, 10, 2<, 66, and 6<.
Cade&omer iodine. $n an"mal models, #ade-ome+ "od"ne has !een +e'o+ted to "n#+ease
e'"de+mal +egene+at"on and e'"thel"al"/at"on "n !oth 'a+t"al-th"#0ness and ,ull-th"#0ness *ounds.
333,6;4
Ho*e(e+, #ade-ome+ "od"ne a''ea+s to ha(e no e,,e#t on g+anulat"on t"ssue ,o+mat"on,
neo(as#ula+"/at"on, o+ *ound #ont+a#t"on.
3594
=ade-ome+ "od"ne has also !een the su!7e#t o, man) #l"n"#al stud"es. $n these stud"es,
#ade-ome+ "od"ne has !een ,ound to !e e,,e#t"(e and !ene,"#"al to *ound heal"ng. B"ne #l"n"#al
t+"als #om'a+"ng the e,,e#ts o, #ade-ome+ "od"ne *"th othe+ t+eatments on #h+on"# (enous ul#e+s
sho*ed enhan#ement o, *ound heal"ng. .he othe+ t+eatments that *e+e #om'a+ed to
#ade-ome+ "od"ne "n#luded (a+"ous Fstanda+d t+eatmentF (#leans"ng *"th d"luted h)d+ogen
'e+o-"de o+ d"lute 'otass"um 'e+manganate !aths and #o(e+"ng *"th e"the+ /"n# 'aste d+ess"ngs
o+ nonadhe+ent d+ess"ngs, ma"nl) 'a+a,,"n-"m'+egnated o+ sal"ne d+ess"ngs, o+ sal"ne *et-to-d+)
#om'+ess"(e d+ess"ngs, o+ gent"an ("olet and 'ol)m)-"n-!a#"t+a#"n o"ntment, o+ su''o+t
!andag"ng%sto#0"ng and a d+) d+ess"ng),
369-<44
de-t+anome+,
3<54
and h)d+o#ollo"d d+ess"ng o+
'a+a,,"n gau/e d+ess"ngs.
3<64
$n one stud), no #ont+ol g+ou' *as used, s"n#e the ma"n 'u+'ose o,
the stud) *as to e-am"ne the sa,et) o, #ade-ome+ "od"ne *"th +ega+d to de(elo'ment o,
sens"t"("t).
3<<4
$n se(e+al stud"es, the ul#e+s had !een +e#al#"t+ant to '+e("ous t+eatments. &ll
stud"es ,ound #ade-ome+ "od"ne not onl) to #ause no "nh"!"t"on on *ound heal"ng !ut to
a##ele+ate "t. Mo+eo(e+, o!se+(at"ons o, +edu#t"on o, 'a"n, +emo(al o, 'us, de!+"s, and e-udate,
and st"mulat"on o, g+anulat"on t"ssue ,o+mat"on *e+e made.
3<14
.he +edu#t"on o, e-udate #ould !e
#ons"de+ed an e-'e#ted a#t"on o, #ade-ome+ "od"ne, s"n#e #ade-ome+ "od"ne "s des"gned to
a!so+! la+ge 6uant"t"es o, e-udate (ea#h g+am #an a!so+! 3m> o, ,lu"d) and then +esults "n slo*
+elease o, "od"ne.
&'el6("st, et al.,
3<;4
e-am"ned the e,,e#ts o, #ade-ome+ "od"ne "n #a("t) ,oot ul#e+s "n d"a!et"#
'at"ents and ,ound no #l"n"#al d",,e+en#e "n #om'a+"son to othe+ t+eatments (gentam"#"n solut"on,
st+e'todo+nase%st+e'to0"nase, o+ d+) sal"ne gau/e) !ut #ons"de+a!le less #osts.
$n a +andom"/ed t+"al, Mo!e+g, et al.,
3<94
#om'a+ed #ade-ome+ "od"ne (n E 16) *"th standa+d
t+eatment (n E 1;) "n 'at"ents *"th de#u!"tus ul#e+s. =ade-ome+ "od"ne s"gn","#antl) +edu#ed
'us, de!+"s, and 'a"n o, the ul#e+s and a##ele+ated the heal"ng +ate. &,te+ e"ght *ee0s o,
t+eatment, the ul#e+ a+eas *e+e +edu#ed !) <6 and 5< 'e+#ent "n the #ado-eme+ "od"ne and
standa+d t+eatment g+ou', +es'e#t"(el). 5"- ul#e+s t+eated *"th #ade-ome+ "od"ne *e+e
#om'letel) healed, *h"le onl) one *"th standa+d t+eatment *as healed.
5umma+"/"ng the +e("e* o, nume+ous in-vivo stud"es o, "od"ne #om'ounds the autho+s #an
#on#lude that "n humans A-$ and #ade-ome+ "od"ne do not ha(e a negat"(e "n,luen#e on
*ound heal"ng, *h"le #ade-ome+ "od"ne #auses an a##ele+at"on o, heal"ng "n #h+on"# human
*ounds. @oth #an !e e,,e#t"(e "n +edu#"ng !a#te+"a num!e+ and de#+eas"ng "n,e#t"ons. Desults
,+om an"mal stud"es de'end on man) (a+"a!les and should !e "nte+'+eted *"th #aut"ousness.
5tud"es o, A-$ ha(e mo+e #on,l"#t"ng +esults, es'e#"all) *"th an"mal models, and ha(e #aused
#on#e+n on man) #l"n"#"ans. Be(e+theless, the +esults ,+om the stud"es e(aluat"ng #ade-ome+
"od"ne a+e #lea+ and lea(e no dou!t that th"s ne*e+ "od"ne #om'ound "s e,,e#t"(e *"thout ha("ng
an) negat"(e "n,luen#e on *ound heal"ng +ate. $n(e+sel), an a##ele+at"on o, *ound heal"ng has
!een o!se+(ed.
'(drogen $ero&ide
& th+ee-'e+#ent solut"on o, h)d+ogen 'e+o-"de "s #ommonl) used as a *ound ant"se't"#. .he
th+ee-'e+#ent solut"on demonst+ates in-vitro !+oad-s'e#t+um e,,"#a#). $ts g+eatest a#t"("t) "s
to*a+ds 1+am-'os"t"(e !a#te+"a, !ut the '+esen#e o, #atalase "n these !a#te+"a ma0es d"lut"ons
!elo* th+ee 'e+#ent less e,,e#t"(e.
314
$n a s"m"la+ ,ash"on, #atalases '+esent "n t"ssues #an +ende+
h)d+ogen 'e+o-"de e(en less !a#te+"#"dal in vivo.
364
&lthough h)d+ogen 'e+o-"de "s (e+)
#ommonl) used, su+'+"s"ngl) ,e* stud"es ha(e !een #ondu#ted to e-am"ne "ts e,,e#t on the
*ound heal"ng '+o#ess and "ts e,,"#a#) as a *ound ant"se't"# (.a!le 3).
&n"mal and human stud"es ha(e sho*n h)d+ogen 'e+o-"de to ha(e no negat"(e e,,e#t on *ound
heal"ng. >"nea*ea(e+, et al.,
3294
d"d not ,"nd +eta+dat"on o, +ee'"thel"/at"on "n a +at model a,te+
"++"gat"on o, the *ound *"th th+ee-'e+#ent h)d+ogen 'e+o-"de. Ho*e(e+, at the in-vitro
#om'onent o, the same stud), he ,ound m"n"mal !a#te+"#"dal e,,e#t o, h)d+ogen 'e+o-"de.
1+u!e+, et al.,
3524
,ound a##ele+at"on o, +ee'"thel"/at"on "n a +at model and "n a #l"n"#al t+"al.
Ho*e(e+, !ullae *e+e ,o+med on o+ a!out the da) o, heal"ng "n most o, the 'at"ents, suggest"ng
'oss"!l) that h)d+ogen 'e+o-"de should not !e used "n ne*l) ,o+med e'"thel"um.
$n anothe+ stud) !) .u+, et al.,
3;04
h)d+ogen 'e+o-"de *as ,ound to s"gn","#antl) "n#+ease the !lood
,lo* "n "s#hem"# ul#e+s "n a gu"nea '"g model. .he "n#+eased !lood ,lo* ma) !e due to ne*
(essel ,o+mat"on th+ough a#t"(at"on o, metallo'+ote"nases. $nte+est"ngl), the !lood ,lo* *as
"n#+eased e(en "n 'la#es d"stant to the lo#al a''l"#at"on o, h)d+ogen 'e+o-"de. Bo e-'lanat"on
*as g"(en ,o+ th"s ,"nd"ng. Ho*e(e+, the autho+s ,ound no d",,e+en#e "n the *ound-heal"ng +ate.
.h"s ma) !e due to the l"m"ted sens"t"("t) o, the method the) used to e(aluate the #l"n"#al
+es'onse (("sual dete+m"nat"on o, the non-ne#+ot"# a+ea).
$n a #l"n"#al stud) e(aluat"ng the e,,e#t"(eness o, h)d+ogen 'e+o-"de on +edu#"ng the "n,e#t"on
+ate o, a''ende#tom) *ounds, no to-"# e,,e#ts *e+e ,ound, !ut "t *as ,ound to !e "ne,,e#t"(e.
3;14

5"m"la+l), "n anothe+ #l"n"#al stud) "n human !l"ste+ *ounds #ontam"nated *"th Staphylococcus
aureus, h)d+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.
3;24
$n #on#lus"on, h)d+ogen 'e+o-"de a''ea+s not to negat"(el) "n,luen#e *ound heal"ng, !ut "t "s
also "ne,,e#t"(e "n +edu#"ng the !a#te+"al #ount. Ho*e(e+, "t ma) !e use,ul as a #hem"#al
de!+"d"ng agent. .he &me+"#an Med"#al &sso#"at"on #on#luded that the e,,e+(es#en#e o,
h)d+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.
3134
Acetic Acid
&#et"# a#"d "s ,+e6uentl) used "n *ounds as a 0.25-'e+#ent o+ 0.5-'e+#ent solut"on. $t "s
!a#te+"#"dal aga"nst man) 1+am-'os"t"(e and 1+am-negat"(e o+gan"sms, es'e#"all)
Pseudomonas aeruginosa. Bo dela) o, +ee'"thel"/at"on has !een ,ound "n an"mal and human
models.
3524
&lthough one stud) ,ound that a#et"# a#"d "n"t"all) dela)ed +ee'"thel"/at"on, a,te+ the
e"ghth da), th"s e,,e#t d"d not 'e+s"st. $n the same stud), "t *as not sho*n to "n,luen#e tens"le
*ound st+ength.
3294
$n t*o human un#ont+olled stud"es, a#et"# a#"d *as ,ound to !e !ene,"#"al "n
*ounds "n,e#ted *"th Pseudomonas aeruginosa.
3;3,;44
$n a stud) *"th 'at"ents *"th (enous leg
ul#e+s,
3;54
gau/e d+ess"ngs *etted *"th a#et"# a#"d *e+e sho*n to e,,e#t"(el) de#+ease the
num!e+ o, Staphylococcus aureus and 1+am-negat"(e +ods. seudomonas *as not +edu#ed
s"gn","#antl).
&lthough se(e+al in-vitro stud"es ,ound a#et"# a#"d to !e #)toto-"#,
331,;64
the in-vivo stud"es do not
#on,"+m these ,"nd"ngs. .he autho+s !el"e(e 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, "n,e#t"on
(.a!le 4).
C!lor!e&idine
=hlo+he-"d"ne has !een #ommonl) used "n d"s"n,e#tant and ant"se't"# solut"ons. =hlo+he-"d"ne
ant"se't"# solut"ons a+e used ma"nl) "n u+olog), g)ne#olog), dent"st+), and "n the t+eatment o,
*ounds. $t "s h"ghl) !a#te+"#"dal.
5e(e+al an"mal stud"es ha(e tested the e,,"#a#) and sa,et) o, #hlo+he-"d"ne on *ounds (.a!le
5). $t has !een ,ound to ha(e m"ld "nh"!"to+) e,,e#ts on *ound heal"ng "n gu"nea '"gs.
3;<4

=hlo+he-"d"ne d"a#etate *as ,ound to a##ele+ate *ound heal"ng "n ,ull-th"#0ness *ounds "n
!eagles.
3;;4
=hlo+he-"d"ne *as also ,ound to !e +elat"(el) sa,e ,o+ use as a su+g"#al *ound
"++"gat"on solut"on, s"n#e onl) the h"ghe+ #on#ent+at"ons tested (0.05K) #aused sl"ght t"ssue
to-"#"t) "n +ats.
3;94
>o*e+ #on#ent+at"ons (0.02K) a+e +e#ommended ,o+ *ound "++"gat"on. $n othe+
stud"es, "t *as ,ound to #ause "nh"!"t"on o, g+anulat"on t"ssue "n gu"nea '"gs
35<4
and de#+eased
tens"le st+ength o, *ounds "n +ats.
3904
Ho*e(e+, @+ennan, et al., ,ound no de#+ease "n #ollagen
'+odu#t"on "n a +at model,
3914
and 5hahan, et al., also "n a +at model, ,ound de#+eased tens"le
st+ength 4; hou+s a,te+ the t+eatment and s"gn","#antl) "n#+eased st+ength at 96 hou+s, s"n#e
#hlo+he-"d"ne de#+eased the heal"ng t"me.
3924
$n human stud"es, #hlo+he-"d"ne +"nses *e+e sho*n e,,e#t"(e "n +edu#"ng m"#+o!"al #om'l"#at"ons
*hen used 'e+"o'e+at"(el) "n 'at"ents that +e#e"(ed dental "m'lants.
3934
=on(e+sel), "n anothe+
stud), "t *as ,ound to !e "ne,,e#t"(e to +edu#e *ound se's"s +ate and length o, hos'"tal sta) "n
'at"ents that had unde+gone a''end"#e#tom).
3944
.he autho+s s'e#ulate that +e"n,e#t"on ,+om
*"th"n as an e-'lanat"on ,o+ the la#0 o, #hlo+he-"d"ne e,,"#"en#).
=hlo+he-"d"ne a''ea+s to !e +elat"(el) sa,e *"th l"ttle e,,e#t on the *ound heal"ng '+o#ess, and
"ts use ma) ,a(o+ heal"ng o, o'en *ounds "n +"s0 ,o+ "n,e#t"on. Ho*e(e+, the +esults ,+om stud"es
to date a+e "nsu,,"#"ent to d+a* #on#lus"ons a!out the use o, #hlo+he-"d"ne on o'en *ounds.
Mo+e human t+"als need !e 'e+,o+med to assess "ts e,,"#a#) and sa,et).
Sil%er Compounds
5"l(e+ #om'ounds ha(e *"del) !een used as *ound ant"se't"#s, ma"nl) "n !u+ns. 5"l(e+
sul,ad"a/"ne (559) and s"l(e+ n"t+ate (&gB:3) a+e among the most #ommonl) used. 5"l(e+
sul,ad"a/"ne "s the most !+oadl) used t+eatment ,o+ the '+e(ent"on o, "n,e#t"on "n 'at"ents *"th
!u+n *ounds.
395,964
=om!"nat"ons o, 559 *"th #e+"um n"t+ate
39<4
and nano#+)stall"ne s"l(e+ +eleas"ng
s)stems (&#t"#oatL, Westa"m @"omed"#al, M-ete+, Be* Hano(e+)
39;4
ha(e !een de(elo'ed "n
o+de+ to "n#+ease "ts e,,"#a#) and%o+ +edu#e "ts to-"#"t). Be*e+ s"l(e+ ,o+mulat"ons a''ea+ to
"n#+ease the +ate and deg+ee o, m"#+o!"al 0"ll"ng, de#+ease e-udate ,o+mat"on, and #an +ema"n
a#t"(e ,o+ da)s.
3994
&n"mal stud"es e-am"n"ng the e,,e#ts o, 559 and &gB:3 on *ounds ha(e sho*ed no s"gn","#ant
e,,e#t
3534
on e'"thel"/at"on +ate (.a!le 6). 559 *as also ,ound to "n#+ease the +ate o,
neo(as#ula+"/at"on.
3534
$n anothe+ stud) "n +ats, s"l(e+ #om'ounds *e+e ,ound to '+omote *ound
heal"ng, +edu#e the "n,lammato+) and g+anulat"on 'hases o, heal"ng, and "n,luen#e metal "on
!"nd"ng.
31004
Mo+eo(e+, 1e+onemus, et al.,
3514
,ound "n#+eased +ee'"thel"/at"on +ate "n domest"# '"gs
*"th the use o, 559.
Net, >e"t#h, et al.,
31014
,ound 559 to #ause "nh"!"t"on o, *ound #ont+a#t"on "n an a#ute *ound +at
model. >"0e*"se, B"edne+, et al.,
35<4
,ound a sl"ght, nons"gn","#ant +edu#t"on o, g+anulat"on t"ssue
,o+mat"on *"th the use o, &gB:3.
&mong human stud"es, the autho+s '+esent onl) those on 'at"ents su,,e+"ng ,+om *ounds othe+
than !u+ns, as the+e "s #u++entl) no #ont+o(e+s) ,o+ the use o, s"l(e+ #om'ounds on !u+n
'at"ents, as ment"oned a!o(e. Hu#an, et al.,
34<4
e-am"ned the e,,e#ts o, 559 on !a#te+"al #ounts
"n 'at"ents *"th "n,e#ted #h+on"# '+essu+e ul#e+s. He ,ound 559 to !e e,,e#t"(e "n de#+eas"ng the
!a#te+"a !elo* 105%g+ t"ssue "n all the ul#e+s t+eated. $n a +andom"/ed t+"al *"th (enous ul#e+s,
559 one-'e+#ent #+eam *as '+o(ed to stat"st"#all) +edu#e the ul#e+ s"/e #om'a+ed to the
'la#e!o,
31024
*h"le "n anothe+ stud) "t *as ,ound to !e *ell tole+ated and e,,e#t"(e on *ound
#leans"ng and g+anulat"on t"ssue ,o+mat"on.
31034
>"("ngstone, et al.,
31044
stud"ed the e,,e#t o, &gB:3
and an ant"!"ot"# solut"on (neom)#"n 'lus !a#"t+a#"n) on +edu#"ng autogenous s0"n g+a,t loss due
to "n,e#t"on "n 'at"ents *"th the+mal "n7u+). .he) ,ound !oth med"#at"ons to !e e,,e#t"(e "n
#om'a+"son to the #ont+ol g+ou' (D"nge+Is la#tate solut"on), !ut the ant"!"ot"# solut"on *as
asso#"ated *"th the +a'"d eme+gen#e o, d+ug-+es"stant o+gan"sms, *h"le &gB:3 *as not.
Bano#+)stall"ne s"l(e+ #om'ounds ha(e !een ,ound to "n#+ease the +ee'"thel"/at"on +ate o,
meshed autog+a,ts
31054
and a''ea+ to !e '+om"s"ng ,o+ the t+eatment o, othe+ #h+on"# *ounds as
*ell. .he ant"-"n,lammato+) e,,e#ts o, s"l(e+ #ould !e asso#"ated *"th the (eh"#le, *h"#h +edu#es
*ound d+)"ng, +edu#"ng the+e,o+e "n,lammat"on (mo"st *ounds ha(e !een ,ound to !e
s"gn","#antl) less l"0el) to !e "n,e#ted).
31114
Mo+e #l"n"#al t+"als a+e needed ,o+ the e(aluat"on o,
nano#+)stall"ne s"l(e+.
5umma+"/"ng, "t a''ea+s that s"l(e+ #om'ounds do not ha(e a negat"(e e,,e#t on *ounds and
ma)!e a##ele+ate *ound heal"ng #l"n"#all). .he"+ in-vivo ant"m"#+o!"al a#t"("t) "s not "n 6uest"on.
Discussion
.he use o, ant"se't"#s on *ounds "s #u++entl) !e"ng ("e*ed *"th s0e't"#"sm. Desults ,+om in-
vitro stud"es ha(e sho*n that ant"se't"#s a+e to-"# not onl) aga"nst !a#te+"a and othe+
m"#+oo+gan"sms !ut also aga"nst human #ells essent"al to the *ound heal"ng +es'onse. .hese
,"nd"ngs +esulted "n a se+"es o, an"mal and human stud"es "n o+de+ to e(aluate the in-vivo a#t"("t)
o, ant"se't"#s. Ho*e(e+, "t seems that "n human su!7e#ts, '+onoun#ed #)toto-"#"t), ,ound in vitro,
*as not #on,"+med. $n the ma7o+"t) o, #l"n"#al t+"als, ant"se't"#s a''ea+ to !e sa,e and *e+e not
,ound to negat"(el) "n,luen#e *ound heal"ng. .he"+ ant"m"#+o!"al e,,"#"en#), *"th the e-#e't"on o,
h)d+ogen 'e+o-"de, seems sat"s,a#to+) as *ell. Dandom"/ed #ont+olled stud"es to e(aluate the
e,,e#t o, ea#h ant"se't"# on the d",,e+ent 0"nds o, *ounds (a#ute, (enous, d"a!et"#, o+ '+essu+e
ul#e+s) a+e "nd"#ated to '+o("de g+eate+ e("den#e +ega+d"ng the !ene,"ts o, ant"se't"# use on
*ounds. M,,o+ts to de(elo' su'e+"o+ ant"se't"# ,o+mulat"ons a+e l"0el) to and should #ont"nue.
9e(elo'ment o, #ade-ome+ "od"ne, *h"#h not onl) does not negat"(el) "n,luen#e *ound heal"ng
!ut also a##ele+ates heal"ng e(en "n non"n,e#ted *ounds, and de(elo'ment o, "m'+o(ed s"l(e+
del"(e+) s)stems, *h"#h +elease s"l(e+ mo+e e,,"#"entl) than '+e("ous ,o+mulat"ons *h"le
enhan#"ng +e-e'"thel"/at"on, a+e 'a+ad"gms o, the the+a'eut"# 'otent"al o, ant"se't"#s. Aeh"#les
that #ont+"!ute to the ma"ntenan#e o, an o't"mal mo"st en("+onment ma) !e mo+e a''+o'+"ate as
del"(e+) s)stems 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"ents
and *ound t)'es *"th h"gh +"s0 o, "n,e#t"on, ant"se't"#s ma) !e used to '+e(ent *ound "n,e#t"on
that *ould ha(e delete+"ous e,,e#ts on *ound heal"ng. &nt"se't"#s '+esent ad(antages o(e+
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 ha(e
!+oade+ ant"m"#+o!"al s'e#t+um and lo*e+ sens"t"/at"on +ates.
$n #on#lus"on, a,te+ +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) sa,e and e,,"#"ent "n '+e(ent"ng "n,e#t"on "n human *ounds. .he
ad(antages o, ant"se't"#s on *ounds ma) out*e"gh 'oss"!le d"sad(antages, 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
+umber
o
Wounds
)reated Control,Comparator Eect on 'ealing
Eect on
Inection
@ennett, et
al.
310<4
a+t"al
th"#0ness
"gs 4; (;
*ounds
,o+ ea#h
g+ou')
Ma,en"de a#etateC
sod"um h)'o#hlo+"teC
h)d+ogen 'e+o-"deC
a#et"# a#"dC no
t+eatment
Bo e,,e#t (;1K
+ee'"thel"al"/at"on,
*"th 1K $, a,te+ 4
da)s (s. 69K ,o+
the no t+eatment
g+ou',
nons"gn","#ant
d",,e+en#e)
5l"ghtl)
de#+eased
!a#te+"al
#ounts, ()et st"ll
J105,
stat"st"#al
d",,e+en#e ,+om
#ont+ol not
#al#ulated)
8umal, et al.
31104
>eg ul#e+s Humans 34 (1<
'at"ents)
Bo t+eatmentC s"l(e+
sul,ad"a/"neC
#hlo+he-"d"ne (all
g+ou's t+eated *"th
h)d+o#ollo"d
d+ess"ng)
$n#+ease (4-1;K
"m'+o(ement o,
heal"ng +ate, 2-9
*ee0s ,aste+ (s.
unt+eated, ' O
0.01)
B%&
Ho*ell, et al.
33<4
=ontam"nated
la#e+at"ons
(*"th S.
aureus)
1u"nea
'"gs
4; (12
an"mals)
5al"neC #e,a/ol"nC no
t+eatment
B%& Bo e,,e#t (4.63
log 5. au+eus
+e#o(e+ed ,+om
*ounds 2 h
a,te+ "++"gat"on
(s. 5.4<, 6.13,
and 6.3< ,o+ no
t+eatment,
#e,a/ol"n, and
sal"ne g+ou's,
+es'e#t"(el)C
nons"gn","#ant
d",,e+en#e)
1eo+g"ades,
et al.
33;4
@u+ns Humans 50 B%& B%& 9e#+ease (<<K
o, *ound
#ultu+es d"d not
ha(e !a#te+"al
g+o*th a,te+
?$9 a''l"#at"on
(s. 42K and
33K ,o+ the
@$9%.$9 and
?:9%?9
a''l"#at"on
g+ou's, ' O
0.001)
1e+on"mus,
et al.
3514
a+t"al
th"#0ness
"gs 600
*ounds
("n 4
an"mals,
300 ,o+
ea#h
g+ou')
Bo t+eatment Bo "n,luen#e (4.55
da)s needed ,o+
50K o, *ounds to
+ee'"thel"al"/e *"th
'ha+mad"ne 39-
12K $ solut"on4
(s. 4.6 ,o+ #ont+ol,
+elat"(e +ate o,
heal"ng P1KC
nons"gn","#ant
d",,e+en#e)
B%&
1+a(ett, et
al.
3394
5utu+ed
la#e+at"ons
Humans 395 Bo t+eatment (all
*ounds *e+e "n"t"all)
"++"gated *"th sal"ne)
B%& 9e#+ease (1K
+ate o, 'u+ulent
*ounds and
5.4<K *ound
se's"s +ate (s.
6.19K and
15.4K at the
#ont+ol g+ou')
1+u!e+, et al.
3524
a+t"al and ,ull
th"#0ness
Dats 40 (20 ,o+
ea#h
g+ou')
5al"ne Bo e,,e#t (12.2
and 9.3 da)s
mean heal"ng t"me
,o+ !etad"ne (s.
12.4 and 9.5 ,o+
sal"ne "n 'a+t"al-
th"#0ness *ounds
"n +ats and
humansC 19.2 (s.
19.5 "n ,ull-
th"#0ness *ounds
"n +ats,
nons"gn","#ant
d",,e+en#e)
B%&
Humans 20 (10 ,o+
ea#h
g+ou')
Hasha)a', et
al.
3564
$n#"s"onal M"#e 120 (2
an"mals)
Aeh"#leC ste+o"dsC no
t+eatment
9e#+eased
st+ength%no e,,e#t
on #ollagen
(334g+ !u+st"ng
st+ength (s. 404,
439, and 322 at
the (eh"#le, no
t+eatment, and
ste+o"d g+ou's,
+es'e#t"(el)C ' O
0.05 (s. no
t+eatment g+ou')
B%&
H7olseth, et 8ull th"#0ness M"#e 23 (13 Bo t+eatment 9e#+ease (11.; B%&
al.
3534
#ont+ol, 10
$)
da)s ,o+ #om'lete
+ee'"thel"/at"on
(s. <.2 ,o+ #ont+ol,
' O 0.01)
Hnutson, et
al.
3644
@u+ns, #h+on"#
*ounds
Humans <59 (90 $
solut"on
and suga+,
515 $
solut"on,
$
o"ntment
and suga+,
154
standa+d
t+eatment)
5tanda+d the+a') $n#+ease (0K
need ,o+ s0"n g+a,t
,o+ the t+"'le
#om!"nat"on
g+ou', 4.5K ,o+
the $ sol%suga+
g+ou' (s. 40.3K
,o+ the #ont+ol
g+ou')
9e#+ease
Hu#an, et al.
34<4
+essu+e
ul#e+s
Humans 40 (15
559, 15
A-$, 14
sal"ne)
5al"neC A-$ B%& Bo e,,e#t (60K
o, 'at"ents
+es'onded to
t+eatment a,te+
14 da)s (s.
60K and 90K
at the sal"ne
and 559
g+ou's)
>amme+s, et
al.
3434
&#ute hea("l)
#ontam"nated
Humans 33 5al"neC no t+eatment B%& Bo e,,e#t
(!a#te+"al
#ounts s"m"la+
to no t+eatment
g+ou' a,te+ 10
m"nC sal"ne
soa0"ng
"n#+eased
!a#te+"al
#ounts, ' O .
0001)
>ee, et al.
3634
9e#u!"tus
ul#e+sC stas"s
ul#e+s
Humans 1; B%& $n#+ease (6<K o,
ul#e+s #u+ed a,te+
6 *0s, 33K o,
ul#e+s "m'+o(ed)
9e#+ease (2
out o, 14
"n,e#ted les"ons
#ont"nued
!e"ng "n,e#ted
a,te+ 6 *0s, ' O
0.001)
Menton, et
al.
3544
$n#"s"onal 1u"nea
'"gs
120 (60
an"mals)
5al"neC 5hu+-=lensC
95 ;9009
9e#+ease
(!etad"ne su+g"#al
s#+u! s"gn","#antl)
dela)ed e'"de+mal
and de+mal
heal"ng (s. all
g+ou's, !ut
"n#+eased
s"gn","#antl)
tens"le st+ength
a,te+ 21 da)s (s.
all g+ou's)
B%&
Me+t/, et al.
310;4
a+t"al
th"#0ness
"gs 54 (9
an"mals)
9"st"lled *ate+C
al#ohol <0K
B%& 9e#+ease (5.94
log !a#te+"al
#ounts a,te+ 24
h+ (s. <.53 and
<.2; at the
*ate+ and
al#ohol g+ou's,
' O 0.05)
Mull"0en, et
al.
3554
$n#"s"onal Dats 341 D"nge+Qs solut"on Bo e,,e#t on
st+ength (1<.52
gm%mm2 tens"le
st+ength a,te+ 1 *0
(s. 1<.90 at the
D"nge+Qs solut"on
g+ou'C
nons"gn","#ant
d",,e+en#e)
B%&
B"edne+
35<4
8ull th"#0ness 1u"nea
'"gs
10 ,o+
ea#h
g+ou'
Bo t+eatment Bo e,,e#t
(nons"gn","#ant
de#+ease !) 19K
o, th"#0ness o, the
g+anulat"on la)e+
"n #om'a+"son to
#ont+ol)
B%&
"e+a+d-
8+a#h"mont,
et al.
3404
Aenous ul#e+s Humans 30 (15
'at"ents)
Bo t+eatment (!oth
g+ou's t+eated *"th
h)d+o#ollo"d
d+ess"ngs)
$n#+ease
("n#+eased heal"ng
+ate *"th A-$
t+eatment,
es'e#"all) du+"ng
the ,"+st 4 *ee0s
o, t+eatment, ' O
0.05)
9e#+ease (less
neut+o'h"l"#
(as#ul"t"s, and
!a#te+"al
#lum's "n A-
$ t+eated g+ou',
s"gn","#an#e not
#al#ulated)
Dodehea(e+,
et al.
3364
=ontam"nated 1u"nea
'"gs
5al"ne B%& 9e#+ease (R)
(1.31 log
+edu#t"on o,
!a#te+"a 10 m"n
a,te+, ' O
0.001C no e,,e#t
4 da)s a,te+ a
s"ngle
a''l"#at"onC no
e,,e#t on
"n,e#t"on +ate)
5e(e+)ns, et
al.
3;94
8emo+al
(essels
se#t"on
Dats 150
an"mals
5al"ne, #hlo+he-"d"ne .o-"#"t) (ma+0ed
d",,e+en#e o, 10K
$ solut"ons on
h"stolog"#al
assessment,
damage to
(as#ula+
endothel"um and
th+om!os"s, (s.
sal"ne, and
#hlo+he-"d"ne)
B%&
5"ndela+, et
al.
3464
5u+g"#al Humans 500 (242
$, 25;
#ont+ol)
5al"ne B%& 9e#+ease
(2.9K *ound
se's"s +ate (s.
15.1K "n the
#ont+ol g+ou',
' O 0.001)
A"l7ando
3414
5u+g"#al Humans 294 5al"ne Bo e,,e#t (#ell
mo+'holog)
s"m"la+ to sal"ne-
"m'eded #ont+ol)
9e#+ease
(2.6K "n,e#t"on
+ate *"th 1K $
solut"on a,te+
a''ende#tom)
(s. ;.5K at the
#ont+ol g+ou'C
ho*e(e+, 19K
"n,e#t"on +ate
*"th 5K $
solut"on (s. ;K
at the #ont+ol
g+ou')
)able -. Cade&omer iodine
Aut!or
Wound
)(pe Species
+umber o
Wounds
)reated Control Eect on 'ealing
Eect on
Inection
&'el6("st,
et al.
3<;4
9"a!et"#
ul#e+s
Humans 25 (12 =$, 13
#ont+ol)
5tanda+d
t+eatment
Bo d",,e+en#e
!et*een g+ou's
B%&
9an"elsen,
et al.
3494
Aenous
ul#e+s *"th
P.
aeruginosa
Humans 1< B%& B%& 9e#+ease
!a#te+"al
#ounts (65K o,
't had negat"(e
. ae+ug"nosa
#ultu+es a,te+ 1
*0)
8lo)e+, et
al.
3<<4
Aenous
ul#e+s
Humans 30 (ul#e+s
dete+"o+at"ng o+
stat"# "n the"+
e-"st"ng
t+eatment)
B%& $n#+ease (15 out o,
1; ul#e+s healed
o+ +edu#ed "n s"/e,
*h"le 3 "n#+eased)
(9e#+easeS)
(e+)thema,
e-udate, 'us,
and de!+"s
*e+e +edu#ed
,+om !asel"ne)
Hansson, et
al.
3<64
Aenous
ul#e+s
Humans 153 H)d+o#ollo"d
d+ess"ng o+
'a+a,,"n
gau/e
$n#+ease (62K
mean +edu#t"on o,
ul#e+ a+ea (s. 41K
and 24K "n the
h)d+o#ollo"d and
'a+a,,"n gau/e
g+ou's)
B%&
Ha+#u', et
al.
3<44
Aenous
ul#e+s
Humans <2 5tanda+d
t+eatment
(d+) d+ess"ng
T to'"#al
ant"!a#te+"al
#leanse+)
$n#+ease (36K
de#+ease o, ul#e+
s"/e a,te+ 4 *0s
(s. 10K "n the
standa+d
t+eatment g+ou', '
O 0.01)
(9e#+easeS)
(de#+ease o,
edema,
e+)thema,
e-udate, 'us,
de!+"s, 'a"n, '
O 0.05-' O
0.001)
Hollo*a), et
al.
3<24
Aenous
ul#e+s
Humans <5 (3; =$, 3<
#ont+ol)
5tanda+d
t+eatment
(*et-to-d+)
d+ess"ngs)
$n#+ease
(0.95T0.12#m2%*0
ul#e+ heal"ng (s.
0.41T0.13 "n the
standa+d
t+eatment, ' O
0.0025)
(Bo e,,e#t-
de#+easeS) (not
stat"st"#all)
s"gn","#ant)
>amme et,
al.
36;4
8ull
th"#0ness
"gs 36 (12 =$, 12
#ade-ome+, 12
sal"ne)
=ade-ome+
and 5al"ne
$n#+ease ("n#+ease
"n
+ee'"thel"al"/at"on
6 and 9 da)s a,te+
t+eatment, ' O
0.05)
B%&
>audans0a,
et al.
3694
Aenous
ul#e+s
Humans 60 (30 =$, 30
#ont+ol)
5tanda+d
t+eatment
(#leans"ng
*"th d"lute
h)d+ogen
'e+o-"de and
#o(e+"ng *"th
a /"n# 'aste
d+ess"ng)
$n#+ease (<4K
mean +edu#t"on o,
ul#e+ a+ea a,te+ 6
*0s (s. 54K "n the
standa+d
t+eatment, ' O
0.01)
(9e#+easeS)
(de#+eased
de!+"s,
e-udate,
e+)thema, and
edema, ' O
0.05-' O 0.001)
Me+t/, et al.
3334
a+t"al
th"#0ness
"gs 120 (,o+ the
e'"thel"al"/at"on
stud)C 40 "n
ea#h g+ou')
&"+ e-'osed
and o"ntment
!ase #ont+ol
$n#+ease (4.6 da)s
,o+ #om'lete
e'"thel"al"/at"on o,
50K o, the
*ounds (s. 4.9
and 5.< da)s ,o+
o"ntment !ase
#ont+ol and a"+
e-'osed *ounds,
s"gn","#ant)
9e#+ease
!a#te+"al
#ounts
(s"gn","#ant
+edu#t"on o, 5.
au+eus #ounts
at 24, 4;, and
<2 hou+s and
o, .
ae+ug"nosa at
4; hou+s)
1; (S. aureus
o+ P.
aeruginosa
"no#ulated
*ounds ,o+ the
!a#te+"olog"#al
stud)C 6 "n ea#h
g+ou')
Mo!e+g, et
al.
3<94
9e#u!"tus
ul#e+s
Humans 34 (1; =$, 16
#ont+ol)
5tanda+d
t+eatment
(sal"ne
d+ess"ngs,
de!+"d"ng
agents o+
non adhes"(e
d+ess"ngs)
$n#+ease (<6K
de#+ease "n ul#e+
s"/e a,te+ ; *ee0s
o, t+eatment, (s.
5<K de#+ease "n
the standa+d
t+eatment g+ou', '
O 0.05)
(9e#+easeS)
(9e#+ease o,
'a"n, 'us, and
de!+"s, ' O
0.005)
:+m"ston,
et al.
3<34
Aenous
ul#e+s
Humans 60 (30 =$, 30
#ont+ol)
5tanda+d
t+eatment
(gent"an
("olet and
'ol)m)-"n-
!a#"t+a#"n
o"ntment)
$n#+ease
(0.;9#m2%*0 ul#e+
heal"ng (s. 0.46 "n
the standa+d
t+eatment, ' O
0.0001)
(Bons"gn","#ant
de#+easeS)
50og, et al.
3<14
Aenous
ul#e+s
Humans <4 (36 =$, 3;
#ont+ol)
5tanda+d
t+eatment
(most
#ommonl)
'a+a,,"n-
"m'+egnated
$n#+ease (34K
de#+ease "n ul#e+
s"/e a,te+ 6 *ee0s
o, t+eatment, (s.
5K "n#+ease "n the
standa+d
9e#+ease ("n
16 out o, 23 't
"n,e#t"on *as
#lea+ed "n
#om'a+"son to
0 out o, 1; "n
d+ess"ngs) t+eatment g+ou') the standa+d
t+eatment
g+ou')
.a+(a"nen,
et al.
3<54
Aenous
ul#e+s
Humans 2< (14 =$, 13
#ont+ol)
9e-t+anome+ $n#+ease (64K o,
't healed a,te+ ;
*0s (s. 50K "n the
de-t+anome+
g+ou')
(Bo e,,e#t)
(+edu#t"on o,
e+)thema,
e-udate, and
'us ,+om
!asel"ne,
nons"gn","#ant
d",,e+en#e
!et*een
g+ou's)
S =ade-ome+ "od"ne de#+eased one o+ mo+e o, 'us and de!+"s, e-udate, 'a"n, and
e+)thema, *h"#h a+e #ons"de+ed as #l"n"#al "nd"#ato+s o, "n,e#t"on.
)able .. '(drogen pero&ide
Aut!or Wound )(pe Species
+umber
o
Wounds
)reated Control
Eect on
'ealing
Eect on
Inection
@ennett,
et al.
310<4
a+t"al
th"#0ness
"gs 4; (;
*ounds
,o+ ea#h
g+ou')
Ma,en"de
a#etateC
sod"um
h)'o#hlo+"teC
'o("done
"od"neC a#et"#
a#"dC no
t+eatment
Bo e,,e#t (69K
+ee'"thel"al"/at"on
a,te+ 4 da)s (s.
69K ,o+ the no
t+eatment g+ou')
9e#+eased
!a#te+"al
#ounts,
(O105 (s.
J105 at the
#ont+ol
g+ou',
stat"st"#al
d",,e+en#e
not
#al#ulated)
1+u!e+,
et al.
3524
a+t"al and ,ull
th"#0ness
Dats 40 (20 ,o+
ea#h
g+ou')
5al"ne $n#+ease (10.2
and ;.4 da)s
mean heal"ng
t"me (s. 12.4 and
9.5 ,o+ sal"ne "n
'a+t"al-th"#0ness
*ounds "n +ats
and humansC 1<
(s. 19.5 "n ,ull-
th"#0ness *ounds
"n +ats, p O 0.05
,o+ the an"mal
stud),
nons"gn","#ant
d",,e+en#e ,o+ the
human stud))
B%&
Humans 20 (10 ,o+
ea#h
g+ou')
>au, et &''ende#tom) Humans 21< (109 Bo t+eatment B%& Bo e,,e#t
al.
3;14
H, 10;
#ont+ol)
(21 't
de(elo'ed
"n,e#t"on
(s. 26 o,
the #ont+ol
g+ou')
>e)den,
et al.
3;24
@l"ste+ *ounds
(#ontam"nated)
Humans 144 (24
(oluntee+s
*"th 3
*ounds
'e+
,o+ea+m)
Bo
t+eatment,
t+"'le
ant"!"ot"#
Bo e,,e#t (14.3
da)s ,o+ heal"ng
(s. 13.2 and 9.4
"n the no
t+eatment and
t+"'le ant"!"ot"#
g+ou')
Bo e,,e#t
(6.< log S.
aureus
#ounts (s.
<.1 and 0.4
"n the no
t+eatment
and t+"'le
ant"!"ot"#
g+ou')
.u+, et
al.
3;04
$s#hem"# ul#e+s 1u"nea
'"gs
34 la#e!o
#+eam
Bo e,,e#t (("sual
e(aluat"on o,
'e+#ent
nonne#+ot"#
*ound su+,a#e
sho*ed no
d",,e+en#e
!et*een g+ou's)C
"n#+eased !lood
,lo* ((as#ula+
'e+,us"on
measu+ed *"th
lase+ 9o''le+
(elo#"mete+ *as
"n#+eased, p O
0.01)
B%&
)able /. Acetic acid
Aut!or
Wound
)(pe Species
+umber
o
Wounds
)reated Control,Comparator
Eect on
'ealing
Eect on
Inection
@ennett,
et al.
310<4
a+t"al
th"#0ness
"gs 4; (;
*ounds
,o+ ea#h
g+ou')
Ma,en"de a#etateC
sod"um h)'o#hlo+"teC
h)d+ogen 'e+o-"deC
'o("done "od"neC no
t+eatment
Bo e,,e#t (<<K
+ee'"thel"al"/at"on
a,te+ 4 da)s (s.
69K ,o+ the no
t+eatment g+ou',
nons"gn","#ant
d",,e+en#e)
Bo e,,e#t
(J105,
stat"st"#al
d",,e+en#e ,+om
#ont+ol not
#al#ulated)
1+u!e+, et
al.
3524
a+t"al and
,ull
th"#0ness
Dats 40 (20
,o+ ea#h
g+ou')
5al"ne Bo e,,e#t (12 and
9.3 da)s mean
heal"ng t"me (s.
12.4 and 9.5 ,o+
sal"ne "n 'a+t"al-
th"#0ness *ounds
"n +ats and
B%&
Humans 20 (10
,o+ ea#h
g+ou')
humansC 1;.6 (s.
19.5 "n ,ull-
th"#0ness *ounds
"n +ats,
nons"gn","#ant
d",,e+en#e)
Hansson,
et al.
3;54
Aenous
ul#e+s
Humans 45 &lum"num
a#etota+t+ateC
'otass"um
'e+manganateC
#hlo+am"ne
B%& 9e#+ease
(a#et"# a#"d
0.25K +edu#ed
!oth S. aureus
and 1+am-
negat"(e +ods,
p O 0.002 and
p O 0.03.
seudomonas,
+oteus, S.
epidermidis,
and S.
hemolyticus
*e+e not
s"gn","#antl)
+edu#ed, p J
0.05)
5loss, et
al.
3;44
@u+ns o+
so,t t"ssue
*ounds
Humans 16 B%& B%& 9e#+ease
(el"m"nated P.
aeruginosa
#ounts "n 14
out o, 16
'at"ent *"th"n 2
*ee0s)
h"ll"'s,
et al.
3;34
5u'e+,"#"al Humans 20 (10
a#et"#
a#"d, 10
#ont+ol)
=hlo+he-"d"ne o+
h)'o#hlo+"te
B%& 9e#+ease
(mean g+o*th
,ell ,+om 4.1 to
0.< a,te+ < da)s
(s. 3.3 to 3.4 "n
the #ont+ol
g+ou')
)able 0. C!lor!e&idine
Aut!or Wound )(pe Species
+umber o
Wounds
)reated Control,Comparator
Eect on
'ealing
Eect on
Inection
@+ennan,
et al.
3914
8ull th"#0ness Dats 540 (45
an"mals *"th 4
*ounds ea#h,
,o+ ea#h
g+ou':
#hlo+he-"d"ne,
sal"ne,
#hlo+am"ne .)
5al"ne, #hlo+am"ne Bo e,,e#t (no
d",,e+en#e
,+om sal"ne on
#ollagen
'+odu#t"on
and on
h"stolog"#
e-am"nat"on)
B%&
=+oss,"ll, et
al.
3944
&''end"#e#tom)
*ounds
Humans 2;; (9<
#hlo+he-"d"ne,
5al"ne, no t+eatment Bo e,,e#t on
hos'"tal sta)
Bo e,,e#t
(o(e+all se's"s
9< sal"ne, 92
no t+eatment)
(a(e+age sta)
o, ;.2 da)s ,o+
non"n,lamed
a''end"#es
(s. ;.3 and
;.; ,o+ sal"ne
and no
t+eatment
g+ou's,
nons"gn","#ant
d",,e+en#e)
+ate 13.2K (s.
12.2K and
14.1K ,o+
sal"ne and no
t+eatment
g+ou's,
nons"gn","#ant
d",,e+en#e)
8umal, et
al.
31104
>eg ul#e+s Humans 34 Bo t+eatmentC s"l(e+
sul,ad"a/"neC
'o("done "od"ne (all
g+ou's t+eated *"th
h)d+o#ollo"d
d+ess"ng)
Bo e,,e#t (m"ld
"m'+o(ement
o, heal"ng +ate
(s. unt+eated,
-1-5K, non
s"gn","#ant)
B%&
>am!e+t, et
al.
3934
9ental "m'lants Humans 2641 (595
'at"ents)
5al"ne B%& 9e#+ease
(4.1K
"n,e#t"ous
#om'l"#at"ons
(s. ;.<K "n
the #ont+ol
g+ou')
5aatman,
et al.
3;<4
$n#"s"onal
*ounds,
a!+as"ons
1u"nea
'"gs
1<5 5al"ne (eh"#le (4K
=H> s0"n #leanse+,
t"n#tu+e 0.5K =H> "n
<0K "so'+o'anolol,
0.5K =H> "n *ate+,
4K =H> "n *ate+,
sal"ne, s0"n #leanse+,
t"n#tu+e)
M"ld de#+ease
(4K
#hlo+he-"d"ne
g+ou's m"ldl)
de#+eased
heal"ng +ate at
da)s 6 and 9
at "n#"s"onal
*ounds and at
all t"me 'o"nts
at a!+as"ons
(s. sal"neC no
d",,e+en#e
!et*een
#hlo+he-"d"ne
and (eh"#lesC
no d",,e+en#es
among g+ou's
a,te+ 21 da)s
o, t+eatment)
B%&
Mo!a#0en,
et al.
3904
$n#"s"onal
*ounds
Dats 130 (65 +ats,
ea#h *"th 1
*ound ,o+
t+eatment and
1 ,o+ #ont+ol)
5al"ne, (eh"#le 9e#+ease
tens"le
st+ength
(s"gn","#ant
de#+ease (s.
!oth sal"ne
and (eh"#le,
a,te+ < da)s, p
O 0.001 and p
O 0.01 ,o+
0.1K and 0.02
K
#hlo+he-"d"ne
B%&
solut"ons)
B"edne+, et
al.
35<4
8ull th"#0ness 1u"nea
'"gs
10 ,o+ ea#h
g+ou'
Bo t+eatment 9e#+eased
g+anulat"on
(66K
de#+ease o,
th"#0ness o,
the
g+anulat"on
la)e+ "n
#om'a+"son to
#ont+ol, p O
0.001)
B%&
5an#he/,
et al.
3;;4
8ull th"#0ness @eagle
dogs
5al"ne, 'o("done
"od"ne
$n#+ease
(la+ge+ healed
*ound a+ea
on da)s < and
14, "n#+eased
#ont+a#t"on on
da)s <, 14
and 21 (s.
sal"ne)
9e#+ease
!a#te+"al
#ounts (0.05K
#hlo+he-"d"ne
solut"on
s"gn","#antl)
+edu#ed
!a#te+"al
#ounts (s. $
and sal"ne)
5e(e+)ns,
et al.
3;94
8emo+al (essels
se#t"on
Dats 150 an"mals 5al"ne, 'o("done
"od"ne
Bo to-"#"t) (no
d",,e+en#e o,
0.02K and
0.001K
#hlo+he-"d"ne
solut"ons on
h"stolog"#al
assessment o,
#ollagen and
elast"# ,"!e+s,
(s. sal"ne.
Bons"gn","#ant
to-"#"t) o,
0.05K
solut"on)
B%&
5hahan, et
al.
3924
8ull th"#0ness Dats ;0 (40
an"mals)
5al"ne $n#+ease
(+edu#ed
tens"le *ound
st+ength *"th
0.12K
#hlo+he-"d"ne
solut"on at
4;h, 12< (s.
150C
"n#+eased at
96h, 202 (s.
1;3, +esult"ng
"n sho+te+
heal"ng t"me,
p O 0.05)
B%&
)able 1. Sil%er compounds
Aut!or
Wound
)(pe Species
+umber o
Wounds
)reated Control,Comparator
Eect on
'ealing
Eect on
Inection
@"sho', et
al.
31024
Aenous
stas"s
ul#e+s
Humans ;6 (2; 559
1K #+eam,
29 #o''e+
t+"'e't"de
#o''e+, 29
'la#e!o)
la#e!o, #o''e+
t+"'e't"de #om'le-
$n#+ease (44K
de#+ease "n
les"on s"/e (s.
1;.< and 22.5
,o+ the othe+
g+ou's, ' O
0.05)
B%&
8umal, et al.
31104
>eg
ul#e+s
Humans 34 Bo t+eatmentC
#hlo+he-"d"neC
'o("done "od"ne (all
g+ou's t+eated *"th
h)d+o#ollo"d
d+ess"ng)
Bo e,,e#t (m"ld
"m'+o(ement o,
heal"ng +ate (s.
unt+eated, 2-
<K,
nons"gn","#ant
d",,e+en#e )
B%&
1e+on"mus,
et al.
3514
a+t"al
th"#0ness
"gs 600 *ounds
("n 4
an"mals, 200
,o+ ea#h
g+ou')
Bo t+eatmentC (eh"#le $n#+ease (3.1
da)s needed
,o+ 50K o,
*ounds to
+ee'"thel"al"/e
*"th 5"l(ad"ne
(1K
sul,ad"a/"ne
s"l(e+) (s. 4.3
,o+ unt+eated
#ont+ol and 3.4
,o+ (eh"#le,
+elat"(e +ate o,
heal"ng P25K)
B%&
H7olseth, et
al.
3534
8ull
th"#0ness
M"#e 46 (13
#ont+ol, 1;
s"l(e+
sul,ad"a/"ne,
15 s"l(e+
n"t+ate)
Bo t+eatment Bo e,,e#t
(<.1and ;.9
da)s ,o+
#om'lete
+ee'"thel"/at"on
*"th s"l(e+
sul,ad"a/"ne
and s"l(e+
n"t+ate (s. <.2
,o+ #ont+ol,
nons"gn","#ant
d",,e+en#e)
B%&
Hu#an, et al.
34<4
+essu+e
ul#e+s
Humans 40 (15 559,
15 A-$, 14
sal"ne)
5al"ne, A-$ B%& 9e#+ease
(90K o,
'at"ents
+es'onded
to t+eatment
a,te+ 14
da)s (s.
60K at the
sal"ne and
A-$
g+ou's, ' O
0.022)
>ansdo*n,
et al.
31004
$n#"s"onal Dat 50 (10
*ounds ,o+
ea#h g+ou')
9e"on"/ed *ate+
(s"l(e+ n"t+ate 0.01K,
0.1K, 1K, 559 0.5g,
de"on"/ed *ate+)
$n#+ease (all
*ounds
#om'letel)
#losed !) da) ;
,o+ 1K, 0.1K
s"l(e+ n"t+ate
and 559 (s.
hal, *ounds
#losed ,o+ the
0.01K s"l(e+
n"t+ate and
*ate+ g+ou's,
s"gn","#an#e not
#al#ulated)
B%&
>e"t#h, et al.
31014
8ull
th"#0ness
Dats 40 (10 ,o+
ea#h g+ou':
5"l(e+
sul,ad"a/"ne,
5"l(a/"ne, a"+
e-'osed,
ma,en"de
a#etate)
&"+ e-'osedC
ma,en"de a#etate
9e#+ease
(de#+eased
*ound
#ont+a#t"on *"th
s"l(e+
#om'ounds "n
#om'a+"son to
#ont+ol,
es'e#"all) the
,"+st 10 da)s o,
t+eatment, ' O
0.05)
9e#+ease
(de#+eased
!a#te+"al
#ounts "n
t+eatment
g+ou's,
stat"st"#al
s"gn","#an#e
not g"(en)
>"("ngstone,
et al.
31044
1+a,t"ng
a,te+ !u+n
"n7u+)
Humans 52 (19 s"l(e+
n"t+ate, 1;
neom)#"n P
!a#"t+a#"n,
15 +"nge+Qs
la#tate)
D"nge+Qs la#tate,
Beom)#"n 'lus
!a#"t+a#"n
B%& 9e#+ease
(16K g+a,t
,a"lu+e,
mostl) due
to "n,e#t"on,
(s. 33K and
53K ,o+
to'"#al
ant"!"ot"#s
and
D"nge+Qs
la#tate
g+ou's, ' E
0.02C 1 out
o, 3
"n,e#t"on
#ases o,
eme+gen#e
o, ant"!"ot"#-
+es"stant
!a#te+"a at
the s"l(e+
n"t+ate
g+ou' (s. 6
out o, 6 and
4 out o, ;
,o+ the othe+
g+ou's, ' O
0.05)
B"edne+, et
al.
35<4
8ull
th"#0ness
1u"nea
'"gs
10 ,o+ ea#h
g+ou'
Bo t+eatment Bo e,,e#t
(nons"gn","#ant
de#+ease !)
B%&
25K o,
th"#0ness o, the
g+anulat"on
la)e+ *"th
&gB:3
solut"on "n
#om'a+"son to
#ont+ol)
:lson, et al.
31064
a+t"al
th"#0ness
"gs <2 (24 ,o+
ea#h g+ou':
s"l(e+ #oated
d+ess"ng
mo"stened
on#e, da"l),
and
'et+olatum
gau/e)
et+olatum gau/e $n#+ease
(100K and
96K o, *ounds
+ee'"thel"al"/ed
!) da) < on
s"l(e+-t+eated
g+ou's (s. 33K
,o+ 'et+olatum
gau/e g+ou', '
O 0.0001)
B%&
:u(+)
31034
Aenous
ul#e+s
Humans <1 B%& $n#+ease (40
ul#e+s healed,
25 "m'+o(ed, 4
+ema"ned
sta!le and 1
*o+sened a,te+
45 da)s *"th
sul,ad"a/"ne
t+eatment)
B%& (no
"n,e#t"ons
o!se+(ed)
.+edget, et
al.
39;4
@u+ns Humans 30 5"l(e+ n"t+ate (s.
&#t"#oatL
B%& 9e#+ease (5
*ounds *"th
J105 #ounts
"n &#t"#oat-
t+eated
*ounds (s.
16 "n s"l(e+
n"t+ate
g+ou' and 1
se#onda+)
!a#te+em"a
(s. 5)
Reerences
1. M#9onnell 1, Dussell &9. &nt"se't"#s and d"s"n,e#tants: &#t"("t), a#t"on and +es"stan#e.
Clinical Microbiology Reviews 1999C12(1):14<-<9.
2. .a)lo+ 9M. $na#t"(at"on o, un#on(ent"onal agents o, the t+ansm"ss"!le degene+at"(e
en#e'halo'ath"es. $n: Dussell &9, Hugo W@, &)l",,e 1&U (eds). Principles and Practice
of isinfection, Preservation and Sterili!ation, "hird #dition. :-,o+d, Mngland: @la#0*ell
5#"en#e, 1999.
3. B"edne+ D. =)toto-"#"t) and sens"t"/at"on o, 'o("done "od"ne and othe+ ,+e6uentl) used
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