The combined use of NPWT and instillation using an octenidine based wound rinsing solution: a case study

Abstract

Effective wound bed preparation is an essential element in the healing of chronic wounds, including pressure ulcers (PUs). Negative pressure wound therapy (NPWT) reduces oedema, stimulates the formation of granulation tissue and helps remove wound exudate. This helps prepare the wound bed for secondary healing, skin grafting or coverage with flaps. Combining NPWT with an instillation phase using an antiseptic (octenidine based) irrigation solution is a novel approach to PU management. Three patients with Category 4 gluteal PUs were treated with NPWT and instillation fluid, following surgical debridement of necrotic tissue. The aim was to achieve optimal wound bed preparation prior to wound closure by local fasciocutaneous flap. The antiseptic efficacy of octenilin wound irrigation solution in microorganism eradication was quantified by in vitro tests simulating real conditions using leg ulcer vacuum exudates. All wounds completely healed after four weeks, and no adverse incidents occurred due to instillation of octenidine. No recurrence of the PU occurred during a one year follow-up.

Consensus on Wound Antisepsis: Update 2018

“…In both studies, a solution with 0.05% OCT without the addition of PE was used. Grade-4 gluteal pressure ulcers 4 ( n = 3) treated by NPWTi with OCT healed completely within 4 weeks [224]. Representative studies (e.g., RCTs, larger prospective cohort studies) using NPWTi in combination with OCT are still lacking.…”

Aseptic surgical preparation for upper eyelid blepharoplasty via full‐face octenidine antiseptic without antibiotic medication shows effective prophylaxis against post‐surgical wound infection

“…None of the 352 patients who underwent upper eyelid blepharoplasty with aseptic proceduring using octenisept ® without antibiotic medication prophylaxis presented with a wound infection, which is well comparable to rates from 0·04% to 0·2% previously described for this surgical procedure. The absence of wound infection mirrors data from ‐previous studies, which show the efficacy of the operative asepsis using octenisept ® and other octenidine hydrochloride‐based products . octenisept ® is a non‐alcoholic wound and membrane antiseptic, displaying a broad spectrum of antiseptic efficacy as well as good tolerance on skin and mucous membranes .…”

Peroxy Pyruvic Acid-Containing Topical Anti-Infective: A Potential Candidate for a Wound Instillation Solution

“…These solutions have included iodine or normal saline, biguanides (polyhexanide), hypochlorite-based solutions, sulfur-based compounds (sulfonamides), cationic solutions (benzalkonium chloride), acetic acid, octenidine dihydrochloride, povidone-iodine, and silver compounds (e.g., silver nitrate). 4,[6][7][8][9] These solutions have been perceived as agents that can facilitate the use of NPWT. Saline alone has demonstrated to be an effective instillation solution.…”

“…9 Two solutions that appear to be the most effective in chronic infected wounds are polyhexamide (0.1%) and acetic acid. 8 Most NPWT solutions will not be effective in killing colonized bacteria present in biofilms unless they have an acid-oxidizing capability.…”

“…8 However, as this current study demonstrates, wounds that have become chronic are likely to be polymicrobial and require further broad-spectrum antibiotic treatment. 6,9,45 Furthermore, increasing resistance among both gram-positive and gram-negative bacteria greatly complicates empirical treatment decision-making, and the number of currently available appropriate antimicrobial agents is limited. 46 Biofilm can form on the surface of a wound within 10 h and is difficult to eradicate due to its recalcitrant nature, including the relative lack of effectiveness of antibiotics due to penetration and the relatively quiescent bacterial colonies encased in a glycocalyx structure.…”