Chronic wounds are a major healthcare problem costing the United States billions of dollars a year. The American Academy of Dermatology has underscored the significance of wound care in dermatological practice. It is critical for all dermatologists to understand the elements of diagnosis and therapy. We emphasize major aspects of diagnosis and present a simple classification of wound dressings with guidelines for usage and relative cost data. Learning objective After completing this learning activity, participants should be able to diagnose common types of chronic wounds, formulate a therapeutic plan, and describe the major classes of topical therapies and dressings for the chronic wound.

http://www.manukahonning.no/uploads/3/9/6/3/39639435/2008_treating_the_chronic_wound_a_practical_approach_to_the_care_of_nonhealing_wounds_and_wound_care_dressings.pdf

Treating the chronic wound: A practical approach to the care of nonhealing wounds and wound care dressings

Dermal Wound Healing Is Subject to Redox Control

The chemical, microbiologic, and toxic characteristics of povidone-iodine solution, a commonly used antiseptic agent, are addressed in a collective review of relevant works published from 1956 to the present. Interactions of this agent with the thyroid gland and the kidneys and its toxicity at the cellular and systemic level are discussed.

Chemical and microbiologic characteristics and toxicity of povidone-iodine solutions.

Both honey and sugar are used with good effect as dressings for wounds and ulcers. The good control of infection is attributed to the high osmolarity, but honey can have additional antibacterial activity because of its content of hydrogen peroxide and unidentified substances from certain floral sources. Manuka honey is known to have a high level of the latter. Seven major wound-infecting species of bacteria were studied to compare their sensitivity to the non-peroxide antibacterial activity of manuka honey and to a honey in which the antibacterial activity was primarily due to hydrogen peroxide. Honeys with activity in the middle of the normal range were used. A comparison of the median response of the various species of bacteria showed no significant difference between the two types of activity overall, but marked differences between the two types of activity in the rank order of sensitivity of the seven bacterial species. The non-peroxide antibacterial activity of manuka honey at a honey concentration of 1.8% (v/v) completely inhibited the growth of Staphylococcus aureus during incubation for 8 h. The growth of all seven species was completely inhibited by both types of honey at concentrations below 11% (v/v).

A comparison of the sensitivity of wound-infecting species of bacteria to the antibacterial activity of manuka honey and other honey

Hydrogen peroxide in the form of carbamide peroxide is widely used for tooth whitening (bleaching), both in professionally- and in self-administered products. Adverse effects have become evident. Cervical root resorption is a possible consequence of internal bleaching and is more frequently observed in teeth treated with the thermo-catalytic procedure. Tooth sensitivity is experienced in 15-78% of patients undergoing external tooth bleaching. However, clinical studies addressing other adverse effects are lacking. Direct contact with hydrogen peroxide induces genotoxic effects in bacteria and cultured epithelial cells, but the effect is reduced or totally abolished in the presence of metabolising enzymes. Several carcinogenesis studies, including the hamster cheek pouch model, indicate that hydrogen peroxide (H(2)O(2)) might possibly act as a promoter. Until further clinical research is concluded to address the question of possible carcinogenicity, it is recommended that: tooth-bleaching products using concentrated H(2)O(2) should not be used without gingival protection; that H(2)O(2) containing products should be avoided in patients with damaged or diseased soft tissues. For nightguard vital bleaching, minimal amounts of low dose H(2)O(2) (including in the form of carbamide peroxide) are preferred, thereby avoiding prolonged and concentrated exposures.

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Hydrogen peroxide tooth-whitening (bleaching) products: Review of adverse effects and safety issues

Wound disinfectants of various kinds were tested on microwounds and on different tissues in animals and in man. The analysis was performed by vital microscopy, electron microscopy, and microangiography. It was found that disinfectants, regardless of type, damaged tissue and interfered with tissue function, thereby increasing the injury already existing in a damaged tissue and delaying wound healing.
The significance of these findings for wound healing is discussed. The importance of using the lowest possible concentration of disinfectant, consistent with adequate antiseptic effects, and of a non-toxic vehicle, is emphasized.
It should be possible to modify already existing disinfectants according to the requirements of the tissue and to take not only the bacteria but also the injured tissue into consideration when new disinfectants are designed, tested, and selected.

Tissue Injury Caused by Wound Disinfectants

Tissue Injury Caused by Wound. Disinfectants

Tissue response to chymopapain in different concentrations. Animal investigations on microvascular effects.

https://www.tandfonline.com/doi/pdf/10.3109/17453676908989508

J. Lundskog

Papers

Tissue Injury Caused by Wound Disinfectants

Tissue Injury Caused by Wound. Disinfectants

Tissue response to chymopapain in different concentrations. Animal investigations on microvascular effects.

The influence of some anti-inflammatory drugs on original and regenerating synovial tissue.