Division Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Int Wound J. 2009 Dec;6(6):420-30. doi: 10.1111/j.1742-481X.2009.00639.x.
Quality of care is a critical requirement for wound healing and 'good' care of wounds has been synonymous with topical prevention and management of microbial contamination. Topical antiseptics are antimicrobial agents that kill, inhibit or reduce the number of microorganisms and are thought to be essential for wounds infection control. However, they have long and commonly been used on wounds to prevent or treat infection, the merits of antiseptic fluid irrigation have received little scientific study. Unlike antibiotics that act selectively on a specific target, antiseptics have multiple targets and a broader spectrum of activity, which include bacteria, fungi, viruses, protozoa and even prions. Although certain skin and wound cleansers are designed as topical solutions with varying degrees of antimicrobial activity, concerns have been raised. Wound cleansers may affect normal human cells and may be antimitotic adversely affecting normal tissue repair. Repeated and excessive treatment of wounds with antiseptics without proper indications may have negative outcomes or promote a microenvironment similar to those found in chronic wounds. However, when applied at the proper times and concentrations, some classes of antiseptics may provide a tool for the clinician to drive the wound bed in desired directions. The present review summarises the various antiseptics in use and their negative impact on the wound healing mechanisms. It is clear that the role of antiseptics on wounds and their role in wound care management need to be reconsidered.
医疗质量是伤口愈合的关键要求，“良好”的伤口护理一直等同于预防和管理微生物污染。局部抗菌剂是一种能够杀死、抑制或减少微生物数量的抗菌药物，被认为是感染控制的必要手段。然而，它们长期以来一直被广泛应用于伤口，以预防或治疗感染，而抗菌液冲洗的优点却很少受到科学研究的关注。与选择性作用于特定靶标的抗生素不同，抗菌剂具有多个靶标和更广泛的活性，包括细菌、真菌、病毒、原生动物甚至朊病毒。尽管某些皮肤和伤口清洁剂被设计为具有不同程度抗菌活性的局部溶液，但人们对此表示担忧。伤口清洁剂可能会影响正常的人类细胞，并且可能具有抗有丝分裂作用，从而对正常组织修复产生不利影响。在没有适当指征的情况下，反复且过度地使用抗菌剂处理伤口可能会产生负面结果，或促进类似于慢性伤口的微环境的形成。然而，在适当的时间和浓度下使用某些类型的抗菌剂，可能为临床医生提供一种工具，将伤口床引导到预期的方向。本综述总结了目前使用的各种抗菌剂及其对伤口愈合机制的负面影响。显然，需要重新考虑抗菌剂在伤口上的作用及其在伤口护理管理中的作用。
