Harnoss Julian Camill, Elrub Qasim Mahmoud Abu, Jung Jin-On, Koburger Torsten, Assadian Ojan, Dissemond Joachim, Baguhl Romy, Papke Roald, Kramer Axel
Department of General, Visceral and Transplantation Surgery and Study Center of the German Surgical Society, University Hospital Heidelberg, Heidelberg, Germany.
Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany.
Wound Repair Regen. 2019 Mar;27(2):183-189. doi: 10.1111/wrr.12689. Epub 2018 Dec 5.
Antiseptics are being used for prevention of infections in acute wounds and for treatment of infections in acute and chronic wounds. However, some antiseptics' high tissue toxicity might delay the healing process. The aim of this study was to investigate the tissue toxicity of preferentially used wound antiseptics and the influence of antiphlogistic additives via the hen's egg test on the chorioallantoic membrane (HET-CAM). The HET-CAM is a semi-in-vivo method testing the tissue tolerability of wound antiseptics by evaluating the blood vessel reaction of the chorioallantoic membrane in terms of hemorrhage, vessel lysis, and coagulation. For each test day, selected test substances were applied on the membranes of two to three eggs according to the test protocol. The overall irritation was then evaluated by referring to a calculated score. Normal distribution of the resulting scores was confirmed by D'Agostino-Pearson omnibus K2 test. Significant differences between the antiseptics were calculated by Tukey's multiple comparisons test. Severe CAM reactions were observed after short-term application of octenidine based wound gel (0.05%) and chlorhexidine digluconate (0.5% solution), moderate reactions for octenidine (0.05%) in aqueous solution combined with dexpanthenol (1.34%) and allantoin (0.2%) or for hydrogen peroxide (1.5% and 0.5%) in aqueous solution, slight reactions were observed for hydrogen peroxide (1.5%) in aqueous solution in combination with sodium thiocyanate (0.698%) and for the combination of NaOCl/HOCl (each 0.004%). Polyhexanide (0.04%) in Ringer solution and polyhexanide (0.05%) in Lipofundin, the hemoglobin spray (10%), dexpanthenol, and allantoin showed no irritation. The HET-CAM qualifies as a primary screening test for tissue tolerance of wound antiseptics. Regarding local tolerability, polyhexanide and hypochlorite are superior to other antiseptics.
防腐剂被用于预防急性伤口感染以及治疗急慢性伤口感染。然而，一些防腐剂的高组织毒性可能会延迟愈合过程。本研究的目的是通过鸡胚绒毛尿囊膜试验（HET-CAM）来研究常用伤口防腐剂的组织毒性以及抗炎添加剂的影响。HET-CAM是一种半体内方法，通过评估绒毛尿囊膜的血管反应（包括出血、血管溶解和凝血）来测试伤口防腐剂的组织耐受性。在每个测试日，根据测试方案将选定的测试物质应用于两到三个鸡蛋的膜上。然后通过参考计算得分来评估总体刺激性。通过D'Agostino-Pearson综合K2检验确认所得分数的正态分布。防腐剂之间的显著差异通过Tukey多重比较检验计算。短期应用基于奥替尼啶的伤口凝胶（0.05%）和葡萄糖酸氯己定（0.5%溶液）后观察到严重的绒毛尿囊膜反应，奥替尼啶（0.05%）水溶液与泛醇（1.34%）和尿囊素（0.2%）混合或过氧化氢（1.5%和0.5%）水溶液观察到中度反应，过氧化氢（1.5%）水溶液与硫氰酸钠（0.698%）混合以及次氯酸钠/次氯酸（各0.004%）组合观察到轻微反应。林格溶液中的聚己缩胍（0.04%）和Lipofundin中的聚己缩胍（0.05%）、血红蛋白喷雾剂（10%）、泛醇和尿囊素未显示出刺激性。HET-CAM可作为伤口防腐剂组织耐受性的初步筛选试验。就局部耐受性而言，聚己缩胍和次氯酸盐优于其他防腐剂。
