Sams-Dodd Jeanette, Sams-Dodd Frank
Willingsford Ltd, Southampton, Hampshire, United Kingdom.
Wounds. 2020 Mar;32(3):E6-E10.
A 72-year-old woman with a nontraumatic spinal cord injury developed eschar on her lower right back. An underlying abscess was identified, which upon surgical debridement left a large wound extending down to the hip bone. In addition, the hip suffered from chronic osteomyelitis and was exposed at the bottom of the wound. The wound was initially treated for 5 weeks with Manuka honey but deteriorated further. Next, micropore particle technology (MPPT) was used. It cleared the wound of necrotic tissue based on autolytic debridement and removed the soft tissue infection; over a 3-month period, the wound reduced 50% in volume. Treatment approach was changed to polyhexamethylene biguanide (PHMB) and was applied as a gel once every second day to the wound. After 6 days, it was observed to cause tissue degeneration, disruption of the structure of the exposed bone, and the appearance of froth coming through the hip bone. A pain syndrome developed and the use of PHMB was terminated on day 10. After a wash-out period, the use of MPPT was reinitiated. Over the following 8 months, MPPT continued to control the infectious debris coming from the hip bone and promote healing without affecting the bone or causing side effects.
It is generally assumed that the cytotoxic properties of antiseptics seen in cell culture experiments do not occur on wounds. The present case shows these cytotoxic properties are expressed on wounds, and they do disrupt tissues and tissue regeneration.
一名72岁非创伤性脊髓损伤女性患者右下腹出现焦痂。发现其下方有脓肿，手术清创后留下一个向下延伸至髋骨的大伤口。此外，髋部患有慢性骨髓炎，在伤口底部暴露。伤口最初用麦卢卡蜂蜜治疗5周，但病情进一步恶化。接下来，使用了微孔颗粒技术（MPPT）。它基于自溶性清创清除了伤口的坏死组织，并消除了软组织感染；在3个月的时间里，伤口体积缩小了50%。治疗方法改为聚六亚甲基双胍（PHMB），每隔一天以凝胶形式涂抹于伤口。6天后，观察到它导致组织变性、暴露骨骼结构破坏以及髋骨处出现泡沫。出现了疼痛综合征，PHMB在第10天停用。经过一段洗脱期后，重新开始使用MPPT。在接下来的8个月里，MPPT继续控制来自髋骨的感染性碎片并促进愈合，而不影响骨骼或产生副作用。
一般认为在细胞培养实验中看到的防腐剂的细胞毒性特性在伤口上不会出现。本病例表明这些细胞毒性特性在伤口上会表现出来，并且它们确实会破坏组织和组织再生。
