Wang Bowen, Peng Mengjia, Yundan Ciren, He Yanlin, Fu Mengmei, Shen Yuandi
Department of Prevention and Control of Infectious Diseases, CDC of Tibet Military Command, Lhasa, Tibet, China; Department of Emergency, General Hospital of Tibet Military Command, Lhasa, Tibet, China.
Department of Emergency, General Hospital of Tibet Military Command, Lhasa, Tibet, China.
Int J Surg Case Rep. 2023 Aug;109:108587. doi: 10.1016/j.ijscr.2023.108587. Epub 2023 Aug 7.
Following debridement, the skin and mucous membranes around the wound must be disinfected with broad-spectrum disinfectants like Iodophor, 75 % ethanol, chlorhexidine, and bromogeramine. Despite the fact that it is rarely reported, skin allergy to disinfectants is extremely detrimental to wound recovery after debridement.
In this study, a 29-year-old man with no previous allergic history developed delayed contact dermatitis after being exposed to multiple disinfectants, including iodophor, 75 % ethanol, and Erythromycin ointment. Given the possibility of the patient's allergic constitution, skin patch tests were repeated to confirm the allergic disinfectants. To avoid the allergy, the wound was simply rinsed with 0.9 % sodium chloride solution and Cefdinir (0.1 g, tid) was taken orally, while all local disinfectants were discontinued. The wound healing process was gradually accelerated, and allergic symptoms were alleviated. Furthermore, our findings revealed that the frequency and immunosuppressive function of Tregs were significantly lower in patients than in healthy controls (P < 0.05).
By minimizing allergic reactions and providing appropriate wound care, the use of 0.9 % sodium chloride solution with oral antibiotics could expedite the healing process. This enabled the wound to close faster and reduces the risk of complications.
The use of 0.9 % sodium chloride solution for wound irrigation, combined with oral administration of antibiotics, could be modified to mitigate further allergic reactions and enhance the recovery process following debridement. However, individual patient characteristics and medical history should also be taken into consideration when making these alterations.
清创后，伤口周围的皮肤和黏膜必须用碘伏、75%乙醇、氯己定和新洁尔灭等广谱消毒剂进行消毒。尽管皮肤对消毒剂过敏的情况鲜有报道，但这种过敏对清创后伤口的恢复极为不利。
在本研究中，一名既往无过敏史的29岁男性在接触包括碘伏、75%乙醇和红霉素软膏在内的多种消毒剂后发生了迟发性接触性皮炎。鉴于患者可能存在过敏体质，重复进行皮肤斑贴试验以确认引起过敏的消毒剂。为避免过敏，伤口仅用0.9%氯化钠溶液冲洗，并口服头孢地尼（0.1g，每日三次），同时停用所有局部消毒剂。伤口愈合过程逐渐加快，过敏症状得到缓解。此外，我们的研究结果显示，患者体内调节性T细胞（Tregs）的频率和免疫抑制功能显著低于健康对照组（P<0.05）。
通过尽量减少过敏反应并提供适当的伤口护理，使用0.9%氯化钠溶液联合口服抗生素可以加快愈合过程。这能使伤口更快闭合并降低并发症风险。
使用0.9%氯化钠溶液冲洗伤口并联合口服抗生素，可调整以减轻进一步的过敏反应并促进清创后的恢复过程。然而，在进行这些调整时，也应考虑个体患者的特征和病史。
