Polihexanide – Perspectives on Clinical Wound Antisepsis

the cytotoxicity of the antiseptic. This area of conflict has always been the driving force in the development of new antimicrobial substances and wound coverings. Despite the lack of knowledge about microorganisms until relatively recently, the search for substances with an antiseptic action is as old as medicine itself, and follows a fascinating path of hope, success, failure and resultant new solutions. Initially, antiseptic wound treatment, first and foremost inaugurated by Lister (1867), marked a turning point in antiseptic prophylaxis and the therapy of contaminated wounds. But hardly 20 years later, ‘Listerism’ started to be criticized, mainly on account of the toxicity of the carbolic acid that he used for antisepsis. After the discovery of penicillin by Alexander Fleming in 1923 and the introduction of antibiotics on the market in 1947, the prevention and therapy of wound infections by means of antiseptics declined in importance almost to the point of insignificance as a result of the sensational initial successes obtained with the use of the well-tolerated and highly effective chemotherapeutic agents and the local and systemic side effects of the antiseptics available at the time. Only with the widespread development of resistance of the wound infection pathogens to antibiotics, the associated necessity of restricting their use to essential indications, and the replacement of antiseptic substances with a narrow therapeutic margin (hydrogen perDisruption of the integrity of the skin is common experience with the resulting wound repair process being a well-orchestrated and complex phenomena. An undistrupted defined sequence of tissue repair, in combination with local and systemic biochemical, immunological and biophysical factors makes normal closure of the wound possible. When intrinsic or extrinsic factors delay the process delayed secondary closure may result in scar formation. Chronic wounds or ulcers result when the disruption in the skin remains open for many weeks or more. The chronic wound may result in increased associated morbidity including infection and amputation, as well as psychological distress. Prolonged bacterial presence is a significant concern as this may lead to chronic inflammation, infection and, in many lower extremity wounds, amputation. One of the most serious disruptive factors of wound healing is infection. The prevention of wound infection is one of the most responsible tasks in medical care, its early recognition one of the most difficult, and the therapy of manifest wound infection one of the most rewarding. With every application of an antiseptic in wound treatment, the therapist treads the narrow path between the benefit of the antimicrobial effect and the risk of reducing the patient’s self-healing powers, e.g. as a result of Published online: September 8, 2010