Chronic wounds are a significant burden not only to the patient but also for the healthcare system. Several factors such as patient age, chronic diseases like diabetes, immunocompromised state impair wound healing. Recently, biofilms in chronic wounds have been identified as the cardinal factor causing delayed wound healing. Biofilms are not distributed uniformly in the chronic wound and are difficult to detect. The phase of critical colonization in the wound, with multiplication of bacteria, signifies the development of biofilm. Such a wound becomes infected, if the proliferating bacteria cross a critical level. Biofilms are resistant to antimicrobials agents. By providing a “window of opportunity”, wound debridement creates a favorable environment for topical antiseptics and promotes wound healing.

In this article, the authors elaborate on the safety and efficacy of topical antiseptics in chronic wounds with focus on povidone‐iodine (PVP‐I) compared to two other commonly used antiseptics namely polyhexamethylene biguanide/polyhexanide (PHMB) and silver. Their discussion is based on review of evidence in a Focus Group meeting on “antiseptics in wound care and biofilm management”. Evidence was also sourced from PubMed. Compared with PHMB and silver, PVP-I has a broader spectrum of antimicrobial activity, no acquired bacterial resistance or cross-resistance, low cytotoxicity and good tolerability. Moreover, it has robust antibiofilm efficacy and enhance wound healing. This signify that PVP-I meets all criteria of an ideal antiseptic making it “a highly viable therapeutic option in wound care and biofilm management” and may be especially y effective in the care of critically colonized wounds with biofilms. The authors have also proposed a new algorithm as a guide for the clinician for management of patients with chronic, non‐healing wounds using PVP‐I.

Source: Alves PJ, et al. Int Wound J. 2021 Jun;18(3):342-358.