C. J. Rust1, A. Karim2, A. Liu2, A. Gibson2 1University Of Wisconsin,School Of Medicine And Public Health,Madison, WI, USA 2University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction:
Wound infection is a major cause of delayed wound healing or non-healing. To prevent infection, wound cleansing is an important step in the management of wounds. However, the choice of antiseptics in wound cleansing remains controversial due to potential cytotoxicity observed in vitro to epithelial cells. Clinical decision-making must balance cytotoxicity and antiseptic efficacy; therefore, more rigorous studies are needed to provide appropriate treatment recommendations on the choice of antiseptic agents. The purpose of this study was to use an ex vivo human skin model to evaluate the cytotoxicity of commonly used wound cleansing agents.
Methods:
Human skin samples were obtained from four patients, who underwent elective reconstructive surgeries. Partial thickness excisional wounds were created using a 6mm biopsy punch in the center of 12mm full thickness skin biopsies. After 24 hours of incubation at 37 oC, wound cleansing agents, including 1x phosphate buffered solution (PBS), Dial Soap, Dove Soap, 10% Povidone Iodine and 2% Chlorhexidine (CHG), were applied topically onto the excisional wounds for 30 minutes and then rinsed and incubated for an additional 24 hours. At 24 hours post-treatment, cell viability was quantified using tetrazolium based (MTT) assay and localization of non-viable cells was visualized using lactate dehydrogenase (LDH) stain. Repeated measures ANOVA and post-hoc comparison using Tukey’s correction were performed and level of significance was determined at p <0.05.
Results:
As measured by MTT, CHG (71.3%, p<0.001) and Dial (81.6%, p<0.05) treated groups had significantly reduced cell viability compared to PBS; CHG treated group also had decreased cell viability compared to Iodine (93.6%, p<0.001) and Dove (90.8%, p<0.001) treated groups. LDH staining showed that cellular death was clearly demarcated along the wound edge in the epidermis and approximately halfway through the dermis in CHG-treated tissues. Cellular death was also evident in the upper dermis of Dove treated tissue. All other biopsies showed cellular viability throughout the tissue.
Conclusion:
CHG had a cytotoxic effect on skin tissue as evidenced by LDH stain and MTT assay compared to other commonly used antiseptics. Future studies will investigate the antiseptic efficacy of the wound cleansing solutions to determine the risk/benefit profile of each antiseptic. Together these data will help guide healthcare providers in the clinical decision-making process.