Dilute Povidone-iodine Solution Research Articles

Dilute Povidone-Iodine Solution Soaking Is Ineffective in Improving Outcomes of Necrotizing Fasciitis Caused by Diabetic Foot.

Wound soaking is a physical debridement method that helps reduce bacterial colonization and consequently promotes wound healing. Although soaking in povidone-iodine solution was ineffective in reducing bacterial colonization in acute trauma wounds, there is still a lack of evidence supporting the efficacy of this method in treating severe soft tissue infection. This study aimed to explore the effects of wound soaking in 1% dilute povidone-iodine solution on necrotizing fasciitis caused by diabetic foot ulcers. We retrospectively reviewed and finally included 153 patients who were admitted because of diabetic foot ulcers after undergoing fasciotomy for necrotizing infection from January 2018 to December 2021. Results showed no statistical difference in the outcomes between patients in the soaking and nonsoaking groups. End-stage renal disease (P = 0.029) and high serum C-reactive protein level (P = 0.007) were the only independent factors for below-knee amputation in the univariate and multivariate logistic regression analyses. Therefore, soaking diabetic wounds with severe infection in 1% dilute povidone-iodine solution may not reduce the hospital length of stay, risk of below-knee amputation, and readmission rate.

Prevention of Surgical Site Infection Following Open Spine Surgery: The Efficacy of Intraoperative Wound Irrigation with Normal Saline Containing Gentamicin Versus Dilute Povidone-Iodine

Intraoperative wound irrigation (IOWI) is an important step in preventing surgical site infection (SSI). This study compared the effectiveness of saline with gentamicin versus povidone-iodine as IOWI solutions in preventing SSI in open spine surgery. It is a prospective comparative study. Patients who had non-instrumented open spine surgery were randomized into two groups. Group A and B patients had their surgical wounds irrigated with saline containing gentamicin solution and dilute povidone-iodine solution, respectively. Both groups were assessed for the occurrence of SSI. A total of 80 patients, divided into two groups of 40 each completed the study. Overall, the SSI rate was 17.5% for patients in the normal saline containing gentamicin group (A) and 2.5% for those in the dilute povidone-iodine group (B), this difference was statistically significant (p=0.025). The cervical and thoracic spine regions have the same SSI rate (7.1% and 0% respectively) in both groups. However, in the lumbosacral region, the SSI rate was 31.6% in A and 0% in B, this was statistically significant (p=0.006). The isolated organisms in patients with SSI were staphylococcus species (42.86% of SSI in A and 0% in B) and pseudomonas species (42.86% of SSI in group A and 100% in group B), and this difference was profound in the lumbosacral spine region (p=0.008). Intraoperative wound irrigation with 3.5% dilute povidone-iodine solution is more efficacious in preventing SSI and has wider microbial coverage compared to normal saline containing gentamicin solution as IOWI fluid in non-instrumented open spine surgery.

Topical Application of Povidone Iodine to Minimize Post Appendectomy Wound Infection

Background: Despite the use of prophylactic antibiotic and sterilization techniques and nemours methodsof wound care, post appendectomy wound infection is still high.Methods: Arandomized controlstudy (RCS) has been implied to prove, whether uses of povidone iodinejust prior to wound suturing could decrease surgical wound infection rates after surgery for appendectomy.Atotal number of 120 patients operated for cute appendicitis with open appendectomy at AL-MawaniTeachingHospital during the period from march 2016 to October 2020.Results: After appendectomy patients was randomize into three groups, group A which include 40 patientsthe subcutaneous tissue was irrigated with 1% diluted povidone-iodine solution before skin closure.Group B which contained other 40 patients the wound has been washed with normal saline, and in groupC(controlgroup) no irrigation was done.All patients were followed for surgical site infection according toSouthampton wound grade system for ten days after surgery.In this study we notice that areductionhappenedin the number of wound infection in group Acompare with group B and C.Conclusion: The uses of povidone iodine 1% before skin closure is an effective method in reducing the rateof infection of the wound after surgery for acute appendicitis.

Efficacy of Prophylactic Intraoperative Povidone-Iodine Solution Irrigation in Preventing Surgical Site Infection Following Spinal Surgery

Objective: Deep wound infection can worsen clinical outcome and increase costs following spinal surgery. The bactericidal activity of povidone-iodine covers a broad spectrum of pathogens including methicillin-resistant Staphylococcus aureus. Our study aimed at evaluating the role that intraoperative dilute povidone-iodine solution irrigation could play in preventing post-operative wound infection following spinal surgery.
 Material and Methods: The clinical data of 41 patients that had undergone posterior spinal surgery in the department of neurosurgery Allama Iqbal hospital Sialkot was retrospectively analyzed. We divided the patients into two groups. In group 1patients wounds were irrigated with 0.35% povidone-iodine solution prior to closure. In group 2 patients wounds were irrigated with normal saline only. The two groups were then compared for evaluation of efficacy of peroperative povidone-iodine solution irrigation in preventing post-operative wound infection.
 Results: No infection occurred in the 16 patients in group 1 in whom wounds had been irrigated with povidone-iodine solution, compared to 3 deep infections developing in the 25 patients in group 2 in whom wounds had been irrigated with normal saline only. In the 3 patients that suffered from deep infections the duration of hospital stay was also significantly increased (P < 0.05).
 Conclusion: Our study supports the notion that perioperative povidone-iodine irrigation is an effective adjunct measure for prevention of surgical site infection following spinal surgical interventions.

Prevention of Periprosthetic Joint Infection (PJI): A Clinical Practice Protocol in High-Risk Patients.

Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk patients. Methods: Multiple databases (Pubmed/MEDLINE, EMBASE, Scopus, Cochrane Library) and recommendations on TKA PJI prevention measures from the International Consensus Meetings on PJI from the AAOS and AAHKS were reviewed. This represents a Level IV study. Results: Strong evidence was found on poor glycemic control, obesity, malnutrition, and smoking being all associated with increased rates of PJI. In the preoperative period, patient optimization is key: BMI < 35, diet optimization, Hemoglobin A1c < 7.5, Fructosamine < 292 mmol/L, smoking cessation, and MRSA nasal screening all showed strong evidence on reducing PJI risk. Intraoperatively, a weight-based antibiotic prophylaxis, accurate fluid resuscitation, betadine and chlorhexidine dual skin preparation, diluted povidone iodine solution irrigation, tranexamic acid administration, and monofilament barbed triclosan-coated sutures for soft tissues closure all represented effective prevention measures. In the postoperative period, failure to reach normalization of ESR, CRP, D-dimer, and IL-6 six weeks postoperatively suggested early PJI. Conclusion: The current recommendations from this group of experts, based on published evidence, support risk stratification to identify high-risk patients requiring implementation of perioperative measures to reduce postoperative PJI.

Comparison of Irrigation with Povidone-Iodine Versus Normal Saline on Wound Infection After Open Appendectomy

Objective: Surgical site infections (SSIs) pose a continued problem to operating surgeons. It adds to the healthcare cost, increases morbidity and mortality and sometimes culminates in re-explorations. Rate of SSIs can be ameliorated by removing damaged or non-viable tissue, metabolic waste and wound exudates; this can be achieved by irrigation of surgical wound intraoperatively. Surgical wound irrigation can also be performed postoperatively. Even after giving prophylactic antibiotics and august aseptic measures, post-appendectomy wound infection remains soaring. The efficacy of povidone-io- dine on non-incised skin is well known but its application as an intraoperative irrigation solution in open surgical wounds is not a mundane practice. Likewise prophylactic irrigation with normal saline solution to prevent wound infection has also turned out to be effective in some studies. The objective of this study is to compare the percentage of superficial SSI post-appendectomy, with intraoperative irrigation of subcutaneous plane using 1% povidone-iodine solution versus normal saline.&#x0D; Methods: 200 cases of open appendectomy for acute appendicitis at Baqai Medical University, Kara- chi were randomly distributed into two arms. In group A, 0.9% Normal Saline was employed to irrigate subcutaneous tissue before skin closure while in group B irrigation with 1% diluted povidone-iodine solution was undertaken. The cases were assessed for infection in surgical wounds in line with Southampton wound grading system for five days after surgery and followed for thirty days.&#x0D; Results: Mean age of participants of this study was 18.65 years. There were 100 patients in both groups and the groups were not different statistically in terms of age, gender and operative findings. A total of 38 (19%) out of 200 patients had Southampton grade 2 and above, signifying wound infection. Out of these, 29 (29%) were from Group A and 9 (9%) from Group B (p=0.001).&#x0D; Conclusion: 1% diluted povidone-iodine irrigation of subcutaneous plane after appendectomy remark- ably lowers the rate of SSI when compared with normal saline irrigation.

Dilute Povidone-Iodine Solution Prevents Intraoperative Contamination of Sterile Water Basins During Total Joint Arthroplasty

BackgroundPeriprosthetic joint infection is a major complication of total joint arthroplasty (TJA). The intraoperative splash basin has been found to be a potential source of contamination. Although consensus recommendations against the use of splash basin have been made, splash basin use continues to be taught and utilized in practice. This study aims to investigate the effect of dilute betadine addition to the sterile water (SW) contents (0.02% solution) of the splash basin on contamination rates. This intervention could preserve the functionality and preferential use of the splash basin. The primary outcome of this study is the rate of splash basin contamination, with secondary outcomes of prevalence of culture speciation and mean operative times association with the rate of positive cultures. MethodsPatients undergoing primary TJA were enrolled in a randomized controlled trial with assignment to either the intervention/betadine group, in which dilute betadine was added to the standard SW splash basin, or the control/standard SW group. For a total cohort of 104 patients, a 120 mL aliquot sample of basin fluid was collected at incision (“preprocedure”) and closure (“postprocedure”). Samples were cultured and monitored for 48 hours for growth, with further testing as necessary to identify microbial speciation. ResultsOf the final 100 postprocedure samples, 0 (0.0%) were positive in the betadine group, while there were 23 (47.9%) positive samples in the SW group (P < .001). Of the positive cultures, the most common species grown were coagulase-negative Staphylococcus, Corynebacterium, and Micrococcus. The mean operative time was an average of 11 minutes longer for cases with positive cultures. ConclusionIn conclusion, treating SW splash basins with dilute povidone-iodine (0.02% solution) eliminates intraoperative contamination of splash basins in TJA procedures. This intervention is simple, low cost, and readily implementable, making it a reasonable addition to TJA protocols. Level of EvidenceLevel 1, Controlled Laboratory Study.

Povidone-Iodine Wound Lavage to Prevent Infection After Revision Total Hip and Knee Arthroplasty: An Analysis of 2,884 Cases.

Postoperative infection remains a major challenge in revision total hip arthroplasty (THA) and revision total knee arthroplasty (TKA). Wound irrigation with dilute povidone-iodine (PI) solution has emerged as a simple, inexpensive, and potentially successful means of reducing postoperative infections. The aim of this study was to assess its effectiveness in reducing infection following revision THA and TKA in, to our knowledge, the largest revision cohort to date. Using our institution's total joint registry, we identified 1,402 revision THAs and 1,482 revision TKAs performed during the study period (2013, when the PI irrigation protocol was first implemented, to 2017). The PI lavage protocol was employed in 27% of the revision THA cases and 34% of the revision TKA cases; in the remaining cases, the protocol was not used. Demographics, comorbid conditions, underlying surgical diagnoses, and whether the revision was for a septic or an aseptic etiology were compared between the groups (use or no use of PI irrigation). Any reoperation due to infection, as assessed at 3 and 12 months following revision arthroplasty, was compared between the groups and propensity scores were calculated to account for differences in baseline characteristics between the groups. After adjusting for baseline differences between the groups using the propensity-score weighted models, we found no significant difference in the rate of reoperation for infection at 3 months (p = 0.58 for revision THA, and p = 0.06 for revision TKA) and at 12 months (p = 0.78 for revision THA, and p = 0.06 for revision TKA). Nonetheless, the hazard ratios from the propensity-score model trended higher for patients who received PI lavage: 1.6 and 1.3 for revision THA at 3 and 12 months, respectively, and 2.9 at both 3 and 12 months for revision TKA. PI wound lavage demonstrated no benefit in reducing any reoperation for infection following revision THA and TKA. Moreover, the trend toward higher rates for reoperation for infection among patients who received PI irrigation merit further consideration. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Intraoperative povidone-iodine irrigation for infection prevention.

Although prevention of infection following arthroplasty requires a multifaceted approach, the use of intraoperative irrigation is an important component of any protocol. Recent clinical practice guidelines from the Centers for Disease Control, World Health Organization, and International Consensus Meeting on Musculoskeletal Infection advocate the use of a dilute povidone-iodine solution prior to wound closure. Our experience suggests that this practice is safe, inexpensive, and easily implemented. The present article describes our institutional irrigation protocol and reviews the current literature regarding povidone-iodine solutions.

What We Do: Povidone-Iodine Solution to Delineate the Cutaneous Roll.

Establishing continuity of the cutaneous roll is critical to cleft lip repair. Unfortunately, this landmark can be difficult to appreciate depending on the patient's skin tone, surgical lighting, or preexisting scar. When applied to the lip, dilute povidone-iodine solution beads off the cutaneous roll and dry vermilion, clearly defining these structures. We use dilute povidone-iodine solution not only to prep the lip but to delineate landmarks critical to cleft lip repair.

Risk analysis and nursing countermeasures for spinal tumor patients during total en bloc spondylectomy and spine reconstruction

Objective To retrospectively summarize the risk factors in 6 spinal tumor patients during primary total en bloc spondylectomy (TES) , to give risk warning, and to propose nursing countermeasures. Methods Totally 6 spinal tumor patients received primary TES and transpedicular screw system fixation in the First Affiliated Hospital of Zhengzhou University between September 2014 and September 2016. In response to high risk factors such as spinal cord injury, massive hemorrhage, tumor cell planting and metastasis and infection as seen in the operation, nursing interventions included protecting spinal cord function, intraoperative blood pressure control, strict surgical isolation techniques, and soaking surgery field with distilled water and diluted povidone-iodine solution. Results The operation for the 6 patients were completed successfully, and all patients recovered well, without any complication such as iatrogenic spinal cord injury, important blood vessel injury or infection. It was found in the 12 to 36-month follow-up visits that the efficacy was satisfying, without local neoplasm recurrence. Conclusions Proper warning and nursing interventions against intraoperative risks make significant contributions to the smooth operation of spinal tumor patients during TES and reduce the incidence of complications effectively. Key words: Intraoperative nursing; Spinal neoplasm; Total en bloc spondylectomy; Risk warning; Nursing countermeasure

Intraoperative Disinfection by Pulse Irrigation with Povidone-Iodine Solution in Spine Surgery.

Background Deep wound infection in spine surgery is a debilitating complication for patients and increases costs. The objective of this prospective study was to evaluate the efficacy of wound pulse irrigation with a dilute povidone-iodine solution in the prevention of surgical site infection. Methods 50 patients undergoing spinal surgery were randomly divided into two groups (A and B) of 25 patients each. In group A, wounds were irrigated with dilute (3%) povidone-iodine solution through a low-pressure pulsatile device. In group B, wounds were irrigated with saline solution through a bulb syringe. In both groups, specimens for bacterial culture were harvested from surgical site before and after irrigation. Results In group A, no surgical site infection occurred; in group B, deep wound infection was observed in 3 patients. In both groups, before irrigation some cultures have been found positive for bacterial contamination. Conclusion Our study seems to support the idea that low-pressure pulsating lavage of surgical wounds with povidone-iodine diluted to a nontoxic concentration of 3% is an effective therapeutic adjunct measure to prevent surgical site infection in spine surgery. However, the number of the enrolled patients is small and a significant statistical analysis is not practicable. This trial is registered with NCT03249363.

Is 1% povidone-iodine solution superior to normal saline for simple traumatic wound irrigation?

Abstract Background Povidone-iodine is a broad spectrum antiseptic irrigation solution which has been used in wound management processes for decades but some recent studies have questioned its superiority to normal saline and even tap water in decreasing the infection rate in different types of wounds. Objective This study compares the efficacy and safety of diluted povidone-iodine solution with normal saline as in decreasing the infection rate in simple traumatic wounds repaired in emergency department. Method Patients with simple traumatic were included and randomly allocated to 2 groups. In 223 patients, wounds were irrigated with 1% povidone-iodine solution. In the other 223 patients, wounds were irrigated with 0.9% normal saline solution. Wound infection rates were compared by assessing the signs and symptomsof infection including cellulitis, abscess, lymphangitis and pus formation. Result Infectious complications were seen in 29 of 446 (7.4%) patients (15 in povidone-iodine versus 14 in normal saline groups). Nineteen (7.91%) patients in povidone-iodine group and 13 (6.68%) patients in normal saline group showed the evidences of infection in follow up visits. There was no statistically significant difference between infection rates in two studied groups (p = 0.86). Conclusion Irrigation with 1% Povidone-iodine did not increase or decrease the infection rate in traumatic wounds compared to wound irrigation with 0.9% saline solution.

Bilateral Portal Percutaneous Endoscopic Debridement and Lavage for Lumbar Pyogenic Spondylitis.

Common management approaches for spinal infections include conservative administration of antibiotics and aggressive surgical debridement. Minimally invasive endoscopic treatment has been reported and is gaining widespread attention because of its simplicity and effectiveness. This study retrospectively evaluated the clinical outcomes of bilateral portal percutaneous endoscopic debridement and lavage with dilute povidone-iodine solution in the treatment of patients with lumbar pyogenic spondylitis. From January 2007 to December 2011, a total of 22 patients diagnosed with single-level lumbar pyogenic spondylitis underwent bilateral portal percutaneous endoscopic debridement and lavage with dilute povidone-iodine solution at the authors' institution. Clinical outcomes were assessed by careful physical examination, visual analog scale pain score, modified MacNab criteria functional score, regular serologic testing, and imaging studies to determine whether percutaneous endoscopic debridement and lavage treatment was successful or if surgical intervention was required. Causative bacteria were identified in 19 (86.4%) of 22 biopsy specimens. Eighteen patients had satisfactory relief of back pain and uneventful recovery after this treatment. The success rate was 81.8% (18 of 22). Both visual analog scale and modified MacNab criteria scores improved significantly in successfully treated patients. No major surgical complications were noted, except for 3 patients who had residual or subsequent paresthesia in the affected lumbar segment. Percutaneous endoscopic debridement and lavage is a minimally invasive procedure that can yield a higher bacterial diagnosis, relieve back pain, and help to eradicate lumbar pyogenic spondylitis. It is an effective alternative treatment for patients with spinal infection before extensive open surgery.

A New Method That Enables Complete Removal of Scabs at Buttonhole Entry Sites.

Scab removal is a time-consuming process and often injures the skin at a buttonhole entry site. Incomplete removal of scabs may cause access-related infection. In a new procedure, buttonhole entry sites were treated with a moist healing step after hemodialysis, and then a formed scab was wiped off with a microfiber towel during bathing on the night prior to hemodialysis, which was performed on the following day. In the moist healing step, the entry site was disinfected with a diluted povidone-iodine solution (0.1% povidone-iodine solution). When the buttonhole entry sites of the patients were treated with the new procedure, the scabs had already been removed at the buttonhole entry sites, and the sites were covered with a thin transparent membrane. Histological examination showed the thin membrane was stratum corneum, in which nuclei are still seen in keratinocytes. By treating the buttonhole entry sites of patients with the wound moist healing method and then rubbing the sites with a microfiber towel during bathing, scabs can be removed without injuring the skin at the sites in advance.

Can povidone-iodine solution be used safely in a spinal surgery?

Intra-operative incidental contamination of surgical wounds is not rare. Povidone-iodine solution can be used to disinfect surgical wounds. Although povidone-iodine is a good broad-spectrum disinfecting agent, it has occasionally been reported to have a negative effect on wound healing and bone union. Therefore, its safety in a spinal surgery is unclear. A prospective, single-blinded, randomized study was accordingly conducted to evaluate the safety of povidone-iodine solution in spinal surgeries. Ascertained herein was the effect of wound irrigation with diluted povidone-iodine solution on wound healing, infection rate, fusion status and clinical outcome of spinal surgeries. From January 2002 to August 2003, 244 consecutive cases undergoing primary instrumented lumbosacral posterolateral fusion due to degenerative spinal disorder with segmental instability had been collected and randomly divided into two groups: the study group (120 cases, 212 fusion levels) and the control group (124 cases, 223 fusion levels). Excluded were those patients with a prior spinal surgery, spinal trauma, malignant tumor, infectious spondylitis, rheumatoid arthritis, ankylosing spondylitis, metabolic bone disease, skeletal immaturity or with an immunosuppressive treatment. In the former group, wounds were irrigated with 0.35% povidone-iodine solution followed by normal saline solution just before the bone-grafting and instrumentation procedure. However, only with normal saline solution in the latter. All the operations were done by the same surgeon with a standard technique. All the patients were treated in the same postoperative fashion as well. Later on, wound healing, infection rate, spinal bone fusion and clinical outcome were evaluated in both groups. A significant improvement of back and leg pain scores, modified Japanese Orthopedic Association function scores (JOA) and ambulatory capacity have been observed in both groups. One hundred and seven patients in the study group and one hundred and nine in the control group achieved solid union. There was no infection in the study group but six deep infections in the control group. Wound dehiscence was noted in one group 1 and two group 2 patients. A subsequent statistical analysis revealed higher infection rate in the control group (P<0.05), but no significant difference in fusion rate, wound healing, improvement of pain score, function score and ambulatory capacity between the two groups. Diluted povidone-iodine solution can be used safely in spinal surgeries, and it will not influence wound healing, bone union and clinical outcome.

APPLICATION OF THE T POUCH AS AN ILEO-ANAL RESERVOIR

We recently reported our initial clinical experience with a novel form of urinary diversion, that is the T pouch. 1 The T pouch incorporates a unique antireflux mechanism and eliminates the complications associated with an intussuscepted nipple valve. We describe the application of this concept with conversion of a ureterosigmoidostomy into a new ileo-anal reservoir with an antireflux mechanism. Others have reported followup of as long as 40 years. 2 To our knowledge 61 years is the longest interval to be reported between construction of a ureterosigmoidostomy and its revision. CASE HISTORY P. K., a 64-year-old woman with a history of bladder exstrophy, underwent cystectomy and ureterosigmoidostomy at age 3 years. At 18 years she underwent right nephrectomy for intractable pyelonephritis, and was well until she was 55 years old and had recurrent episodes of pyelonephritis, which necessitated suppressive antibiotic therapy. Multiple drug allergies developed, and she was ultimately hospitalized for urosepsis. Renal ultrasound demonstrated moderate to severe left hydroureteronephrosis. A furosemide nuclear scan was consistent with obstruction. Creatinine was 1.6 mg./dl. (normal 0.3 to 0.9) and blood chemistry study revealed severe hyperchloremic metabolic acidosis. Colonoscopy showed no evidence of malignancy. The patient was satisfied with the voiding pattern and declined any form of external urinary diversion. Conversion of the ureterosigmoidostomy to an ileoanal reservoir incorporating the T pouch antireflux mechanism to the sigmoid colon was performed. At the time of surgery a 24F Medina tube was placed into the anus and, after copious irrigation with a diluted povidone-iodine solution, sutured in place. The Medina tube served as a tactile cue for proper placement of the proctostomy. The colon was mobilized and the previous ureterocolostomy was excised at its junction and sent for frozen section to rule out neoplastic degeneration. A 15 cm. proctostomy was then made at the tip of the Medina tube 10 cm. proximal to the transition zone between the rectum and anus. A portion of sigmoid colon was isolated 4 to 6 cm. proximal to the proctostomy and intussuscepted to prevent urine reflux into the proximal colon. A T pouch was then constructed using techniques previously described. 1 A 20 cm. segment of distal ileum was placed in an inverted V configuration with each limb of the V measuring 10 cm. A more proximal 10 cm. segment of ileum was isolated as the afferent limb. Adhering to the principles outlined for the T pouch, the antireflux mechanism was created by anchoring the distal 3 to 4 cm. of afferent limb into a serosal lined trough. This trough was constructed by maintaining the windows of Deaver to the afferent limb, which allowed for permanent fixation to the serosa of the ileal pouch. The ileal trough was then closed by over sewing the adjacent ileal flaps that are created when the bowel is detubularized (part A of figure). The ileum was left open to be laid onto the rectum as a pouch

Peritoneal irrigation with povidone-iodine solution after laparoscopic-assisted splenectomy significantly decreases port-tumor recurrence in a murine model.

The development of port-wound tumor recurrences has raised questions regarding the safety of laparoscopic methods for the resection of malignancies. The cause and the incidence of abdominal-wall tumor recurrences remain unknown. It is also not clear how to avoid or lower the incidence of port-tumor recurrences. The purpose of the current study was to determine the impact of abdominal irrigation with povidone-iodine on the port-wound tumor incidence in a murine model. A splenic tumor model was used for this study. To establish splenic tumors, female BALB/c mice (N = 48) were given subcapsular splenic injections of a 0.1 ml suspension containing 10(5) C-26 colon adenocarcinoma cells via a left-flank incision at the initial procedure. Seven days later, the animals with isolated splenic tumors (100 percent) were randomly assigned to one of three groups: 1) control, 2) saline irrigation (saline), or 3) povidone-iodine irrigation. All animals underwent laparoscopic mobilization of the spleen using a three-port technique, intra-abdominal crushing of the tumor, followed by an extracorporeal splenectomy via a subcostal incision. No irrigation was performed for control group animals. In the saline irrigation group, the subcostal incision was closed and pneumoperitoneum was re-established. The abdominal cavity was irrigated with 5 ml of normal saline for 60 seconds before instrument removal. In the povidone-iodine irrigation group, similar abdominal irrigation was performed, using 0.25 percent povidone-iodine. Attempts were made to recover completely the irrigation for both irrigation groups. Seven days after the splenectomy, animals were killed and inspected for abdominal-wall tumor implants. There were significantly more animals with at least one port-tumor recurrence in the control group than in the povidone-iodine group (P = 0.007). Although not statistically significant, the number of animals with port-wound tumors was higher in the saline group than in the povidone-iodine group (P < 0.08). There was no significant difference between the saline group and the control group. When each port site was considered independently, the incidence of port-wound tumors (number of ports with tumors per total number of ports) was significantly lower in the povidone-iodine group than in both the control (P = 0.00001) and saline groups (P = 0.03). The incidence of port-wound tumors was also significantly lower in the saline group compared with the control group incidence (P = 0.03). Abdominal irrigation with dilute povidone-iodine solution significantly reduced the number of animals with port-tumor recurrences. Abdominal irrigation with saline was also effective in reducing the incidence of port-wound tumor formation when each port was considered separately. However, povidone-iodine irrigation was much more effective than saline irrigation in preventing port-wound tumor formation.

Nonselective debridement and antimicrobial cleansing of a venting ductal breast carcinoma

A woman with a moderately differentiated carcinoma that erupted through the skin and amputated her breast was treated with whirlpool, topical antimicrobials, radiation, and chemotherapy. The draining, necrotic, and septic wound was treated for 5 months with a whirlpool containing dilute povidone-iodine solution and intravenous chemotherapy. Wet bandages, necrotic tissue, and softened eschar were removed by whirlpool agitation or mechanically debrided. To start treatment the wound was dressed with Debrisan crystals and sterile gauze for 1 week. Afterwards, wet-to-dry dressings wetted with Dakin's solution were applied. Tissue ingrowth at the wound margin started after 2 weeks, with whirlpool treatments effecting a tissue-reddening hyperemia. Wound drainage ceased after 2 months, with granulation and revascularization resulting. Eleven months later the wound was closed, aseptic, and undergoing dry flaking. The patient was cancer free with a completely healed wound 2 years after treatment. In this case, nonspecific debridement using whirlpool and topical antimicrobials promoted healing of an open fungating wound from a breast carcinoma.

The role of a modified eloesser flap in the management of mixed tuberculous and other complex empyemas

A permanent pleurocutaneous window was created to facilitate dependent drainage and efficient irrigation in 18 patients with empyema thoracis. Fourteen patients had mixed tuberculous, and four had non-tuberculous empyemas. Dilute povidone iodine solution was used for irrigation. Eight patients had complete obliteration of the empyema cavity within eight to 20 months. Six are showing satisfactory progress. Three patients died of causes not directly related to the procedure. This technique was found effective as well as economical in the management of chronic empyemas.