Leonard D. Kurtz

Pluronic F-68": A Promising New Skin Wound Cleanser

Pluronic F-68 is a new skin wound cleanser that has been approved by the Food and Drug Administration for use in humans. In experimental studies, this nonionic detergent prevented the development of infection with no discernible toxicity. We have used Pluronic F-68 clinically in wounds in more than 1,000 patients without demonstrable side effects. As a result of this experience, Pluronic F-68 has replaced all other commercially available scrub solutions for use as a skin wound cleanser in our medical center.

Mechanical performance of surgical sutures.

A comprehensive analysis of the mechanical performance of sutures has been made to provide information concerning the reliability and security of knotted sutures. The tests utilized in this analysis were designed to be easily reproduced by other investigators. The construction of the knot and the knot performance analysis were undertaken utilizing an Instron Tensile Tester. The mechanical reliability of each knotted suture was determined by measuring the number of throws to reach knot break, the expected slippage of the knot when it reaches knot break, and the maximal holding force at knot break. On the basis of these measurements, recommendations are made for the use of a suture at operation.

Pharmacokinetics of a new skin wound cleanser

Iodophors are effective germicidal agents that have prolonged antiseptic activity in contaminated wounds. A nontoxic surfactant, Pluronic F-68, has been used to formulate a safe and effective iodophor. The parameters necessary to regulate the activity of the iodophor were studied to develop a potent, yet safe bactericidal solution for use in human subjects. The parameters found to be most important were the pH of the solution and the concentration of sodium iodide. Lowering the pH of iodophors increased their stability and antiseptic activity. The free iodine in iodophor solutions prepared with a low pH is predominantly the highly biocidal diatomic iodine (I2). The concentration of iodide regulated the equilbrium of the dissolved iodine between its free and complexed form. Increasing the concentration of iodide in the iodophor lowered the amount of free iodine in solution and enhanced the concentration of the complexed iodide. It is the level of free iodine in an iodophor that determines its antiseptic activity. Low levels of free iodine yielded iodophors that had a slow bacterial kill rate but a prolonged duration of action. Manipulation of these variables permitted the generation of iodophors that varied considerably in their kill rates of bacteria and their duration of antibacterial activity. Iodophors tested in this study demonstrated a distinct superiority to noncomplexed iodine solutions (tincture and aqueous iodine solutions) as wound and skin cleansers.

Role of inoculation site as a determinant of infection in soft tissue wounds

Summary The purpose of this study was to develop an experimental model for evaluating the role of the inoculation site as a determinant of infection in soft tissue wounds. In addition, the effects of a foreign body, a local anesthetic agent, and a vasoactive drug on the inoculation sites resistance to infection were ascertained. The infection rates of tongue, fat, muscle, and skin after inoculation with Staph aureus or E coli were proportional to the size of the bacterial inoculum. The ability of these tissues to resist infection did not differ significantly. The resistance of the inoculation site to infection was not impaired by the presence of liquid silicone or lidocaine hydrochloride. In contrast, concentrated solutions of epinephrine potentiated the development of infection.

Mechanical performance of sutures in surgery

In this study, we have compared the recommended configuration of a knot with specified sutures as ascertained by mechanical performance tests to that employed by a group of board-certified surgeons. Agreement between the surgeon and the results of the test was encountered in only one fourth of the instances. In another one fourth of the cases the surgeon overestimated the number of throws required for a knot to reach knot break. This additional suture material further handicaps the hosts defenses, thereby inviting infection. Surgeons employed knots that untied without reaching knot break in the remaining half of the cases. The holding power of many of the knots that untied was substantially less than that of knots reaching knot break. On the basis of the study, it is recommended that results of the mechanical performance tests be made readily available to the surgeon so that his patient can receive maximal benefits from the knotted suture with the least damage to the hosts defenses.

Proteolytic enzymes as adjuncts to antibiotic prophylaxis of surgical wounds

Abstract The success of antibiotic treatment of contaminated open wounds is related to the time at which the antibiotic is administered. In standardized guinea pig wounds contaminated with 10 6 S aureus , immediate treatment with topical benzyl penicillin prevents the development of infection. When this same treatment is delayed three hours, all wounds become infected. It is our belief that the fibrinous exudate present in open wounds prevents the antibiotic from gaining access to the sites of bacterial contamination and limits the therapeutic benefits of delayed antibiotic therapy. Enzymatic hydrolysis of the wound coagulum with the proteolytic enzyme trypsin significantly enhances the therapeutic value of antibiotics in the delayed treatment of contaminated wounds. On the basis of these experimental studies, a regimen has been established for the use of proteolytic enzymes as an adjunct to delayed antibiotic treatment of contaminated wounds. When treatment is delayed three hours, the optimal dose of trypsin is 25,000 NF units per wound. The effectiveness of trypsin is enhanced by prolonging its application time; contact of the enzyme with the wound for thirty minutes prevents the development of infection and limits bacterial growth. The effectiveness of the enzyme is increased by repeating the applications. The route by which the antibiotic is administered does not affect the value of proteolytic enzymes; proteolytic enzymes enhance the therapeutic value of both topical and systemic antibiotics.

Antimicrobial prophylaxis of contaminated tissues containing suture implants

Neomycin sulfate was the only antibiotic tested that significantly reduced the incidence of infections around suture implant sites. The therapeutic efficacy of this antibiotic was related to the chemical and physical configuration of the sutures.