An in vivo comparison of topical agents on wound repair

Selection of the ideal antiseptic or antimicrobial treatment for contaminat ed wounds remains a controversial decision. Clinical decisions are often ma de on the basis of in vitro studies and personal preference. Although topic al solutions are widely used, their comparative in vivo effects on wound he aling are largely unreported. A porcine wound model was used to compare five commonly used topical agents -5% mafenide acetate (Sulfamylon solution), 10% povidone with 1% free iodin e (Betadine), 0.25% sodium hypochlorite ("half-strength" Dakin), 3% hydroge n peroxide, and 0.25% acetic acid-with a control group. Reepithelialization, angiogenesis, neodermal regeneration, fibroblast proli feration, collagen production, and bacterial colony counts were analyzed at 4 and 7 days after wounding (n = 4). Reepithelialization was not significa ntly influenced among the various treatment modalities tested. Sulfamylon a nd Dakin solutions significantly increased neodermal thickness (P < 0.05), whereas hydrogen peroxide and acetic acid significantly inhibited neodermal formation (p < 0.001). All treatments except hydrogen peroxide significant ly increased fibroblast proliferation. Sulfamylon and Betadine significantl y enhanced angiogenesis (p < 0.05). Sulfamylon proved most effective in mai ntaining an aseptic environment while concomitantly increasing angiogenesis , fibroblast proliferation, and dermal thickness compared with control. These data show that selection of a particular topical treatment can affect various aspects of wound repair in an animal model. These results suggest that the selection of topical treatments in the clinical setting should be carefully tailored to match unique wound situations and therapeutic endpoin ts.