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Matiasek et al. Plast Aesthet Res 2018;5:36 I http://dx.doi.org/10.20517/2347-9264.2018.50 Page 9 of 11

octenilin® wound irrigation solution instillation. During the instillation of the rinsing solution the negative
pressure is not maintained and the system is prone to leakage, so this phase should be as short as possible.

Conventional NPWT or the use of antiseptic soaked dressings are typically the treatments of choice for
preparing the wound bed prior to grafting or flap coverage. In the novel approach described in this paper, both
methods were combined successfully. A short treatment period was required using this approach, meaning
that less than a week was needed for the combined NPWT/instillation phase. After only 6 days, there were no
signs of wound infection and granulation was taking place in the studied patients.

Given that chronic PUs can be difficult to treat and are often accompanied by bacterial infections, future
studies examining NPWT combined with instillation should be considered. It would be particularly
interesting to undertake a comparative study examining different wound rinsing solutions. This could be
useful in providing data on which to base optimum care.

[1]
Although NPWT is recognised as a useful treatment option for chronic wound management , it is possible
that in combination with octenilin® wound irrigation solution instillation, NPWT may also be considered as
part of the management of other chronic complex wounds. In the “Negative-pressure wound therapy with
[26]
instillation: international consensus guidelines” an instillation time of 10-20 min using non-octenidine
based rinsing solutions is regarded as appropriate. At the time of publication, octenidine based solutions were
not available in the US. Perhaps it is now time to revisit these guidelines and give consideration to the much
shorter instillation times observed in this study.

As seen in this study, the instillation of an antiseptic rinsing solution with proven in vitro antibacterial efficacy
provides an interesting approach for effective wound healing. This method was found to be successful in all 13
patients studied, in terms of preparing the wound bed prior to surgical intervention.

After 2 min of exposure to octenilin® wound irrigation solution a sufficient bactericidal effect to eradicate MRSA
and the accompanying flora of the wound exudates was shown during in vitro testing. In comparison the
microbial load was not sufficiently reduced within the required contact time when the same wound exudates
were exposed to different PHMB based rinsing solutions. Therefore it is worth considering that the short
duration of antiseptic wound rinsing during NPWT, may be insufficient if PHMB rinsing solutions are used.
[27]
This requires further investigation. Our findings are similar to those in a study conducted by Ludolph et al. ,
where a total of 111 patients were treated with negative pressure therapy combined with instillation. They also
found a positive effect concerning reduction of the bacterial load in contaminated wounds.

It is generally acknowledged that the high treatment costs of managing chronic wounds place a considerable
burden on healthcare resources. Given the successful wound healing and absence of observed infection in
all 13 patients, the combination of NPWT with octenidine wound rinsing could indicate a novel protocol for
chronic wound management.

In conclusion, in this small study, 13 patients with category 4 PUs were managed with NPWT and instillation
of octenilin® wound irrigation solution, following surgical debridement. The results demonstrated that this
combination was effective in preparing the wound bed before the wound was surgically closed. No signs of
infection were observed, good tissue compatibility with octenidine-based solutions was noted and complete
healing was seen after 90 days. None of the observed patients required subsequent follow up appointments.

A broad-spectrum antimicrobial efficacy was demonstrated in vitro for octenilin® wound irrigation solution,
with only a short contact time required and with good tissue compatibility. Further investigations are now
required to examine in more depth the possibilities offered by NPWTi and octenilin® wound irrigation