title: Polyvinyl pyrrolidone-iodine liposome hydrogel improves epithelialization by combining moisture and antisepis. A new concept in wound therapy.
abstract: Moist treatment of wounds has been shown to improve epithelialization, however at an increased risk of bacterial infection. In this monocentric, randomized, open, phase II pilot study of polyvinyl pyrrolidone-iodine, a well-established topical antiseptic was tested in a new liposomal complexed form in patients receiving meshed skin grafts after burns or reconstructive procedures. Mesh skin graft sites of 36 patients were dressed either with the new polyvinyl-pyrrolidone-iodine liposome hydrogel formulation (Betasom hydrogel) (n = 21), or chlorhexidine-gauze (n = 15). After the first dressing change, wounds were assessed daily and documented every other day until they were healed. Methods of analysis included clinical assessment, photoplanimetry (rate of epithelialization), impedance measurement (moisture of surface and wound healing quality), patient's assessment of pain and other sensations, and thyroid hormones (T3, T4, and TSH). The rate of epithelialization was improved with Betasom hydrogel compared to chlorhexidine-gauze on day 11 (96.3% vs. 75.9% p = 0.056) and significantly on day 13 (100% vs. 82.3% p = 0.005), respectively. Impedance measurements showed an earlier return to normal values (day 9) in Betasom-hydrogel-treated wounds as opposed to chlorhexidine treatment (day 11). Clinical assessment indicated significantly better antiseptic efficacy (p = 0.002) and wound healing quality (p = 0.004) of Betasom hydrogel. Graft loss occurred at a significantly lower rate in Betasom treatment (n = 1; 5%), than in chlorhexidine treatment (n = 5; 35.7%) (p = 0.001). No relevant adverse events or clinically relevant changes of thyroid hormones were observed with Betasom hydrogel. The rationale of this new polyvinyl pyrrolidone-iodine liposomal formulation was based on the properties of liposomes that provide higher moisture to the wound surface, release PVP-iodine at a low rate, and target the substance more exactly by interaction with the cell surface. These initial clinical results show earlier epithelialization and better healing in wounds treated with polyvinyl pyrrolidone-iodine liposome hydrogel, which combines moisture and antisepsis, compared to wounds treated with a conventional antiseptic chlorhexidine-gauze.
authors.affiliation: Universitätsklinik für Plastische Chirurgie und Schwerbrandverletzte, BG-Kliniken Bergmannsheil, Ruhr-Universität, Bochum and Mundipharma GmbH, Limburg, Germany.
authors.forename: P M
authors.initials: PM
authors.lastname: Vogt
authors.forename: J
authors.initials: J
authors.lastname: Hauser
authors.forename: O
authors.initials: O
authors.lastname: Rossbach
authors.forename: B
authors.initials: B
authors.lastname: Bosse
authors.forename: W
authors.initials: W
authors.lastname: Fleischer
authors.forename: H U
authors.initials: HU
authors.lastname: Steinau
authors.forename: K
authors.initials: K
authors.lastname: Reimer
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage* / Q000627:therapeutic use*; D004848:Epithelium / Q000502:physiology; D005260:Female; D006801:Humans; D020100:Hydrogels; D008081:Liposomes; D008297:Male; D010865:Pilot Projects; D011206:Povidone-Iodine / Q000008:administration & dosage* / Q000627:therapeutic use*; D016038:Skin Transplantation; D014945:Wound Healing / Q000187:drug effects*; D014946:Wound Infection / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; D020100:Hydrogels; D008081:Liposomes; D011206:Povidone-Iodine