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Monday, June 08, 2009

Persistent Subcutaneous Oedema and Aseptic Fatty Tissue Necrosis after Using Octenisept(R).

Persistent Subcutaneous Oedema and Aseptic Fatty Tissue Necrosis after Using Octenisept(R).
Eur J Pediatr Surg. 2009 Jun

Schupp CJ, Holland-Cunz S.
1Division of Pediatric Surgery, University Hospital Heidelberg, Heidelberg, Germany.

INTRODUCTION: Wound management and the prevention and treatment of tissue infections are part of daily routine. Octenisept ((R)) (Schülke & Mayr), an antiseptic with a broad antimicrobiological effect, is widely used for various indications. This paper reports prolonged oedema and tissue swelling after treatment of deep wounds with Octenisept ((R)) in three children.

CASE REPORTS: Three paediatric patients, aged between 2 months and 4 years, were treated with Octenisept ((R)) in different hospitals. One initially presented with an abscess of the gluteal area, two with deep wounds of the cheek following injury with a wooden stick. The wounds were cleaned and washed out with Octenisept ((R)). Adequate drainage was in place at all times.

COMMON FINDINGS: We observed aseptic, non painful subcutaneous tissue swelling and oedema in all three cases after wound lavage with Octenisept ((R)). This occurred shortly after the wound was initially treated and lasted for weeks until the symptoms slowly declined. It was not accompanied by persistent general infection parameters. A biopsy taken from one patient demonstrated an aseptic inflammatory reaction and oedema of the subcutaneous tissue, with partial tissue necrosis. Neither surgical revision nor antibiotic therapy brought any improvement.

CONCLUSIONS: Retrospectively, one can consider these occurrences as a consequence of the use of Octenisept ((R)), since the changes are consistent with those described by Schülke & Mayr when Octenisept ((R)) was accidentally administered by subcutaneous injection or under pressure to flush deep hand stab wounds that were not drained. The underlying pathobiological mechanism remains unclear. Hence, we recommend not to apply Octenisept ((R)) in any wound cavity until further investigation has taken place. If aseptic fatty tissue necrosis and oedema develop after using Octenisept ((R)), further surgical intervention or antibiotic treatment will not give any benefit. Changes subside slowly. So far, adequate treatment is not available.


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