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There is no evidence to support the use of Povodine-iodine in the management of diabeic foot ulcers

Similarly no evidence to support other topical anti-infectives such as Silver Dressings, Codexomer Iodine, Flaminal etc. They have all shown themselves effective in vitro to reduce a bioburden, and even in vivo for most, but no evidence that they affect wound healing outcomes (maybe because the current research has been poor)
We do know that all topical anti infectives not only have an effect on bacteria, but also fibroblasts, which are necassary for healing.

If a wound is frankly infected systemic cover is required and is supported by evidence, if just colonised, you can remove a bioburden with debridement, but again limited evidence.

Personally, I haven't used betadine for a long time. But when I did use it it was more as a wound flush, which I would follow up with saline.

The evidence that does exist points to a moist wound environment, pressure reduction (TCC best) and control of blood sugars etc.
NPWT and more recently in the vascularly compromised HBO also have an evidence base

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Stephen Tucker
Calvary Health Care

My location

I thought Flaminal had minimal impact upon fibroblasts. The below quote is from the following link: http://www.flaminal.co.uk/news.php

Happy to be corrected

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Stephen Tucker
Calvary Health Care

My location

Related thread:
Betadine and Diabetic Wounds

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so it looks like betadine is probably not a great option for ulcer esp long term use, is there any other topical prepartion that is ideal in preventing/ridding of infection?

No. They will all have their pros and cons, and you will need to use your clinical judgement. Pretty much all of the antiseptics can cause too much damage to the wound bed to be of any use, especially if used more than once.
Also preventing infection is quite different to ridding infection. A sterile dressing on a clean wound should prevent infection. And you need to definine infection, as a truely infected wound is best treated with systemic agents. A colinised wound though can sometimes benefit from local anti infectives, depending on the wound bed etc.

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Stephen Tucker
Calvary Health Care

My location

Thx for the clarification Stephen

This may make you laugh but I have personally seen Penaten heal diabetic ulcers in geriatrics when nothing else worked. " Penaten Cream is a softening cream infused with Zinc Oxide and Hamamelis Extract to help provide a soothing effect on the skin. How to use Apply to skin as required.Warnings: For... more >>"
Just thought I'd share.

I use betadine regularly, particularly on neuropathic wounds.

I work in a sub-tropical area. Infection is the enemy, not a few extra days of wound healing. One could argue that any foot inside a shoe is living in a sub/tropical environment.

Given I have already subjected the wound to serious physical insult via sharp debridement, splashing (liquid) betadine around is of little consequence in the big picture. Dont use ointment/cream - it just makes everything sloughy and too wet.

Treat it like an alternative to antibiotic prophylaxis. I think there is an inordinate amount of hysteria about it.

LL

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