Betadine and Laceration Repairs

Clinical question: Should Betadine (Povidone-Iodine) be used to clean the wound in an acute traumatic laceration repair?

Background: The use of betadine, either put within the saline irrigation solution or dabbed directly onto the wound, is a common practice seen in some emergency rooms for wound management and closure of acute traumatic lacerations.

Evidence:

  • Betadine has been shown in some studies to suppress bacterial growth on intact skin; however, Betadine has also been shown in other studies to reduce host defenses and increase bacterial growth in open wounds.  Therefore, an argument could be made that if used, it should only be used only on the wound edges and surrounding the wound, being careful not to get any in the wound itself1.
  • A recent literature review article in the “Journal of Advances in Skin & Wound Care” found that the benefits and risks of using Betadine for wound healing is still not well known with only a few studies done in animal and human models. No study has been able to demonstrate that Betadine has a statistically significant benefit when used for wound care but it was shown in 2 studies to be superior to saline without statistical significance2.
  • A prospective trial of 418 patients with hand lacerations were randomized to either receive routine repair with suture post irrigation or to have a Betadine spray administered to the wound and skin edges prior to closure. The patients were then followed up 7 days later to assess for wound healing and infection. The Betadine treated patients had slightly lower rates of infection and poor wound healing, but the difference was not found to be statistically significant3.
  • Another human study from 1990 compared the use of high-pressure irrigation with povidone-iodine 1% to irrigation with just normal saline. Wound infection rates were shown to be lower in the povidone-iodine group, but the difference was again not statistically significant. However the study was poorly designed with differences in time to irrigation and apparent contaminations of the wound prior to irrigation.  Also, two mice studies done in 1980 and 1995 had contrasting results. The study in 1995 showed that wounds treated with povidone-iodine ointment had reduced strength while the study in 1980 showed no change in tensile strength of the wound with use of povidone-iodine4.
  • Another prospective study looked at 500 patients with lacerations requiring suture repair in the emergency room. Patients were randomized to irrigation only versus irrigation and a scrub with a povidone-iodine 1% solution. The results showed that the Betadine treated group had purulent infections in 5.4% of the wounds while the non-treated group had 15.46% with purulent infections5. However, the study results are limited by the poor follow up of the study, with only slightly over half the patients having actual follow up to assess the wound.

Conclusions: The use of Betadine for wound irrigation and cleansing prior to closure for traumatic wounds is controversial and needs further research. Several studies showed no benefit to using Betadine with irrigation versus using solely high-pressure irrigation, suggesting that the use of Betadine is not supported by the evidence and should not be routinely used for acute traumatic wounds.

References:

  1. “Tintinalli’s Emergency Medicine: A comprehensive study guide.” 7th edition. Section 6; chapter 44, page 304.
  2. Wound cleaning and wound healing: a concise review.” Adv Skin Wound Care. 2013 Apr;26(4):160-3.
  3. “A prospective trial of prophylactic povidone iodine in lacerations of the hand.” J Hand Surg Br. 1985 Oct;10(3):370-4.
  4. “The cleansing of superficial traumatic wounds.” Br J Nurs. 2000 Oct;9(19 Suppl):S28, S30, S32 passim.
  5. “A trial of povidone-iodine in the prevention of infection in sutured lacerations.” Ann Emerg Med. 1987 Feb;16(2):167-71.

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