Now that you have completely pre-medicated for pain, completed a full wound assessment for inflammation versus infection, and collected any necessary tissue samples, you are ready to clean/debride the wound before dressing it.
Many experts agree that it is necessary to cleanse wounds at each dressing change to remove wound exudates, cellular waste, debris, bacteria, etc. (Doughty & McNichol, 2015). However, caution is warranted regarding the use of antimicrobial wound cleansers.
Cytotoxicity relates to a substance being toxic to human tissue cells. Cytotoxic wound cleansers will kill germs and kill healthy cells such as fibroblasts (white blood cells that manufacture collagen/new tissue) or epidermal keratinocytes (skin cells) (Doughty & McNichol, 2015). Also, many of these cleansers are antimitotic (they actually prevent cellular mitosis and regeneration), which is how some chemotherapy agents function to prevent cancer cell growth. While that may be a desirable trait for cancer treatment, it may not be desirable for a wound cleanser!
In most cases, wound experts recommend using water or saline to cleanse the wound. Some articles suggest potable tap water may be appropriate to cleanse a chronic wounds (Sibbald et al., 2021). However, it has been concluded that the decision to use tap water to cleanse wounds should consider the quality of water, nature of wounds, and the patient's general condition, including the presence of comorbid conditions (Gupta et al., 2017; Doughty & McNichol, 2015). Water must be potable for tap water to be considered for wound cleansing. Caution may be warranted for several reasons when considering tap water. It is not known if water used for wound cleansing vs. normal saline was tested for bacteria, cysts, fungi, or the presence of any other contaminants. If obtained from a well, tap water may contain contaminants such as bacteria or other contaminants undetectable to the human eye. Alternatively, "city water" is typically chlorinated at around three parts per million or 0.3mg/L and also typically contains fluoride (0.5mg/L to 1.0mg/L). Therefore, it is unknown what effect this may have on cellular activity in the wound bed (Gupta et al., 2017; Doughty & McNichol, 2015).
An exception to using cytotoxic wound cleansers is when the benefits outweigh the risks. For instance, in the case of localized bacterial invasion in which the host is unable to overcome the bioburden of the infecting organism(s) with its immune defenses (such as pseudomonas aeruginosa infection resulting in further wound deterioration), the fibroblasts and epidermal keratinocytes are not likely to survive this hostile wound environment anyway. Therefore, it may justify using a short-term application of cytotoxic wound cleanser, such as a dilute Dakin's Solution (sodium hypochlorite) long enough to eradicate the infecting organisms (Gupta et al., 2017; Doughty & McNichol, 2015). Yes, this is likely to impair cellular function temporarily. Still, the infecting organisms would do far worse if you did not address/control them. Once the wound is "cleaned up" (perhaps for even a few weeks), you should return to non-cytotoxic moist wound healing principles for wound care.