Iodoform in Surgical Practice: A Comprehensive Review of Its Historical Evolution, Clinical Applications, and Safety...

Iodoform, a halogenated organic compound, has been a cornerstone in surgical practice due to its potent antiseptic and antimicrobial properties. This comprehensive review examines the historical evolution, mechanism of action, clinical applications, and safety profile of iodoform across various surgical disciplines. Historically significant formulations like Whitehead's varnish and bismuth iodoform paraffin paste (BIPP) demonstrated remarkable efficacy in wound healing during the late 19th and early 20th centuries. BIPP, extensively used for cavity packing, combines bismuth subnitrate for its antibacterial and astringent effects with paraffin to minimize tissue trauma. The antimicrobial action of iodoform is attributed to the release of iodine upon activation by free radicals, leading to the denaturation of bacterial proteins and cytotoxic effects on inflammatory cells, thereby enhancing therapeutic efficacy. Clinically, iodoform has diverse applications in ear, nose, and throat surgery, neurosurgery, oral and maxillofacial surgery, and general dental practice. It is utilized for dressing wounds, packing surgical cavities, and managing conditions such as nasal fractures, epistaxis, cerebrospinal fluid leaks, and dry sockets. The radiopacity of BIPP, due to its bismuth content, aids in radiographic identification but necessitates clear communication with radiologists to prevent misinterpretation. Despite its benefits, iodoform use is associated with potential complications. Bismuth and iodoform toxicities, though rare, can lead to neurotoxicity and systemic symptoms, requiring prompt recognition and intervention. Allergic reactions, particularly in patients with prior exposure, and dermatological side effects like dermatitis herpetiformis flare-ups have been documented. Mechanical complications and considerations during pregnancy, owing to the potential transfer of iodine to the fetus, highlight the need for cautious application. This review underscores the enduring significance of iodoform in surgical settings while emphasizing the importance of awareness regarding its potential risks. Careful clinical judgment and ongoing research are imperative to optimize its therapeutic benefits and enhance patient safety.