Wound infections represent a persistent challenge in clinical practice, contributing to delayed healing, increased healthcare costs, and greater patient morbidity. The global rise in antimicrobial resistance has renewed interest in topical antiseptics as adjuncts to standard wound care. Octenidine dihydrochloride (OCT), a bispyridine-type cationic surfactant, has emerged as a promising agent owing to its broad-spectrum antimicrobial activity, rapid action, and minimal potential for resistance development. This review critically examines the current evidence on the use of octenidine in wound management. We discuss its mechanism of action, which involves disruption of microbial membranes and biofilms, and highlight its applications across acute and chronic wound types. Comparative studies evaluating octenidine against other antiseptics and standard solutions suggest its effectiveness, particularly in complex and critically colonised wounds. Octenidine’s favourable safety profile, with low cytotoxicity and minimal systemic absorption, supports its use even in vulnerable populations such as neonates and pregnant women. Future research is needed to define further its role within standardised wound care protocols and antimicrobial stewardship strategies.