|Year : 1985 | Volume
| Issue : 1 | Page : 28-33
Dextranomer dressing in the treatment of infected wounds and cutaneous ulcers.
BG Parulkar, MK Sobti, DS Pardanani
B G Parulkar
|How to cite this article:|
Parulkar B G, Sobti M K, Pardanani D S. Dextranomer dressing in the treatment of infected wounds and cutaneous ulcers. J Postgrad Med 1985;31:28-33
|How to cite this URL:|
Parulkar B G, Sobti M K, Pardanani D S. Dextranomer dressing in the treatment of infected wounds and cutaneous ulcers. J Postgrad Med [serial online] 1985 [cited 2023 Feb 3 ];31:28-33
Available from: https://www.jpgmonline.com/text.asp?1985/31/1/28/5431
Cutaneous ulcers and infected wounds are common in clinical practice. Some of them are large lesions consisting of unhealthy granulation tissue, marked exudation, inflammatory oedema, necrosis and slough. There may be underlying diseases like malnutrition, hypoproteinemia, diabetes or uremia. A combination of above conditions causes delay in the normal healing process. Treatment of an ulcer consists of systemic administration of suitable antimicrobials and the application of local antiseptics and dressing. Inflammatory exudate, slough and necrotic tissue often prevent the access of local antiseptics to the floor of the ulcer, and the systemically administered antibiotics may not reach the infected area in sufficient concentration to be effective. Agents used locally to sterilize the area and to promote healing include acriflavin, glycerin magnesium-sulfate, hydrogen peroxide, eusol, cetrimide, povidone iodine as also the topical antibiotics such as neomycin and soframycin; the latter have the disadvantage of poor penetration coupled with sensitisation, dermatitis, development of resistant strains and delayed wound healing. An ideal wound dressing should absorb exudate and thereby remove bacteria, permit some evaporation of fluid, and either not be incorporated in the eschar or allow the eschar to be sufficiently fragile to allow its removal without jeopardising healing of the wound.
We describe in this paper the results of a new method of local treatment of ulcers arid infected wounds. The method consists of the use of dextranomer, a dextran polymer which is applied locally to the ulcer or the infected wound. Dextranomer is a sterile, insoluble powder in the form of circular beads, 0.1 to 0.3 mm in diameter, when dry. It is a long chain polysaccharide constructed in a three dimensional network of cross-linked dextran molecules. Dextranomer is highly hygroscopic due to its high hydroxyl group content and 1 g of it absorbs 4 ml of water and swells till it is saturated. The suction force generated in vitro is in the range of 200 mm Hg. The speed of this absorption is greater than the secretion by the wound. The microorganisms and high molecular weight substances which get confined to the interspaces move at a faster rate due to capillary action. All these substances migrate through the interspaces as the wound exudate is continually sucked up. Dextranomer does not react chemically with tissues and is nontoxic; so, there is no risk of sensitization or tissue damage.,
MATERIAL AND METHODS
Fifteen patients with infected wounds and cutaneous ulcers admitted in the K.E.M. Hospital, Bombay, were treated with local application of dextranomer. The patients received thorough general medical assessment. Cultures were taken from all lesions and suitable antiobiotics were given systemically when pathogenic bacteria were found. Nutritional supplements and proteins were provided. Diabetes was controlled with insulin. During treatment, patients were strictly kept off smoking. The part was given adequate rest. Excessive amounts of necrotic tissue and black eschar was excised prior to dextranomer therapy.
The area was washed thoroughly in running water and dried gently with a sterile absorbent gauze. The lesion was then covered with a thick layer of dextranomer, not less than 5 mm thick. The lesion was further covered with a dry absorbent gauze and dressed with a none too-occlusive rollar bandage dressing. Tight occlusive dressings were avoided so as to prevent maceration of the surrounding skin. In cases where the powder could not be kept in position in contact with the lesion, it was mixed with glycerin to make a thick paste before application. On saturation, the colourless dextranomer became greenish yellow. The dressings were changed when the superficial layers of dextranomer changed colour due to saturation. This had to be done 1 to 3 times a day, depending, upon the quantity of exudate and saturation of beads. The powder was easily rinsed from the ulcer without pain. If the powder is allowed to dry, it is known to form encrustations which makes removal difficult. The clinical findings concerning the lesions were carefully documented and the lesions were photographed serially.
Once the edema subsided and the slough lifted off, a healthy granulation was seen on the surface of the ulcer. The patients were then given glycerin-acriflavin dressings till the wound healed completely. [Table 1] to [Table 3] show the details of the 15 cases treated with dextranomer. Treatment with dextranomer was used for an average period of 8t days (range 3-19 days).
Of the 15 lesions treated in the series, 12 healed completely; 2 others who responded to the treatment satisfactorily were lost to follow-up; and one, a case of diathermy burns, was taken off the trial because the patient complained of increase in pain. Two patients had secondary suturing of the surgical wound and one was skin grafted at a suitable time after dextranomer treatment. The control of infection and the promotion of healing was seen in all cases.
The effect of dextranomer treatment on an infected, discharging wound was rapid and striking. The inflammatory reaction around the wound decreased remarkably during the first day, and within a few days healthy granulation tissue appeared. The most noticeable features were the disappearance of pain, edema and tenderness. During the treatment, the lesions became clean and odourless. Rapid epithelization set in, and the wound healed by secondary intention or was secondarily sutured or grafted. If necrotic tissue was present, it was debrided surgically before dextranomer was applied. Randomised controlled trials in other centres have proved the efficacy of dextranomer in infected wounds and cutaneous ulcers.,
The mechanism of action of dextranomer has been discussed in the literature. Dextranomer cleanses the lesion by absorbing the wound exudate, protein degradation products, prostaglandins, bacteria and other contaminants. This action reduces inflammation. In recent studies, it has been shown that dextranomer causes activation of alternative complement pathway (properdin pathway). The factors produced by the activation cause receptor mediated leucotaxis of both polymorphonuclear cells and mononuclear cells. By this action, it augments wound healing. The histopathological reports of punch biopsies of dextranomer treated wounds have shown inflammatory leukocytes at a more superficial level and unlike controls there was very little inflammation at the basal dermis. The wound edema decreases due to the hygroscopic action of dextranomer as well as the control of inflammation. Since it absorbs fibrin and degradation products from the lesion, the formation of crust is reduced and the wound remains soft and supple. It encourages healing by improving local blood supply and by keeping the lesion moist. It eliminates odours by removing degradation products and bacterial toxins. It does not cause sensitization since it is chemically inert and free from toxic effects. In a controlled study, total bacterial counts were seen to diminish at the wound surface when dexranomer was used.
In one patient with cautery burns on the thigh in this study, the pain actually increased on the application of dextranomer. The possible explanation is that the wound which was a dry, non-healing ulcer at the onset was dessicated due to hygroscopic dextranomer powder; a similar observation was made by Pace.
Thus, dextranomer is a useful wound healing agent. The properties of this substance fulfil some of the important requirements of an ideal agent which may be used locally for the treatment of an acute exudative ulcer or an infected wound. From our observations, it appears that the action of dextranomer was most evident in grossly infected and exudative lesions.
We thank the Dean, K.E.M. Hospital, Parel, Bombay, for his permission to carry out this work. We also thank Pharmacia International, Sweden, for the supply of dextranomer for this study.
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