A wound is the aftermath to an injury to a tissue or membrane in the body, and open wounds involve a breakage in the skin. These can be caused by any kind of accidental incident or diabetic foot ulcers, bed sores, venous leg ulcers etc. 

Wound infection

An open injury on the surface of the skin is susceptible to microbial infection if left exposed or untreated. Bacteria and fungi can enter the wound from the surrounding skin or the environment and begin to multiply.

The risk of infection can become higher with larger expose to foreign objects. For example, if the wound is very deep, or has been caused by an animal bite or if it is an injury from a rusty or germ ridden object, the chances of bacteria entering the site of injury increases like in tetanus disease. Other risk factors can include co-morbidities like diabetes, obesity, immune system issues like HIV, nutritional deficiencies, or long hours of immobility in the person’s daily routine.

How to recognize wound infection?

It is extremely important to consult a doctor when you incur a skin injury, especially if you are someone with co-morbidities like diabetes. In case of deep or large wounds, the chances of infection or complications are high, and all caution must be taken to aid wound healing.

Here are a few basic signs to look out for to determine wound infection:

• Discharge of pus from the wound site
• Pain or tenderness around the wounded area
• Swelling, redness and/or heat
• Healing taking much more time than normal
• Foul smell emanating from the wound
• Discoloration of the tissue surrounding the wound

Wound healing

Irrespective of how one incurs the wound, healing is extremely important to ensure good health. Based on the timeline of healing, wounds can be sub-divided into acute and chronic wounds.

• Acute wounds: The timeline of healing for these wounds follows a normal schedule across each stage of the healing process. They usually do not have complications and show signs of healing within one and four weeks.
• Chronic wounds: A wound that does not progress positively and on time through the stages of healing is known as a chronic wound. These do not heal completely up to 4 weeks of wound care treatment. When it is not healed even within two months of treatment, then it is referred to as a chronic wound.

Preventing infection in open wounds

A deep or open wound is highly susceptible to microbial infection if not attended to properly. Here are a few things you can to prevent infection in an open injury or wound:

• Wash your hands with clean water and soap before attending to the wound care.
• If you need to use any equipment like tweezers, ensure that they are clean and sterilized using rubbing alcohol (70% IPA).
• Clean the wounded area with warm water.
• If there is any object at the wound site like pieces of glass, remove gently.
• You can apply an antimicrobial wound gel or ointment or powder on the wound, but only on the advice of a doctor.
• Let the wound air dry and then apply a suitable dressing that helps in wound healing.

Taking care of chronic wounds can be a bit complicated as they require long-term medical attention. Although day-to-day care can be done at home, however, caregivers must be especially careful to ensure that the physician’s instructions are followed, and the patient does not experience much discomfort.

Antimicrobial dressings for wound healing

In the event that your wound gets infected, your doctor may advise the use of anti-microbial wound dressings to aid healing. This kind of a dressing can help in the healing process because of the following properties:

• Providing a moist environment that aids the healing process.
• Providing a physical barrier against attack of microbes and their growth
• Providing anti-microbial agents like antiseptics to heal on-going infection at the wound site.

A few commonly used anti-microbial dressings include:

• Chitosan based dressings: Chitosan is a natural biopolymer derived from the shellfish mainly. It offers effectiveness against a large variety of bacteria and fungi, and can act on the micro-organism in both intracellular and extracellular ways. Positively charged chitosan binds to negatively charged cell wall of microorganisms which results in the leakage of proteinaceous and other intracellular constitutes. Chitosan inhibits the mRNA and protein synthesis via the penetration into the nuclei of microorganisms. It can be infused in to a wide range of dressings materials used for wound healing like hydrogels, microfibers, nanofibers,  sponges, foams and composite dressings. Chitosan based dressings are known to be highly effective in healing chronic wounds, first and second degree burns, ulcers and wounds with high risk of infection. The risk of antimicrobial drug resistance is not applicable to chitosan which provide additional benefits in safety profile for next generation wound dressing.

• Biguanide based dressings: Wound dressings infused with polyhexamethylene biguanide (PHMB) is effective in preventing as well as healing infection caused by a wide range of bacteria and some fungi. The mechanism of antimicrobial action of PHMB is also based on electrostatic interaction like chitosan. PHMB is known to be effective for reducing wound pain and act as surfactant to provide wound cleansing efficacy.

• Silver based dressings: Dressings in the form of hydrocolloids, hydrofibres, or foam that are impregnated with Silver are effectively used for treatment of burns, surgical wounds, ulcers and chronic wounds. Silver has strong antimicrobial properties and is useful against a large range of bacterial species, including drug-resistant bacteria. It helps kill bacteria and prevent its proliferation, while protecting the human tissue
• Iodine based dressings: Iodine is useful in the treatment of chronic wounds and is effective against a large variety of bacteria, fungi, viruses, fungi, amoebic cysts, etc. It also possesses anti-inflammatory properties and offers good exudate absorption.

Chitosan in wound dressings

Chitosan is derived from Chitin, a second most abundantly available natural polymer after cellulose, and is found in the exoskeleton of shellfish such as crabs and shrimps, and in the cell membranes of fungi, yeasts, and other microorganisms.

The antimicrobial properties of chitosan can be attributed to the binding of its positively charged molecules to the negatively charged microbial cell membranes, which leads to the disruption of the microbial membrane, and subsequently the leakage of proteinaceous and other intracellular constituents. It also offers pain relief by reducing the concentration of inflammatory mediators (bradykinin) at site of injury. It is also highly effective for scar prevention.

Chitosan aids wound healing through many pathways like: polymorphonuclear cell activation, fibroblast activation, cytokine production, giant cell migration and stimulation of type IV collagen synthesis.

The effectiveness of chitosan against bacteria can be attributed to its polycationic form, which shows anti-microbial activity against both Gram positive and Gram negative bacteria, with different action based on the bacterial cell membrane structure. In the former, the chitosan interacts with the organism’s cell wall layer with the negative charges of peptidoglycan teichoic acids. In the latter, chitosan interacts with the anionic structures present on the surface like the lipopolysaccharides and proteins.

Maxiocel – advanced wound care

Choosing the right kind of wound dressing is very important for healing of chronic wounds. MaxioCel is a highly absorbent wound dressing, designed to heal patients suffering from chronic wounds by effectively managing exudate, pain relief and scar improvement. MaxioCel can be used for moderate to heavily exudating wounds of varied depth, shape, and size.

It has been tested for bactericidal effects (>99.99 % reduction) against most common pathogenic bacteria responsible for wound infections, like Staphylococcus aureus,  Pseudomonas aeruginosa, Streptococcus species, MRSA etc. It also shows activity against drug-resistant bacteria, especially with infected wounds that are often difficult to heal. No other marketed chitosan dressing has been reported to have antimicrobial efficacy against drug-resistant bacteria.

MaxioCel has properties of bacterial sequestration, offering barrier against bacteria, trapping cellular debris and microbes within its gel network, preventing bacterial spread and promoting autolytic debridement. This ensures a clean environment for optimal healing. 

To know more, reach out to us at: info@axiobio.com