A collaborative study with Harvard Medical School
VENOUS LEG ULCER
MaxioCel - 100% Chitosan Wound Dressing on Venous Leg Ulcer
Center
Rajalakshmi Clinic, Bangalore-India: Dr. Vivekananda
Wound before using Maxiocel
Using Maxiocel on the wounds
Wound improvement after 2 weeks
Patient details:- 61 years , Male
Diabetes:- No
Nicotine Consumption:- No
Localized Infection:- Yes
Nutritional Status:- Well-nourished
Co-morbidities:- Immuno-compromised
Previous Medication:- Immunotherapy
Wound History:- Patient suffering from Multiple Foot Ulcers for more than 1 year (Chronic) Ulcers were on both foot which measured 60mm X 40mm X 5mm (length X width X depth) Patient was being treated with collagen dressings with high pain score
Initial wound bed evaluation
| Infection (Local Factors) | Yes | No |
| Exudate | ✓ | |
| Erythema | ✓ | |
| Malodorous | ✓ | |
| Pain | ✓ | |
| Oedema | ✓ |
| Exudate | Dry | Low | Medium | High |
| Levels | ✓ |
| Exudate | Watery | Cloudy | Thick | Purulent | Red |
| Type | ✓ |
Tissue type
Wound management goals
| Parameters | Yes | No |
| Debridement | ✓ | |
| Infection Prevention | ✓ | |
| Exudate Management | ✓ | |
| Optimum Moisture Maintenance | ✓ | |
| Protect granulation tissue / Epithelializing tissue | ✓ |
End Report
| No of MaxioCel dressings done | 2 |
| Frequency of MaxioCel dressings | Alternate days |
| MaxioCel Variant used | 10cm X 10cm |
| Final day wound condition | At the end of 2 weeks, there was desloughing and wound was granulated |
Result
| Patient Outcome with Maxiocel | Ease of Application/Removal | Antimicrobial barrier | Wound adherence | Conformability | Wound scar improvement | Pain management |
| Excellent | ✓ | ✓ | ✓ | ✓ | ✓ | |
| Good | ✓ | |||||
| Fair | ||||||
| Poor |
Discussion
- Venous leg ulcers (VLUs) are defined as open lesions between the knee and ankle joint that occur in the presence of venous disease. They are the most common cause of leg ulcers, accounting for 60-80% of them. The prevalence of VLUs is between 0.18% and 1%. Over the age of 65, the prevalence increases to 4%. On average 33-60% of these ulcers persist for more than 6 weeks and are therefore referred to as chronic VLUs.*
- Maxiocel is a non-woven microfibre dressing made up of 100% Chitosan, is a highly absorbent antimicrobial dressing with pain reduction and scar improvement properties. It can be used for moderate to heavily exuding wounds of varied depth,
shape and size. - Overall, Maxiocel was also found to be an excellent chitosan wound dressing in patients suffering from Venous Leg Ulcers.
MAXIOCEL - 100% CHITOSAN
WOUND DRESSING ON ARTERIAL ULCERS
Center
Safdarjung hospital, Delhi-India: Dr. Deepak
| Patient details | 37 years , Male |
| Diabetes | No |
| Nicotine Consumption | Yes |
| Localized Infection | Yes |
| Nutritional Status | Well - nourished |
| Co-morbidities | None |
| Previous Medication | None |
| Wound History | Patient suffering from Leg Ulcers (above ankle) for 5 months Ulcers were on the foot measured 2.5cm X 1.5cm X 0.5cm (length X width X depth) Patient was in extreme pain and did not accept any treatment |
Initial wound bed evaluation
| Infection (Local Factors) | Yes | No |
| Exudate | ✓ | |
| Erythema | ✓ | |
| Malodorous | ✓ | |
| Pain | ✓ | |
| Oedema | ✓ |
| Exudate | Dry | Low | Medium | High |
| Levels | ✓ |
| Exudate | Watery | Cloudy | Thick | Purulent | Red |
| Type | ✓ | ✓ |
Wound before using Maxiocel
Using Maxiocel on the wounds
Wound improvement after 2 weeks
Tissue type
Wound management goals
| Parameters | Yes | No |
| Debridement | ✓ | |
| Infection Prevention | ✓ | |
| Exudate Management | ✓ | |
| Optimum Moisture Maintenance | ✓ | |
| Protect granulation tissue / Epithelializing tissue | ✓ |
End Report
| No of MaxioCel dressings done | 4 |
| Frequency of MaxioCel dressings | Twice a week |
| MaxioCel Variant used | 2.5cm X 30cm |
| Final day wound condition | At the end of 2 weeks, there was epithelization and scar improvement |
Result
| Patient Outcome with Maxiocel | Ease of Application/Removal | Antimicrobial barrier | Wound adherence | Conformability | Wound scar improvement | Pain management |
| Excellent | ✓ | ✓ | ✓ | |||
| Good | ✓ | ✓ | ✓ | |||
| Fair | ||||||
| Poor |
Discussion
- Arterial ulcers (AUs) are defined as open lesions between the knee and ankle joint that occur in the presence of venous disease.
- They are the most common cause of leg ulcers, accounting for 60-80% of them. The prevalence of AUs is between 0.18% and 1%. Over the age of 65, the prevalence increases to 4%. On an average 33-60% of these ulcers persist for more than 6 weeks and are therefore referred to as chronic AUs.*
- Maxiocel is a non-woven microfibre dressing made up of 100% Chitosan, is a highly absorbent antimicrobial dressing with pain reduction and scar improvement properties. It can be used for moderate to heavily exuding wounds of varied depth, shape and size.
- Overall, Maxiocel was also found to be an excellent chitosan wound dressing in patients suffering from Venous Leg Ulcers
MAXIOCEL - 100% CHITOSAN
WOUND DRESSING ON POST-TRAUMATIC LEG ULCERS
Center
Safdarjung hospital, Delhi-India: Dr. Deepak
| Patient details | 26 years , Male |
| Diabetes | No |
| Nicotine Consumption | Yes |
| Localized Infection | Yes |
| Nutritional Status | Malnourished |
| Co-morbidities | None |
| Previous Medication | The patient was not taking any medication |
| Wound History | Patient suffering from Venous Leg Ulcers (in the ankle) for 2 months (Chronic) Ulcers on the ankle measured 5cm X 3cm X 0.5cm(length X width X depth) |
Initial wound bed evaluation
| Infection (Local Factors) | Yes | No |
| Exudate | ✓ | |
| Erythema | ✓ | |
| Malodorous | ✓ | |
| Pain | ✓ | |
| Oedema | ✓ |
| Exudate | Dry | Low | Medium | High |
| Levels | ✓ |
| Exudate | Watery | Cloudy | Thick | Purulent | Red |
| Type | ✓ |
Wound before using Maxiocel
Using Maxiocel on the wounds
Wound improvement after 2 weeks
Tissue type
Wound management goals
| Parameters | Yes | No |
| Debridement | ✓ | |
| Infection Prevention | ✓ | |
| Exudate Management | ✓ | |
| Optimum Moisture Maintenance | ✓ | |
| Protect granulation tissue / Epithelializing tissue | ✓ |
End Report
| No of MaxioCel dressings done | 4 |
| Frequency of MaxioCel dressings | Twice a week |
| MaxioCel Variant used | 10cm X 10cm |
| Final day wound condition | At the end of 2 weeks, there was epithelization and scar improvement |
Result
| Patient Outcome with Maxiocel | Ease of Application/Removal | Antimicrobial barrier | Wound adherence | Conformability | Wound scar improvement | Pain management |
| Excellent | ✓ | |||||
| Good | ✓ | ✓ | ✓ | ✓ | ✓ | |
| Fair | ||||||
| Poor |
Discussion
- Post-traumatic leg ulcers (TLUs) are defined as open lesions between the knee and ankle joint that occur in the presence of venous disease. They are the most common cause of leg ulcers, accounting for 60-80% of them. The prevalence of TLUs is between 0.18% and 1%. Over the age of 65, the prevalence increases to 4%. On an average 33-60% of these ulcers persist for more than 6 weeks and are therefore referred to as chronic TLUs.*
- Maxiocel is a non-woven microfibre dressing made up of 100% Chitosan, is highly absorbent antimicrobial dressing with pain reduction and scar improvement properties. It can be used for moderate to heavily exuding wounds of varied depth, shape and size.
- Overall, Maxiocel was also found to be an excellent chitosan wound dressing in patients suffering from Venous Leg Ulcers
MAXIOCEL – 100% CHITOSAN WOUND DRESSING ON
FEMORAL DEEP VEIN THROMBOSIS
Center
INDO VASC Hospital , Ahmedabad-Iindia: Dr. Srujal Shah
| Patient details | 65 years , Female |
| Comorbidities | Diabetes & Hypertension |
| Patient symptoms | Patient suffering from extreme pain and exudating wounds |
| Diagnostic Evaluation | Stage 1 – Emergency IVC filter placement. Stage 2 – Open Venous Thrombectomy Stage 3 – Wound debridement for dead ischemic calf muscles Stage 4 – VAC Therapy for large calf wound Stage 5 – Suturing under LA with drain |
| Confirmed | Massive ilio femoral DVT presented as phlegmesia cerulea dolens |
| No of Maxiocel used & Duration | 4 Maxiocel ; results received in 2 weeks |
Wound before using Maxiocel
Woundafter using Maxiocel and
complete healing seen
Result
| Patient Outcome with Maxiocel | Ease of Application/Removal | Antimicrobial barrier | Wound adherence | Conformability | Wound scar improvement | Pain management |
| Excellent | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Good | ||||||
| Fair | ||||||
| Poor |
Discussion
- Venous thromboembolism (VTE) is the most serious and potentially fatal complication that can arise from DVT. Venous conditions are implicated in compromised wound healing. Postthrombic syndrome is caused by persistent outflow occlusion, scarred or incompetent valves, and dependent positioning of lower extremities. Both venous ulceration and chronic venous insufficiency are exacerbated by increased venous hypertension; thus, often postthrombotic syndrome is demonstrated even in the absence of DVT Consequently, patients with venous ulcers should have their venous disease carefully evaluated to determine if past or present increased venous hypertension is contributing to delayed healing. One study demonstrated the most important factor affecting ulceration and ambulatory venous pressure in post DVT patients was valvular incompetence. Ulceration did not occur in patients with persistent occlusion and competent valves. Similar findings of the importance of valvular competence were reported in another study assessing long-term sequelae of DVT. Because 80% to 85% of all leg ulcers are associated with venous hypertension, compression and leg elevation remain key factors in alleviating symptoms and promoting healing.
- MaxioCel is a non-woven microfibre dressing made up of 100% Chitosan, is highly absorbent antimicrobial dressing with pain reduction and scar improvement properties. It can be used for moderate to heavily exuding wounds of varied depth, shape and size.
- Overall, MaxioCel was also found to be an excellent chitosan wound dressing in patients suffering from Femoral DVT
MAXIOCEL – 100% CHITOSAN WOUND DRESSING ON
DIABETIC FOOT INFECTION ( AMPUTATION )
Center
INDO VASC Hospital , Ahmedabad-India: Dr. Srujal Shah
| Patient details | 45 years , Male |
| Comorbidities | Diabetes & Hypertension |
| Patient symptoms | K/c/o DM, uncontrolled |
| Diagnostic Evaluation | Presented with DFI involving right great toe with exposed tendon and osteomyelitis of phalangeal bones. Vascularity was normal. |
| Confirmed | Severe diabetic foot infection |
| No of Maxiocel used & Duration | 5 Maxiocel ; results received in 2 weeks |
Course of wound healing with Maxiocel over 2 weeks
Result
| Patient Outcome with Maxiocel | Ease of Application/Removal | Antimicrobial barrier | Wound adherence | Conformability | Wound scar improvement | Pain management |
| Excellent | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Good | ||||||
| Fair | ||||||
| Poor |
Discussion
- The management of DFI includes wound debridement and drainage, antimicrobial therapy, pressure offloading, and appropriate wound dressing as the mainstays of treatment. Additionally, providing coordinated management which utilizes multidisciplinary foot teams consisting of a diabetologist, an infectious disease specialist, a surgeon, a podiatrist, and other specialists with skills relevant to managing DFI has been shown to improve outcomes.1,8 Even with current treatment, diabetic foot ulcers are still a leading cause for amputation, accounting for approximately 85% of all lower extremity amputation cases, with the presence of infection increasing the chance for amputation by 50% compared to patients with uninfected foot ulcers.
- MaxioCel is a non-woven microfibre dressing made up of 100% Chitosan, is highly absorbent antimicrobial dressing with pain reduction and scar improvement properties. It can be used for moderate to heavily exuding wounds of varied depth, shape and size.
- Overall, MaxioCel was also found to be an excellent chitosan wound dressing in patients suffering from Femoral DVT
MAXIOCEL – 100% CHITOSAN WOUND
DRESSING ON MULTIPLE CHRONIC VENOUS ULCERS
Center
INDO VASC Hospital, Ahmedabad-India: Dr. Srujal Shah
| Patient details | 92 years , Female |
| Comorbidities | Diabetes & Hypertension |
| Patient History | Chronic Venous Insufficiency (CVI) & multiple bilateral Chronic Venous Ulcers (Since 3 years) |
| Patient symptoms | Patient suffering from extreme pain and exudating wounds |
| Diagnostic Evaluation | Venous doppler |
| Confirmed | Old, recanalized DVT & Venous hypertension |
| Wound Size & Wound Desicription | 6 cm x 10 cm ; 5 cm x 5 cm ; 3 cm x 3 cm Pale granulation and minimal slough |
Venous ulcer before use of wound dressing
Application of chitosan wound dressing
Complete wound healing within four weeks
Result
| Patient Outcome with Maxiocel | Ease of Application/Removal | Antimicrobial barrier | Wound adherence | Conformability | Wound scar improvement | Pain management |
| Excellent | ✓ | ✓ | ✓ | ✓ | ✓ | |
| Good | ✓ | |||||
| Fair | ||||||
| Poor |
Discussion
- Considering old age, poor nutrition and immobility it was decided to go for medical management and start skin grafting.
- Wound management started with Chitosan Wound Dressing along with compression bandages.
After the first dressing there was significant reduction in pain. - After 5 days, there was an improvement in the wound site with reduced secretion and pink granulation.
- Complete wound healing was achieved with 6 dressings. (4 weeks)
- Significant patient satisfaction and reduced pain score.
- Overall, Maxiocel was also found to be an excellent wound dressing in patients with Chronic Venous Insufficiency and Bleeding wounds
BURN CAUSED BY HOT WATER,
TREATED WITH SCARLESS SOLUTION
May 1st 06
June 2nd 06
SUPERFICIAL BURN WITH STEAM TREATED
WITH SCARLESS SOLUTION
FROM 21 TO 24 JANUARY 2006
BURN CAUSED BY STEAM CAR RADIATOR
TREATED WITH SCARLESS SOLUTION
FROM APRIL 10 TO MAY 06, 2005
BURNS CAUSED BY MILK
TRAITED WITH SCARLESS SOLUTION
FROM 5 AGUST14 APRIL 2006.
5 April 06
9 April 06
14 April 06
13 May 06
BRULURE CAUSEE PAR DE L’HUILE CHAUDE
TRAITEE AVEC SCARLESS SOLUTION
12 AU 25 APRIL 2006.
12 0ctober 06
25 0ctobre 06
30 Octobre 06
04 March 07
MAXIOCEL-100% CHITOSAN WOUND DRESSING ON
ISCHEMIC WOUND (LEG ULCER)
Center
Manipal Hospital, Bangalore-India: Dr. Venkatesh Reddy
| Patient details | 26 years , Male |
| Diabetes | No |
| Nicotine Consumption | No |
| Localized Infection | Yes |
| Nutritional Status | Malnourished |
| Co-morbidities | None |
| Previous Medication | 6 months localised treatment with gauze and saline along with compression bandages |
| Wound History | Patient suffering from Chronic Ischemic ulcer located on left leg (Anterior Tibia area), wound edges attached, measurements being 15cmx4cmx0.5cm (lengthxwidthxdepth) |
Initial wound bed evaluation
| Infection (Local Factors) | Yes | No |
| Exudate | ✓ | |
| Erythema | ✓ | |
| Malodorous | ✓ | |
| Pain | ✓ | |
| Oedema | ✓ |
| Exudate | Dry | Low | Medium | High |
| Levels | ✓ |
| Exudate | Watery | Cloudy | Thick | Purulent | Red |
| Type | ✓ |
Wound before MaxioCel treatment
Wound improvement after 8 days
Tissue type
Wound management goals
| Parameters | Yes | No |
| Debridement | ✓ | |
| Infection Prevention | ✓ | |
| Exudate Management | ✓ | |
| Optimum Moisture Maintenance | ✓ | |
| Protect granulation tissue / Epithelializing tissue | ✓ |
End Report
| No of MaxioCel dressings done | 4 |
| Frequency of MaxioCel dressings | Alternate days |
| MaxioCel Variant used | 10x05cm (2 units per dressing) |
| Final day wound condition | No signs of localised infection in wound, granulated with early signs of epithelialization without scarring |
Result
| Patient Outcome with Maxiocel | Ease of Application/Removal | Antimicrobial barrier | Wound adherence | Conformability | Wound scar improvement | Pain management |
| Excellent | ✓ | ✓ | ✓ | ✓ | ||
| Good | ✓ | ✓ | ||||
| Fair | ||||||
| Poor |
Discussion
- Ischemic ulcers (wounds) can occur when there is poor blood flow in your legs. Ischemic means reduced blood flow to an area of the body. Poor blood flow causes cells to die and damages tissue. Most ischemic ulcers occur on the feet and legs. These types of wounds can be slow to heal.
- The shown patient has had multiple digit amputations in the past and was undergoing treatment with saline and gauze dressings from the past 6 months.
- MaxioCel treatment was initiated and within 4 dressings(alternative days), significant improvements were seen.
- The treatment was continued at a local clinic and the ulceration has healed completely with no signs of Scarring.
MAXIOCEL-100% CHITOSAN WOUND DRESSING ON
PLANTAR SURFACE WOUND
Center
Manipal Hospital, Bangalore-India: Dr. Venkatesh Reddy
| Patient details | 62 years , Male |
| Diabetes | Yes |
| Nicotine Consumption | No |
| Localized Infection | Yes |
| Nutritional Status | Well nourished |
| Co-morbidities | None |
| Previous Medication | Diabetic medication from 10 years, localised treatment with Saline and Gauze from past 3 months |
| Wound History | 3 month old non healing chronic ulcer on left leg palm and metatarsal area, measurements being 6cmx3cmx0.5cm (Lengthxwidthxdepth) |
Initial wound bed evaluation
| Infection (Local Factors) | Yes | No |
| Exudate | ✓ | |
| Erythema | ✓ | |
| Malodorous | ✓ | |
| Pain | ✓ | |
| Oedema | ✓ |
| Exudate | Dry | Low | Medium | High |
| Levels | ✓ |
| Exudate | Watery | Cloudy | Thick | Purulent | Red |
| Type | ✓ |
Wound before MaxioCel treatment
Wound after 12 days of MaxioCel treatment
Tissue type
Wound management goals
| Parameters | Yes | No |
| Debridement | ✓ | |
| Infection Prevention | ✓ | |
| Exudate Management | ✓ | |
| Optimum Moisture Maintenance | ✓ | |
| Protect granulation tissue / Epithelializing tissue | ✓ |
End Report
| No of MaxioCel dressings done | 6 |
| Frequency of MaxioCel dressings | Alternate days |
| MaxioCel Variant used | 10x05cm (2 units per dressing) |
| Final day wound condition | Granulated wound progressing towards epithelialisation, no signs of localised infection. |
Result
| Patient Outcome with Maxiocel | Ease of Application/Removal | Antimicrobial barrier | Wound adherence | Conformability | Wound scar improvement | Pain management |
| Excellent | ✓ | ✓ | ✓ | ✓ | ||
| Good | ✓ | ✓ | ||||
| Fair | ||||||
| Poor |
Discussion
- Increased plantar pressures and associated ulcers need to be treated by off-loading of the plantar surface. Useful off-loading mechanisms include reduction of walking speed, alteration of foot rollover during gait, and transfer of load from affected areas to other areas of the foot or the lower leg. These plantar off-loading mechanisms could result in an optimization of treatment.
- Wound treatment was done using MaxioCel for a period of 12 days, 6 dressings were done on alternative days. The wound circumference was significantly reduced along with healthy granulation.
- Overall, MaxioCel was found to be an excellent wound dressing in patients suffering from plantar surface wounds.
MAXIOCEL-100% CHITOSAN WOUND DRESSING IN A
BREAST CAVITY WOUND AFTER ABSCESS REMOVAL
Center
Sai Shradha Hospital, Mumbai – India: Dr.J.S.Majithia
| Patient details | 29 years , Female |
| Diabetes | Yes |
| Nicotine Consumption | No |
| Localized Infection | Yes |
| Nutritional Status | Well nourished |
| Co-morbidities | None |
| Previous Medication | Treatment-Saline and Hydrogen peroxide with gauze dressings |
| Wound History | 7 days old cavity wound in right breast with measurements being L=30mm ,D= 80mm ,W= 40mm, high exudation after removal of breast abscess , pain score were high throughout the week. |
Initial wound bed evaluation
| Infection (Local Factors) | Yes | No |
| Exudate | ✓ | |
| Erythema | ✓ | |
| Malodorous | ✓ | |
| Pain | ✓ | |
| Oedema | ✓ |
| Exudate | Dry | Low | Medium | High |
| Levels | ✓ |
| Exudate | Watery | Cloudy | Thick | Purulent | Red |
| Type | ✓ |
Wound before using Maxiocel
Using Maxiocel on the wounds
Wound improvement after 4 dressings
Tissue type
Wound management goals
| Parameters | Yes | No |
| Debridement | ✓ | |
| Infection Prevention | ✓ | |
| Exudate Management | ✓ | |
| Optimum Moisture Maintenance | ✓ | |
| Protect granulation tissue / Epithelializing tissue | ✓ |
End Report
| No of MaxioCel dressings done | 4 |
| Frequency of MaxioCel dressings | Daily |
| MaxioCel Variant used | MX2530 |
| Final day wound condition | Final day wound condition –Pain managed, Cavity size significantly reduced as wound is granulating, exudate levels reduced by 70% |
Result
| Patient Outcome with Maxiocel | Ease of Application/Removal | Antimicrobial barrier | Wound adherence | Conformability | Wound scar improvement | Pain management |
| Excellent | ✓ | ✓ | ✓ | |||
| Good | ✓ | ✓ | ✓ | |||
| Fair | ||||||
| Poor |
Discussion
- Most breast abscesses occur as a complication of mastitis, a bacterial infection that causes the breast to become red and inflamed.
- Mastitis usually affects breastfeeding women, but it can sometimes occur in women who are not breastfeeding.
- Small breast abscesses can be drained using a needle and syringe. For larger abscesses, a small incision may be needed to drain the pus.
- In the shown case, the patient was suffering with a deep cavity wound in the right breast with high levels of discomfort due to increased pain score and delayed healing post breast abscess removal.
- MaxioCel rope variant was used for the treatment regime and within 4 dressings over a period of 8 days lead to significant reduction in wound size, wound exudates as well as pain scores