Does A New Cellulose Dressing Have Potential In Chronic Wounds?

By Barbara J. Aung, DPM

We have all heard about the concept of moist wound healing. We know that the right moisture balance is critical to the healing of chronic wounds because it promotes a healthy wound environment. We have modalities such as hydrogels and hydrocolloids, as well as normal saline and gauze. The latter is becoming antiquated but nonetheless continues to support the theory of moist wound healing principles. The new modality to emerge in wound care is the XCell® Cellulose Wound Dressing (Xylos Corporation). This product reportedly provides both hydration and absorption to achieve the moisture balance that wounds require for optimal healing. XCell is derived from a new technological process. The product is comprised of biosynthesized cellulose which is produced in a liquid media during a static fermentation process. Cellulose is one of the most abundant natural biopolymers and is synthesized by many organisms, including multicellular plants, unicellular plants and bacteria. The organism in this fermentation process is the Acetobacter species, which takes in sugar molecules and polymerizes them into distinct microfibrils excreted through the organism’s cell wall. This same bacteria is also used in the manufacturing of natural vinegar. The cellulose film is generated on the liquid surface during fermentation, and the length of the fermentation process determines the thickness and amount of the material formed. These sheets of cellulose are called a pellicle. The cellulose pellicle contains 99 percent fluid and 1 percent solid. The bacteria cells that produce the cellulose are removed by a series of chemical washes without disrupting the existing cellulose matrix. This biosynthesized cellulose is about 200 times smaller than the cellulose from multicellular plants (trees and cotton), giving it a natural high fluid holding capacity and tensile strength. It also has shape retention superior to many synthetic fibers so you can form or cut the material into virtually any size or shape. Assessing The Indications And Possible Impact Of The Dressing The XCell Wound Dressing is available in 3.5-inch and 5.5-inch square pads, a larger 6- by 7-inch sacral pad and in a rope form. It comes individually in a single use sterile pouch. The indications for this product include autolytic debridement, exudate absorption and tissue hydration. You can leave it in place for up to seven days. The non-adherent nature of the dressing allows for painless dressing changes with little to no disruption of new granulation tissue within the wound bed. The features of this dressing may simplify the complex process of dealing with chronic wounds at the clinic level. This dressing may facilitate an easier dressing change and possibly less of them. If we can reduce the amount of materials needed, reduce the frequency of dressing changes and make it easier for patients to make the dressing change themselves, it can certainly reduce the cost of caring for these chronic wounds. Using the dressing may also reduce or eliminate the cost of home care nursing. However, keep in mind that when you use XCell, you do need to use a secondary dressing whether it’s a thin film or gauze and Kling. XCell is also now available with antimicrobial properties. What Clinical Testing Has Revealed About Cellulose Products There have been several publications about the use of biosynthesized cellulose products as a temporary skin substitute. One of the latest articles on biosynthesized cellulose illustrates its use as a permanent implantable patch for neurosurgical applications for repairing dura mater. The preclinical animal testing and biocompatibility testing have shown no evidence of delayed dermal contact sensitization in the guinea pigs, and there was no evidence of significant irritation or toxicity when it was injected subcutaneously into rabbits. The cytotoxicity of the dressing with mammalian cells showed no cytotoxicity and did not inhibit cell growth. The cellulose wound dressing successfully passed all of these tests, ensuring that the product is biocompatible, safe and will not inhibit wound healing. During human clinical trials, the cellulose wound dressing exhibited strength in removing slough necrosis in deep pressure ulcers. It also reduced the hypergranulation tissue down to the level of the surrounding epithelium.

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