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Drugs

, Volume 18, Issue 2, pp 89–102 | Cite as

Dextranomer: A Review of its General Properties and Therapeutic Efficacy

  • R. C. Heel
  • P. Morton
  • R. N. Brogden
  • T. M. Speight
  • G. S. Avery
Evaluations on New Drugs

Summary

Synopsis: Dextranomer1 is a hydrophilic dextran polymer advocated as a ‘cleansing agent’ for various types of exudating wounds or ulcers, including stasis (venous) ulcers and decubitus ulcers. It appears to exert its effect by a capillary action which absorbs wound exudate, as well as wound debris and micro-organisms, into the dextranomer beads or into the spaces between the beads, thus removing such products from the wound surface. Dextranomer is an aid to wound or ulcer management, and does not directly affect tissue repair in such ulcers, but as with other ‘cleansing’ agents or techniques, removal of debris (and possibly micro-organisms) from the wound could be expected to promote natural healing. Reports of its effectiveness in open studies, often in patients with seemingly resistant lesions, have been encouraging. Similarly, in comparative trials results have usually favoured dextranomer, but a clear indication of the relative efficacy and benefits as compared with other treatments used for exudating lesions has not yet emerged. Further well designed comparative studies are needed to provide such information.

General Properties: When applied to an exudating wound, dextranomer produces a ‘chromatographic like’ separation of constituents of the wound exudate and of other particles (e.g. bacteria, cellular debris) which may be found at the wound surface. Prostaglandins, hormones and other relatively small molecules freely enter the beads and are removed along with the beads at dressing changes. Larger particles such as micro-organisms and wound debris remain in the spaces between the beads and appear to be drawn by capillary flow toward the surface of the dextranomer layer, and thus away from the wound surface. It would seem that such a ‘cleansing’ effect is likely to generally promote healing, but the clinical significance of the removal from the wound surface of prostaglandins and other possible mediators of the inflammatory response, and of fibrinolytic substances, is unclear.

Therapeutic Trials: Dextranomer clearly aids in ‘cleansing’ exudate and wound debris from moist wound lesions. Indeed, its ability to remove accumulated exudate has resulted in some reports of transient initial apparent increases in wound size, due to removal of debris. Results reported in open studies with dextranomer, often in patients with chronic, seemingly nonresponsive ulcers or wounds, have seemed impressive, although such studies were often anecdotal in nature and must be interpreted with caution. Comparative studies in patients with decubitus or stasis ulcers or other wounds are made more difficult by the lack of an accepted standard treatment to use for comparison, and by the difficulty in objectively evaluating improvement in such lesions. Indeed, most of the ‘traditional’ treatments used have not been well studied. Nevertheless, well designed controlled studies are needed to clearly establish the efficacy of any agent used in wound treatment. A few controlled studies have been reported with dextranomer, and in those studies which made the best attempts to overcome design difficulties, dextranomer was usually more effective in many of the various evaluation parameters used (e.g. effect on pus and debris, pain, oedema, erythema, granulation, epithelialisation and in some studies wound healing) than treatment such as normal saline dressings, ‘conservative’ debridement with repeated gauze dressing changes, collagenase ointment or povidone iodine. However, a more clear picture of dextranomer’s relative efficacy as compared with these and other treatments used for exudating wounds or ulcers, such as Unna’s boot treatment, benzoyl peroxide, pressure bandaging with adequate exercising, etc., must await further well designed comparative studies.

Adverse Effects: Dextranomer is well tolerated. With the exception of isolated reports of erythema or slightly blistered skin, or other isolated occurrences for which a causative association with dextranomer was not clearly established, the only adverse effect seems to be pain on removal of the saturated beads from some wounds. This would probably also occur with other treatments during cleansing and dressing changes.

Method of Use: Dextranomer is poured on to a wound, which has been previously cleaned with normal saline, to a thickness of a least 3mm. Alternatively, if the wound is shallow or in an awkward place, a paste of dextranomer and glycerol (4:1) may be prepared just prior to use and applied in the same thickness. The wound is then bandaged, but room for expansion of the beads as they absorb fluid must be allowed. The dextranomer should be replaced on an individualised schedule, depending on the extent of exudation. When it assumes a grey to yellow colour it is saturated and no longer exerting a capillary effect. Normal saline solution should be used to remove the saturated gel and to wash the wound before adding fresh dextranomer. Most wounds require twice daily changes.

Keywords

Benzoyl Peroxide Serum Zinc Povidone Iodine Decubitus Ulcer Wound Surface 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Aberg, M.; Hedner, U.; Jacobsson, S. and Rothman, U.: Fibrionolytic activity in wound secretions. Scandinavian Journal of Plastic and Reconstructive Surgery 10: 103 (1976).PubMedCrossRefGoogle Scholar
  2. Arturson, G.; Hakelius, L.; Jacobsson, S. and Rothman, U.: A new topical agent (Debrisan) for the early treatment of the burned hand. Burns 4: 225 (1978).CrossRefGoogle Scholar
  3. Bewick, M. and Anderson, J.: A new method for treating infected wounds. Studies on the dextranomer (Debrisan): Case reports. Clinical Trials Journal 15: 120 (1978).Google Scholar
  4. Botel, U.: Debrisorb® bei der Behandlung von Dekubital-Geschwuren. Eine empirische Studie. Fortschritte der Medizin 31: 1572 (1978).Google Scholar
  5. Dagher, F.J.; Alongi, S.V. and Smith, A.: Bacterial studies of leg ulcers. Angiology 29: 641 (1978).PubMedCrossRefGoogle Scholar
  6. Editorial: Treating pressure sores. British Medical Journal 1: 1232 (1978).Google Scholar
  7. Falk, J. and Tollerz, G.: Chronic tissue response to implantation of Debrisan®: An experimental study. Clinical Therapeutics 1: 185 (1977).Google Scholar
  8. Floden, C.H. and Wikstrom, K.: Controlled clinical trial with dextranomer (Debrisan®) on venous leg ulcers. Current Therapeutic Research 24: 753 (1978).Google Scholar
  9. Fraki, J.E.; Peltonen, L. and Hopsu-Havu, V.K.: Allergy to various components of topical preparations in stasis dermatitis and leg ulcer. Contact Dermatitis, in press (1979).Google Scholar
  10. Frithz, A.: Behandling av decubitalsar med dextranpolymerparlor. Opuscula Medica 23: 167 (1978).Google Scholar
  11. Ganrot, K.; Jacobsson, S. and Rothman, U.: A method for determining plasma proteins in inflammatory exudate absorbed by Sephadex. Scandinavian Journal of Plastic and Reconstructive Surgery 10: 73 (1976).PubMedGoogle Scholar
  12. Groenewald, J.H.: The use of dextranomer (Debrisan) as a cleansing agent in the treatment of the post-phlebitic stasis ulcer. Unpublished study, on file Pharmacia (1979).Google Scholar
  13. Hallbrook, T. and Lanner, E.: Serum zinc and healing of venous leg ulcers. Lancet 2: 780 (1972).CrossRefGoogle Scholar
  14. Hurme, H. and Linna, M.: Debrisan, a new treatment of postoperative infections in the anal and sacrococcygeal region. Unpublished report, Pharmacia (1978).Google Scholar
  15. Jacobsson, S.; Jonsson, L.; Rank, F. and Rothman, U.: Studies on healing of Debrisan-treated wounds. Scandinavian Journal of Plastic and Reconstructive Surgery 10: 97 (1976).PubMedCrossRefGoogle Scholar
  16. Jacobsson, S.; Rothman, U.; Arturson, G.; Ganrot, K.; Haeger, K. and Juhlin, I.: A new principle for the cleansing of infected wounds. Scandinavian Journal of Plastic and Reconstructive Surgery 10: 65 (1976a).PubMedGoogle Scholar
  17. Jonsson, G.: Testing of potential allergic contact sensitisation of Debrisan® in guinea pigs. Clinical Therapeutics 1: 260 (1978).Google Scholar
  18. Kogler, H.: The management of post-surgical infected wounds: a one-year trial on lower-leg amputation stumps. The Management of Infected Wounds, Proceedings of a European Symposium held in The Hague, 9th September, p.47 (Excerpta Medica, 1978).Google Scholar
  19. Krizek, T.J. and Robson, MC: Biology of Surgical Infection. Surgical Clinics of North America 55: 1261 (1975).PubMedGoogle Scholar
  20. Lassus, A.; Karvonen, J. and Juvakoski, T.: Dextran polymer particles (Debrisan®) in the treatment of penile ulcers. Acta Dermatovener (Stockholm) 57: 361 (1977).Google Scholar
  21. Lim, L.T.; Michuda, M. and Bergan, J.J.: The therapy of peripheral vascular ulcers — surgical management. Angiology 29: 654 (1978).PubMedCrossRefGoogle Scholar
  22. Lochbuhler, H.; Kaufmann, W. and Storz, W.L.: Ein neues Prinzip zur Behandlung infizierter Wunden. Therapiewoche 28: 2664 (1978).Google Scholar
  23. Lookingbill, D.P.; Miller, S.H. and Knowles, R.C.: Bacteriology of chronic leg ulcers. Archives of Dermatology 114: 1765 (1978).PubMedCrossRefGoogle Scholar
  24. Lundberg, C. and Campbell, D.: Effect of Debrisan treatment on wound oedema in rats. Data on file, Pharmacia (1979).Google Scholar
  25. McClement, E.J.W.; Shand, I.G. and Ramsay, B.: Pressure sores: A new method of treatment. British Journal of Clinical Practice 33: 21 (1979).Google Scholar
  26. Molokhia, M.M. and Portnoy, B.: Serum zinc and healing of venous leg ulcers 1: 41 (1973).Google Scholar
  27. Morrison, J.D.: Debrisan: An effective new wound cleanser. Scottish Medical Journal 23: 277 (1978).PubMedGoogle Scholar
  28. Nakano, J.: General pharmacology of the prostaglandins; in Cuthbert (Ed) The Prostaglandins. Pharmacological and Therapeutic Advances, p.23 (William Heineman, London 1973).Google Scholar
  29. Nierman, M.M.: Treatment of dermal and decubitus ulcers. Drugs 15: 226 (1978).PubMedCrossRefGoogle Scholar
  30. Olejniczak, S. and Zielinski, A.: Topical oxygen promotes healing of leg ulcers. Resident and Staff Physician 23: 165 (1977).Google Scholar
  31. Paavolainen, P. and Sundell, B.: The effect of dextranomer (Debrisan®) on hand burns. A preliminary report on a new method in the treatment of hand burns. Annales Chirurgiae et Gynaecologiae 65: 313 (1976).PubMedGoogle Scholar
  32. Pace, W.E.: Treatment of cutaneous ulcers with benzoyl peroxide. Canadian Medical Association Journal 115: 1101 (1976).PubMedGoogle Scholar
  33. Pace, W.E.: Beads of a dextran polymer for the local treatment of cutaneous ulcers. Journal of Dermatologic Surgery and Oncology 4: 678 (1978).PubMedGoogle Scholar
  34. Parish, L.C. and Collins, E.: Decubitus ulcers: a comparative study. Cutis 23: 106 (1979).PubMedGoogle Scholar
  35. Phillips, A.; Davidson, M. and Greaves, M.W.: Venous leg ulceration: evaluation of zinc treatment, serum zinc and rate of healing. Clinical and Experimental Dermatology 2: 395 (1977).PubMedCrossRefGoogle Scholar
  36. Roenigk, H.: Dextranomer (Debrisan®) as a postoperative dermabrasion dressing. Presented at the 3rd International Symposium on Plastic and Reconstructive Surgery, New Oreleans, April 29–May 4 (1979).Google Scholar
  37. Romasz, R.S.; Barnhart, B.S. and Schinagl, E.F.: Application of dextranomer beads (Debrisan®) in the treatment of exudating skin lesions: results of a cooperative study. Angiology 29: 675 (1978).PubMedCrossRefGoogle Scholar
  38. Salisbury, R.E.; Loveless, S.; Silverstein, P.A.; Wilmore, D.W.; Moylan, J.A., and Pruitt, B.A.: Postburn edema of the upper extremity: evaluation of present treatment. Journal of Trauma 13: 857 (1973).PubMedGoogle Scholar
  39. Sawyer, P.N.; Dowbak, G.; Sophie, Z.; Feller, J. and Cohen, L.: A preliminary report of the efficacy of Debrisan® (dextranomer) in the debridement of cutaneous ulcers. Surgery, 85: 201 (1979).PubMedGoogle Scholar
  40. Sawyer, P.N.; Sophie, Z.; Dowbak, G.; Cohen, L. and Feller, J.: New approaches in the therapy of the peripheral vascular ulcer. Angiology 29: 666 (1978).PubMedCrossRefGoogle Scholar
  41. Soul, J.: A trial of Debrisan in the cleansing of infected surgical wounds. British Journal of Clinical Practice 32: 172 (1978).PubMedGoogle Scholar
  42. Wallgren, R.: The therapeutic effect of Debrisan®. A controlled clinical trial performed at the Aurora Hospital, Helsinki. On file, Pharmacia (1975).Google Scholar
  43. Zelikovski, A.; Agranati, A.; Sternberg, A.; Hadad, M. and Urca, I.: Conservative treatment of stasis ulcers of the lower limb. Angiology 29: 832 (1978).PubMedCrossRefGoogle Scholar

Copyright information

© ADIS Press Australasia Pty Ltd 1979

Authors and Affiliations

  • R. C. Heel
    • 1
  • P. Morton
    • 1
  • R. N. Brogden
    • 1
  • T. M. Speight
    • 1
  • G. S. Avery
    • 1
  1. 1.Australasian Drug Information ServicesBirkenhead, Auckland 10New Zealand

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