Modern wound dressings: Manufacturing and properties

DRUG SYNTHESIS METHODSAND MANUFACTURING TECHNOLOGY

MODERN WOUND DRESSINGS:

MANUFACTURING AND PROPERTIES

T. N. Yudanova1 and I. V. Reshetov1

Translated from Khimiko-Farmatsevticheskii Zhurnal, Vol. 40, No. 2, pp. 24 – 31, February, 2006.

Original article submitted March 28, 2005.

The main directions of research aimed at the development of new wound dressings are considered. An impor-

tant modern trend is the use of biocompatible natural and synthetic polymers and their compositions as the

bases of wound dressings. The new products are free of the disadvantages of traditional textile materials, have

flexible design, and possess combined properties (including antimicrobial activity), which expands their func-

tions. Important advantages of new dressings are the atraumatic character, effective curative action, and re-

duced therapy time.

The production of wound dressings and bandages has be-

come a rapidly developing field of polymer chemistry for

medical applications. Modern dressings significantly differ

from traditional in both design and properties. Below, by

“wound dressing” we will imply both the usual textiles

(gauze, net, tricot, and unwoven fabric) and other materials

such as films and film-forming compositions, sponges, hy-

drocolloids, gels, powders, pastes, and combinations thereof

[1, 2].

Data on wound dressings of the Koletex type [3] indicate

that the breakthrough in this field has also involved the do-

mestic medicinal industry. However, Koletex bandages

based on traditional textiles possess have some disadvan-

tages. Indeed, the tricot of rather high density used in this

material cannot provide for a good modeling of the wound

surface and retains some drawbacks inherent in the tradi-

tional cotton–gauze dressings (see below), thus decreasing

the field of possible applications. Anyhow, the presence of a

gel layer somewhat decreases the traumatic action of ban-

dages, while the presence of drugs in the composition en-

sures a certain therapeutic effect.

Numerous publications reveal a variety of new research

direction and show that there are important advantages and

good prospects in this field. This paper shows factors that

make possible such cardinal changes in the design and func-

tions of modern wound dressings and reviews, based on the

data available in the literature, some important aspects of

their production and properties.

Extensive research was stimulated by a change in the

commonly accepted notions about the optimum conditions of

wound healing, according to which wet medium favors the

course of repair processes in a wound [4, pp. 47 – 49]. This

implies that a dressing should not only produce drainage of

the wound, but it must also maintain a certain optimum mi-

croclimate including vapor and air circulation. There is an in-

crease in the level of other requirements on dressings, which

is related to the development and sophistication of medicinal

technology, the need for increasing the efficacy of the first

aid and post-operation repair, and the increased level of aes-

thetic demands. In order to meet all these requirements,

dressings must ensure good modeling of the wound surface,

be atraumatic, make possible contactless monitoring of the

wound, produce no toxic and local irritant action, admit ster-

ilization, provide a maximum level of comfort, be simple in

maintenance, and admit long-term use on the wound. As was

noted above, modern dressings are also expected to produce

a curative effect; for this reason, many of them carry biologi-

cally active substances, which must be released into the

wound in a certain dose. The above combination of proper-

ties offers a definition of the “ideal” dressing [1, 4], which

can be considered as indicating the main direction of re-

search and development in this field.

850091-150X/06/4002-0085 © 2006 Springer Science+Business Media, Inc.

Pharmaceutical Chemistry Journal Vol. 40, No. 2, 2006

1Moscow State Textile University, Moscow, Russia;.

2Hertzen Cancer Research Institute, Moscow, Russia.

The main role in performing the aforementioned func-

tions belongs to the polymer matrix. The large variety of

wound dressings created to the present is explained to a con-

siderable extent by the broad spectrum of available polymers

whose physicochemical properties determine the properties

and functions of each dressing. However, despite the rather

large number of types of wound dressings, there are no uni-

versal ones that would be suited for wounds of all types

[5, 6]. Apparently, this circumstance is quite natural because

a conservative treatment must take into account the phase

and variability of the process of wound development [7]. The

variety of modern wound dressings implies the need for their

systematization. Classification of dressings can be based on

various characteristic features [8]. A largest group includes

curative dressings containing biologically active substances,

which implies a certain risk in their application.

Wound Dressings Possessing Antimicrobial Properties

One of the main functions of wound dressings is to pro-

tect the wound from penetration of a pathogenic microflora

from the environment. The traditional cotton-gauze dressing

only provides a reliable initial mechanical protection, but,

absorbing the wound discharge, it becomes a medium favor-

ing the growth of the pathogenic microflora. In order to pre-

vent a wound from the development of pyoinflammatory

complications, it is expedient to use dressings producing a

certain antimicrobial action [1, 2].

The main principles of synthesis of biologically active

polymers and the requirements on polymeric carriers have

been formulated in [9]. However, the use of polymers con-

taining biologically active components always implies cer-

tain features that must be borne in mind. Since wound dress-

ings are intended for a single external application, the solu-

bility or biodegradability of the polymeric carrier are less

important than the function of drug release in an amount suf-

ficient for the desired therapeutic action, which can be

achieved by using ionic and labile covalent bonds ruptured in

vivo. With respect to the mechanism of action, such poly-

mer-based curative wound dressings are close to transdermal

therapeutic systems [11].

The first investigations devoted to the creation of poly-

meric would dressings frequently involved the preliminary

chemical modification of polymers in order to introduce cer-

tain functional groups into macromolecules, which were

used for grafting drugs. Extensive research was devoted to

materials based on the well-known natural polysacchari-

de — cellulose and its numerous derivatives. One important

reason for this interest was economics, because the high cost

of would dressings can hinder their wide use. This factor can

be less important only if the efficacy of new materials will

significantly reduced the time of wound healing. An advan-

tage of cellulose-fiber-based materials is the existence of rich

sources of raw materials, the well-developed technological

basis for their processing, and a large variety of their forms,

including textiles (gauze), unwoven fabrics and tricots, cot-

ton, etc. Chemical modification of the available types of cel-

lulose fibers and their use as drug carriers offers a highly

technological approach, since it can be implemented using

existing or slightly modified equipment. It is the very low

cost that makes traditional cellulose-based bandages still

competitive. However, it is well known that gauze adheres

tightly to wounds and leads to the occlusion and accumula-

tion of wound discharge under the dressing, which favors the

growth of pathogenic microflora in the wound. On the other

hand, the high hygienic, sorption, and mechanical properties

of materials based on cellulose fibers allow them to exist to-

gether with the new polymeric wound dressings. Many in-

vestigations are still devoted to the modification of tradi-

tional (e.g., gauze) dressings with the aim of eliminating the

aforementioned disadvantages and imparting new useful

properties.

In some cases, chemically modified cellulose acquires

intrinsic physiological activity that imparts to cellulose

dressings curative properties even without the introduction

of drugs. An interesting example is viscose fibers partly hy-

drolyzed by the enzyme cellulase [11]. The ability of partly

hydrolyzed viscose to absorb staphylococci, which is 90%

higher as compared to the initial fibers, decreases the degree

of wound contamination by these microbes. Another cellu-

lose derivative — carboxymethylcellulose (CMC) contain-

ing acid functional groups — is capable of binding peptides

in the wound medium, thus inhibiting the activity of some

enzymes such as elastase [12]. Mono-CMC gauze is widely

used as a hemostatic dressing [13].

At the same time, the aforementioned cellulose deriva-

tives are potential matrices for the physical or chemical im-

mobilization of biologically active substances. Repeated im-

pregnation of base materials with a soluble compound of

mono-CMC with lincomycin was used to obtain the

so-called lincomycin film, which is intended for the prophy-

laxis and treatment of pyoinflammatory processes in wounds

of various localization and origin, and is especially recom-

mended in the case of diffuse blood discharge from damaged

tissues [14].

Carboxymethylated cellulose tricot fabric was rendered

antimicrobial through impregnation with furagin or

chlorhexidine bigluconate solutions, followed by treatment

with an ethanol solution of menthol [15]. Oxidized medicinal

gauze (dialdehydecellulose) was used for the covalent bind-

ing of lysozyme [16]. On a commercial level, an antimicro-

bial cellulose-fiber-based material, containing a quaternary

ammonium base ketamine-AB, is produced in a continuous

technological process involving preliminary activation of a

cellulose fabric or gauze by the sodium dichloroisocyanurate

of hydrogen peroxide. Such gauze produces a pronounced

antimicrobial effect, accelerates epithelization, and exhibits

no toxic action on the organism [17, pp. 113 – 114].

The cellulose matrix with grafted poly(acrylic acid)

(PAA) was additionally modified by poly(hexamethylenegu-

anidine hydrochloride), an antimicrobial polymer of the

cationic type [18]. It was established that such gauze contain-

86 T. N. Yudanova and I. V. Reshetov

ing 4.3% of the active component retained the antimicrobial

properties at a two times lower concentration of the antimic-

robial agent as compared to the materials obtained by simple

impregnation [19, p. 218]. This circumstance allows the drug

consumption and the toxicity of dressing material to be sig-

nificantly reduced. In a similar manner, the medicinal gauze

was activated by treatment with EDTA solution and impreg-

nated with hyaluronic acid, which was modified by complex-

ation with poly(hexamethyleneguanidine phosphate) [20].

Various types of biologically active wound dressings

have been created based on poly(vinyl alcohol) (PVA), a

polymer characterized by high biocompatibility and hydro-

philicity. In order to attach drugs (antibiotics, antiseptics, an-

esthetics) to PVA fibers, these were modified through

etherification with maleic acid and grafting of acrylic acid

[21]. Such fibers were used to make unwoven and knitted

tampons and ribbons. Investigations of the drug release ki-

netics in vitro showed that up to 50% of the initial drug is re-

tained in these materials on the 10th day, whereas analogous

samples containing the same initial amount of drugs not

chemically bound to the PVA matrix exhibited their complete

desorption within 1 – 3 days [17, pp. 112 – 113]. However,

these results may cast doubt on the need for chemical modifi-

cation of PVA fibers, since a drug release over 1 – 3 days is

usually considered quite satisfactory.

The long time required for the production of

antimicrobial dressings, which includes the process of chem-

ical modification of the polymer matrix and the subsequent

attachment of drugs, frequently makes this technology inef-

fective [16, 18, 20, 21]. In this respect, an interesting alterna-

tive approach is offered by the introduction of biologically

active substances into soluble polymer compositions, fol-

lowed by the formation of wound dressings of the desired

shape. By selecting polymers with various fictional groups, it

is possible to influence the character of interactions between

components of the system, thus controlling the kinetics of

desorption of the biologically active substances and the

physicochemical properties of wound dressings.

The rich special features of the chemical structure and

supramolecular structure of biopolymers (polysaccharides,

proteins) offer broad possibilities for new solutions in the

creation of wound dressings. Many of these polymers pos-

sess high biocompatibility and intrinsic physiological activ-

ity. This group of polymers includes alginate, which is

known to stimulate repair processes [19, 22]. Alginate is ca-

pable of forming high-viscosity gels whose degree of

structurization can be controlled by introducing cations (e.g.,

of calcium). This principle was used for the creation of nu-

merous wound dressings in the form of sponges and fibers

[22 – 25]. In order to increase the elasticity of alginate-based

dressings, it is possible to introduce poly(ethylene oxide)

[25]. Antimicrobial properties can be imparted to alginate-

based matrices by the inclusion of drugs such as furacilin

(algipor sponge dressing) [26, p. 328], solafur, iodopiron,

katapol, dioxidine, or etonium [27]. The rate of drug release

from alginate-based matrices can be controlled by various

means. The kinetics of furacilin release from algipor sponge

is limited by the low solubility of this drug in water, while

the biological action of alginate fibers is controlled by the

rate of their dissolution, which depends on the degree of

alginate crosslinking by metal (calcium or copper) cations.

Unwoven alginate drapes are recommended for use in sur-

gery as a hemostatic dressing material [27].

The group of natural polymers, which are rather fre-

quently used as bases or components of wound dressings,

also includes collagen. The main difficulty that hinders a still

wider use of natural collagen is its very low solubility in typ-

ical protein solvents [28]. In most cases, the collagen-based

wound dressings have the form of sponges, which are ob-

tained by lyophilic drying of various collagen-containing

compositions [29, 30]. The solubility and porosity of such

sponges are determined by the production technology. Colla-

gen-based sponges containing drugs (antiseptics, antibiotics,

etc.) can be additionally structurized by exposure to formal-

dehyde vapor [31].

Collagen-based dressings may have complex structures

of various design. For example, the second layer of a colla-

gen sponge can play the role of a membrane, and an active

antibacterial layer (containing gentamicin, amikacin, or any

other antibiotic with limited solubility) is placed between the

first sponge and the membrane [29]. In vitro tests showed

that the antibiotic component is released from this system

over a period of three days. Another example is offered by

the “artificial skin” structure, in which an antibiotic compo-

nent is introduced into the external silicon layer formed

above a collagen sponge covering the wound [32]. For this

purpose, poly(L-lactide) microspheres containing the drug

are embedded into the silicon matrix.

Collagen dressings frequently include polymers of a dif-

ferent chemical nature, for example, chitosan [33 – 35]. A

collagen sponge structure reported in [35] contained a dis-

persed powdered sorbent representing a natural or synthetic

polymer (dextran, CMC, chitosan, partly crosslinked PVA)

or an inorganic substance. The sponge may also contain an

antimicrobial (e.g., furagin) [33, 35] and/or anesthetic [35]

component. Such a dressing ensured effective drainage of the

wound discharge and retained the initial shape well, although

lysis of the sponge layer contacting with the wound and

sticking of the dressing material to the wound surface created

some difficulties in redressing.

In order to make a collagen-based dressing containing an

antimicrobial drug chemically stable in the wound medium,

it can be additionally crosslinked, for example, by genipin

(of natural origin) [36], glutaraldehyde, or glyoxal; in addi-

tion, it is possible to introduce sodium alginate [37].

Other biopolymers, which can also be used as bases or

components of composite wound dressings, include hyaluro-

nate [38], its mixture with gelatin [39], and mixtures of gela-

tin with collagen [40 – 42], chitosan [43], and alginate [44],

which can be additionally crosslinked in order to make it re-

sistant to the action of collagenase in vivo [39, 40. 45]. Such

wound dressings may also contain gentamicin sulfate, silver

Modern Wound Dressings 87

sulfadiazine, or some other biologically active substances

(e.g., growth factor) [41, 42].

As was noted above, wound dressings are frequently de-

signed as multilayer systems. It is possible to combine poly-

mer matrices of different natures and physical structures,

which ensures the use of their advantageous properties. As a

rule, the layer contacting with the wound is made of an

atraumatic material, which provides the maximum drainage

of discharge and retains it in a sorbent layer. The simplest

variants of this kind are dressings with a sandwich structure,

in which the first layer is made of polyester or medicinal

gauze and the second layer (sorbent) is made of an unwoven

fabric [4, pp. 96 – 97]. As a rule, one layer in such a system

also contains an antimicrobial agent whose amount and re-

lease rate can be controlled by selecting the drug structure,

the type of fibrous material, and the kind of chemical bonds

between the active component and the matrix. The first layer

base can be rendered atraumatic by applying a wax coating

or an ointment with a drug component (voskopan dressings)

[8, pp. 91 – 93].

In multilayer dressing of another type, the layers cannot

be separated because one of them (gauze, tricot, etc.) is a car-

rier for another (polymer) that usually penetrates into the

support. In contact with a wound medium, the polymer layer

converts into a gel. This principle is used for the creation of

biologically active dressings with collagen, polysaccharide

(alginate, CMC), or other dressings (Koletex, Activtex)

[4, 8]. Some of such dressings contain furagin, chlorhexidine

bigluconate, DMSO, metronidazole, mexidol, etc. [4, 8].

Dressings of still another type with a textile base and

polymer coating do not exhibit a clearly pronounced

two-layer structure, since the initial base (gauze) impreg-

nated, for example, with a collagen solution containing

gentamicin sulfate [46] or modified starch containing

lysozyme [47] exhibits interpenetration with the second

polymer. The treatment of a textile matrix with a polymer

composition imparts increased wettability to the former and

ensures prolonged drug release (within 2 – 3 days).

With respect to the structure, the above dressing materi-

als [46, 47] can be classified into composites. In recent years,

composites predominate among novel dressing materials.

Such composites are obtained (in the form of gels, films,

plates, powders, etc.) by blending polymers, which are some-

times thermodynamically incompatible. The advantage of

such systems is the possibility to vary the dressing composi-

tion and structure within broad limits, thus controlling the

properties of the polymer matrix and the level of biological

activity. This type of dressings includes hydrogels, which

have the form of plates (slabs) of an amorphous gel or a

dense gel with a protective layer, which are applied onto a

wound and covered by a draper from above [48, 49]. The

nonwetting hydrogel dressings offer some advantages over

gauze dressings. Hydrogels ensure faster healing and facili-

tate redressing, since the gel used is removed without damag-

ing the regenerated wound surface [50]. However, it was

pointed out that hydrogels not containing antimicrobial com-

ponents create favorable conditions for microbial contamina-

tion of the wound [32, 50]. Therefore, more promising

systems are offered by hydrogel dressings containing anti-

microbial agents.

Hydrogels can be obtained using both synthetic and natu-

ral polymers. A jelly dressing with chlorhexidine intended

for the treatment of skin damages [51] can be made of a

crosslinked copolymer of an unsaturated acid (acrylic,

methacrylic, crotonic, 2-acrylamido-2-methylpropanesul-

fonic) and vinylpyrrolidone. This composition is atraumatic

and exhibits increased absorption capacity.

Some dressing compositions (e.g., Appollo) containing

antiseptics or antibiotics were created on the basis of hydro-

gels containing (i) a crosslinked copolymer of N,N-methyl-

enebisacrylamide, acrylamide, and/or sodium acrylate, (ii)

poly(vinyl pyrrolidone) (PVP), and (iii) plasticizers (glycerin

and propanediol) [2, 52]. A carrier for such gels can be pro-

vided by a net, gauze, or another synthetic or natural mate-

rial. A wound-healing hydrogel composition based on a mix-

ture of poly(styrene) – poly(ethylenebulylene) block copoly-

mer and Vaseline was also suggested as a supporter on gauze

[53]. This composition can also include a biologically active

component representing anti-inflammatory or analgesic

drugs, antibiotic, antifungal, antibacterial, antiseptic, or anes-

thetic agents, growth factors, etc.

The biologically active PVA-based gel dressing de-

scribed in [54] employs the principle whereby a polymer ma-

trix containing a bound antibiotic is activated only in the case

of wound infection. In this dressing, gentamicin is bound to

PVA via a peptide link containing �-(D)-Phe-Pro-Arg frag-

ment. Proteinases present in exudating wounds hydrolyze the

bonds between the antibiotic and PVA only in the presence of

Staphylococcus aureus or Pseudomonas aeruginosa, after

which gentamicin is released into the wound medium.

Since hydrogels represent structurized polymer composi-

tions, the desorption of drugs from such polymeric carriers

may encounter diffusion limitations. The kinetics of release

of various substances (hydrophilic, hydrophobic, proteins)

from a hydrogel based on human serum albumin and poly-

(ethylene glycol) (PEG) was studied in [55]. It was estab-

lished that the time of half-release from this carrier is 0.8 h

for theophylline and 4.2 h for lysozyme. The desorption of

biologically active components from a matrix containing

more than 96% of water can be controlled by varying its po-

rosity and thickness.

Wound dressings have also been developed in the form

of polymer compositions based on polysaccharide mixtures.

These compositions include a water-soluble cellulose deriva-

tive (methylcellulose, CMC, or their mixture), alginic acid,

and at least one more polysaccharide from a group contain-

ing carrageenan, pectin, fucoidin, zosterin, gum arabic,

xanthane gum, or tragacanth [56, 57]. The composition

forms an elastic vapor-permeable dressing on a wound,

which does not require additional fixation. Possible antimic-

robial agents are antiseptics (myramistine, chlorhexidine),


antibiotics (lincomycin, gentamicin), and others. The dress-

ing composition can also include rubber latex [58].

The group of sorbents capable of effectively producing

wound drainage with gel formation in the stage of dehydra-

tion includes copolymers of vinyl acetate and vinyl glutarate

in the form of powders with a particle size from 10 to

1500 �m (Diovin and Anilodiovin sorbents). These composi-

tions may also contain antimicrobial (dioxidine) or other

(anilocaine) drug components [2, 59].

The use of biodegradable polymers is another direction

in the creation of wound dressings [60 – 62], although the

expediency of using such materials for external application is

not as evident (since the products of polymer degradation are

also retained in the wound). In a dressing patented in [61],

the layer contacting with the wound consists of microfibers

of a blend of polylactide and PVP, while the protective film

layer is made of a copolymer of polylactide with up to 50%

of caprolactone of glycolide. The microfibrous layer may

also contain antimicrobial components (e.g., chlorhexidine)

and other drugs. Dressings intended for cleaning wounds,

which comprise biodegradable fibers made of synthetic or

natural polymers (polylactides, polyglycolides, PVP, poly(vi-

nylcaptolactam), collagen, alginate, chitosan, etc.) and a

powdered sorbent based on crosslinked polysaccharides,

polyacrylates, cellulose esters, and PVA derivatives with ad-

ditional drug components (antimicrobial, etc.) can be formed

immediately on a wound surface [62].

In addition to hydrophilic dressings, there exist hydro-

phobic materials, which are based on polyurethane [63, 66]

or polysiloxane [17, pp.128 – 129] matrices. Unfortunately,

no data were reported on the kinetics of drug desorption from

the latter material, which would be of considerable interest in

view of the hydrophobic character of the polymer matrix.

According to some data, hydrophobic materials are inferior

to hydrophilic ones in many respects. For example, a com-

parative investigation of the properties of collagen and poly-

urethane films showed the absence of discomfort and faster

healing (within 5 days) with collagen dressings [66, 67]. For

this reason, polyurethane is usually combined with hydro-

philic polymers [64, 67 – 69] by introducing collagen [64] or

fibrin [69] layers. In a two-layer dressing described in [69], a

layer of unwoven material (a mixture of viscose and polyes-

ter fibers) with a high adsorption capacity (about 20 g�g) was

lined with a polyurethane solution in isopropyl alcohol con-

taining a dispersed antibiotic (silver N-(1,3-diazin-2-yl)sul-

fanylamide salt, or silver sulfadiazine).

A special group of wound dressings includes those based

on chitin and its derivatives, in particular, chitosan. The

unique properties of chitosan as a carrier for biologically ac-

tive components are related to its chemical nature, as a

cationic biodegradable polymer with intrinsic biological ac-

tivity [70 – 74]. Chitosan-based dressings can be manufac-

tured in various forms, including fibers [75, 76], films

[77, 78], asymmetric spongy membranes [79], and gels [80].

Most of such dressings do not contain drugs [75 – 77, 79,

80]. The mechanical properties of chitosan dressings can be

improved by introducing polymers of a different chemical

nature. A chitosan film with antimicrobial properties [78]

may contain up to 20% of another hydrophilic polymer (e.g.,

PVA, gelatin, collagen, PVP, PEG, PAA, and poly(metha-

crylic acid) (PMA)), which increases the film strength and

improves adhesion. By crosslinking of the polymer (for ex-

ample with epichlorohydrin), it is possible to control the ad-

sorption capacity of chitosan in a range from 500 to 1500%.

Wound dressings based on chitosan – alginate complexes

were obtained in the form of films [77] and sponges impreg-

nated with silver sulfadiazine [81]. The equilibrium adsorp-

tion capacity of the sponge and the release of the drug com-

ponent can be controlled by varying conditions of the

chitosan – alginic acid complex formation. A combination of

different chitosan-based materials was used to obtain

two-layer dressings [82, 83]. A nonsticking wound dressing

[82] comprises an upper layer of carboxymethylchitin

hydrogel and a lower layer, representing a biopolymer

(chitosan acetate foam) impregnated with an antimicrobial

component (chlorhexidine gluconate). The hydrogel layer

acts as a mechanical and antimicrobial barrier and absorbs

the wound exudates (4 g�g), whereas the lower foamy layer

impregnated with chlorhexidine gluconate layer releases the

drug into the wound medium in vivo over a period of about

24 h. Another chitosan-based dressing [83] has a dense upper

layer and spongy lower layer, from which silver sulfadiazine

is released at a high rate (loading dose) in the first day and at

a much lower rate after that. In vivo tests showed that the

dressing effectively suppresses the growth of pathogenic

flora over a period of about one week.

Of special interest are wound dressings of the film type,

in particular, those based on PVA. Such films are character-

ized by a high plasticity that ensures good modeling of the

wound surface. The film can be transparent, which makes

possible visual monitoring of the healing process. The kinet-

ics of antimicrobial agent release from such dressings de-

pends on the drug affinity to the polymeric carrier. Among

the films containing iodine, katapol, and dioxidine [84, 85],

the maximum rate of drug release under model conditions in

vitro (physiological solution, 20°C) was observed for the lat-

ter agent: only about 20% of this antiseptic was retained in

the film after a 24-h exposure.

It was established that the rate of an antimicrobial agent

release from PVA-based film dressings decreases with in-

crease in the molecular weight of the drug and the degree of

film swelling. In order to prolong the drug desorption stage,

it was suggested to use a polymeric antimicrobial agent:

dimethylbenzylalkylammonium salt of a copolymer of

crotonic acid with vinylpyrrolidone [86, 87]. The introduc-

tion of CMC – a high-swelling polymer component – into a

PVA-based dressing composition also delays the desorption

of drugs (trichopol, iodine, levorin) [88]. This delay is

achieved at the expense of reduced mechanical strength, but

the strength can be improved by additional crosslinking with

boric acid [88]. Crosslinking agents are introduced into poly-

mer matrices for various purposes. In particular, sodium


tetraborate in a PVA-based film containing chlorhexidine

bigluconate and lysozyme provides for optimum adsorption

capacity (2 g�g), strength under wet medium conditions, and

delayed drug release [89]. Such a film exhibits limited vapor

permeability, and the exudate is discharged due to perfora-

tion of the dressing, which provides for the optimum humid-

ity in the wound.

In a patented dressing based on PVA and a copolymer of

�-cyanacrylate with PAA [90], which is intended for the

treatment of wounds, burns, and decubitus and contains

3 – 30% of dioxidine, the polymer matrix is structurized in

order to increase the adsorption capacity. The degree of

swelling in this dressing is controlled by the introduction of

biologically active substances such as furagin, silver nitrate,

or trimecaine with a variable concentration of 2 – 30%. Note

that this dressing has a very high total content of drugs,

which is probably related to the low solubility of dioxidine,

strong binding of other antimicrobial agents, and increased

swelling (6200 – 20,000%). The dressing may consist of sev-

eral layers fastened together by perforation.

A collagen-based film of the Bifocal type was used for

the development of multilayer dressing materials intended

for the treatment of burns, tropic ulcers, etc. The polymer

matrix carries a single layer of fibroblasts or two active lay-

ers (keratinocytes and fibroblasts) [4, p. 44].

A quite original idea was to use a perforated polyethyl-

ene film as a base for wound dressings, with the inner surface

coated by a powder comprising 95% of talc and 5% of a mix-

ture of eleven antibiotics and antiseptics (cephalolexin, strep-

tomycin, erythromycin, terramycin, tetracycline, vibromy-

cin, synthomycin, neomycin, kanamycin, nistatin, daktarin,

canesten, and rivinol) [91, pp. 64 – 65]. The mixture may

also contain a powder based on water-soluble keratin (a wool

protein), with the same ratio of components in the drug mix-

ture [92]. This film is not vapor-permeable, which favors the

creation of a wet medium. It was reported that this dressing

promotes a scarless healing of burns. However, the absence

of any means of fixing the drug mixture on the hydrophobic

film surface can lead to its inhomogeneous distribution on

the wound surface and removal with the wound discharge.

A necessary requirement to wound dressings is their ste-

rility. The choice of the method of sterilization and the study

of its influence on the stability of a polymer matrix and bio-

logically active components is an important part in the pro-

cess of creating new dressings. However, the results of inves-

tigations into the effect of sterilization on the

physicochemical and biological properties of materials con-

taining antimicrobial agents are rarely reported. It was estab-

lished [84, 85] that radiation sterilization at a dose of

~25 kGy did not influence the antimicrobial properties of

PVA-based films with iodine and katapol, but produced a

30% decrease in the antimicrobial activity of dioxidine

(which is indicative of the low stability of this drug under ir-

radiation). The biological activity of a PVA-based [89] film

containing chlorhexidine bigluconate and lysozyme was

practically completely retained upon radiation sterilization

and subsequent long-term storage.

An analysis of the literature shows evidence of the exten-

sive search for new “ideal dressings” for the treatment of

various wounds. Characteristic trends in the modern stage of

this research are the rejection of traditional textile bases and

expansion of the circle of novel base materials, which pro-

vides for the development of dressing with improved proper-

ties and increased functions. The obvious advantages of

modern dressings are the increased atraumatic character, re-

duced drug content (achieved due to highly effective use and

dosage of the active components), and convenient applica-

tion and usage.

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Documents

Modern wound dressings: Manufacturing and properties