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http://www.worldwidewounds.com/News/News2002.html


Antimicrobial preparations for WBP

Cadexomer iodine:
Iodine plays a natural role in the body's immune system and in fighting infection. It serves as a halide, which is needed for neutrophils to exert their action during the inflammatory phase of healing. Cadexomer iodine (cadexomer beads with 0.9% iodine, Iodoflex) is a topical preparation which helps to address all the main barriers to healing. It has a unique mode of action, described by Falanga as a SMART release system [2], whereby the cadexomer beads actively respond to exudate by releasing iodine in a controlled sustained manner, providing broad spectrum antimicrobial activity for up to three days [3]. The iodine is deactivated by organic matter in the wound, detected by the cadexomer carrier, which in turn releases more iodine. This ensures that there is always a greater concentration of iodine in the dressing than at the wound site, thereby avoiding any cellular toxicity, which has been a problem with traditional antimicrobial preparations.
It has been demonstrated, beyond reasonable doubt, that CI is non-toxic to cells both in vitro and in vivo. In a study by Zhou et al, histological assessment of chronic wound cells following CI treatment revealed no cell necrosis or morphological changes [4]. Falanga states that the propaganda of the 1980s about the toxicity of antiseptics was based on the inappropriate use of traditional antiseptic agents (e.g. povidone iodine), which release their complete load of iodine in one short action resulting in cellular toxicity [2].
Other advantages of using CI include:

• assists in debridement and absorption of high levels of exudate (up to 6 ml/g of dressing), making it a highly versatile agent and an integral part of WBP
• reduces problems with dressing removal - cadexomer beads are naturally derived from starch molecules which allow any remnants of the dressing to biodegrade.

Falanga states that 'Judicious use of iodine antiseptics promotes wound bed preparation and accelerates wound healing ... CI is an effective debridement and antiseptic agent for chronic exudative wounds. When used directly over the wound CI removes pus, debris and wound exudate and effectively reduces the bacterial counts' [2].
Finally, Carita Hansson has shown that if the instructions for correct use are followed, CI is an effective therapy which decreases the microbial burden, cleans the ulcer from slough and exudate and promotes healing [5].
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