Title: A comparison of hemorrhage control and hydrogen peroxide generation in commercial and cotton-based wound dressing materials Authors
Submitted to: Meeting Abstract
Publication Type: Proceedings
Publication Acceptance Date: February 5, 2013
Publication Date: March 6, 2013
Citation: Edwards, J.V., Bopp, A.F., Graves, E.E., Condon, B.D. 2013. A comparison of hemorrhage control and hydrogen peroxide generation in commercial and cotton-based wound dressing materials. Proceedings of the Wound Healing Society Wound Repair and Regeneration. 21(2):A21. Interpretive Summary: Greige cotton (cotton fibers that have not been scoured or bleached) when mechanically cleaned to a high standard of purity provides potential untapped benefits for wound healing materials. The waxes and pectin present on the surface of the fiber have been found to have properties that are associated with stimulating wound healing of disrupted stages in the wound healing process. Here we report how greige cotton possesses properties that accelerate both hemostasis and granulation tissue formation. Nonwoven greige cotton was found to accelerate blood clotting, which was measured using thromboelastography, in half the time that bleached cotton did. Whereas nonwoven greige cotton pectin levels were found to generate low-level hydrogen peroxide levels associated with accelerated granulation tissue formation.
Technical Abstract: Nonwoven UltraCleanTM Cotton (highly cleaned and hydroentangled, greige cotton) retains the native wax and pectin content (~2%) of the cotton fiber traditionally removed from scoured and bleached cotton gauze, yet potentially affording wound healing properties. In vitro thromboelastography, hydrogen peroxide generation and protease uptake assays were employed to compare a dressing prototype of Hydroentangled, UltraClean Cotton (HE-UCC) with scoured and bleached cotton gauze (SB-CG), and occlusive dressing. Thromboelastography (TEG) was used to measure coagulation of bovine blood in the presence of HE-UCC compared with SB-CG by monitoring enzymatic clotting reaction time (R), rate of fibrin formation (a), fibrinogen-mediated clot formation (K) and strength of clot formation (MA). The TEG analysis revealed coagulation was affected as follows; R (min.) = 4.1 +1.0, K (min) = 3.2 +0.6, a (deg.) = 45.2 +6.3, MA (mm) = 62.5 +3.3.; whereas SB-CG performance was; R (min.) = 9.6 +1.6, K (min) = 6.6 +2.2, a (deg.) = 32.8 +7.5, MA (mm) = 67.7 +3.9. Hence HE-UCC significantly accelerated clotting reaction time and rate of fibrin formation over SB-CG, with clot strength being similar. Pectin-based release of hydrogen peroxide enhances the granulation phase. The hydrogen peroxide production of HE-UCC was compared with pectin and a commercial pectin-containing dressing using fluorescent scopoletin/horseradish peroxidase. Over a 72 hour time course at a dose of 10 mg/mL, HE-UCC produced comparable levels of hydrogen peroxide (10-6) to 2.5% pectin and 0.1% of the pectin-containing occlusive dressing. Human neutrophil elastase sequestration (HNE) by HE-UCC was compared with SB-CG. Cotton dressing levels of 50mg/mL (mimicked wound fluid) have sufficient sites on HE-UCC and SB-GC to bind >90% of available HNE at chronic wound concentrations (50 mU HNE). In vitro assessment of HE-UCC reveals promising findings on its potential to initiate clotting, low level hydrogen peroxide production, and protease uptake.