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Topic: Current Concepts in Wound Healing

Limited access dressing and wound infection

Pramod Kumar

Department of Plastic Surgery, King Abdulaziz Specialist Hospital, Sakaka 42421, Al-Jouf, Saudi Arabia.
Address for correspondence: Dr. Pramod Kumar, Department of Plastic Surgery, King Abdulaziz Specialist Hospital, Sakaka 42421, Al-Jouf,
Saudi Arabia. E-mail: pkumar86@hotmail.com

Acute and chronic wound infection poses a major problem autoinducers. This process, termed “quorum sensing”,
to wound care physicians (also known as woundologists). allows bacteria to monitor the environment for other
Emergence of multidrug‑resistant (MDR) bacteria and bacteria and to alter the behavior on a population‑wide
biofilm is a real challenge to physicians. Failure to use scale in response to changes in the number and/or species
antimicrobials judiciously leads to toxic damage to of bacteria present in a community (wound environment).
[3]
host cells with a wide spectrum of problems and super Quorum sensing signals are the essential components of
infections. Newer methods of dissolving biofilms and the communication system. These signals regulate virulence
interrupting cell‑to‑cell communication are yet to be gene expression in a variety of plant and animal
established and included into routine practice. (including human) bacterial pathogens. The detection
[4]
of a minimum stimulatory concentration threshold of an
Intermittent negative pressure regimen of limited access autoinducer leads to an alteration in gene expression. In
dressing (LAD) could be effectively used for most issues general, Gram‑negative bacteria use acylated homoserine
[1]
related to wound infection and its spread (wound to lactones as autoinducers and Gram‑positive bacteria
environment and vice versa) in the following manner:
use processed oligopeptides for communication.
Wound isolation and safe disposal of drainage: occlusive Recent advances in the field indicate that cell‑to‑cell
dressing in LAD isolates the wound from the environment communication via autoinducers occurs both within and
and the safe disposal of wound drainage in a closed between bacterial species. Community cooperation
[5]
system with prefilled disinfectants (for viruses, spores probably enhances the effectiveness of processes like
and resistant strains) may prove vital in reducing cross virulence factor expression (invasion) and biofilm development
infections and hospital‑acquired infections. (resistance to treatment). Various chemicals are identified
[6]
for chemical quenching of quorum sensing (quorum
Prevention of wound invasion: invasive bacteria actively quenching). [4,7] LAD may be used to mechanically remove
induce their own uptake by phagocytosis of normally the chemical signal molecules intermittently by negative
non‑phagocytic cells, and then either establish a protected pressure before it reaches a concentration level to produce
niche within which they survive and replicate or effective quorum sensing for virulence factor expression,
disseminate from cell‑to‑cell by means of an actin‑based thereby preventing the invasion of host tissues.
motility process. Alternatively, intermittent negative
[2]
pressure channel effectively to divert bacteria to the Mechanical disruption of biofilm: in general, bacteria have
drainage system, which mechanically prevents wound two life forms during growth and proliferation. In one form,
invasion and hence prevents them from establishing a bacteria exist as single, independent cells (planktonic)
[1]
protected niche required for dissemination. assumed to produce acute infections. In the other
form, bacteria are organized into sessile aggregates,
Mechanical disruption of quorum sensing by negative
pressure: bacteria communicate with one another using commonly referred to as biofilm growth phenotype.
chemical signal molecules. Chemical communication in In cases, where bacteria form a biofilm within the
bacteria involves producing, releasing, detecting and human host, the infection becomes chronic with extreme
responding to small hormone‑like molecules, termed resistance to antibiotics and conventional antimicrobial
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How to cite this article: Kumar P. Limited access dressing and wound
DOI: infection. Plast Aesthet Res 2015;2:237-8.
10.4103/2347-9264.158856
Received: 17-10-2014; Accepted: 20-04-2015

© 2015 Plastic and Aesthetic Research | Published by Wolters Kluwer - Medknow 237