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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
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