Effect of activated charcoal dressings on healing outcomes of chronic wounds

Abstract

To compare the ability of activated charcoal dressings with that of a hydrocolloid dressing to reduce the wound area of chronic wounds.
Two separate randomised controlled trials (RCTs) were undertaken; both used the same hydrocolloid as the control. One RCT compared Actisorb (without silver) with the control on chronic pressure ulcers and the other RCT compared Actisorb Silver 220 with the control on chronic venous leg ulcers. Patients were followed for four weeks. Baseline patient demographic and wound characteristics were comparable between the treatment and control groups. Wounds were assessed at weekly intervals. Ulcers were photographed and then traced by an experienced, independent investigator. Both the reduction in ulcer area and the percentage reduction were calculated.
Sixty patients were enrolled into each study, although data for one patient were not available in the pressure ulcer study. There were differences in results at week 1 in favour of the treatment group in both studies, although the results for the two groups in each study were comparable at week 4. Activated charcoal dressing was better tolerated than the control.
These clinical data indicate the potential usefulness of using activated charcoal impregnated with silver in the management of chronic wounds, even at the debridement stage. This dressing may help remove fluids and toxins that impair the healing process.

Full text

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JOURNAL OF WOUND CARE VOL 19, NO 5, MAY 2010208
Effect of activated charcoal
dressings on healing outcomes of
chronic wounds
● Objective: To compare the ability of activated charcoal dressings with that of a hydrocolloid dressing
to reduce the wound area of chronic wounds.
● Method: Two separate randomised controlled trials (RCTs) were undertaken; both used the same
hydrocolloid as the control. One RCT compared Actisorb (without silver) with the control on chronic
pressure ulcers and the other RCT compared Actisorb Silver 220 with the control on chronic venous
leg ulcers. Patients were followed for four weeks. Baseline patient demographic and wound
characteristics were comparable between the treatment and control groups. Wounds were assessed at
weekly intervals. Ulcers were photographed and then traced by an experienced, independent
investigator. Both the reduction in ulcer area and the percentage reduction were calculated.
● Results: Sixty patients were enrolled into each study, although data for one patient were not available
in the pressure ulcer study. There were differences in results at week 1 in favour of the treatment group
in both studies, although the results for the two groups in each study were comparable at week 4.
Activated charcoal dressing was better tolerated than the control.
● Conclusion: These clinical data indicate the potential usefulness of using activated charcoal
impregnated with silver in the management of chronic wounds, even at the debridement stage. This
dressing may help remove fl uids and toxins that impair the healing process.
● Declaration of interest: These studies were sponsored by Systagenix Wound Management.
activated charcoal; adsorption; bacteria; toxins; debridement; pressure ulcers; leg ulcers
A
ctivated charcoal is a charcoal that has
been activated to adsorb (bind mole-
cules to its surface) by steaming or heat-
ing in a vacuum. Charcoal becomes
activated when heated with steam to
approximately 1000°C in the absence of oxygen.1
This process makes charcoal extremely porous. As a
consequence, activated carbon has a large pore vol-
ume and a large surface area, giving it a unique
adsorption capacity.2 When applied onto a wound,
activated charcoal dressings adsorb bacteria, locally
released toxins and wound degradation products,
thereby promoting wound healing.3
The fi rst available dressing of this type was Acti-
sorb (Systagenix Wound Management). Later, silver
was added to the charcoal cloth (Actisorb Silver 220)
as silver ions have a broad-spectrum antimicrobial
effect,4,5 and so should help kill adsorbed bacteria
within the carbon matrix. It is possible that this
might help promote healing in stagnating chronic
wounds, which have a high bioburden.6-8
Two randomised controlled trials, briefl y reported
in 2003 in Journal des Plaies et Cicatrisations, investi-
gated the healing outcomes achieved with Actisorb.9
Both had similar study designs (open, four-week,
parallel group), with one following the use of Acti-
sorb (without silver) on pressure ulcers (PUs) and
the other the use of Actisorb Silver 220 on venous
leg ulcers (VLUs). Both used a carboxymethylcellu-
lose dressing (hydrocolloid) as the control. This
paper describes the methodology and results of the
two studies.
The two studies are described separately below.
Both studies were approved by the same ethics com-
mittee (Comité Consultatif de Protection des Person-
nes dans la Recherche Biomédiale) at the Hôtel-Dieu
University Hospital, Paris, France. All subjects received
detailed information about the study protocols and
gave written informed consent to participate.
Method: pressure ulcer study
Six hospitals participated in the PU study. Both
inpatients and outpatients were eligible for recruit-
ment into the study.
Inclusion criteria were:
● PUs with an area ranging from 5 to 100cm2
● PUs of less than three months’ duration
● PUs graded IIc or IV on the Yarkoni classifi cation10
— that is, full-thickness ulcers that had not extend-
ed down to the bone. This classifi cation system was
used throughout the study hospitals to grade PUs,
and so was incorporated into the study design.
● PUs considered by investigators to have abundant
necrotic tissue and slough (covering >50% of the
wound surface). (In France, Actisorb Silver 200 can
be used as a debriding agent in conjunction with
J.C. Kerihuel, MD,
Scientifi c Manager,
Vertical, Paris, France.
Email: jc.kerihuel@
vertical-pharm.com

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JOURNAL OF WOUND CARE VOL 19, NO 5, MAY 2010210
sharp debridement if required.)
Main exclusion criteria were:
● Inability to give written consent to participate
● Severe illness
● Pressure ulcers totally covered with necrotic tissue
or requiring surgical debridement
● Infected ulcers requiring systemic antibiotics
● Known allergy to the study dressing
● Previous use of Actisorb
One ulcer per patient was included in the study.
Randomisation
Patients were randomly allocated to either the test
dressing (Actisorb) or the control (DuoDerm, Con-
vaTec).
Randomisation was by blocks of four: identical
sealed boxes containing the allocated dressings,
gauze and saline were randomly allocated to each
patient. The box reference number indicated which
study arm the patient had been allocated to,
although this was unknown to the patient and
investigator. The box reference numbers were veri-
fi ed by a coordinating centre before allocation.
Intervention
Standardised PU management strategies (regular
repositioning and use of pressure-redistributing sur-
faces) were applied to all patients.
Necrotic tissue and debris were sharp debrided.
The wounds were cleansed with sterile saline only,
and either the test dressing or the control dressing
was then applied. In the case of large wounds, two
dressings could be applied side by side. Dressings
were impregnated with saline, covered with gauze
and secured with a non-compressive bandage. The
study protocol stipulated that the dressing should
be changed two to three times per week or more
frequently in cases of abundant exudation.
The test dressing was applied for four weeks.
After four weeks, patients in the treatment group
whose ulcers had not healed switched from the test
dressing to Adaptic (Systagenix Wound Manage-
ment). Only results for the fi rst four weeks, when
the test dressing was used, are given here. No sec-
ondary dressing was used at any stage in the
study.
Assessment
The investigators assessed the patients/wounds once
weekly for four weeks, or less if complete wound
closure (defi ned as complete re-epithelialisation)
occurred before then.
At each weekly assessment, the wound was traced
and photographed, and the exudate level and
wound bed characteristics were assessed. Box 1 gives
details on the assessment of the wound bed charac-
teristics, which included assessment of the extent of
devitalised tissue.
All wound tracings were measured by two inde-
pendent, experienced clinicians who were unaware
of the treatment allocation. Each evaluator twice
measured the largest and shortest wound dimen-
sions, and the mean of the two wound axis meas-
urements was used as the fi nal value. Estimation of
the wound surface area was based on the sum of the
two axes.
All local care was performed and recorded by the
same nursing team in each of the participating cen-
tres.
Method: leg ulcer ulcer study
Seven hospitals particpated in this study. Two also
participated in the PU study.
Inclusion criteria were:
● Ulcers of primarily venous origin (ankle brachial
pressure index >0.7) that were not contraindicated
to compression bandaging
● VLUs of <12 months’ duration
● VLUs with an area ranging from 5 to 100cm2
● VLUs considered by the investigators to have
abundant necrotic tissue and slough (covering >50%
of the wound surface).
Exclusion criteria were:
● Poorly controlled diabetes (in the investigator’s
opinion)
● Presence of peri-wound eczema
● Severe illness
● Infected ulcers requiring systemic antibiotics
Box 1. Secondary outcome: percentage of completely
debrided wound
Actisorb was used in conjunction with sharp debridement to remove the necrotic
tissue. One of the secondary outcomes assessed was the percentage of
completely debrided tissue — that is, no exudation, no necrotic tissue and
<25% of the wound surface covered with slough (a score of 0 on the scale
outlined below).
A colormetric scale was used to record the percentage of wound surface covered
with necrotic tissue (black), slough (yellow), granulation (red) and re-
epithelialisation (pink) tissue. The following were scored at each assessment,
according to the scale developed for these two studies:
● Exudation: 0 = none; 1 = mild to moderate; 2 = abundant
● Slough: 0 = <25% of wound area covered with slough; 1 = 25–50% covered;
2 = >50% covered
Necrotic tissue: 0 = none; 1 = <25% of wound area covered; 2 = 25–50% covered;
3 = >50% covered
The total score could range from 0 to 7. A score of 0 was considered to indicate
appropriate debridement. Baseline wound characteristics are given in Tables 1
and 2.
At the end of the four weeks, 11 (37.9%) PUs treated with the test dressing were
totally debrided, compared with fi ve (16.1%) control-treated PUs (p=0.056); 18
VLUs (60%) treated with the test dressing were totally debrided compared with
17 (56.7%) controls. While these results are of interest, it should be noted that
they are attributable to the use of sharp debridement as well as the dressing

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▲
JOURNAL OF WOUND CARE VOL 19, NO 5, MAY 2010 211
● Known allergy to the study dressing
● Previous use of the test dressing.
One ulcer per patient was included in the study.
Randomisation
The same randomisation procedure was used as in
the PU study, except that the study dressing was
Actisorb Silver 220 and the box also contained com-
pression bandaging.
Intervention
Again, the same protocol was used as for the PU
study, except that patients were strongly recom-
mended to wear compression bandage on a daily
basis. All patients used the same system: Bifl ex 16,
Thuasne, France. Overall, the investigators consid-
ered patient concordance with compression
throughout the study to be acceptable in 12 (40%)
and 15 (50%) of the patients in the test and control
groups respectively.
Assessment
VLUs were assessed using the same protocol as for
the PU study
Study outcomes
The primary study outcome for both studies was the
absolute reduction in wound area (cm2) achieved in
the fi rst four weeks of the study, when the test dress-
ing was applied, compared with baseline.
The secondary outcome measure for both studies
was the relative (percentage) reduction in wound
area compared with baseline. Another secondary
outcome measure was the percentage reduction of
debrided tissue. Assessment methods and results for
this are given in Box 1.
Statistical analysis
No a priori power calculations were performed. Sam-
ple sizes were pragmatically determined with the
view that 30 patients per group would be suffi cient
to detect clinically relevant trends in favour of the
test dressing.
All analyses used data from the intention-to-treat
population (defi ned as all randomised patients
whose wounds were traced in at least one assess-
ment during the fi rst four weeks of the study).
Scale variables are presented as mean ± standard
deviation or as median (range).
Absolute and relative changes in wound area were
compared between groups at weeks 1, 2, 3 and 4
using the non-parametric Mann-Whitney U test. No
adaptation of the alpha risk for repeated testing was
used. Ordinal and nominal variables were compared
using either the chi-square test or Fisher’s exact test.
SPS software was used. A p value of less than 5%
(<0.05) was considered as indicating statistical sig-
nifi cance.
Results: pressure ulcer study
Patient and wound characteristics
Sixty patients were recruited into the PU study: 29
to the treatment group and 31 to the control group.
One patient was not included in the intention-to-
treat analysis because her wound tracing was not
available for analysis (she died suddenly two days
after randomisation). Patients and wound charac-
teristics are presented in Table 1.
In 42 cases (71.2%), the study PU was located on
the heel. For the sample as a whole, 29 patients
(49.2%) were able to ambulate with or without help,
21 (35.6%) had very limited mobility and nine
(15.3%) were bedridden. None of the patients had
Table 1. Pressure ulcer study: patients and
wound characteristics at baseline
Treatment Control
group group
(n=29) (n=30)
Demographic data
Sex (male/female):
No. 5/24 9/21
(%) (17/83) (30/70)
Age (years) 83.2 ± 13.2 78.5 ± 16.5
mean ± SD
Body mass index:
● >30 3.6% 10.3%
● 20–29 89.3% 62.1%
● <19 7.1% 27.6%
Wound characteristics
Ulcer location:
● Sacrum 4 (13.8%) 6 (20%)
● Heel 22 (75.9%) 20 (66.7%)
● Other 3 (10.3%) 4 (13.3%)
Wound duration:
● >1 month 15 (51.7%) 15 (50%)
● >3 months 3 (10.3%) 1 (3.3%)
Wound area (cm2)
mean ± SD 25.3 ± 24.6 22.6 ± 18.4
(median) (17.5) (16.0)
Pain experienced at 19 (65.5%) 19 (63.3%)
dressing change
Necrotic tissue 5 (17.2%) 4 (13.3%)
present
Slough >50% of 13 (44.8%) 17 (56.7%)
wound area
Strong exudation 6 (20.7%) 5 (16.7%)
Oedema 1 (3.4%) 5 (16.7%)

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JOURNAL OF WOUND CARE VOL 19, NO 5, MAY 2010212
severe dementia and 38 (64.4%) had incontinence
problems.
Baseline characteristics (including wound charac-
teristics) were comparable between groups.
Withdrawals
Fourteen patients (23.7%) withdrew from this study.
Seven withdrew from the treatment group for the
following reasons:
● Wound stagnation (n=3)
● Intercurrent event (septicaemia) (n=1)
● Other reasons (one death, returned home in two
cases) (n=3)
Seven patients also withdrew from the control
group:
● Local adverse event (wound infection) (n=1)
● Wound stagnation (n=2)
● Intercurrent events (hip fracture and death) (n=2)
● Wound graft (n=1)
● Other reasons (wish to return home) (n=1)
Reduction in wound area
The median reductions in wound area (cm2), com-
pared with baseline, reported for both groups at
weeks 1–4 are given in Table 2. At week 1, the medi-
an reduction in wound area was -2.5cm2 and 0.0cm2
in the treatment and control groups respectively.
This was not statistically signifi cant (p=0.255).
While a larger median reduction was reported for
the treatment group throughout the study period,
this does not reach statistical signifi cance.
Percentage reduction
The median percentage reductions in wound size,
compared with baseline, reported for both groups at
weeks 1–4 are given in Table 3. Again, wound regres-
sion was higher at week 1 in the test group but the
difference in favour of the test dressing was not sta-
tistically signifi cant different (-11.7% versus 0.0).
This difference was not maintained throughout the
study, with a median reduction of -26.9% reported
for the treatment group compared with -18.5% for
the control group at week 4.
Dressing tolerability
Local adverse events reported by investigators are
presented in Table 4. Two patients in the treatment
group reported adverse events (6.9%) compared
with seven in the control group (161.1%).
Results: venous leg ulcer study
Patient and wound characteristics
Sixty patients were recruited into the VLU study, 30
to the test dressing group and 30 to the control
group. Patient and wound characteristics are given
in Table 5.
Of the patients recruited to the VLU study, eight
(13.8%) had diabetes. For the group as a whole, 16
(26.7%) had a history of venous thrombosis, and 27
(45%) were already being treated with compression
at inclusion. Sixteen (53.3%) and 19 (63.3%) patients
given the test and control dressing respectively had
a history of ulceration.
Table 4. Pressure ulcer study: local
adverse events
Treatment Control
group group
Maceration/high 0 2
exudation level
Wound infection 1 2
Wound aggravation 0 1
Overgranulation 0 1
Eczema 0 1
Pruritus 1 0
Pain 0 0
Skin irritation 0 0
Bleeding at
dressing removal 0 0
References
1 Marsh, H., Rodríguez-
Reinoso, F. Activated
Carbon. Elsevier, 2006.
2 Baker, F.S., et al. Activated
carbon. Kirk-Othmer
Encyclopedia of Chemical
Technology 1992; 4: 1015-
1037.
3 Kerihuel, J.C., Charcoal
combined with silver for
the treatment of chronic
wounds. Wounds UK 2009;
5: 3.
4 Stephen-Haynes, J., Toner,
L. Assessment and
management of wound
infection: the role of silver.
Br J Community Nurs,
2007; 12: 3, S6-S12.
Table 2. Pressure ulcer study: reduction in
wound area (cm2)
Treatment Control
group (n=29) group (n=30)
Week 1 -2.5 (-22.4–18.4) 0.0 (-8.8–24.0)
Week 2 -2.8 (-41.2–16.1) -2.7 (-24.1–24.0)
Week 3 -4.2 (-28.2–11.7) -1.8 (-24.1–28.7)
Week 4 -4.3 (-31.2–13.8) -3.1 (-24.1–46.0)
Results are reported as median (range)
Table 3. Pressure ulcer study: percentage
reduction
Treatment Control
group (n=29) group (n=30)
Week 1 -11.7 (-55–130.5) 0.0 (-85.7–77.4)
Week 2 -25.0 (-73–114.5) -14.1 (-95–148.1)
Week 3 -30.8 (-72.6–61.6) -10.3 (-95.6–215.8)
Week 4 -26.9 (-82–97.9) -18.5 (-100–260.9)
Results are reported as median (range)

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JOURNAL OF WOUND CARE VOL 19, NO 5, MAY 2010214
5 Leaper, D.J., Silver
dressings: their role in
wound management. Int
Wound J 2006; 3: 4, 282-
294.
6 Martin, J.M., Zenilman,
J.M., Lazarus, G.S. Molecular
microbiology: new
dimensions for cutaneous
biology and wound healing.
J Invest Dermatol 2010;
130: 1, 38-48.
7 Singh, V.A., Barbul, A.
Bacterial biofi lms in
wounds. Wound Repair
Regen 2008; 16: 1, 1.
8 Xu, L., McLennan, S.V., Lo,
L. et al., Bacterial load
predicts healing rate in
neuropathic diabetic foot
ulcers. Diabetes Care 2007;
30: 2, 378-380.
9 Kerihuel, J.C., Dujardin-
Detrez, S. Actisorb Plus 25,
a review of its clinical
experience based on more
than 12 000 various
wounds. JPC 2003; 8: 39, 3-
7.
10 Yarkony, G.M. Pressure
ulcers: a review. Arch Phys
Med Rehabil 1994; 75: 8,
908-917.
11 Mulligan, C.M., Bragg, A.J.
O’Toole, O.B. A controlled
comparative trial of
Actisorb activated charcoal
cloth dressings in the
community. Br J Clin Pract,
1986; 40: 4, 145-148.
12 Wunderlich, U., Orfanos,
C.E. Treatment of venous
leg ulcers with silver-
impregnated xero dressings.
Hautartz 1991; 42: 446-450.
13 White, R.J. A charcoal
dressing with silver in
wound infection: clinical
evidence. Br J Comm Nurs
2001; 6: 12 (Suppl), 2.
14 Du, X.N., Niu, Z., Zhou,
G.Z., Li, Z.M. Effect of
activated charcoal on
endotoxin adsorption. Part
I. An in vitro study. Biomater
Artif Cells Artif Organs
1987; 15: 1, 229-235.
continued opposite
Baseline characteristics (including wound charac-
teristics) were comparable between groups.
Withdrawals
Seven patients (11.7%) withdrew from the VLU
study. Only one patient withdrew from the test
dressing (hospitalisation for heart failure). Six
patients withdrew from the control group for the
following reasons:
● Local adverse event (eczema) (n=2)
● Intercurrent event (death) (n=1)
● Other reasons: withdrawal of consent (n=2) and
discharge home (n=1)
Reduction in wound area
The median reductions in wound area (cm2), com-
pared with baseline, reported for both groups at
weeks 1–4 are given in Table 6. At week 1, the medi-
an reduction was -2.2cm2 and -0.1cm2 for the treat-
ment and control groups respectively (p=0.066) and
reached -4.5cm2 and -3.5cm2 respectively at week 4.
Percentage reduction
The median percentage reductions in wound size,
compared with baseline, reported for both groups at
weeks 1–4 are given in Table 7. At week 1, median
reductions reported were -16.4% and -0.9% for the
treatment and control groups respectively (p=0.074).
By week 4, the percentage reductions reported were
similar for the both groups: -35.6% versus -40.9%.
Dressing tolerability
Local adverse events reported by the investigators
are presented in Table 8. Five patients reported
adverse events in the treatment group (13.3%),
compared with 20 in the control group (33.3%).
Discussion
These results support those of other studies per-
formed on Actisorb. In Mulligan et al.’s RCT, 101
Table 5. Leg ulcer study: patients and
wound characteristics at baseline
Treatment Control
group group
(n=30) (n=30)
Demographic data
Sex (male/female):
No. 10/20 11/19
(%) (33/67) (37/63)
Age (years) 77.6 ± 12.9 76.0 ± 12.2
mean ± SD
Body mass index:
● >30 28.0% 32.1%
● 20–29 60.0% 60.7%
● <19 12.0% 7.1%
Wound
characteristics
Aetiology:
● Venous 22 (73.3%) 21 (70.0%)
● Arterial 8 (26.7%) 9 (30.0%)
component
Wound duration:
> 1 month 10 (33.3%) 11 (36.7%)
> 3 months 9 (30.0%) 1 (46.7%)
Wound area (cm2)
mean ± SD 18.1 ± 18.2 17.5 ± 24.4
(median) (12.1) (8.2)
Pain experienced at 16 (53.3%) 13 (43.3%)
dressing change
Necrotic tissue 2 (6.7%) 2 (6.7%)
present
Slough >50% of 0 (0.0%) 0 (0.0%)
wound area
Strong exudation 0 (0.0%) 0 (00.0%)
Oedema 13 (43.3%) 9 (30.0%)
Table 6. Leg ulcer study: reduction in
wound area (cm2)
Treatment Control
group (n=30) group (n=30)
Week 1 -2.2 (-21.2–5.0) -0.1 (-23.4–18.3)
Week 2 -3.2 (-27.7–5.2) -1.3 (-49.5–4.5)
Week 3 -4.5 (-26.4–14.0) -2.3 (-53.3–18.4)
Week 4 -4.5 (-30.9–22.5) -3.5 (-53.3–18.5)
Results are reported as median (range)
Table 7. Leg ulcer study: percentage
reduction
Treatment Control
group (n=30) group (n=30)
Week 1 -16.4 (-100–80) -0.9 (-84–82.9)
Week 2 -18.7 (-100–61.5) -14.6 (-96.4–10)
Week 3 -29.5 (-100–156.4) -24.3 (-100–50)
Week 4 -35.6 (-100–182.1) -40.9 (-100–308.3)
Results are reported as median (range)

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JOURNAL OF WOUND CARE VOL 19, NO 5, MAY 2010 215
subjects with ulcers were treated with either
Actisorb (without silver) or a control (any other
dressing regarded as most appropriate by investiga-
tors) for six weeks, unless healing occurred sooner.11
Compared with baseline, the mean percentage
reduction in wound area was statistically signifi cant
for the treatment group (28.7% ± 3.9%) versus the
control (11.7% ± 6.8%). In addition, the test dress-
ing was found to be statistically superior in terms of
reducing exudate levels, malodour and oedema
(p=0.005).
Wunderlich et al., in their RCT, randomised 40
patients with chronic VLUs to receive treatment
with either Actisorb Silver 220 or zinc paste for six
weeks. Results showed that use of the test dressing
resulted in a statistically signifi cant reduction in
wound area when compared with the controls
(p<0.05), with 6/19 evaluated patients in the treat-
ment group healing fully versus 2/19 evaluated
patients in the control group.12
Evidence from non-controlled studies, large pop-
ulation surveys and case studies also support the
clinical benefi t of using Actisorb dressing in various
clinical situations.9,13
Furthermore, in the present study, patients in the
treatment group reported fewer dressing-related
adverse events. The most frequent adverse event
reported in the control groups was maceration/high
exudate level, but this was not reported in either of
the two treatment groups. This suggests that, by
binding toxins, Actisorb helps to promote healing.
Activated charcoal has been reported to remove
endo- and exotoxins from fl uid in vitro.14 Other in
vitro studies have found that, when submerged in a
milieu enriched with Escherichia coli, activated char-
coal removed 90–95% of this toxin.15,16
In in vitro and in vivo experiments using a murine
model of gut-derived endotoxemia, activated char-
coal was able to bind enotoxin in both test meth-
ods.17 It also has been shown that activated charcoal
can adsorb bacteria, viruses and various other bio-
chemicals in vitro and in vivo.18,19 Additionally, ex
vivo and in vitro, activated charcoal fi lters has been
found to fi lter infl ammatory chemokines and
cytokines such as IL-8 or TNF-α from blood.20-22
When silver is incorporated in the activated char-
coal matrix, it is not released. However, an in vitro
study found that the silver killed the bacteria
adsorbed by the activate charcoal, suggesting that it
will reduce the bioburden.23 Verdu Soriano et al.
clearly confi rmed that Actisorb Silver 220 substan-
tially reduced bacterial burden.24
Study limitations
While following the same methodology, including
blind evaluation of wound tracings, these studies
had small sample size, so were underpowered. Nev-
ertheless, it is of interest that both indicated that
the test dressing may help to promote healing,
regardless of the wound aetiology.
Conclusion
Experimental and clinical data indicate the poten-
tial usefulness of using activated charcoal impreg-
nated with silver in the management of chronic
wounds, even at the debridement stage. This type of
dressing may help remove from the wound bed fl uid
and toxins that impair the healing process. ■
Table 8. Leg ulcer study: local adverse
events
Treatment Control
group group
Maceration/high 0 9
exudation level
Wound infection 1 1
Wound aggravation 2 0
Overgranulation 0 0
Eczema 0 5
Pruritus 0 0
Pain 1 1
Skin irritation 1 3
Bleeding at
dressing removal 0 1
15 Nolan, J.P., McDevitt, J.J.,
Goldman, G.S., Bishop, C.
Endotoxin binding by charged and
uncharged resins. Proc Soc Exp
Biol Med 1975; 149: 3, 766-770.
16 Maitra, S.K., Yoshiawa, T.T.,
Guze, L.B., Schotz, M.C.
Properties of binding of
Escherichia coli endotoxin to
various matrices. J Clin Microbiol
1981; 13: 1, 49-53.
17 Ditter, B., Urbaschek, R.,
Urbaschek, B. Ability of various
adsorbents to bind endotoxins in
vitro and to prevent orally induced
endotoxemia in mice. Gastro-
enterology 1983; 84: 6, 1547-1552.
18 Drucker, M.M., et al., The effect
of attapulgite and charcoal on
enterotoxicity of Vibrio cholerae
and Escherichia coli enterotoxins
in rabbits. Infection 1977; 5: 4,
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