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Venous ulceration, a relative common manifestation of chronic venous insufficiency and venous hypertension, is often difficult to treat. Successful treatment begins with the management of the underlying pathology and wound bed preparation. This article reports the authors' experience with a novel wound dressing produced from microbial cellulose synthesized by an acid- producing bacterium, Acetobacter xylinium. Twenty-four patients with chronic venous insufficiency and lower-leg ulceration were treated with either biocellulose wound dressing (BWD) plus a two- layer compression bandage or standard care. Standard care consisted of a nonadherent primary wound dressing plus a two-layer compression bandage. Evaluations were performed weekly to measure wound pain, nonviable tissue reduction, degree of wound granulation, and wound healing (reduction in wound size and surface area). BWD was significantly more effective than standard care for autolytic debridement (reduction in the amount of nonviable tissue [p=0.0094]). The mean number of days to >75-percent granulation was 43 days for the BWD treated group and 71 for the standard care group. Mean percent reduction in wound area was also greater for the BWD treated group at Week 6 (39% vs. 19%) and at Week 12 (74% vs. 49%). When compared to patients treated with standard care, the group treated with BWD reported less wound pain at each evaluation point. Significant differences in wound pain scores between the two treatments were noted at Week 3, 6 (p=0.039), and 8 (p=0.043).

Biosynthesized cellulose is produced by the bacteria, Acetobacter xylinum, and possesses unique properties not present in other biomaterials. The material is formed during fermentation having a multi-layered structure composed of fine, nonwoven, cellulose hydrophilic fibers. This structure allows biosynthesized cellulose to have a high-fluid capacity, superior strength, and biocompatibility, which makes it suitable for topical and implantable biomedical applications. Initial product development of biosynthesized cellulose has focused on advanced wound-care applications. The product, XCell (Xylos Corporation, Langhorne, PA, USA), has been bioengineered to have the ability to both donate and absorb moisture, depending on the wound environment. Comparative bench testing has shown that XCell is the only wound dressing with this unique dual-fluid-handling capability. The product has been studied thoroughly using animal models and proved to be safe and biocompatible. Human clinical testing has demonstrated its effectiveness in providing a moist environment, essential to treating hard-to-heal chronic wounds. The major clinical benefits of the product include: 1) help in removal of non-viable tissue and promotion of autolytic debridement, which results in increased granulation tissue; 2) cleansing of wound margins that leads to epithelial migration and reduction of wound size; and 3) healing of various types of chronic wounds.