Achieving Hemostasis and Contributing to an Environment that may be Beneficial to the Wound Healing Paradigm: Use of a Chitosan Derived Hemostatic Agent in Wound Care

Abstract Body: Introduction Debridement is a key component in several wound care guidelines.1 Its use in patients on anti-coagulant therapy can result in difficult to control active bleeding of the wound bed.2 Pressure and/or application of silver nitrate are common modalities used to cease bleeding. However, they involve an extended time period, and can burn tissue therefore perpetuating inflammation.2, 3  Other modalities like Topical Thrombin, Surgicel, and gelatin sponges are expensive and can extend time to clotting. Gelatin sponges may even slow the healing cascade.4,5 Chitosan is a naturally occurring biocompatible, biodegradable, and non-toxic hemostatic agent with antimicrobial and antifungal properties that has been shown to promote wound healing.6,7 Presented here is a case report of a chronic wound in a compromised patient on anti-coagulant therapy treated with hemostatic granules whose use achieved hemostasis and appeared to accelerate healing. Case Report A 55 year old female with rheumatoid arthritis and lower extremity fracture presented with a chronic wound secondary to casting. The patient had a decreased cardiac output and history of chronic steroid and anti-coagulant use.  Treatment consisted of sharp debridement followed by application of hemostatic granules and secondary dressing. Dressing change at one week revealed significant reduction in wound size. Wound resolution occurred at four weeks.  Discussion Use of chitosan derived hemostatic agents have been shown to result in statistically significant shorter time to hemostasis and improved granulation tissue quality compared to standard of care in patients with chronic wounds on anti-coagulant therapy.2 Chitosan is believed to assist in every phase of wound healing by enhancing inflammatory and reparative cell functions aiding in cell migration and increasing tensile strength within the wound.6 Conclusion Use of a hemostatic agent in the case presented here achieved hemostasis and appeared to accelerate healing with wound resolution occurring at one month.