Dextranomer (Topical) (Monograph)

Drug class: Emollients, Demulcents, and Protectants

Medically reviewed by Drugs.com on May 10, 2024. Written by ASHP.

Introduction

Dextranomer is a synthetic cross-linked dextran polymer used to cleanse exudative wounds.

Uses for Dextranomer (Topical)

Dextranomer is used to cleanse exudative wounds such as venous stasis ulcers, decubitus ulcers, infected traumatic and surgical wounds, and infected burns. Dextranomer may be used to prepare a wound for skin grafting. The drug is not effective in cleansing nonexudative wounds. Usual treatment of the underlying condition (including systemic antibiotics, surgical debridement, and other conventional therapy) should proceed concurrently with dextranomer application as needed. Dextranomer should not be used concomitantly with topical antibiotics or debriding enzymes. In one study, application of dextranomer twice daily following hexachlorophene soaks in addition to elevation of the legs and pressure dressings resulted in faster healing of venous stasis ulcers than did the same therapy without dextranomer. In animals with experimental burns, healing occurred at the same rate with dextranomer application as with petrolatum-gauze dressings. In uncontrolled studies, dextranomer has been used to reduce pain and promote healing of burns, nonvenereal penile ulcers, and other exudative wounds. However, most clinicians believe that the drug is no more effective than conventional therapy and further controlled studies are required to determine the precise role of dextranomer in the management of exudative wounds.

Dextranomer (Topical) Dosage and Administration

Dextranomer is applied topically using strict aseptic technique. Before applying dextranomer, the wound must be cleansed with sterile water, sodium chloride solution, or other cleansing agents (e.g., hydrogen peroxide, hexachlorophene, povidone-iodine) and left moist. Dextranomer beads are poured onto the wound to a thickness of at least ¼ inch. A bandage is then applied to hold the dextranomer in place; space should be allowed for dextranomer to swell as the beads absorb fluids. Alternatively, a small amount of glycerin may be poured onto a dry dressing large enough to cover the wound and a sufficient amount of dextranomer beads added to make a layer at least ¼ inch thick; the dressing is then applied to the wound. To minimize the possibility of cross-contamination, the contents of a dextranomer beads container should be limited to use in one patient. For areas where it would be difficult to pour dextranomer onto the wound, the commercially available paste or a freshly prepared paste of 3 parts dextranomer and 1 part glycerin may be applied at least ¼ inch thick over the wound. Alternatively, the wound can be lined with sterile nylon net (e.g., Envinet), leaving an additional ½-inch extension from the wound for overlap, and the net moistened with saline; the commercially available paste is then applied to the nylon net, pressing lightly to ensure contact with the wound contours, and a semiocclusive film dressing is applied over the wound, allowing sufficient room for expansion of the dextranomer.

Dextranomer dressings are usually changed once or twice daily, although profusely draining wounds may require 3 or 4 dressing changes daily. When the dextranomer turns a greyish-yellow color, the beads are saturated and should be removed by washing, showering, or irrigation. Occasionally, vigorous irrigation may be needed to remove dextranomer. To facilitate removal, one manufacturer recommends changing the dextranomer dressing before the beads become completely saturated and dried out. If drying of the dextranomer gel occurs, soaking with water, sodium chloride, or a cleansing solution may facilitate removal. Therapy with dextranomer is discontinued when the area is free of exudate and edema or when a healthy granulation base is present.

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Cautions for Dextranomer (Topical)

Local Effects

Dextranomer has been reported to cause pain of short duration during dressing changes in some patients; bleeding, blistering, and erythema have been reported occasionally. A wound that becomes tightly packed with dextranomer may be painful. The beads have not been reported to become incorporated in healing wounds. The reduction of edema that occurs with dextranomer application may make a wound appear larger after initiation of therapy. Maceration of the tissue surrounding a treated wound has occurred in a few patients. Dextranomer appears to have a low sensitizing potential and allergic reactions have not been reported.

Precautions and Contraindications

Dextranomer beads must be completely removed by soaking and irrigation before skin grafting. Dextranomer should not be used in deep fistulas, sinus tracts, or any body cavity from which complete removal is not assured. The drug also should not be used in dry wounds, since it is not effective in cleaning such wounds. Dextranomer must be removed before any surgical procedure to close a wound (graft or flap). To avoid encrustation of the beads, the drug should be removed as soon as possible after the polymer is saturated. Care should be taken to avoid contact of the drug with the eyes.

Pharmacology

Dextranomer cleanses the surface of wounds by drawing wound exudate, bacteria, and particulate contaminants into the beads by capillary action. Substances with a molecular weight of less than 1000 are readily absorbed by the beads, those with a molecular weight of 1000–5000 are less readily absorbed, and those with a molecular weight greater than 5000 remain in the interspaces between the beads. Each gram of dextranomer retains about 4 mL of fluid. By removing bacteria, fibrinogen, fibrin, and fibrin degradation products from the surface of the wound, dextranomer retards scab formation and may decrease infection. Dextranomer may also decrease inflammation and edema at the wound. Dextranomer continues to rapidly absorb exudate until the polymer is saturated. Dextranomer is not absorbed from intact or abraded skin, nor is it phagocytized.

Chemistry

Dextranomer is a synthetic cross-linked dextran polymer used to cleanse exudative wounds. Dextranomer occurs as white spherical hydrophilic beads that are 0.1–0.3 mm in diameter. Dextranomer paste is a mixture of the beads in polyethylene glycol. The drug is insoluble in water and in alcohol. Upon absorption of fluid, dextranomer beads swell and form a gel.

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

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