Bacterial toxins and wound healing.

Infection--a factor commonly related to delayed closure for many chronic and acute wounds--is associated with relatively high levels of bacteria in viable tissues. But bacteria also can delay wound healing at lower levels before tissue invasion via toxin secretion either directly from viable cells (exotoxins) or as a result of cell lysis (endotoxins). These toxins tend to cause local necrosis and disrupt the delicate balance of critical mediators such as cytokines and proteases necessary for healing progression. Therefore, toxin control or absorption is a potentially valuable adjunct to any infection control modality. A long-standing method of controlling toxins of many types is the use of high surface area adsorbents, such as activated charcoal. Recent data suggest that activated charcoal may offer specific advantages in topical wound management through its effects on bacterial toxins.