Nearly ten feet of pure chitosan that packs like any Z-fold. Know the job you are buying it for — and whether your program requires a evidence-based standard dressing instead.
At a glance
12 things to know about the Axiostat Z-Fold
What it is made of, how to pack it, what the FDA cleared, and how thin the evidence behind it is.
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01
Chitosan from end to end
The gauze is a nonwoven fabric made of 100% chitosan extracted from shellfish — no carrier fabric underneath and no powder or granules to shed into the wound.3,7
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02
Nearly ten feet of gauze
MIL300 carries 300 cm (118 in.) of soft, pliable 3 in. gauze built for packing deep wounds. Axio recommends it for deep penetrating wounds, gunshot and shrapnel wounds, head and neck trauma and the lower limbs.3 Axio also makes a 150 cm version, MIL150.4
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03
How Axio says it works
Axio's Protonated Bioadhesive Technology describes positively charged chitosan adhering to blood components, platelets being activated, and a fibrin plug forming at the bleeding site.8 The FDA submission describes the gauze acting as a mechanical barrier when pressed onto the bleeding site.7 In laboratory work that included Axio co-authors, porous chitosan activated platelets through Toll-like receptor 2.12
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04
Three minutes of pressure, then ten in place
Axio labels at least 3 minutes of continuous pressure after packing, the same minimum the TCCC Guidelines set.1,3 Both are minimums — keep pressure on until the bleeding has stopped. Once it has, leave the gauze in position at least 10 minutes.3
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05
It comes out with water
The gauze must come out within 24 hours. The receiving team unwraps the outer dressing, irrigates the gauze with saline or water and removes it gently; Axio states it comes out intact, in one piece.3,6
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06
FDA-cleared in 2023
Axiostat Gauze was cleared under 510(k) K222909 on 7 April 2023 as a temporary external dressing to control moderate to severe bleeding, and for minor cuts, lacerations and abrasions. The submission covers the 3 in. × 118 in. Z-fold; in its swine extremity arterial model, every animal reached hemostasis in under 5 minutes with no re-bleeding over 2 hours.7
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07
NSN-coded, vacuum-packed
Axio lists MIL300 under NSN 6510-72-057-0460, and the number is printed on the pouch.4,5 The camouflage pouch is vacuum-packed with four tear notches and carries the CE 2460 mark.3,4,5
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08
Carried by India's armed forces
Axio states Axiostat — known in India as "Bharat Ka Bandage" — is extensively used by Indian and other armed forces.9 In a 2023 company statement, Axio said more than 1.5 million units had been used on battlefields in more than 50 countries.10
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09
The animal evidence is small — and Axio's own
Axio's swine study pitted Axiostat gauze against Combat Gauze with 3 animals per group. The tested gauze was the rolled format, not this Z-fold; the study is manufacturer-authored and not indexed in PubMed. Post-treatment blood loss was 7.1 versus 36.2 mL/kg, all six animals reached eventual hemostasis, and survival was 3 of 3 versus 1 of 3.11 Three animals per group cannot settle which dressing is better.
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10
The human data come from the patch
There is no published human study of the Z-fold. The closest is the Axiostat patch: in 104 bleeding scalp wounds randomly allocated during ambulance transport, an 8 × 5 cm patch stopped bleeding in 4.68 minutes on average against 18.56 minutes for cotton gauze.13 Same material, different format and different wounds.
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11
Made from shellfish — and labeled that way
The pouch states the gauze contains chitosan from shellfish, and Axio's warnings say not to use it on a patient who is allergic to shellfish.5,6 For that casualty, use a kaolin dressing such as Combat Gauze.
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12
Not evidence-based standard
Axiostat is not on the Evidence-Based Standard Devices & Adjuncts list.2 Combat Gauze is the evidence-based hemostatic dressing of choice.1 A program that must field evidence-based standard hemostatics needs one of those; elsewhere, the Z-fold is a chitosan option for your medical director to weigh.
How to pack the Axiostat Z-Fold
The technique taught in TCCC, TECC and public bleeding-control courses, with Axio's labeled steps, in order.
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1Find the source. Expose the wound, clear the pooled blood and find where the bleeding is coming from.3 Keep direct pressure on it while you tear the pouch open at a notch.
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2Start with a tight wad. Make the first folds into a firm ball — the "power ball" — and press it directly onto the bleeding vessel.
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3Feed it in. Work the gauze in one or two folds at a time, keeping pressure on what is already packed.
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4Fill every corner. Pack tightly to the source and leave no empty space until the wound is full.
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5Hold firm pressure. At least 3 minutes of continuous pressure — Axio's label and the TCCC Guidelines set the same minimum1,3 — and in every case until the bleeding has stopped.
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6Lock it in. Wrap a secondary dressing or pressure bandage over the packed wound to hold the gauze in place and keep the wound clean.3
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7If it keeps bleeding, repack. Remove the packing and pack again with a fresh dressing, the same type or another hemostatic.1 Piling more gauze on top of a failed pack does not fix it.
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8Hand it off. Tell the receiving team a chitosan gauze is in the wound, that it stays at least 10 minutes after bleeding stops, and that it comes out within 24 hours with a saline or water rinse.3,6
Where it fits
- Junctional wounds — groin and armpit — where a limb tourniquet cannot be applied
- Neck wounds, packed with care so the airway is not compressed; the lower neck above the collarbone can be packed
- Deep limb wounds where a tourniquet is not possible, or as an adjunct when a trained provider converts a tourniquet1
- Gunshot and shrapnel wounds with a track you can pack3
- The chest or abdomen — never pack into the chest or abdominal cavity; Axio does not intend it for internal bleeding6
- Life-threatening limb bleeding a tourniquet can control — tourniquet first — high and tight over clothing when the source can't be seen, or on bare skin 2–3 in. above the wound once exposed; never across a joint1
- A casualty allergic to shellfish — choose a kaolin dressing6
- Programs that must field a evidence-based standard hemostatic — carry Combat Gauze or another listed dressing1,2
The evidence
Every study cited above, what it tested, and how strong the evidence is.
| Study | Evidence type | What was studied | What it found |
|---|---|---|---|
| Kumar et al., Int J Health Technol Innov 2024 | Animal · manufacturer-authored, not PubMed-indexed | Axiostat rolled gauze (not the Z-fold) vs Combat Gauze, swine femoral artery injury, 3 animals per group, 3-minute hold | Post-treatment blood loss 7.1 vs 36.2 mL/kg; eventual hemostasis 3/3 vs 3/3; survival 3/3 vs 1/3; re-bleeding after simulated walking 2/3 vs 3/3 |
| FDA 510(k) K222909 summary, 2023 | Animal · regulatory testing | Axiostat Gauze in a swine extremity arterial hemorrhage model run by an external laboratory | Hemostasis in under 5 min in all animals; no re-bleeding over 2 hours |
| Kabeer et al., Cureus 2019 | Human · randomized, prehospital | Axiostat 8 × 5 cm patch (not the Z-fold) vs cotton gauze, 104 bleeding scalp wounds during ambulance transport | Time to hemostasis 4.68 vs 18.56 min (p < 0.0001); success 94% vs 74%; manufacturer supplied the dressings |
| Lee et al., Proc Natl Acad Sci USA 2024 | Laboratory · animal | Porous chitosan pad (includes Axio co-authors): platelet mechanism, murine and swine liver and carotid injuries | Chitosan activated platelets via Toll-like receptor 2; bleeding stopped within minutes, including under anticoagulation |
Strongest to weakest: human studies, then animal and laboratory work. No study of the Z-fold itself has been published; the animal data are small and manufacturer-generated, and the human data come from the patch format.
How it compares
The packing options a buyer most often weighs against each other.
| Axiostat Z-Fold | Combat Gauze | Celox Rapid | Plain compressed gauze | |
|---|---|---|---|---|
| Active agent | 100% chitosan, nonwoven | Kaolin (mineral) | Chito-R™ chitosan granules bonded to gauze | None |
| Strip | 3 in. × 118 in. (7.6 × 300 cm) Z-fold | 3 in. × 4 yd (12 ft) Z-fold | 3 in. × 5 ft Z-fold | 4.5 in. × 4.1 yd roll |
| Labeled pressure hold | At least 3 min, continuous | At least 3 min | 60 s, or until bleeding stops | Longer than a hemostatic — pressure is the only mechanism |
| evidence-based standard | No | Yes — hemostatic dressing of choice | Yes | No — not a hemostatic |
| Shellfish-derived | Yes | No | Yes | No |
Labeled hold times come from each manufacturer's instructions; the TCCC Guidelines set at least 3 minutes of direct pressure for any hemostatic dressing.1 Combat Gauze is the evidence-based hemostatic dressing of choice.
Build the system
The evidence-based standard alternatives, the bandage that locks the packing in, the tourniquet that comes first, and the trainer.
Questions buyers ask
Package & specifications
Specifications coming soon. Contact us for detailed product information.
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