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Sharma S, Kishen A. Bioarchitectural Design of Bioactive Biopolymers: Structure-Function Paradigm for Diabetic Wound Healing. Biomimetics (Basel) 2024; 9:275. [PMID: 38786486 PMCID: PMC11117869 DOI: 10.3390/biomimetics9050275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Chronic wounds such as diabetic ulcers are a major complication in diabetes caused by hyperglycemia, prolonged inflammation, high oxidative stress, and bacterial bioburden. Bioactive biopolymers have been found to have a biological response in wound tissue microenvironments and are used for developing advanced tissue engineering strategies to enhance wound healing. These biopolymers possess innate bioactivity and are biodegradable, with favourable mechanical properties. However, their bioactivity is highly dependent on their structural properties, which need to be carefully considered while developing wound healing strategies. Biopolymers such as alginate, chitosan, hyaluronic acid, and collagen have previously been used in wound healing solutions but the modulation of structural/physico-chemical properties for differential bioactivity have not been the prime focus. Factors such as molecular weight, degree of polymerization, amino acid sequences, and hierarchical structures can have a spectrum of immunomodulatory, anti-bacterial, and anti-oxidant properties that could determine the fate of the wound. The current narrative review addresses the structure-function relationship in bioactive biopolymers for promoting healing in chronic wounds with emphasis on diabetic ulcers. This review highlights the need for characterization of the biopolymers under research while designing biomaterials to maximize the inherent bioactive potency for better tissue regeneration outcomes, especially in the context of diabetic ulcers.
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Affiliation(s)
- Shivam Sharma
- The Kishen Lab, Dental Research Institute, University of Toronto, Toronto, ON M5G 1G6, Canada;
- Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, ON M5G 1G6, Canada
| | - Anil Kishen
- The Kishen Lab, Dental Research Institute, University of Toronto, Toronto, ON M5G 1G6, Canada;
- Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, ON M5G 1G6, Canada
- Department of Dentistry, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
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Pennington E, Bell S, Hill JE. Should video laryngoscopy or direct laryngoscopy be used for adults undergoing endotracheal intubation in the pre-hospital setting? A critical appraisal of a systematic review. JOURNAL OF PARAMEDIC PRACTICE : THE CLINICAL MONTHLY FOR EMERGENCY CARE PROFESSIONALS 2023; 15:255-259. [PMID: 38812899 PMCID: PMC7616025 DOI: 10.1002/14651858] [Citation(s) in RCA: 2444] [Impact Index Per Article: 2444.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The safety and utility of endotracheal intubation by paramedics in the United Kingdom is a matter of debate. Considering the controversy surrounding the safety of paramedic-performed endotracheal intubation, any interventions that enhance patient safety should be evaluated for implementation based on solid evidence of their effectiveness. A systematic review performed by Hansel and colleagues (2022) sought to assess compare video laryngoscopes against direct laryngoscopes in clinical practice. This commentary aims to critically appraise the methods used within the review by Hansel et al (2022) and expand upon the findings in the context of clinical practice.
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Affiliation(s)
| | - Steve Bell
- Consultant Paramedic, North West Ambulance Service NHS Trust
| | - James E Hill
- University of Central Lancashire, Colne, Lancashire
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Priyadarsini SL, Suresh M, Nikhila G. Assessment framework for the selection of a potential interactive dressing material for diabetic foot ulcer. Heliyon 2023; 9:e16476. [PMID: 37292346 PMCID: PMC10245162 DOI: 10.1016/j.heliyon.2023.e16476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023] Open
Abstract
Diabetic foot ulcer is a chronic health issue leading to lower leg amputations in approximately 15% of patients with diabetics. There are many factors directly or indirectly involved in the physiology of wound healing but being a multisystem disorder, wound healing in diabetic patients retard or worsen with heavy exudates and severe microbial infections. Wound management is of prime importance and is an emerging area to incorporate wound regenerative materials in natural or synthetic dressing materials along with proper microbial control. The article aim to identify suitable dressing materials which exhibit inherent wound healing properties at the same time flexible to be used as drug carriers for slow, consistent and effective delivery of 'functional drugs' to the wound environment. The authors selected nine materials from the popular and well accepted dressings of patient choice, analyzed them using graph theoretic approach and ranked them on the basis of graph index values obtained. A critical review has also been done on the basis of their ranking, providing insights to the advantages, disadvantage and potential of top 5 ranked candidate materials. Alginate, Honey, Medifoam, Saline, and Hydrogel dressings were the top five candidate materials ranked respectively, even then, the authors suggests that 'modified hydrogels' can have the potential to be used as a future candidate in DFU treatment as it is the only material (among the top ranked ones) which can effectively used as regenerative drug carrier, while providing all other wound healing properties in relative proportions. The proposed framework can be modified and applied in the selection and ranking of materials for any kind of applications both in industry and medical fields by identifying factors influencing the final outcome of study and by listing the characteristics of the materials selected.
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Affiliation(s)
| | - M. Suresh
- Amrita School of Business, Amrita Vishwa Vidyapeetham, Coimbatore, 641112, India
| | - G. Nikhila
- Government Victoria College, University of Calicut, Palakkad, 678001, Kerala, India
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Wang G, Lin Z, Li Y, Chen L, Reddy SK, Hu Z, Garza L. Colonizing microbiota is associated with clinical outcomes in diabetic wound healing. Adv Drug Deliv Rev 2023; 194:114727. [PMID: 36758858 PMCID: PMC10163681 DOI: 10.1016/j.addr.2023.114727] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
With the development of society and the improvement of life quality, more than 500 million people are affected by diabetes. More than 10 % of people with diabetes will suffer from diabetic wounds, and 80 % of diabetic wounds will reoccur, so the development of new diabetic wound treatments is of great importance. The development of skin microbe research technology has gradually drawn people's attention to the complex relationship between microbes and diabetic wounds. Many studies have shown that skin microbes are associated with the outcome of diabetic wounds and can even be used as one of the indicators of wound prognosis. Skin microbes have also been found to have the potential to treat diabetic wounds. The wound colonization of different bacteria can exert opposing therapeutic effects. It is necessary to fully understand the skin microbes in diabetic wounds, which can provide valuable guidance for clinical diabetic wound treatment.
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Affiliation(s)
- Gaofeng Wang
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510515, China; Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21210, USA.
| | - Zhen Lin
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Yue Li
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Lu Chen
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Sashank K Reddy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21210, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Zhiqi Hu
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Luis Garza
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21210, USA; Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21210, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21210, USA.
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Hamid MH, Arbab AH, Yousef BA. Bacteriological profile and antibiotic susceptibility of diabetic Foot infections at Ribat University hospital; a retrospective study from Sudan. J Diabetes Metab Disord 2020; 19:1397-1406. [PMID: 33553032 DOI: 10.1007/s40200-020-00660-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/08/2020] [Indexed: 12/19/2022]
Abstract
Purpose Diabetic foot infection (DFI) is one of the most feared complications of diabetes. In Sudan, the number of cases and the problems associated with diabetic foot infections increased in recent years. This study aimed to assess the bacteriological profile of patients with DFIs and their antibiotic susceptibility pattern. Methods A descriptive retrospective cross-sectional study was carried out at Surgery Department of Ribat University Hospital. All medical records of patients with DFIs during the period from September 2017 to February 2019 were reviewed using data collection sheet. The collected data were analyzed using Statistical Package for Social Sciences. Results Out of 250 DFI patients, 73.2% of them were males, and 86.4% of them had type 2 diabetes mellitus, and most of them suffered from diabetes for more than 10 years. Regarding culture results, 64.7% and 35.3% of the samples revealed presence of single microorganism and mixed infections, respectively. A total of 335 bacterial isolates were identified, gram-negative were more prevalent than gram-positive organisms. The most frequently isolated organisms were Proteus spp. Staphylococcus aureus, and Escherichia coli. Furthermore, antibiotic susceptibility pattern showed that imipenem, amikacin and vancomycin have the highest activity against isolated bacteria, and all isolates were found to be completely resistant to different cephalosporin drugs. Conclusion Among the studied samples, gram-negative bacteria were found to be more common in DFI patients, Proteus spp. and S. aureus were the most common microorganisms. Moreover, different isolated microorganisms showed to have different degrees of resistance and sensitivity to various antibacterial drugs.
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Affiliation(s)
- Maram H Hamid
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Al-Qasr Ave, 1111 Khartoum, Sudan
| | - Ahmed H Arbab
- Department of Pharmacognosy, Faculty of Pharmacy, University of Khartoum, Al-Qasr Ave, 11111 Khartoum, Sudan.,Department of Pharmacognosy, Faculty of Pharmacy, Omdurman Islamic University, Omdurman, Sudan
| | - Bashir A Yousef
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Al-Qasr Ave, 11111 Khartoum, Sudan
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Kathawala MH, Ng WL, Liu D, Naing MW, Yeong WY, Spiller KL, Van Dyke M, Ng KW. Healing of Chronic Wounds: An Update of Recent Developments and Future Possibilities. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:429-444. [PMID: 31068101 DOI: 10.1089/ten.teb.2019.0019] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic wounds are the result of disruptions in the body's usual process of healing. They are not only a source of significant pain and discomfort but also, more importantly, an unguarded port of entry for pathogens into the body. While our current understanding of this phenomenon is far from complete, findings in physiological patterns and advancements in wound healing technologies have helped develop wound management and healing solutions to this long-standing medical challenge. This review presents an overview of known wound healing mechanics, abnormalities that lead to chronic wounds, and a summary of established and new wound healing technologies. Various approaches to heal wounds are discussed, from dermal replacements to advanced biomaterial-based treatments, from cell-, synthetic-, and composite-based approaches to preclinical approaches, which make developing such products possible. While tested breakthrough products are described, the authors focused more on recently developed innovations, which are at varying stages of maturity. The review concludes with a note on future perspectives and opinions on where the field and industry are headed and where they should be. Impact Statement Wound healing is an important area of research and clinical practice, and has captured the attention of tissue engineers since the nascent beginnings of the discipline. Tissue-engineered skin was the first FDA-approved product, achieved in 1996. Despite this success, and the passage of time, healing wounds, particularly chronic wounds, remains a vexing challenge. This comprehensive review article will provide readers with a synopsis of current issues, research approaches, animal models, technologies, and products that span the continuum from early development to clinical studies, in the hope of fueling new interests and ideas to overcome this long-standing medical challenge.
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Affiliation(s)
| | - Wei Long Ng
- Singapore Centre for 3D Printing (SC3DP), School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Dan Liu
- Singapore Institute of Manufacturing Technology (SIMTECH), Singapore, Singapore
| | - May Win Naing
- Singapore Institute of Manufacturing Technology (SIMTECH), Singapore, Singapore
| | - Wai Yee Yeong
- Singapore Centre for 3D Printing (SC3DP), School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Kara L Spiller
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Mark Van Dyke
- Department of Biomedical Engineering and Mechanics (BEAM), Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Kee Woei Ng
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore.,Skin Research Institute of Singapore (SRIS), Singapore, Singapore.,Environmental Chemistry & Materials Centre, Nanyang Environment and Water Research Institute (NEWRI), Singapore, Singapore
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Liu Z, Dumville JC, Hinchliffe RJ, Cullum N, Game F, Stubbs N, Sweeting M, Peinemann F. Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Syst Rev 2018; 10:CD010318. [PMID: 30328611 PMCID: PMC6517143 DOI: 10.1002/14651858.cd010318.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Foot wounds in people with diabetes mellitus (DM) are a common and serious global health issue. People with DM are prone to developing foot ulcers and, if these do not heal, they may also undergo foot amputation surgery resulting in postoperative wounds. Negative pressure wound therapy (NPWT) is a technology that is currently used widely in wound care. NPWT involves the application of a wound dressing attached to a vacuum suction machine. A carefully controlled negative pressure (or vacuum) sucks wound and tissue fluid away from the treated area into a canister. A clear and current overview of current evidence is required to facilitate decision-making regarding its use. OBJECTIVES To assess the effects of negative pressure wound therapy compared with standard care or other therapies in the treatment of foot wounds in people with DM in any care setting. SEARCH METHODS In January 2018, for this first update of this review, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies, reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. We identified six additional studies for inclusion in the review. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) that evaluated the effects of any brand of NPWT in the treatment of foot wounds in people with DM, irrespective of date or language of publication. Particular effort was made to identify unpublished studies. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. Initial disagreements were resolved by discussion, or by including a third review author when necessary. We presented and analysed data separately for foot ulcers and postoperative wounds. MAIN RESULTS Eleven RCTs (972 participants) met the inclusion criteria. Study sample sizes ranged from 15 to 341 participants. One study had three arms, which were all included in the review. The remaining 10 studies had two arms. Two studies focused on postamputation wounds and all other studies included foot ulcers in people with DM. Ten studies compared NPWT with dressings; and one study compared NPWT delivered at 75 mmHg with NPWT delivered at 125 mmHg. Our primary outcome measures were the number of wounds healed and time to wound healing.NPWT compared with dressings for postoperative woundsTwo studies (292 participants) compared NPWT with moist wound dressings in postoperative wounds (postamputation wounds). Only one study specified a follow-up time, which was 16 weeks. This study (162 participants) reported an increased number of healed wounds in the NPWT group compared with the dressings group (risk ratio (RR) 1.44, 95% confidence interval (CI) 1.03 to 2.01; low-certainty evidence, downgraded for risk of bias and imprecision). This study also reported that median time to healing was 21 days shorter with NPWT compared with moist dressings (hazard ratio (HR) calculated by review authors 1.91, 95% CI 1.21 to 2.99; low-certainty evidence, downgraded for risk of bias and imprecision). Data from the two studies suggest that it is uncertain whether there is a difference between groups in amputation risk (RR 0.38, 95% CI 0.14 to 1.02; 292 participants; very low-certainty evidence, downgraded once for risk of bias and twice for imprecision).NPWT compared with dressings for foot ulcersThere were eight studies (640 participants) in this analysis and follow-up times varied between studies. Six studies (513 participants) reported the proportion of wounds healed and data could be pooled for five studies. Pooled data (486 participants) suggest that NPWT may increase the number of healed wounds compared with dressings (RR 1.40, 95% CI 1.14 to 1.72; I² = 0%; low-certainty evidence, downgraded once for risk of bias and once for imprecision). Three studies assessed time to healing, but only one study reported usable data. This study reported that NPWT reduced the time to healing compared with dressings (hazard ratio (HR) calculated by review authors 1.82, 95% CI 1.27 to 2.60; 341 participants; low-certainty evidence, downgraded once for risk of bias and once for imprecision).Data from three studies (441 participants) suggest that people allocated to NPWT may be at reduced risk of amputation compared with people allocated to dressings (RR 0.33, 95% CI 0.15 to 0.70; I² = 0%; low-certainty evidence; downgraded once for risk of bias and once for imprecision).Low-pressure compared with high-pressure NPWT for foot ulcersOne study (40 participants) compared NPWT 75 mmHg and NPWT 125 mmHg. Follow-up time was four weeks. There were no data on primary outcomes. There was no clear difference in the number of wounds closed or covered with surgery between groups (RR 0.83, 95% CI 0.47 to 1.47; very low-certainty evidence, downgraded once for risk of bias and twice for serious imprecision) and adverse events (RR 1.50, 95% CI 0.28 to 8.04; very low-certainty evidence, downgraded once for risk of bias and twice for serious imprecision). AUTHORS' CONCLUSIONS There is low-certainty evidence to suggest that NPWT, when compared with wound dressings, may increase the proportion of wounds healed and reduce the time to healing for postoperative foot wounds and ulcers of the foot in people with DM. For the comparisons of different pressures of NPWT for treating foot ulcers in people with DM, it is uncertain whether there is a difference in the number of wounds closed or covered with surgery, and adverse events. None of the included studies provided evidence on time to closure or coverage surgery, health-related quality of life or cost-effectiveness. The limitations in current RCT evidence suggest that further trials are required to reduce uncertainty around decision-making regarding the use of NPWT to treat foot wounds in people with DM.
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Affiliation(s)
- Zhenmi Liu
- West China Hospital, Sichuan UniversityWest China School of Public HealthChengduSichuanChina610041
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthManchesterUKM13 9PL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthManchesterUKM13 9PL
| | - Robert J Hinchliffe
- St George's Healthcare NHS TrustSt George's Vascular Institute4th Floor, St James WingBlackshaw RoadLondonUKSW17 0QT
| | - Nicky Cullum
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthManchesterUKM13 9PL
| | - Fran Game
- Derby Hospitals NHS Foundation TrustDepartment of Diabetes and EndocrinologyUttoxeter RoadDerbyUKDE22 3NE
| | - Nikki Stubbs
- St Mary's HospitalLeeds Community Healthcare NHS Trust3 Greenhill RoadLeedsUKLS12 3QE
| | - Michael Sweeting
- University of LeicesterDepartment of Health Sciences, College of Life SciencesGeorge Davies CentreUniversity RoadLeicesterUKLE1 7RH
| | - Frank Peinemann
- Children's Hospital, University of ColognePediatric Oncology and HematologyKerpener Str. 62CologneGermany50937
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Schaarup C, Pape-Haugaard LB, Hejlesen OK. Models Used in Clinical Decision Support Systems Supporting Healthcare Professionals Treating Chronic Wounds: Systematic Literature Review. JMIR Diabetes 2018; 3:e11. [PMID: 30291078 PMCID: PMC6238865 DOI: 10.2196/diabetes.8316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 04/17/2018] [Accepted: 05/03/2018] [Indexed: 12/17/2022] Open
Abstract
Background Chronic wounds such as diabetic foot ulcers, venous leg ulcers, and pressure ulcers are a massive burden to health care facilities. Many randomized controlled trials on different wound care elements have been conducted and published in the Cochrane Library, all of which have only a low evidential basis. Thus, health care professionals are forced to rely on their own experience when making decisions regarding wound care. To progress from experience-based practice to evidence-based wound care practice, clinical decision support systems (CDSS) that help health care providers with decision-making in a clinical workflow have been developed. These systems have proven useful in many areas of the health care sector, partly because they have increased the quality of care, and partially because they have generated a solid basis for evidence-based practice. However, no systematic reviews focus on CDSS within the field of wound care to chronic wounds. Objective The aims of this systematic literature review are (1) to identify models used in CDSS that support health care professionals treating chronic wounds, and (2) to classify each clinical decision support model according to selected variables and to create an overview. Methods A systematic review was conducted using 6 databases. This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews. The search strategy consisted of three facets, respectively: Facet 1 (Algorithm), Facet 2 (Wound care) and Facet 3 (Clinical decision support system). Studies based on acute wounds or trauma were excluded. Similarly, studies that presented guidelines, protocols and instructions were excluded, since they do not require progression along an active chain of reasoning from the clinicians, just their focus. Finally, studies were excluded if they had not undergone a peer review process. The following aspects were extracted from each article: authors, year, country, the sample size of data and variables describing the type of clinical decision support models. The decision support models were classified in 2 ways: quantitative decision support models, and qualitative decision support models. Results The final number of studies included in the systematic literature review was 10. These clinical decision support models included 4/10 (40%) quantitative decision support models and 6/10 (60%) qualitative decision support models. The earliest article was published in 2007, and the most recent was from 2015. Conclusions The clinical decision support models were targeted at a variety of different types of chronic wounds. The degree of accessibility of the inference engines varied. Quantitative models served as the engine and were invisible to the health care professionals, while qualitative models required interaction with the user.
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Affiliation(s)
- Clara Schaarup
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | | | - Ole Kristian Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
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Da LC, Huang YZ, Xie HQ. Progress in development of bioderived materials for dermal wound healing. Regen Biomater 2017; 4:325-334. [PMID: 29026647 PMCID: PMC5633688 DOI: 10.1093/rb/rbx025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 02/05/2023] Open
Abstract
Treatment of acute and chronic wounds is one of the primary challenges faced by doctors. Bioderived materials have significant potential clinical value in tissue injury treatment and defect reconstruction. Various strategies, including drug loading, addition of metallic element(s), cross-linking and combining two or more distinct types of materials with complementary features, have been used to synthesize more suitable materials for wound healing. In this review, we describe the recent developments made in the processing of bioderived materials employed for cutaneous wound healing, including newly developed materials such as keratin and soy protein. The focus was on the key properties of the bioderived materials that have shown great promise in improving wound healing, restoration and reconstruction. With their good biocompatibility, nontoxic catabolites, microinflammation characteristics, as well as their ability to induce tissue regeneration and reparation, the bioderived materials have great potential for skin tissue repair.
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Affiliation(s)
- Lin-Cui Da
- Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China
| | - Yi-Zhou Huang
- Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China
| | - Hui-Qi Xie
- Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China
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10
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Curbing Inflammation in Skin Wound Healing: A Review. Int J Inflam 2015; 2015:316235. [PMID: 26356299 PMCID: PMC4556061 DOI: 10.1155/2015/316235] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 07/24/2015] [Accepted: 07/27/2015] [Indexed: 12/15/2022] Open
Abstract
Wound healing is a complex regulated process that results in skin scar formation in postnatal mammals. Chronic wounds are major medical problems that can confer devastating consequences. Currently, there are no treatments to prevent scarring. In the early fetus wounds heal without scarring and the healing process is characterized by relatively less inflammation compared to adults; therefore, research aimed at reducing the inflammatory process related to wound healing might speed healing and improve the final scar appearance.
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Tricco AC, Antony J, Vafaei A, Khan PA, Harrington A, Cogo E, Wilson C, Perrier L, Hui W, Straus SE. Seeking effective interventions to treat complex wounds: an overview of systematic reviews. BMC Med 2015; 13:89. [PMID: 25899006 PMCID: PMC4406332 DOI: 10.1186/s12916-015-0288-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 02/03/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Numerous, often multi-faceted regimens are available for treating complex wounds, yet the evidence of these interventions is recondite across the literature. We aimed to identify effective interventions to treat complex wounds through an overview of systematic reviews. METHODS MEDLINE (OVID interface, 1946 until October 26, 2012), EMBASE (OVID interface, 1947 until October 26, 2012), and the Cochrane Database of Systematic Reviews (Issue 10 of 12, 2012) were searched on October 26, 2012. Systematic reviews that examined adults receiving care for their complex wounds were included. Two reviewers independently screened the literature, abstracted data, and assessed study quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. RESULTS Overall, 99 systematic reviews were included after screening 6,200 titles and abstracts and 422 full-texts; 54 were systematic reviews with a meta-analysis (including data on over 54,000 patients) and 45 were systematic reviews without a meta-analysis. Overall, 44% of included reviews were rated as being of high quality (AMSTAR score ≥ 8). Based on data from systematic reviews including a meta-analysis with an AMSTAR score ≥ 8, promising interventions for complex wounds were identified. These included bandages or stockings (multi-layer, high compression) and wound cleansing for venous leg ulcers; four-layer bandages for mixed arterial/venous leg ulcers; biologics, ultrasound, and hydrogel dressings for diabetic leg/foot ulcers; hydrocolloid dressings, electrotherapy, air-fluidized beds, and alternate foam mattresses for pressure ulcers; and silver dressings and ultrasound for unspecified mixed complex wounds. For surgical wound infections, topical negative pressure and vacuum-assisted closure were promising interventions, but this was based on evidence from moderate to low quality systematic reviews. CONCLUSIONS Numerous interventions can be utilized for patients with varying types of complex wounds, yet few treatments were consistently effective across all outcomes throughout the literature. Clinicians and patients can use our results to tailor effective treatment according to type of complex wound. Network meta-analysis will be of benefit to decision-makers, as it will permit multiple treatment comparisons and ranking of the effectiveness of all interventions. Please see related article: http://dx.doi.org/10.1186/s12916-015-0326-3.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Jesmin Antony
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Afshin Vafaei
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Paul A Khan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Alana Harrington
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Elise Cogo
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Charlotte Wilson
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Laure Perrier
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Wing Hui
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
- Department of Geriatric Medicine, University of Toronto, 27 Kings College Circle, Toronto, Ontario, M5S 1A1, Canada.
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12
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Kavitha KV, Tiwari S, Purandare VB, Khedkar S, Bhosale SS, Unnikrishnan AG. Choice of wound care in diabetic foot ulcer: A practical approach. World J Diabetes 2014; 5:546-556. [PMID: 25126400 PMCID: PMC4127589 DOI: 10.4239/wjd.v5.i4.546] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/28/2014] [Accepted: 05/29/2014] [Indexed: 02/05/2023] Open
Abstract
Diabetic foot ulcers are the consequence of multiple factors including peripheral neuropathy, decreased blood supply, high plantar pressures, etc., and pose a significant risk for morbidity, limb loss and mortality. The critical aspects of the wound healing mechanism and host physiological status in patients with diabetes necessitate the selection of an appropriate treatment strategy based on the complexity and type of wound. In addition to systemic antibiotics and surgical intervention, wound care is considered to be an important component of diabetic foot ulcer management. This article will focus on the use of different wound care materials in diabetic foot. From a clinical perspective, it is important to decide on the wound care material depending on the type and grade of the ulcer. This article will also provide clinicians with a simple approach to the choice of wound care materials in diabetic foot ulcer.
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13
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Junker JP, Kamel RA, Caterson E, Eriksson E. Clinical Impact Upon Wound Healing and Inflammation in Moist, Wet, and Dry Environments. Adv Wound Care (New Rochelle) 2013; 2:348-356. [PMID: 24587972 DOI: 10.1089/wound.2012.0412] [Citation(s) in RCA: 235] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Indexed: 11/12/2022] Open
Abstract
SIGNIFICANCE Successful treatment of wounds relies on precise control and continuous monitoring of the wound-healing process. Wet or moist treatment of wounds has been shown to promote re-epithelialization and result in reduced scar formation, as compared to treatment in a dry environment. RECENT ADVANCES By treating wounds in a controlled wet environment, delivery of antimicrobials, analgesics, other bioactive molecules such as growth factors, as well as cells and micrografts, is allowed. The addition of growth factors or transplantation of cells yields the possibility of creating a regenerative wound microenvironment that favors healing, as opposed to excessive scar formation. CRITICAL ISSUES Although several manufacturers have conceived products implementing the concept of moist wound healing, there remains a lack of commercial translation of wet wound-healing principles into clinically available products. This can only be mitigated by further research on the topic. FUTURE DIRECTIONS The strong evidence pointing to the favorable healing of wounds in a wet or moist environment compared to dry treatment will extend the clinical indications for this treatment. Further advances are required to elucidate by which means this microenvironment can be optimized to improve the healing outcome.
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Affiliation(s)
- Johan P.E. Junker
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rami A. Kamel
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - E.J. Caterson
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elof Eriksson
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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14
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Abstract
BACKGROUND Foot ulcers in people with diabetes are a prevalent and serious global health issue. Wound dressings are regarded as important components of ulcer treatment, with clinicians and patients having many different types to choose from including hydrocolloid dressings. There is a range of different hydrocolloids available including fibrous-hydrocolloid and hydrocolloid (matrix) dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use. OBJECTIVES To compare the effects of hydrocolloid wound dressings with no dressing or alternative dressings on the healing of foot ulcers in people with diabetes. SEARCH METHODS For this first update, in April 2013, we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) that have compared the effects on ulcer healing of hydrocolloid with alternative wound treatments in the treatment of foot ulcers in people with diabetes. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS We included five studies (535 participants) in the review: these compared hydrocolloids with basic wound contact dressings, foam dressings, alginate dressings and a topical treatment. Meta-analysis of two studies indicated no statistically significant difference in ulcer healing between fibrous-hydrocolloids and basic wound contact dressings: risk ratio 1.01 (95% CI 0.74 to 1.38). One of these studies found that a basic wound contact dressing was more cost-effective than a fibrous-hydrocolloid dressing. One study compared a hydrocolloid-matrix dressing with a foam dressing and found no statistically significant difference in the number of ulcers healed. There was no statistically significant difference in healing between an antimicrobial (silver) fibrous-hydrocolloid dressing and standard alginate dressing; an antimicrobial dressing (iodine-impregnated) and a standard fibrous hydrocolloid dressing or a standard fibrous hydrocolloid dressing and a topical cream containing plant extracts. AUTHORS' CONCLUSIONS Currently there is no research evidence to suggest that any type of hydrocolloid wound dressing is more effective in healing diabetic foot ulcers than other types of dressing or a topical cream containing plant extracts. Decision makers may wish to consider aspects such as dressing cost and the wound management properties offered by each dressing type e.g. exudate management.
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Affiliation(s)
- Jo C Dumville
- University of ManchesterDepartment of Nursing, Midwifery and Social WorkManchesterUKM13 9PL
| | - Sohan Deshpande
- Kleijnen Systematic ReviewsUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
| | - Susan O'Meara
- University of LeedsSchool of HealthcareRoom LG.12, Baines WingLeedsUKLS2 9JT
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15
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Edwards JV, Caston-Pierre S. Citrate-linked keto- and aldo-hexose monosaccharide cellulose conjugates demonstrate selective human neutrophil elastase-lowering activity in cotton dressings. J Funct Biomater 2013; 4:59-73. [PMID: 24955952 PMCID: PMC4030900 DOI: 10.3390/jfb4020059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 04/12/2013] [Accepted: 04/17/2013] [Indexed: 01/29/2023] Open
Abstract
Sequestration of harmful proteases as human neutrophil elastase (HNE) from the chronic wound environment is an important goal of wound dressing design and function. Monosaccharides attached to cellulose conjugates as ester-appended aldohexoses and ketohexoses were prepared on cotton gauze as monosccharide-citrate-cellulose-esters for HNE sequestration. The monosaccharide-cellulose analogs demonstrated selective binding when the derivatized cotton dressings were measured for sequestration of HNE. Each monosaccharide-cellulose conjugate was prepared as a cellulose citrate-linked monosaccharide ester on the cotton wound dressing, and assayed under wound exudate-mimicked conditions for elastase sequestration activity. A series of three aldohexose and four ketohexose ester cellulose conjugates were prepared on cotton gauze through citric acid-cellulose cross linking esterification. The monosaccharide portion of the conjugate was characterized by hydrolysis of the citrate-monosaccharide ester bond, and subsequent analysis of the free monosaccharide with high performance anion exchange chromatography. The ketohexose and aldohexose conjugate levels on cotton were quantified on cotton using chromatography and found to be present in milligram/gram amounts. The citrate-cellulose ester bonds were characterized with FTIR. Ketohexose-citrate-cellulose conjugates sequestered more elastase activity than aldohexose-citrate-cellulose conjugates. The monosaccharide cellulose conjugate families each gave distinctive profiles in elastase-lowering effects. Possible mechanisms of elastase binding to the monosaccharide-cellulose conjugates are discussed.
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Affiliation(s)
- Judson V Edwards
- USDA-ARS, Southern Regional Research Center, 1100 Robert E. Lee Blvd., New Orleans, LA 70124, USA.
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16
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Abstract
ZusammenfassungEinleitung: Die nicht heilende Wunde stellt einen zunehmenden Kostenfaktor im Gesundheitssystem dar. Ziel der fachgerechten Wundtherapie ist es, die gestörte Wundhei-lung zu durchbrechen, um das Durchlaufen der physiologischen Abheilung zu ermögli-chen.Methoden: Es erfolgte eine selektive Literaturrecherche in den Datenbanken AWMF, PubMed und Cochrane Library mit den Schlüsselwörtern „chronic wound” oder „ulcer” in Kombination mit den Begriffen alginates, hydrofibre, hydrogel, collagen, foam.Ergebnisse: Die heute verfügbaren Wundtherapeutika erlauben es nicht, bei chronischen Wunden anstelle einer narbigen Reparatur eine physiologische Regeneration der Haut zu erreichen. Vor jeder Wundtherapie müssen mögliche Ursachen für die gestörte Wundhei-lung identifiziert werden und sofern möglich kausal therapiert werden. Zur topischen Therapie chronischer Wunden steht eine große Auswahl verschiedener Wundauflagen zur Verfügung. Die dezidierte Kenntnis dieser Wundtherapeutika ermöglicht deren differenzierten Einsatz, und ist damit die Voraussetzung für eine heilungsphasenadaptierte Anwendung.Schlussfolgerung: Die derzeitige Studienlage erlaubt kaum Rückschlüsse auf die Überlegenheit einzelner Wundauflagen bezüglich des Endpunktes Wundverschluss. Obwohl die mangelhafte Evidenz die Entscheidung bei den Behandelnden für oder gegen die einzelnen Produkte erschwert, zeigt es auch, dass teure Wundauflagen preiswerteren Alternativen nicht eindeutig überlegen sind.
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