The local treatment and available dressings designed for chronic wounds

Cryopreservable, scalable and ready-to-use cell-laden patches for diabetic ulcer treatment

Stem cell-laden hydrogel patches are promising candidates to treat chronic ulcers due to cells' long-lasting and dynamic responses to wound microenvironment. However, their clinical translations are prohibited by the cryopreservation difficulty due to their weak mechanical strength and slow biotransport capability, and by the morphological mismatch between clinical ulcers and pre-fabricated patches. Here we report a stem cell-laden alginate-dopamine hydrogel patch that can be readily cryopreserved, processed, and scaled toward clinical usages. This cell-hydrogel patch not only maintains cell viability and structure integrity during cryopreservation, but also can be directly utilized without centrifugation or incubation post cryopreservation. In addition, this tissue-adhesive hydrogel patch enables close wound contact and fast cellular response, and its scalable and flexible structure enables assembly for large or irregularly shaped ulcers. Therefore, it accelerates ulcer healing and reduces scar formation via continuous, versatile, self-adjusting paracrine of imbedded, cryopreserved stem cells. These findings highlight its potential for scalable clinical applications in chronic wound management and pave the way for broader adoption of ready-to-use regenerative therapies.

Preparation of Oligopeptide Hydrogel with Rapid Hemostatic and Broad-Spectrum Antibacterial Properties for Accelerating Wound Healing

The development of biomaterials with rapid hemostatic and antibacterial activity is essential for the treatment of chronic bacterial infected wounds. In this study, bacterial membrane chromatography combined with one-bead-one-compound (OBOC) method is used for rapid screening of antimicrobial peptides with potential antimicrobial properties. The screened antimicrobial peptide LKAPI (AMP LI5) has broad-spectrum bactericidal properties. Besides, AMP LI5 exhibited superior activation of the coagulation cascade and increased adherence to blood cells and platelets, which allows it to quickly coagulate blood. The hemostatic results showed that the AMP LI5 has a desirable hemostatic effect on the mouse tail-breaking model (9 ± 0.47 s). Finally, an HA-base composite antimicrobial peptide hydrogel is prepared antibacterial and hemostatic effects, which have injectability, compressibility, self-healing, and good biocompatibility. In addition, the antimicrobial peptide hydrogel significantly accelerated wound healing in chronic bacterial infected wounds in mouse. In summary, antimicrobial-hemostatic peptide hydrogels are expected to be competitive and multifunctional wound dressings for hemostasis and healing of bacterial-infected wounds.

Carboxymethyl Chitosan Capped Bimetallic Nanoparticles Entrapped in Theranostic Nanofibers: Antimicrobial Peptide Coating, In Vitro, In Vivo Characterization for MDR Microbial Infection and Photoacoustic/Optical Imaging

Wound dressings, integrated with nanotechnology, have garnered considerable attention recently due to their ability to synergistically combine antimicrobial efficacy with wound healing properties, while also supporting adherence to standardized wound care protocols. We have developed smart theranostic wound dressings composed of carboxymethyl chitosan coated gold-silver-LL37 nanoparticles (G-S-CMC-Pep-NPs), of 155.1 ± 11.2 nm in size and a charge over the surface of +34.6 ± 3.7 mV. The optimized G-S-CMC-Pep-NPs were observed to exhibit minimal inhibitory and bactericidal concentration in the range of 0.390-0.781 μg/mL, also illustrated the maximum zone of inhibition (ZOI) of 21.61 ± 1.06 and 18.85 ± 1.22 mm, toward multidrug resistant (MDR) bacteria of P. aeruginosa and S. aureus respectively. TEM analysis of the microbial cells post-12-h treatment revealed irregularly undulating and disrupted cell walls, loss of cell wall integrity, and evidence of DNA condensation. Additionally, hemolysis assays demonstrated that G-S-CMC-Pep-NPs exhibited a nonhemolytic profile when tested on rodent blood, indicating their excellent biocompatibility. Furthermore, G-S-CMC-Pep-NPs were uniformly integrated into chitosan poly(vinyl alcohol) nanofibers (G-S-CMC-Pep-NPs-NFs) having a size ranging from 100 to 350 nm, resulting in an antimicrobial wound dressing, when applied to microbial-infected wounds in mice, achieved a 92.4% wound closure rate within 12 days of treatment. Additionally, this study is further substantiated through the analysis of wound marker protein expression levels, along with in vivo optical and ultrasound/photoacoustic imaging. The ultrasound/photoacoustic imaging offered an in-depth evaluation of the complex wound healing mechanism, enabling real-time visualization, high-resolution spatial imaging, and precise assessment of blood flow dynamics.

Injectable polypeptide/chitosan hydrogel with loaded stem cells and rapid gelation promoting angiogenesis for diabetic wound healing

Diabetic wounds face challenges like infection, prolonged inflammation, and poor vascularization. To address these, we developed an injectable hydrogel for diabetic wound dressing by grafting palmitoyl tetrapeptide-7 (Pal-7) onto chitosan (CS) to form CS/Pal-7 (CP7). Glutaraldehyde (GA) was used to enhance crosslinking between CS, creating the CP7 hydrogel. The hydrogel showed rapid gelation, good mechanical properties, biocompatibility, and strong antibacterial effects. Additionally, stem cells derived from human deciduous teeth (SHED) were loaded into the CP7 hydrogel to form SHED@CP7. This complex promoted human umbilical vein endothelial cell (HUVEC) migration and tube formation, aiding angiogenesis, and induced macrophage polarization toward the M2 phenotype, exerting anti-inflammatory effects. In streptozotocin-induced diabetic mouse wounds, SHED@CP7 significantly improved wound healing with over 95 % wound closure, increased collagen deposition, and reduced tumor necrosis factor-α (TNF-α) expression by approximately 75 % and Interleukin-6 (IL-6) expression by around 81 %. It also increased Interleukin-10 (IL-10) expression by approximately 58 %, modulating the inflammatory microenvironment for regeneration. Moreover, SHED@CP7 enhanced angiogenesis, as shown by a 69 % increase in endothelial cell marker CD31 staining, supporting faster wound healing. These results highlight the potential of SHED@CP7 as an effective treatment for diabetic wounds.

Material Design, Fabrication Strategies, and the Development of Multifunctional Hydrogel Composites Dressings for Skin Wound Management

The skin is fragile, making it very vulnerable to damage and injury. Untreated skin wounds can pose a serious threat to human health. Three-dimensional polymer network hydrogels have broad application prospects in skin wound dressings due to their unique properties and structure. The therapeutic effect of traditional hydrogels is limited, while multifunctional composite hydrogels show greater potential. Multifunctional hydrogels can regulate wound moisture through formula adjustment. Moreover, hydrogels can be combined with bioactive ingredients to improve their performance in wound healing applications. Stimulus-responsive hydrogels can respond specifically to the wound environment and meet the needs of different wound healing stages. This review summarizes the material types, structure, properties, design considerations, and formulation strategies for multifunctional hydrogel composite dressings used in wound healing. We discuss various types of recently developed hydrogel dressings, highlights the importance of tailoring their physicochemical properties, and addresses potential challenges in preparing multifunctional hydrogel wound dressings.

Curdlan/xanthan gum-based composite hydrogel with near-infrared irradiation responsive properties for infected wounds healing

Open wounds are prone to bacterial contamination and delayed healing due to environmental exposure, necessitating the development of advanced wound dressings. Hydrogels are ideal candidates for wound care for maintaining a moist environment which benefits for the cell migration and tissue regeneration. However, conventional polysaccharide hydrogels lack intrinsic antibacterial properties, prompting the incorporation of antibacterial agents. Herein, we present a novel composite hydrogel synthesized from curdlan (CUR) and xanthan gum (XG) via thermal annealing, augmented with MXene and Mg2+ to enhance antibacterial efficacy and promote cellular migration. The results proved that the mechanical properties of the composite hydrogel prepared with CUR and XG are significantly enhanced. Due to the influence of near-infrared irradiation, the antibacterial rates of XC/Mg2+/MX against S. aureus and P. aeruginosa are 81.84 % and 89.27 %, respectively. This innovative composite hydrogel offers new insights and avenues in the progress of sophisticated wound healing dressings areas.

Evaluation of smart bi-functional dressing based on polysaccharide hydrogels and Brassica oleracea extract for wound healing and continuous monitoring

Skin wounds can drive global impacts, socially and economically, in parallel with their elevated incidence rate. Therefore, utilizing the dual-activity of Brassica Oleracea (Red Cabbage) extract, of being pH-sensitive and biologically active in designing novel, therapeutic, and pH-sensitive wound dressings with an easily stripped-off feature, is critical. Wound dressings were designed using two separate hydrogels based on chitosan (CS) and hydroxyethylcellulose (HEC), each loaded with RCE. The pH sensitivity of prepared bandages exhibited a noticeable visual change in color during wound treatment. Wound closure has reached 99.69 % for CS/RCE dressings. Results showed that RCE had raised the hydroxyproline and collagen content in the healed skin. Histopathological investigation proves that skin returned to its regular thickness within 10 days of treatment. RCE showed marked improvement in the healing quality by acting as an antioxidant, anti-inflammatory, and antimicrobial agent. Therefore, dual-function dressings are potential candidates to sense and cure skin wounds.

Comparison of different modern wound dressings on full-thickness murine cutaneous wound healing with wild-type and type-2 diabetes db/db mice

BACKGROUND

To evaluate the process of cutaneous wound healing, experiments have been conducted. However, to date, what modern wound dressings are suitable remains unclear. Therefore, this study aimed to compare the healing process in different modern wound dressings to determine their suitability in experimental acute wound and chronic diabetic wound.

MATERIALS AND METHODS

Twelve C57BL/6J mice and eleven db/db mice were subjected to full-thickness wound injuries. The mice were divided into the following four groups: hydrocolloid, form, film, and gauze groups in both wild-type and db/db mice. Wound healing was assessed until day 14.

RESULTS

In the wild-type groups, all wounds were healed and completed re-epithelialization by day 14. However, the wound surface was dry, and the periwound was hypercontracted in the wild-type-form and wild-type-gauze groups. In the db/db groups, wounds were not healed until day 14. Wound exudates in the db/db-hydrocolloid group were abundant and gradually increased until day 14. Wound exudates in the db/db-film group were present until day 14. Conversely, in the db/db-form and db/db-gauze groups, the wound surface was dry, and the periwound was hypercontracted.

CONCLUSION

These results showed that hydrocolloid and film dressings are suitable modern wound dressings for the mice wound models of acute wound and chronic diabetic wound. Moreover, using either hydrocolloid or film dressing depending on the purpose of the study on cutaneous wound healing in diabetes is necessary.

Hydration response technology dressings for low to excessively exuding wounds: a systematic review

OBJECTIVE

The aim of this systematic review was to identify and qualify the current available evidence of the wound exudate handling capabilities and the cost-effectiveness of hydration response technology (HRT). HRT combines physically modified cellulose fibres and gelling agents resulting in wound dressings that absorb and retain larger quantities of wound exudate.

METHOD

A systematic search was conducted in MEDLINE (via PubMed and PubMed Central) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was conducted using an unlimited search period. Studies or reviews that evaluated effect on wound exudate and cost-effectiveness, as well as the impact on wound healing were considered. Records focusing on wound management using HRT devices were included.

RESULTS

The literature search identified four studies and one comparative analysis, ranging from low to moderate quality, that compared HRT dressings to other interventions (carboxymethyl cellulose dressing, other superabsorbent dressings, negative pressure wound therapy).

CONCLUSION

The analysed data supported the beneficial use of dressings with HRT for exuding wounds which was characterised by fewer dressing changes, improved periwound skin conditions and reduced costs.

Human-Derived collagen hydrogel as an antibiotic vehicle for topical treatment of bacterial biofilms

The complexity of chronic wounds creates difficulty in effective treatments, leading to prolonged care and significant morbidity. Additionally, these wounds are incredibly prone to bacterial biofilm development, further complicating treatment. The current standard treatment of colonized superficial wounds, debridement with intermittent systemic antibiotics, can lead to systemic side-effects and often fails to directly target the bacterial biofilm. Furthermore, standard of care dressings do not directly provide adequate antimicrobial properties. This study aims to assess the capacity of human-derived collagen hydrogel to provide sustained antibiotic release to disrupt bacterial biofilms and decrease bacterial load while maintaining host cell viability and scaffold integrity. Human collagen harvested from flexor tendons underwent processing to yield a gellable liquid, and subsequently was combined with varying concentrations of gentamicin (50-500 mg/L) or clindamycin (10-100 mg/L). The elution kinetics of antibiotics from the hydrogel were analyzed using liquid chromatography-mass spectrometry. The gel was used to topically treat Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium perfringens in established Kirby-Bauer and Crystal Violet models to assess the efficacy of bacterial inhibition. 2D mammalian cell monolayers were topically treated, and cell death was quantified to assess cytotoxicity. Bacteria-enhanced in vitro scratch assays were treated with antibiotic-embedded hydrogel and imaged over time to assess cell death and mobility. Collagen hydrogel embedded with antibiotics (cHG+abx) demonstrated sustained antibiotic release for up to 48 hours with successful inhibition of both MRSA and C. perfringens biofilms, while remaining bioactive up to 72 hours. Administration of cHG+abx with antibiotic concentrations up to 100X minimum inhibitory concentration was found to be non-toxic and facilitated mammalian cell migration in an in vitro scratch model. Collagen hydrogel is a promising pharmaceutical delivery vehicle that allows for safe, precise bacterial targeting for effective bacterial inhibition in a pro-regenerative scaffold.

Advancements in 3D-printable polysaccharides, proteins, and synthetic polymers for wound dressing and skin scaffolding - A review

This review investigates the most recent advances in personalized 3D-printed wound dressings and skin scaffolding. Skin is the largest and most vulnerable organ in the human body. The human body has natural mechanisms to restore damaged skin through several overlapping stages. However, the natural wound healing process can be rendered insufficient due to severe wounds or disturbances in the healing process. Wound dressings are crucial in providing a protective barrier against the external environment, accelerating healing. Although used for many years, conventional wound dressings are neither tailored to individual circumstances nor specific to wound conditions. To address the shortcomings of conventional dressings, skin scaffolding can be used for skin regeneration and wound healing. This review thoroughly investigates polysaccharides (e.g., chitosan, Hyaluronic acid (HA)), proteins (e.g., collagen, silk), synthetic polymers (e.g., Polycaprolactone (PCL), Poly lactide-co-glycolic acid (PLGA), Polylactic acid (PLA)), as well as nanocomposites (e.g., silver nano particles and clay materials) for wound healing applications and successfully 3D printed wound dressings. It discusses the importance of combining various biomaterials to enhance their beneficial characteristics and mitigate their drawbacks. Different 3D printing fabrication techniques used in developing personalized wound dressings are reviewed, highlighting the advantages and limitations of each method. This paper emphasizes the exceptional versatility of 3D printing techniques in advancing wound healing treatments. Finally, the review provides recommendations and future directions for further research in wound dressings.

Multi-functional composite dressings with sustained release of MSC-SLP and anti-adhesion property for accelerating wound healing

Exudate management is of significant clinical value for the treatment of acute wound. Various wound dressings have been developed to restore the function of injured tissues and promote wound healing, but proper exploiting the healing factors inside exudate and achieving anti-adhesion wound care remains a challenge. Herein, we present a novel multi-functional composite dressing (MCD) by coupling supernatant lyophilized powder of mesenchymal stem cells (MSC-SLP) with a sandwich-structured wound dressing (SWD). The developed MCDs demonstrated unique unidirectional drainage capability, stable anti-adhesion characteristics, and improved wound healing performance. The designed SWD with both superhydrophobic inner surface and liquid-absorption ability of mid layer enables the dressings exhibit desired anti-adhesion property to neoformative granulation tissues, favorable shielding effect to exogenous bacteria, as well as appropriate exudate-retaining capability and unidirectional exudate-absorption property. The introduction of MSC-SLP in SWD was demonstrated to further improve wound healing quality. Compared to medical gauze, the synergic effect of SWD and MSC-SLP significantly accelerates wound healing rate by over 30%, avoids tissue avulsion when changing dressings, and produces a flat-smooth closure surface. More importantly, the wound treated with MCDs presents more skin accessory organs and blood vessels in regenerated tissues than other groups. In vivo/vitro biocompatibility evaluations indicated little toxicity, demonstrating the biosecurity of the developed dressings. The proposed method offers great potential in clinical applications particularly for chronic wound treatments.

Nanofibers of N,N,N-trimethyl chitosan capped bimetallic nanoparticles: Preparation, characterization, wound dressing and in vivo treatment of MDR microbial infection and tracking by optical and photoacoustic imaging

Recent advancements in wound care have led to the development of interactive wound dressings utilizing nanotechnology, aimed at enhancing healing and combating bacterial infections while adhering to established protocols. Our novel wound dressings consist of N,N,N-trimethyl chitosan capped gold‑silver nanoparticles (Au-Ag-TMC-NPs), with a mean size of 108.3 ± 8.4 nm and a zeta potential of +54.4 ± 1.8 mV. These optimized nanoparticles exhibit potent antibacterial and antifungal properties, with minimum inhibitory concentrations ranging from 0.390 μg ml-1 to 3.125 μg ml-1 and also exhibited promising zones of inhibition against multi-drug resistant strains of S. aureus, E. coli, P. aeruginosa, and C. albicans. Microbial transmission electron microscopy reveals substantial damage to cell walls and DNA condensation post-treatment. Furthermore, the nanoparticles demonstrate remarkable inhibition of microbial efflux pumps and are non-hemolytic in human blood. Incorporated into polyvinyl alcohol/chitosan nanofibers, they form Au-Ag-TMC-NPs-NFs with diameters of 100-350 nm, facilitating efficient antimicrobial wound dressing. In vivo studies on MDR microbial-infected wounds in mice showed 99.34 % wound healing rate within 12 days, corroborated by analyses of wound marker protein expression levels and advanced imaging techniques such as ultrasound/photoacoustic imaging, providing real-time visualization and blood flow assessment for a comprehensive understanding of the dynamic wound healing processes.

CSMP: A Self-Assembled Plant Polysaccharide-Based Hydrofilm for Enhanced Wound Healing

Wound management remains a critical healthcare issue due to the rising incidence of chronic diseases leading to persistent wounds. Traditional dressings have their limitations, such as potential for further damage during changing and suboptimal healing conditions. Recently, hydrogel-based dressings have gained attention due to their biocompatibility, biodegradability, and ability to fill wounds. Particularly, polysaccharide-based hydrogels have shown potential in various medical applications. This study focuses on the development of a novel hydrofilm wound dressing produced from a blend of chia seed mucilage (CSM) and polyvinyl alcohol (PVA), termed CSMP. While the individual properties of CSM and PVA are well-documented, their combined potential in wound management is largely unexplored. CSMP, coupled with sorbitol and glycerin, and cross-linked using ultraviolet light, results in a flexible, adhesive, and biocompatible hydrofilm demonstrating superior water absorption, moisturizing, and antibacterial properties. This hydrofilm promotes epithelial cell migration, enhanced collagen production, and outperforms existing commercial dressings in animal tests. The innovative CSMP hydrofilm offers a promising, cost-effective approach for improved wound care, bridging existing gaps in dressing performance and preparation simplicity. Future research can unlock further applications of such polysaccharide-based hydrofilm dressings.

Adhesive, Flexible, and Fast Degradable 3D-Printed Wound Dressings with a Simple Composition

3D printing technology has revolutionized the field of wound dressings, offering tailored solutions with mechanical support to facilitate wound closure. In addition to personalization, the intricate nature of the wound healing process requires wound dressing materials with diverse properties, such as moisturization, flexibility, adhesion, anti-oxidation and degradability. Unfortunately, current materials used in digital light processing (DLP) 3D printing have been inadequate in meeting these crucial criteria. This study introduces a novel DLP resin that is biocompatible and consists of only three commonly employed non-toxic compounds in biomaterials, that is, dopamine, poly(ethylene glycol) diacrylate, and N-vinylpyrrolidone. Simple as it is, this material system fulfills all essential functions for effective wound healing. Unlike most DLP resins that are non-degradable and rigid, this material exhibits tunable and rapid degradation kinetics, allowing for complete hydrolysis within a few hours. Furthermore, the high flexibility enables conformal application of complex dressings in challenging areas such as finger joints. Using a difficult-to-heal wound model, the manifold positive effects on wound healing in vivo, including granulation tissue formation, inflammation regulation, and vascularization are substantiated. The simplicity and versatility of this material make it a promising option for personalized wound care, holding significant potential for future translation.

Soy protein/β-chitin sponge-like scaffolds laden with human mesenchymal stromal cells from hair follicle or adipose tissue promote diabetic chronic wound healing

Chronic wounds are a worldwide problem that affect >40 million people every year. The constant inflammatory status accompanied by prolonged bacterial infections reduce patient's quality of life and life expectancy drastically. An important cell type involved in the wound healing process are mesenchymal stromal cells (MSCs) due to their long-term demonstrated immunomodulatory and pro-regenerative capacity. Thus, in this work, we leveraged and compared the therapeutic properties of MSCs derived from both adipose tissue and hair follicle, which we combined with sponge-like scaffolds (SLS) made of valorized soy protein and β-chitin. In this regard, the combination of these cells with biomaterials permitted us to obtain a multifunctional therapy that allowed high cell retention and growing rates while maintaining adequate cell-viability for several days. Furthermore, this combined therapy demonstrated to increase fibroblasts and keratinocytes migration, promote human umbilical vein endothelial cells angiogenesis and protect fibroblasts from highly proteolytic environments. Finally, this combined therapy demonstrated to be highly effective in reducing wound healing time in vivo with only one treatment change during all the experimental procedure, also promoting a more functional and native-like healed skin.

An Advanced Review: Polyurethane-Related Dressings for Skin Wound Repair

The inability of wounds to heal effectively through normal repair has become a burden that seriously affects socio-economic development and human health. The therapy of acute and chronic skin wounds still poses great clinical difficulty due to the lack of suitable functional wound dressings. It has been found that dressings made of polyurethane exhibit excellent and diverse biological properties, but lack the functionality of clinical needs, and most dressings are unable to dynamically adapt to microenvironmental changes during the healing process at different stages of chronic wounds. Therefore, the development of multifunctional polyurethane composite materials has become a hot topic of research. This review describes the changes in physicochemical and biological properties caused by the incorporation of different polymers and fillers into polyurethane dressings and describes their applications in wound repair and regeneration. We listed several polymers, mainly including natural-based polymers (e.g., collagen, chitosan, and hyaluronic acid), synthetic-based polymers (e.g., polyethylene glycol, polyvinyl alcohol, and polyacrylamide), and some other active ingredients (e.g., LL37 peptide, platelet lysate, and exosomes). In addition to an introduction to the design and application of polyurethane-related dressings, we discuss the conversion and use of advanced functional dressings for applications, as well as future directions for development, providing reference for the development and new applications of novel polyurethane dressings.

Utilization of Lyotropic Liquid Crystalline Gels for Chronic Wound Management

Management of chronic wounds is becoming a serious health problem worldwide. To treat chronic wounds, a suitable healing environment and sustained delivery of growth factors must be guaranteed. Different therapies have been applied for the treatment of chronic wounds such as debridement and photodynamic therapy. Among them, growth factors are widely used therapeutic drugs. However, at present, growth factor delivery systems cannot meet the demand of clinical practice; therefore new methods should be developed to meet the emerging need. For this reason, researchers have tried to modify hydrogels through some methods such as chemical synthesis and molecule modifications to enhance their properties. However, there are still a large number of limitations in practical use like byproduct problems, difficulty to industrialize, and instability of growth factor. Moreover, applications of new materials like lyotropic liquid crystalline (LLC) on chronic wounds have emerged as a new trend. The structure of LLC is endowed with many excellent properties including low cost, ordered structure, and excellent loading efficiency. LLC can provide a moist local environment for the wound, and its lattice structure can embed the growth factors in the water channel. Growth factor is released from the high-concentration carrier to the low-concentration release medium, which can be precisely regulated. Therefore, it can provide sustained and stable delivery of growth factors as well as a suitable healing environment for wounds, which is a promising candidate for chronic wound healing and has a broad prospective application. In conclusion, more reliable and applicable drug delivery systems should be designed and tested to improve the therapy and management of chronic wounds.

Chronic Wound Management: From Gauze to Homologous Cellular Matrix

BACKGROUND

Chronic wounds are a significant health problem with devastating consequences for patients' physical, social, and mental health, increasing healthcare systems' costs. Their prolonged healing times, economic burden, diminished quality of life, increased infection risk, and impact on patients' mobility and functionality make them a major concern for healthcare professionals.

PURPOSE

This review offers a multi-perspective analysis of the medical literature focusing on chronic wound management.

METHODS USED

We evaluated 48 articles from the last 21 years registered in the MEDLINE and Global Health databases. The articles included in our study had a minimum of 20 citations, patients > 18 years old, and focused on chronic, complex, and hard-to-heal wounds. Extracted data were summarized into a narrative synthesis using the same health-related quality of life instrument.

RESULTS

We evaluated the efficacy of existing wound care therapies from classical methods to modern concepts, and wound care products to regenerative medicine that uses a patient's pluripotent stem cells and growth factors. Regenerative medicine and stem cell therapies, biologic dressings and scaffolds, negative pressure wound therapy (NPWT), electrical stimulation, topical growth factors and cytokines, hyperbaric oxygen therapy (HBOT), advanced wound dressings, artificial intelligence (AI), and digital wound management are all part of the new arsenal of wound healing.

CONCLUSION

Periodic medical evaluation and proper use of modern wound care therapies, including the use of plasma-derived products [such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF)] combined with proper systemic support (adequate protein levels, blood sugar, vitamins involved in tissue regeneration, etc.) are the key to a faster wound healing, and, with the help of AI, can reach the fastest healing rate possible.

Overexpression of Bacterial Beta-Ketothiolase Improves Flax (Linum usitatissimum L.) Retting and Changes the Fibre Properties

Beta-ketothiolases are involved in the beta-oxidation of fatty acids and the metabolism of hormones, benzenoids, and hydroxybutyrate. The expression of bacterial beta-ketothiolase in flax (Linum usitatissimum L.) results in an increase in endogenous beta-ketothiolase mRNA levels and beta-hydroxybutyrate content. In the present work, the effect of overexpression of beta-ketothiolase on retting and stem and fibre composition of flax plants is presented. The content of the components was evaluated by high-performance liquid chromatography, gas chromatography–mass spectrometry, Fourier-transform infrared spectroscopy, and biochemical methods. Changes in the stem cell walls, especially in the lower lignin and pectin content, resulted in more efficient retting. The overexpression of beta-ketothiolase reduced the fatty acid and carotenoid contents in flax and affected the distribution of phenolic compounds between free and cell wall-bound components. The obtained fibres were characterized by a slightly lower content of phenolic compounds and changes in the composition of the cell wall. Based on the IR analysis, we concluded that the production of hydroxybutyrate reduced the cellulose crystallinity and led to the formation of shorter but more flexible cellulose chains, while not changing the content of the cell wall components. We speculate that the changes in chemical composition of the stems and fibres are the result of the regulatory properties of hydroxybutyrate. This provides us with a novel way to influence metabolic composition in agriculturally important crops.

Engineered Sandwich-Structured Composite Wound Dressings with Unidirectional Drainage and Anti-Adhesion Supporting Accelerated Wound Healing

Proper management of exudate is of great clinical value for reducing wound infection and promoting wound healing, thus various dressings have been studied to address this widespread medical challenge. Herein, a novel sandwich-structured composite wound dressing (SCWD), integrating of a superlyophobic (SLO) polydimethylsiloxane (PDMS) layer, a superlyophilic gauze layer, and a lyophobic PDMS layer is presented, with particular unidirectional droplet drainage and stable anti-adhesion capabilities, which realizes effective management of wound exudate and provides a favorable environment for wound healing. Thanks to the stable SLO property on the PDMS surface with hierarchical micro/nanostructures, the continuously accumulated wound exudate at the interface between dressing and wound surface is gradually deformed, eventually passing through SLO PDMS layer through milli-scale channels and being absorbed by gauze layer. Experimental results show that the application of SCWD can significantly reduce the occurrence of wound infection, avoid the tearing of wound tissues when replacing dressings, and accelerate wound healing by ≈20%. The combination of SCWD and lyophilized powders of stem cells supernatant (LPSCS) is verified to better accelerate the healing process. The proposed method offers great potential in clinical applications, particularly for acute trauma wound treatments.

The diversified hydrogels for biomedical applications and their imperative roles in tissue regeneration

Repair and regeneration of tissues after injury are complex pathophysiological processes. Microbial infection, malnutrition, and an ischemic and hypoxic microenvironment in the injured area can impede the typical healing cascade. Distinguished by biomimicry of the extracellular matrix, high aqueous content, and diverse functions, hydrogels have revolutionized clinical practices in tissue regeneration owing to their outstanding hydrophilicity, biocompatibility, and biodegradability. Various hydrogels such as smart hydrogels, nanocomposite hydrogels, and acellular matrix hydrogels are widely used for applications ranging from bench-scale to an industrial scale. In this review, some emerging hydrogels in the biomedical field are briefly discussed. The protective roles of hydrogels in wound dressings and their diverse biological effects on multiple tissues such as bone, cartilage, nerve, muscle, and adipose tissue are also discussed. The vehicle functions of hydrogels for chemicals and cell payloads are detailed. Additionally, this review emphasizes the particular characteristics of hydrogel products that promote tissue repair and reconstruction such as anti-infection, inflammation regulation, and angiogenesis.

Hydrogels for the management of second-degree burns: currently available options and future promise

Burn wounds result from exposure to hot liquids, chemicals, fire, electric discharge or radiation. Wound severity ranges from first-degree injury, which is superficial, to fourth-degree injury, which exposes bone, tendons and muscles. Rapid assessment of burn depth and accurate wound management in the outpatient setting is critical to prevent injury progression into deeper layers of the dermis. Injury progression is of particular pertinence to second-degree burns, which are the most common form of thermal burn. As our understanding of wound healing advances, treatment options and technologies for second-degree burn management also evolve. Polymeric hydrogels are a class of burn wound dressings that adhere to tissue, absorb wound exudate, protect from the environment, can be transparent facilitating serial wound evaluation and, in some cases, enable facile removal for dressing changes. This review briefly describes the burn level classification and common, commercially available dressings used to treat second-degree burns, and then focuses on new polymeric hydrogel burn dressings under preclinical development analyzing their design, structure and performance. The review presents the follow key learning points: (1) introduction to the integument system and the wound-healing process; (2) classification of burns according to severity and clinical appearance; (3) available dressings currently used for second-degree burns; (4) introduction to hydrogels and their preparation and characterization techniques; and (5) pre-clinical hydrogel burn wound dressings currently being developed.

Hydrogel Dressing Containing Basic Fibroblast Growth Factor Accelerating Chronic Wound Healing in Aged Mouse Model

Due to the decreasing self-repairing ability, elder people are easier to form chronic wounds and suffer from slow and difficult wound healing. It is desirable to develop a novel wound dressing that can accelerate chronic wound healing in elderly subjects to decrease the pain of patients and save medical resources. In this work, Heparin and basic fibroblast growth factor(bFGF) were dissolved in the mixing solution of 4-arm acrylated polyethylene glycol and dithiothreitol to form hydrogel dressing in vitro at room temperature without any catalysts, which is convenient and easy to handle in clinic application. In vitro re-lease test shows the bFGF could be continuously released for at least 7 days, whereas the dressing surface integrity maintained for 3 days degradation in PBS solution. Three groups of treatments including bFGF-Gel, bFGF-Sol and control without any treatment were applied on the full-thickness wound on the 22 months old mice back. The wound closure rate and histological and immunohistochemical staining all illustrated that bFGF-Gel displayed a better wound healing effect than the other two groups. Thus, as-prepared hydrogel dressing seems supe-rior to current clinical treatment and more effective in elderly subjects, which shows promising potential to be applied in the clinic.

Hybrid-Based Wound Dressings: Combination of Synthetic and Biopolymers

Most commercialized wound dressings are polymer-based. Synthetic and natural polymers have been utilized widely for the development of wound dressings. However, the use of natural polymers is limited by their poor mechanical properties, resulting in their combination with synthetic polymers and other materials to enhance their mechanical properties. Natural polymers are mostly affordable, biocompatible, and biodegradable with promising antimicrobial activity. They have been further tailored into unique hybrid wound dressings when combined with synthetic polymers and selected biomaterials. Some important features required in an ideal wound dressing include the capability to prevent bacteria invasion, reduce odor, absorb exudates, be comfortable, facilitate easy application and removal as well as frequent changing, prevent further skin tear and irritation when applied or removed, and provide a moist environment and soothing effect, be permeable to gases, etc. The efficacy of polymers in the design of wound dressings cannot be overemphasized. This review article reports the efficacy of wound dressings prepared from a combination of synthetic and natural polymers.

Clinical efficacy of wet dressing combined with chitosan wound dressing in the treatment of deep second-degree burn wounds: A prospective, randomised, single-blind, positive control clinical trial

To evaluate the efficacy and safety of wet dressing combined with chitosan wound dressing for deep II degree burn wounds, and provide the basis for clinical application. From October 2019 to October 2021, 80 patients with second-degree deep burn treated in the Department of burn and plastic surgery of our hospital were selected as the research objects. Patients were randomly divided into two groups. The control group (40n) was treated with wet compress, and the study group (40n) was treated with wet compress combined with chitosan wound dressing. The wound healing time, wound healing percentage and pain score were used as the effectiveness indexes, and the incidence of adverse events and serious adverse events and the detection rate of bacterial culture of wound exudates were used as the safety indexes. The efficacy and safety of the two groups were compared. The wound healing time of the study group (19.53 ± 2.74 days) was shorter than that of the control group (24.78 ± 4.86 days), the difference was significant (t = 3.571, P = 0.015). The percentage of wound healing at the 14th after treatment in the study group was higher than that in the control group (65.00% versus 37.50%) (X²  = 6.054, P = 0.014). There was no significant difference in pain scores between the two groups at each time point. The scar growth was observed 3 months after wound healing. The scar score of the study group (6.00 ± 0.98) was lower than that of the control group (8.77 ± 1.19) (t = 2.571, P = 0.031). The positive rate of wound secretion culture on the 7th and 14th day was statistically significant (X²  = 4.528, P = 0.033; X²  = 6.646, P = 0.010), and the study group was lower than the control group (29.03% versus 81.82%; 8.11% versus 42.86%). There was no significant difference in treatment cost between the study group and the control group (1258.7 ± 223.6 versus 1248.9 ± 182.3) (t = 1.571, P = 0.071). No adverse events or serious adverse events occurred in both groups. Chitosan wound dressing can significantly shorten the time of wound healing and reduce wound pain and wound infection in patients with deep second-degree burns. And it can effectively improve the situation of scar hyperplasia, which is worthy of clinical application.

Development of responsive chitosan-based hydrogels for the treatment of pathogen-induced skin infections

Vancomycin (Van) remains one of the first-line drugs for the treatment of wound infections caused by methicillin-resistant Staphylococcus aureus (MRSA). However, the unsatisfactory bioavailability of vancomycin alone has greatly limited its potential health benefits. Here a responsive chitosan-based hydrogel was developed as the delivery system which not only would reduce this side effect but also increase efficacy of vancomycin. The hydrogel was prepared by grafting chitosan and cinnamaldehyde-based thioacetal (CTA) together with ginipin (G) as the crosslinker. Upon exposure to reactive oxygen species which were enriched in the bacterial wound, the hydrogel can locally degrade and sustainably release the loaded vancomycin near the lesion to compete with the troubling MRSA. Compared with vancomycin alone, the chitosan-based hydrogel loaded with vancomycin demonstrated accelerated acute wound healing. This achievement reveals that this multi-functional hydrogel may be a promising drug-delivery device for improving the efficacy of local antibiotic therapy.

Microgel-integrated, high-strength in-situ formed hydrogel enables timely emergency trauma treatment

High-strength hydrogels formed in situ through a convenient gel transition process are highly desirable for emergency treatment due to their ability to quickly respond to accidents. However, current in-situ formed hydrogels require a laborious precursor preparation process or lack sufficient mechanical strength. Herein, we reported a series of microgels that were capable of convenient in-situ transition to high-strength hydrogels from their easily portable form, thereby facilitating emergency treatment. Three kinds of microgels were derived from two types of hydrogen bonds (H-bonds; OH⋯OC, NH⋯OC) crosslinked preformed hydrogels, and all exhibited excellent stability when stored at room temperature. After mixing with water, all these microgels could undergo a quick hydration process and then transform into high-strength hydrogels in situ through H-bonds. Specifically, stronger H-bond crosslinked microgels could build hydrogels with higher mechanical strength, albeit at the cost of longer hydration and operation time. Nevertheless, the whole operation process could be finished within several minutes, and the resultant hydrogels could exhibit maximally megapascal-level compressive strength and tens of kilopascal storage modulus. In the comparison of emergency application performance with commercial chitosan hemostatic powder (CHP), we found that the microgels could stop accidental bleeding almost immediately, and the whole process from taking out the stored microgels to hemostasis could be completed within 15 s, which was superior to CHP. Overall, the results indicated that the in-situ formed microgel-based hydrogels with convenient gel-transition ability and high strength showed great potential in emergency treatments.

An Updated Account On Formulations And Strategies For The Treatment Of Burn Infection – A Review

Background:

Burn injury is considered one of the critical injuries of the skin. According to WHO (World Health Organization), approximately 3,00,000 deaths are caused each year mainly due to fire burns, with additional deaths attributed to heat and other causes of burn e.g., electric devices, chemical materials, radioactive rays, etc. More than 95% of burn injuries occur in developing countries.

Introduction:

Burn injuries have been a prominent topic of discussion in this present era of advancements. Burns are one of the common and devastating forms of trauma. Burn injuries are involved in causing severe damage to skin tissues and various other body parts triggered particularly by fire,blaze, or exposure to chemicals and heated substances. They leave a long-lasting negative impact on the patients in terms of their physical and mental health.

Method:

The various methods and bioactive hydrogels, a viable and widely utilised approach for treating chronic wounds remains a bottleneck. Many traditional approaches such as woven material, conventional antimicrobial agents, hydrogel sheets, creams are utilised in wound healing. Nowadays, lipid-based nanoparticles, nanofibres systems, and foam-based formulations heal the wound.

Result:

The prepared formulation shows wound healing activity when tested on rat model. The nanofibres containing SSD help in the burn-wound healing study on Male Sprague Dawley (SD) rats. The healing effect on rats was examined by western blot analysis, digital camera observation, and histological analyses.

Conclusion:

Burn is also considered the most grievous form of trauma. Nowadays, several large and foam-based formulations are used in wound healing, which heals the wound better than previously existing formulations and is less prone to secondary infection. Recently, nanofiber delivery has piqued the interest of academics over the years because of its excellent features, which include an extraordinarily high surface to volume ratio, a highly porous structure, and tiny pore size.

Wound Healing Modulation through the Local Application of Powder Collagen-Derived Treatments in an Excisional Cutaneous Murine Model

Wound healing includes dynamic processes grouped into three overlapping phases: inflammatory, proliferative, and maturation/remodeling. Collagen is a critical component of a healing wound and, due to its properties, is of great interest in regenerative medicine. This preclinical study was designed to compare the effects of a new collagen-based hydrolysate powder on wound repair to a commercial non-hydrolysate product, in a murine model of cutaneous healing. Circular excisional defects were created on the dorsal skin of Wistar rats (n = 36). Three study groups were established according to the treatment administered. Animals were euthanized after 7 and 18 days. Morphometric and morphological studies were performed to evaluate the healing process. The new collagen treatment led to the smallest open wound area throughout most of the study. After seven days, wound morphometry, contraction, and epithelialization were similar in all groups. Treated animals showed reduced granulation tissue formation and fewer inflammatory cells, and induction of vasculature with respect to untreated animals. After 18 days, animals treated with the new collagen treatment showed accelerated wound closure, significantly increased epithelialization, and more organized repair tissue. Our findings suggest that the new collagen treatment, compared to the untreated control group, produces significantly faster wound closure and, at the same time, promotes a slight progression of the reparative process compared with the rest of the groups.

A multifunctional 3D dressing unit based on the core-shell hydrogel microfiber for diabetic foot wound healing

The healing mechanism of diabetic foot wounds is very complicated, and it is difficult for a single-function medical dressing to achieve good therapeutic effects. We propose a simple coaxial biological 3D printing technology, which uses one-step 3D deposition to continuously produce multifunctional medical dressings on the basis of core-shell hydrogel fibers. These dressings have good biocompatibility, controlled drug-release performance, excellent water absorption and retention, and antibacterial and anti-inflammatory functions. In vivo experiments with type 2 diabetic rats were performed over a 14-day period to compare the performance of the multifunctional 3D dressing with a gauze control; the multifunctional 3D dressing reduced inflammation, effectively increased the post-healing thickness of granulation tissue, and promoted the formation of blood vessels, hair follicles, and highly oriented collagen fiber networks. Therefore, the proposed multifunctional dressing is expected to be suitable for clinical applications for healing diabetic foot wounds.

Smart 3D Printed Hydrogel Skin Wound Bandages: A Review

Wounds are a major health concern affecting the lives of millions of people. Some wounds may pass a threshold diameter to become unrecoverable by themselves. These wounds become chronic and may even lead to mortality. Recently, 3D printing technology, in association with biocompatible hydrogels, has emerged as a promising platform for developing smart wound dressings, overcoming several challenges. 3D printed wound dressings can be loaded with a variety of items, such as antibiotics, antibacterial nanoparticles, and other drugs that can accelerate wound healing rate. 3D printing is computerized, allowing each level of the printed part to be fully controlled in situ to produce the dressings desired. In this review, recent developments in hydrogel-based wound dressings made using 3D printing are covered. The most common biosensors integrated with 3D printed hydrogels for wound dressing applications are comprehensively discussed. Fundamental challenges for 3D printing and future prospects are highlighted. Additionally, some related nanomaterial-based hydrogels are recommended for future consideration.

Use of autologous conditioned serum dressings in hard-to-heal wounds: a randomised prospective clinical trial

OBJECTIVE

In this study, we aimed to assess both the efficacy and tolerability of autologous conditioned serum (ACS) as an innovative wound dressing in the local management of hard-to-heal wounds.

METHOD

In this single-blinded randomised controlled trial, patients with hard-to-heal wounds were randomly assigned to receive either ACS treatment or normal saline (NS) dressings. The treatment was applied once a week for three weeks with a final assessment at three weeks from the first ACS application.

RESULTS

A total of 30 patients took part in the study. Analysis of wound assessment data demonstrated statistically significant differences for wound surface area and Pressure Ulcer Scale for Healing scores (area score, exudate and tissue) from baseline to the end of the study in patients who received the ACS dressing, but not in patients who received the normal saline dressing. There were statistically significant differences in changes in: the wound surface area at week three (-6.4±2.69cm² versus +0.4±2.52cm²); area score at week three (-2.2±1.08 versus +0.2±0.86); exudate at week two (-1.2±0.70 versus +0.0±0.45) and at week 3 (-1.3±0.72 versus -0.1±0.63); tissue at week two (-1.1±0.35 versus +0.0±0.53) and at week three (-1.8±0.65 versus -0.1±0.63); and the PUSH total score at week one (-1.6±0.98 versus +0.4±1.22), week two (-3.2±0.86 versus +0.4±0.98) and week three (-5.3±1.17 versus -0.0±1.33) between the ACS and NS groups, respectively.

CONCLUSION

This trial revealed a significant decrease in wound surface area as well as a considerable improvement in wound healing in the ACS dressing group.

The Technological Process of Obtaining New Linen Dressings Did Not Cause the Loss of Their Wound-Healing Properties

BACKGROUND

Linen dressings were invented a few years ago but are still being worked on.

METHODS

The obtained fabrics from the traditional variety of flax (Nike), two transgenic types of flax (M50 and B14) and the combination of these two flax fibers (M50 + B14) were tested in direct contact in cell cultures. Cell viability tests were performed, and the proliferation potential of cells on Balb3T3 and NHEK cell lines was checked using the Sulforhodamine-B (SRB) test. Moreover, the effect of new linen fabrics on apoptosis of THP-1 cells, as well as on the cell cycle of NHEK, HMCEV and THP-1, cells after 24 h of incubation was assessed.

RESULTS

All tested linen fabrics did not raise the number of necrotic cells. The tested fabrics caused a statistically significant decrease in the total protein content in skin cancer (except for 0.5 cm of Nike-type fabrics). The smallest cells in the apoptotic phase were in cultures treated with M50 fiber on an area of 0.5 cm. After 48 h of incubation of HEMVEC, NHEK and THP-1 cells with the tested fabrics, the growth of S-phase cells was noticed in all cases. At the same time, the greatest increase was observed with the use of B14 fabric. Necrosis is not statistically significant.

CONCLUSIONS

All the obtained flax fibers in the form of flax dressings did not lose their wound-healing properties under the influence of the technological process. New dressings made of genetically modified flax are a chance to increase the effectiveness of treatment of difficult healing wounds.

Synthesis and Characterization of Nonwoven Cotton-Reinforced Cellulose Hydrogel for Wound Dressings

Hydrogels wound dressings have enormous advantages due to their ability to absorb high wound exudate, capacity to load drugs, and provide quick pain relief. The use of hydrogels as wound dressings in their original form is a considerable challenge, as these are difficult to apply on wounds without support. Therefore, the incorporation of polymeric hydrogels with a certain substrate is an emerging field of interest. The present study fabricated cellulose hydrogel using the sol-gel technique and reinforced it with nonwoven cotton for sustainable wound dressing application. The nonwoven cotton was immersed inside the prepared solution of cellulose and heated at 50 °C for 2 h to form cellulose hydrogel-nonwoven cotton composites and characterized for a range of properties. In addition, the prepared hydrogel composite was also loaded with titania particles to attain antibacterial properties. The Fourier transform infrared spectroscopy and scanning electron microscopy confirmed the formation of cellulose hydrogel layers inside the nonwoven cotton structure. The fabricated composite hydrogels showed good moisture management and air permeability, which are essential for comfortable wound healing. The wound exudate testing revealed that the fluid absorptive capacity of cellulose hydrogel nonwoven cotton composite was improved significantly in comparison to pure nonwoven cotton. The results reveal the successful hydrogel formation, having excellent absorbing, antimicrobial, and sustainable properties.

An Overview of Cellulose Derivatives-Based Dressings for Wound-Healing Management

Presently, notwithstanding the progress regarding wound-healing management, the treatment of the majority of skin lesions still represents a serious challenge for biomedical and pharmaceutical industries. Thus, the attention of the researchers has turned to the development of novel materials based on cellulose derivatives. Cellulose derivatives are semi-synthetic biopolymers, which exhibit high solubility in water and represent an advantageous alternative to water-insoluble cellulose. These biopolymers possess excellent properties, such as biocompatibility, biodegradability, sustainability, non-toxicity, non-immunogenicity, thermo-gelling behavior, mechanical strength, abundance, low costs, antibacterial effect, and high hydrophilicity. They have an efficient ability to absorb and retain a large quantity of wound exudates in the interstitial sites of their networks and can maintain optimal local moisture. Cellulose derivatives also represent a proper scaffold to incorporate various bioactive agents with beneficial therapeutic effects on skin tissue restoration. Due to these suitable and versatile characteristics, cellulose derivatives are attractive and captivating materials for wound-healing applications. This review presents an extensive overview of recent research regarding promising cellulose derivatives-based materials for the development of multiple biomedical and pharmaceutical applications, such as wound dressings, drug delivery devices, and tissue engineering.

Wound dressings: curbing inflammation in chronic wound healing

Chronic wounds represent an economic burden to healthcare systems worldwide and a societal burden to patients, deeply impacting their quality of life. The incidence of recalcitrant wounds has been steadily increasing since the population more susceptible, the elderly and diabetic, are rapidly growing. Chronic wounds are characterised by a delayed wound healing process that takes longer to heal under standard of care than acute (i.e. healthy) wounds. Two of the most common problems associated with chronic wounds are inflammation and infection, with the latter usually exacerbating the former. With this in mind, researchers and wound care companies have developed and marketed a wide variety of wound dressings presenting different compositions but all aimed at promoting healing. This makes it harder for physicians to choose the correct therapy, especially given a lack of public quantitative data to support the manufacturers’ claims. This review aims at giving a brief introduction to the clinical need for chronic wound dressings, focusing on inflammation and evaluating how bio-derived and synthetic dressings may control excess inflammation and promote healing.

Preparation and characterization of smart therapeutic pH-sensitive wound dressing from red cabbage extract and chitosan hydrogel

Developing a multifunctional wound dressing that protects, cures and indicates the healing progress, is a new approach of investigation. Red cabbage extract (RCE), consisting of bioactive compounds that have antioxidant, anti-inflammatory, anti-carcinogenic, bactericidal, antifungal, and antiviral activities, was utilized as a natural pH-sensitive indicator. Chitosan-based hydrogel, encapsulating RCE, was developed to obtain a smart therapeutic pH-sensitive wound dressing as antimicrobial bio-matrix provides a comfortable cushion for wound bed and indicates its status. Methacrylated-chitosan was crosslinked by different concentrations of methylenebisacrylamide (MBAA) by which hydrogel mechanical and morphological properties were tuned. The proposed mechanism for hydrogel formation was confirmed by FT-IR. The coloristic properties of the RCE and the changes in color intensity as a function of pH were confirmed by UV-Vis spectroscopy. The effect of MBAA on the mechanical, swelling, release and morphological properties of hydrogel were investigated. MBAA (2.5% wt/v) in 2% wt/v chitosan showed preferable mechanical (20 KPa), swelling (1294% at pH 8 ± 0.2), and release (prolonged up to 5 days) properties. Hydrogel matrices, loaded on cotton gauze submerged in different pH buffer solutions, showed explicit color changes from green to red as pH changed from 9 to 4.

In Vitro Efficacy of Bacterial Cellulose Dressings Chemisorbed with Antiseptics against Biofilm Formed by Pathogens Isolated from Chronic Wounds

Local administration of antiseptics is required to prevent and fight against biofilm-based infections of chronic wounds. One of the methods used for delivering antiseptics to infected wounds is the application of dressings chemisorbed with antimicrobials. Dressings made of bacterial cellulose (BC) display several features, making them suitable for such a purpose. This work aimed to compare the activity of commonly used antiseptic molecules: octenidine, polyhexanide, povidone-iodine, chlorhexidine, ethacridine lactate, and hypochlorous solutions and to evaluate their usefulness as active substances of BC dressings against 48 bacterial strains (8 species) and 6 yeast strains (1 species). A silver dressing was applied as a control material of proven antimicrobial activity. The methodology applied included the assessment of minimal inhibitory concentrations (MIC) and minimal biofilm eradication concentration (MBEC), the modified disc-diffusion method, and the modified antibiofilm dressing activity measurement (A.D.A.M.) method. While in 96-well plate-based methods (MIC and MBEC assessment), the highest antimicrobial activity was recorded for chlorhexidine, in the modified disc-diffusion method and in the modified A.D.A.M test, povidone-iodine performed the best. In an in vitro setting simulating chronic wound conditions, BC dressings chemisorbed with polyhexanide, octenidine, or povidone-iodine displayed a similar or even higher antibiofilm activity than the control dressing containing silver molecules. If translated into clinical conditions, the obtained results suggest high applicability of BC dressings chemisorbed with antiseptics to eradicate biofilm from chronic wounds.

A cut above the rest: oxidative stress in chronic wounds and the potential role of polyphenols as therapeutics

OBJECTIVES

The pathophysiology of chronic wounds typically involves redox imbalance and inflammation pathway dysregulation, often with concomitant microbial infection. Endogenous antioxidants such as glutathione and tocopherols are notably reduced or absent, indicative of significant oxidative imbalance. However, emerging evidence suggests that polyphenols could be effective agents for the amelioration of this condition. This review aims to summarise the current state of knowledge surrounding redox imbalance in the chronic wound environment and the potential use of polyphenols for the treatment of chronic wounds.

KEY FINDINGS

Polyphenols provide a multi-faceted approach towards the treatment of chronic wounds. Firstly, their antioxidant activity allows direct neutralisation of harmful free radicals and reactive oxygen species, assisting in restoring redox balance. Upregulation of pro-healing and anti-inflammatory gene pathways and enzymes by specific polyphenols further acts to reduce redox imbalance and promote wound healing actions, such as proliferation, extracellular matrix deposition and tissue remodelling. Finally, many polyphenols possess antimicrobial activity, which can be beneficial for preventing or resolving infection of the wound site.

SUMMARY

Exploration of this diverse group of natural compounds may yield effective and economical options for the prevention or treatment of chronic wounds.

Aloe Vera extract-based composite nanofibers for wound dressing applications

Natural, biocompatible, and biodegradable composite nanofibers made of Aloe vera extract, pullulan, chitosan, and citric acid were successfully produced via Forcespinning® technology. The addition of Aloe vera extract at different weight percent loadings was investigated. The morphology, thermal properties, physical properties, and water absorption of the nanofibers were characterized using scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), and thermogravimetric analysis (TGA). The developed nanofiber membranes exhibited good water absorption capabilities, synergistic antibacterial activity against Escherichia coli, and promoted cell attachment and growth. Its porous and high surface area structure make it a potential candidate for wound dressing applications due to its ability to absorb excessive blood and exudates, as well as provide protection from infection while maintaining good thermal stability.

Chronic wounds and novel therapeutic approaches

In the past decade, the frequency of chronic wounds in older population has increased, and their impact on quality of life is substantial. Chronic wounds are a public health problem associated with very high economic and psychosocial costs. These wounds result from various pathologies and comorbidities, such arterial and venous insufficiency, diabetes mellitus and continuous skin pressure. Recently, the role of infection and biofilms in the healing of chronic wounds has been the subject of considerable research. This paper presents an overview of various methods and products used to manage chronic wounds and discusses recent advances in wound care. To decide on the best treatment for any wound, it is crucial to holistically assess the patient and the wound. Additionally, multiple strategies could be used to prevent or treat chronic wounds.

Wound healing: cellular mechanisms and pathological outcomes

Wound healing is a complex, dynamic process supported by a myriad of cellular events that must be tightly coordinated to efficiently repair damaged tissue. Derangement in wound-linked cellular behaviours, as occurs with diabetes and ageing, can lead to healing impairment and the formation of chronic, non-healing wounds. These wounds are a significant socioeconomic burden due to their high prevalence and recurrence. Thus, there is an urgent requirement for the improved biological and clinical understanding of the mechanisms that underpin wound repair. Here, we review the cellular basis of tissue repair and discuss how current and emerging understanding of wound pathology could inform future development of efficacious wound therapies.

Scaffolds for Wound Healing Applications

In order to overcome the shortcomings related to unspecific and partially efficient conventional wound dressings, impressive efforts are oriented in the development and evaluation of new and effective platforms for wound healing applications. In situ formed wound dressings provide several advantages, including proper adaptability for wound bed microstructure and architecture, facile application, patient compliance and enhanced therapeutic effects. Natural or synthetic, composite or hybrid biomaterials represent suitable candidates for accelerated wound healing, by providing proper air and water vapor permeability, structure for macro- and microcirculation, support for cellular migration and proliferation, protection against microbial invasion and external contamination. Besides being the most promising choice for wound care applications, polymeric biomaterials (either from natural or synthetic sources) may exhibit intrinsic wound healing properties. Several nanotechnology-derived biomaterials proved great potential for wound healing applications, including micro- and nanoparticulate systems, fibrous scaffolds, and hydrogels. The present paper comprises the most recent data on modern and performant strategies for effective wound healing.

Bio-Composite of Sodium Alginate-Titanium Dioxide for Wound Healing Applications

Sodium alginate is a natural polymer used for many biomedical applications. The excellent biodegradability and biocompatibility of sodium alginate have provided ample space for future development in wound healing applications. In this study, bio-composite film was prepared by solvent casting technique by blending sodium alginate (SA) solution and titanium dioxide (TiO2) followed by crosslinking with calcium chloride. The bio-composite film was characterized with different characterization technique such as Fourier Transform Infrared (FTIR) and X-ray Diffraction (XRD). AFM analysis provides information about surface roughness. The microstructure of bio-composite film was determined by Field Emission Scanning Electron Microscope (FESEM). The wettability of surface material is measure by contact angle. The result demonstrate that the bio-composite film shows high value of surface roughness and contact angle to enhanced blood clotting for wound healing applications

A Phytocomplex Consisting of Tropaeolum majus L. and Salvia officinalis L. Extracts Alleviates the Inflammatory Response of Dermal Fibroblasts to Bacterial Lipopolysaccharides

Background

The antimicrobial activity and effects of a phytocomplex consisting of Tropaeolum flos (T) and Salviae folium (S) extracts on the cytokine levels and transcription factors on dermal fibroblast BJ exposed to bacterial lipopolysaccharides were examined.

Methods

In order to select the most optimal combination ratio of the two extracts for using in vitro, the physicochemical characterization of vegetal extract mixtures was performed and the antioxidant and antibacterial activities were evaluated on five different formulations of T : S, namely, 1 : 1, 1 : 2, 2 : 1, 3 : 1, and 1 : 3. The best combination of bioactive compounds with regard to antioxidant and antibacterial activities (T : S 1 : 2) was selected for in vitro evaluation of the anti-inflammatory effect. Human dermal fibroblast BJ cells were treated with two doses of the extract mixture and then exposed to bacterial lipopolysaccharides (LPS). The levels of the cytokines involved in inflammatory response, namely, interleukin- (IL-) 6, tumor necrosis factor- (TNF-) α, IL-31, and IL-33, were quantified by ELISA, and the expression of transcription factors, namely, signal transducer and activator of transcription (STAT) 3, nuclear factor kappa B (NFκB), and phosphorylated NFκB (pNFκB), were evaluated by western blot analysis.

Results

The results have shown that the mixture of T : S 1 : 2 exhibited significant antibacterial effects on Staphylococcus aureus ATCC 25923. LPS exposure increased the cytokine levels in BJ cells and enhanced the NFκB expression. The pretreatment of BF cells exposed to LPS with the two doses of the extract mixture markedly inhibited the increase of IL-33 and TNF-α levels and amplified the NFκB expression and its activation, especially with the high dose. The low doses of the extract reduced NFκB expression but increased its activation.

Conclusions

These experimental findings suggest that the mixture of T : S 1 : 2 can exert some protection against bacterial infections and inflammation induced by LPS in BJ cells being a good therapeutic option in related conditions associated with inflammation.

Effectiveness of autologous platelet-rich plasma gel in the treatment of hard-to-heal leg ulcers: a randomised control trial

OBJECTIVE

Regenerative medicine products such as autologous platelet-rich plasma (autologous PRP) gel may speed up the process of healing. Clinical studies show promising results in the treatment of diabetic foot ulcers (DFUs), however there is lack of scientific evidence of autologous PRP effectiveness in treating leg ulcers of other aetiology. This study evaluates the effectiveness of autologous PRP gel in the treatment of hard-to-heal leg ulcers compared with existing conventional treatment.

METHOD

A prospective, randomised controlled, open-labelled clinical trial was carried out between 2014 and 2018. An eight-week study protocol was chosen or until 100% wound re-epithelialisation was observed. Wound size reduction, granulation tissue formation, microbiological wound bed changes and safety were evaluated.

RESULTS

A total of 69 patients (35 in the autologous PRP group and 34 in the control group) were included in the study; 25.71% of the autologous PRP group and 17.64% of control group had ulcers completely re-epithelialised (p>0.05). Wound size reduction in the autologous PRP group was 52.35% and 33.36% in the control group (p=0.003). The autologous PRP group showed superiority over conventional treatment in wound bed coverage with granulation (p=0.001). However, more frequent wound contamination was observed at the end of treatment in the autologous PRP group (p=0.024). No severe adverse events were noted during the study. Both treatment methods were considered equally safe.

CONCLUSION

Topical application of autologous PRP gel in leg ulcers of various aetiology show beneficial results in wound size reduction and induces the granulation tissue formation. However, it is associated with more frequent microbiological wound contamination.