The physiology of wound healing

Accelerating Wound Healing through a Mechano-Electric Synergistic Conductive Hydrogel

To address the challenge of achieving faster wound healing, we present an innovative approach using hydrogel wound dressings that leverage the mechano-electric synergistic effect. This method incorporates piezoelectric zinc oxide nanoparticles (ZnO NPs) and conductive carbon nanotubes (CNTs) into a thermosensitive poly(N-isopropylacrylamide) (PNIPAM) hydrogel matrix. The engineered hydrogel demonstrates exceptional mechanical strength, optimal swelling properties, enhanced antibacterial activity, and excellent biocompatibility and biosafety. Upon application to a wound site, the hydrogel undergoes temperature-induced centripetal contraction, which enhances the wound closure process. Moreover, the morphological changes in the hydrogel caused by self-contraction and alterations in skin shape can trigger a piezoelectric effect, generating stable and lasting bioelectric signals that promote fibroblast migration. Consequently, a wound approximately 1 cm2 in size can nearly completely heal within 14 days, thanks to the hydrogel's multifaceted therapeutic potential, including anti-inflammatory effects, promotion of cell migration, induction of fibroblast-to-myofibroblast differentiation, and enhancement of angiogenesis. This breakthrough represents a significant advancement over conventional hydrogel wound dressings, offering considerable promise for clinical application.

Engineered polyvinyl alcohol/chitosan/carrageenan nanofibrous membrane loaded with Aloe vera for accelerating third-degree burn wound healing

This study introduces an innovative nanofibrous membrane included polyvinyl alcohol (PVA), chitosan (CS), carrageenan (CG), and Aloe vera (AV), designed to enhance burn wound healing through a coaxial electrospinning technique. The PVA/AV@PVA/CS/CG membrane exhibited smooth surface, well-defined layered structure, and uniform nanofibers with a diameter of 180 ± 49 nm, as confirmed by SEM, TEM images. AV was efficiently incorporated into the membrane system, achieving encapsulation efficiency exceeding 80 % and loading efficiency of ∼3 %. The release profile of AV followed the Fickian diffusion mechanism, described by the Peppas-Sahlin model, with the membrane demonstrating ∼85 % delivery performance. The membrane exhibited favorable blood coagulation properties and a sufficient water vapor transmission rate. The membrane's balanced performance in boosting cell survival while also demonstrating antibacterial activity as well as anti-inflammatory effect, made it a suitable setting for wound healing. The synergistic interaction between the components significantly accelerated burn wound recovery and histological evaluation showed that less inflammation, fibroblast proliferation, and collagen deposition without formation of hypertrophic scars. The PVA/AV@PVA/CS/CG membrane showed statistically superior performance (p-values) in various experiments compared to the remaining samples. Conclusively, PVA/AV@PVA/CS/CG membrane exhibited numerous positive biochemical features, making it an excellent choice for third-degree burn wound dressing.

Hyaluronic acid based approaches for wound healing: A comprehensive review

Wound healing is a natural, however complex, tissue repair and regeneration mechanism. Understanding the cascade of biological events associated with wound healing facilitates scientists in designing topical skin formulations with enhanced therapeutic outcomes. In recent years, several innovative approaches have been utilized to treat wounds. Hyaluronic acid (HA)-based formulations have shown promising results. The current manuscript provides a systematic review of various aspects of HA, including its structure, synthesis, mechanism involved in wound healing, and various formulations developed using HA to treat wounds. Covered are innovative treatment strategies explicitly emphasizing nanocarrier-based approaches. Various patents wherein HA has been used to treat wounds are also summarized with the help of a Google patent search. Diving deep, clinical perspectives, toxicity aspects, and application of computational chemistry in HA research are also discussed.

Advances in the study of polysaccharide-based hydrogel wound dressings

Due to the complexity of wound healing, the rapid promotion of wound healing has been a major unresolved challenge for the medical community. If a suitable wound dressing is not found, it can easily induce wound infection and slow down the wound repair process. Hydrogels have been recognized as the best alternative to traditional wound dressings due to their unique water-retention properties as well as their drug-carrying properties. We first outlined the entire process of wound healing, while introducing the biological activities of ten different natural polysaccharides and their mechanisms for promoting wound healing. Subsequently, we summarized the advantages and limitations of various polysaccharides in use and proposed corresponding solutions. In addition, wound dressings for a wide range of wounds, including diabetes, burns, and radiation, have also been reviewed, providing a comprehensive understanding of the applications of these hydrogels in different wound types. This paper provides an important reference for the biomedical application and clinical research of natural polysaccharide-based hydrogel in wound dressings.

Green synthesis of silver and gold nanoparticles using seeds extract of Cichorium intybus and their comparative analysis with commercially available ointment for wound healing activity

Wound healing is a complicated physiological process that involves several stages including hemostasis, inflammation, proliferation and repair to rebuild the integrity of the skin and subcutaneous tissue. Millions of people around the world are affected by poor wound healing, causing increased mortality rates and related costs. Immedicable wounds are a health problem because they directly affect the person's standard of living and produce an ultimatum to the health of people and the international economy because of the expensive medical treatment. Other schemes/approaches must be designed to achieve productive and therapeutic results. In this context, the emergence of Nano biotechnology may provide another manifesto to produce latest drugs for long-term treatment processes. This article shows that the implementation of metal nanoparticles (Au and Ag) has unbolted a brand-new gateway in the discipline of eco-friendly medicine due to their unique properties such as medicine transportation, antimicrobial activity and quick recovery. Moreover, metal nanoparticles (NPs) manufactured by green synthesis not only add the effects of nanoparticles and plant extracts but also reduce toxicity to tissues and make their use safer. In the present work, Ag and Au nanoparticles were synthesized using an aqueous seed extract of Cichorium intybus and their wound healing ability was assessed by performing in-vivo wound healing activity on albino mice. Till now there is no study available on the in-vivo wound healing potential of Ag and Au nanoparticles using Cichorium intybus. This is the first study ever to assess the ability of Cichorium intybus seed extract and its metal nanoparticles (AgNPs & AuNPs) to promote wound healing in animals which shows its uniqueness and novelty. The results displayed augmented and quicker wound closure with Ag as compared to the Au nanoparticles, polyfax and simple plant extract in a 21-day research work. These results illustrated that eco-friendly prepared nanoparticles provide a prominent approach to fight with the bacteria resistant against combination therapy without any lethal affair. Environment-friendly NPs declared to be the low-cost best treatment for the faster recovery of wounds. The main goal of this research is to provide aid in the creation of plant-based, durable and affordable Nano medicine for wound care, lowering dependency on synthetic techniques and encouraging environmental friendly biomedical applications.

Porous Sodium Carboxymethyl Starch Microspheres for Hemostasis and Skin Wound Healing

An effective and rapid hemostatic material with flexible properties for clinical wound dressings is still an unmet need. Herein, a porous sodium carboxymethyl starch (CMS-Na-P) hemostatic microsphere was successfully fabricated through polysaccharide fluffy aggregate (PSFA) technology with a facile and low-cost process. CMS-Na-P exhibited rapid water absorption capabilities alongside favorable cytocompatibility and hemocompatibility. Additionally, CMS-Na-P could absorb red blood cells (RBCs), adhere to and activate platelets, and shorten clotting time in vitro. More importantly, its good in vivo hemostatic ability was further demonstrated against hemorrhage in rat liver and tail, pig superficial skin, superficial body vein, superficial abdominal vein, and femoral artery. Meanwhile, in a rat full-thickness skin defect model, CMS-Na-P could enhance wound healing through accelerated epidermal regeneration and collagen deposition. These properties make CMS-Na-P a promising candidate for treating bleeding and full-thickness wounds.

Skin and Wound Healing: Conventional Dosage versus Nanobased Emulsions Forms

The skin plays a crucial role in the body's homeostasis through its thermoregulation functions, metabolic activity, and, mainly, its barrier function. Once this system has its homeostasis disturbed, through the promotion of tissue discontinuity, an injury happens and a restoration process starts. Different products can be used to promote, accelerate, or stimulate the healing process, such as hydrogels, emulsions, and ointments (main conventional formulations). Despite the historical use and wide market and consumer acceptance, new systems emerged for wound management with the main challenge to overcome conventional form limitations, in which nanosystems are found, mainly nanobased emulsion forms (nano- and microemulsions, NE and ME). Here, we discuss the skin function and wound healing process, highlighting the cellular and molecular processes, the different wound classifications, and factors that affect physiological healing. We also investigated the recent patents (2012-2023) filed at the United States Patent and Trademark Office, where we found few patents for conventional forms (hydrogels = 5; emulsions = 4; ointments = 6) but a larger number of patents for nanobased emulsions filed in this time (NE = 638; ME = 4,072). Furthermore, we address the use of nanobased emulsions (NE and ME) and their particularities, differences, and application in wound treatment. This work also discusses the challenges, bottlenecks, and regulatory framework for nanosystems, industrial, academic, and government interest in nanotechnology, and future perspectives about this key factor for the nanosystems market and consumer acceptance.

Efficacy of RADA16-Based Self-Assembling Peptides on Wound Healing: A Meta-Analysis of Preclinical Animal Studies

Objectives: This analysis aims to provide evidence supporting the feasibility of clinical application of self-assembling peptides for skin wound healing. Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Web of Science, and Cochrane Library were searched (up to June 17, 2024). The primary outcome, wound closure rate at 7 and 14 days post-injury, was pooled using a random-effects meta-analysis. The risk of bias (ROB) assessment and meta-analysis were performed using the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE)'s ROB tool for animal studies and RevMan software. Results: A total of 502 unique records were identified from our search, with 12 experimental animal studies meeting the prespecified inclusion criteria (n = 272 animals). The RADA16 interventions promoted wound closure rate compared to controls (saline or no treatment group) in both diabetic and non-diabetic animal models (Mean Difference (MD) = 11.25, 95% Confidence Interval (CI): 5.73 to 16.78, p < 0.0001; MD = 9.48, 95% CI: 4.75 to 14.22, p < 0.0001 at 7 and 14 days post-injury, respectively). Healing was further enhanced using RADA16-based functional self-assembling peptides compared to RADA16 group in both diabetic and non-diabetic animal models (MD = 27.25, 95% CI: 22.68 to 31.83, p < 0.00001; MD = 29.11, 95% CI: 24.30 to 33.91, p < 0.00001 at 7 and 14 days after injury, respectively). The ROB was uncertain for most studies due to insufficient reporting. Conclusions: RADA16-based self-assembling peptides, particularly those modified with functional peptide motifs, represent a promising treatment for non-diabetic and diabetic wounds in pre-clinical studies, and translation to the clinical domain appears warranted.

Molecular insights and efficacy of guava leaf oil emulgel in managing non diabetic as well as diabetic wound healing by reducing inflammation and oxidative stress

Wound healing in diabetic patients is often compromised due to excessive inflammation, oxidative stress, and impaired angiogenesis, leading to delayed recovery and increased susceptibility to complications. This study aimed to develop an emulgel formulation of guava leaf oil, derived from Psidium guajava (Myrtaceae), and evaluate its wound healing potential in nondiabetic and diabetic rats. Preliminary phytochemical analysis of guava leaf oil identified active compounds such as D-limonene, β-caryophyllene, and 1,8-cineole, which are known for their anti-inflammatory and antioxidant properties. The emulgel was formulated and assessed for physical attributes, including pH, viscosity, spreadability, and stability. The emulgel demonstrated potent antimicrobial activity, with the 1% concentration showing significant efficacy. In vivo studies revealed enhanced wound contraction in diabetic rats treated with the emulgel, supporting its role in promoting excision wound healing. These findings underscore the therapeutic potential of guava leaf oil emulgel as an effective agent for managing nondiabetic and diabetic wounds, providing a foundation for future clinical applications.

Polyphenols in wound healing: unlocking prospects with clinical applications

Wound healing is a multifaceted, complex process that factors like aging, metabolic diseases, and infections may influence. The potentiality of polyphenols, natural compounds, has shown anti-inflammatory and antimicrobial properties in promoting wound healing and their potential applications in wound management. The studies reviewed indicate that polyphenols have multiple mechanisms that promote wound healing. This involves enhancing antioxidant defenses, reducing oxidative stress, modulating inflammatory responses, improving healing times, reducing infection rates, and enhancing tissue regeneration in clinical trials and in vivo and in vitro studies. Polyphenols have been proven to be effective in managing hard-to-heal wounds, especially in diabetic and elderly populations. Polyphenols have shown significant benefits in promoting angiogenesis and stimulating collagen synthesis. Polyphenol treatment has been demonstrated to have therapeutic effects in wound healing and chronic wound management. Their ability to regulate key healing processes makes them suitable for new wound care products and treatments. Future research should enhance formulations and delivery methods to optimize polyphenols' bioavailability and therapeutic efficacy in wound management approaches.

Clinical study on wound healing properties of Nile tilapia fish skin as biological dressing in dogs

Frequency of clinical cases of dogs with massive skin losses is very high in urban areas of Pakistan following road accidents, sharp objects exposure and attack by other dog. These cases need intensive veterinary assistance for safe and speedy healing of wounds. Recently, skin of Nile tilapia fish (Oreochromis niloticus) is internationally gaining hype in medical field as biological dressing to boost dermatological reconstruction process. Nile tilapia skin is a recent research trend and a very limited research data is available on this topic for both human and animal subjects. This study was conducted at Department of Small Animal Clinical Sciences, University of Veterinary and Animal Sciences (UVAS), Lahore, Pakistan considering the wound healing promoter properties of Nile tilapia skin as a biological dressing for dogs with massive skin losses. Aim of this study was to evaluate Nile tilapia fish skin as wound healing promoter biological dressing following sutured and non-sutured application techniques. For this study 10 clinical cases of dogs were randomly selected as per set criteria and divided into groups A and B comprising 5 dogs each. Consent document was signed by each dog owner for volunteer participation in this study. Nile tilapia skin was collected from fresh subjects and treated with 10% povidone-iodine for 10-15 minutes to prepare biological dressing. In group A, biological dressing was sutured on wound (non-absorbable silk suture material) on the area with dermal loss. In group B, biological dressing was applied in a wrap manner on area of dermal loss without application of sutures. Wound healing was evaluated grossly and histologically on days 0, 7 and 14. Statistical analysis of comparison between groups A and B revealed that application of Nile tilapia skin derived biological dressing in wrap fashion results in fast and complication-free wound healing as compared to sutured tilapia biological dressing in dogs.

Advances of exosomes in diabetic wound healing

Poor wound healing is a refractory process that places an enormous medical and financial burden on diabetic patients. Exosomes have recently been recognized as crucial players in the healing of diabetic lesions. They have excellent stability, homing effects, biocompatibility, and reduced immunogenicity as novel cell-free therapies. In addition to transporting cargos to target cells to enhance intercellular communication, exosomes are beneficial in nearly every phase of diabetic wound healing. They participate in modulating the inflammatory response, accelerating proliferation and reepithelization, increasing angiogenesis, and regulating extracellular matrix remodeling. Accumulating evidence indicates that hydrogels or dressings in conjunction with exosomes can prolong the duration of exosome residency in diabetic wounds. This review provides an overview of the mechanisms, delivery, clinical application, engineering, and existing challenges of the use of exosomes in diabetic wound repair. We also propose future directions for biomaterials incorporating exosomes: 2D or 3D scaffolds, biomaterials loaded with wound healing-promoting gases, intelligent biomaterials, and the prospect of systematic application of exosomes. These findings may might shed light on future treatments and enlighten some studies to improve quality of life among diabetes patients.

New Perspectives of Hydrogels in Chronic Wound Management

Chronic wounds pose a substantial healthcare concern due to their prevalence and cost burden. This paper presents a detailed overview of chronic wounds and emphasizes the critical need for novel therapeutic solutions. The pathophysiology of wound healing is discussed, including the healing stages and the factors contributing to chronicity. The focus is on diverse types of chronic wounds, such as diabetic foot necrosis, pressure ulcers, and venous leg ulcers, highlighting their etiology, consequences, and the therapeutic issues they provide. Further, modern wound care solutions, particularly hydrogels, are highlighted for tackling the challenges of chronic wound management. Hydrogels are characterized as multipurpose materials that possess vital characteristics like the capacity to retain moisture, biocompatibility, and the incorporation of active drugs. Hydrogels' effectiveness in therapeutic applications is demonstrated by how they support healing, including preserving ideal moisture levels, promoting cellular migration, and possessing antibacterial properties. Thus, this paper presents hydrogel technology's latest developments, emphasizing drug-loaded and stimuli-responsive types and underscoring how these advanced formulations greatly improve therapy outcomes by enabling dynamic and focused reactions to the wound environment. Future directions for hydrogel research promote the development of customized hydrogel treatments and the incorporation of digital health tools to improve the treatment of chronic wounds.

Application and influence of four drain configurations on fluid dispersal and retrieval in a cadaveric canine wound infusion-retrieval system model

OBJECTIVE

To describe fluid dispersal and retrieval patterns in an infusion-retrieval system across various configurations and locations in a cadaveric canine model.

STUDY DESIGN

Cadaveric study.

ANIMALS

Four large breed canines.

METHODS

Four full-thickness wounds (10 × 10 cm) were created bilaterally in four canine cadavers (shoulder, thorax, flank, and thigh). A wound infusion catheter and active suction drain were placed in four configurations (diagonal, opposite, parallel, and perpendicular) and the incisions were closed. Diluted methylene blue was instilled, allowed to dwell for 10 min, and quantified after retrieval. A 14 × 14 cm full-thickness skin segment, including the initial 10 × 10 cm wound, was removed. Images of the removed skin and cadaver wound bed were taken to calculate surface area (SA) and to evaluate fluid dispersion. A mixed-effects linear regression model was used for statistical analysis.

RESULTS

Fluid retrieval did not differ by configuration (p = .92) or location (p = .32), although the perpendicular configuration resulted in the highest retrieval (11.35 ± 6.1 mL) (56.8 ± 30% volume instilled) and the flank location resulted in the lowest (7.2 ± 6.4 mL) (35.9 ± 32% volume instilled). Configuration influenced SA coverage of the wound bed (p < .01), whereas location did not (p = .10). The parallel configuration had the greatest SA coverage (83.4 ± 11.6%). No difference existed for leakage of methylene blue (MB) beyond the borders for configuration (p = .74) or location (p = .10).

CONCLUSION

The parallel configuration maximized the fluid dispersion within the cadaveric wound bed in comparison with other configurations (p < .01).

CLINICAL SIGNIFICANCE

An infusion-retrieval system could be considered during wound closure to administer topical solutions and remove excess free fluid.

Copper-Based Nanozymes: Potential Therapies for Infectious Wounds

Bacterial infections are a significant obstacle to the healing of acute and chronic wounds, such as diabetic ulcers and burn injuries. Traditional antibiotics are the primary treatment for bacterial infections, but they present issues such as antibiotic resistance, limited efficacy, and potential side effects. This challenge leads to the exploration of nanozymes as alternative therapeutic agents. Nanozymes are nanomaterials with enzyme-like activities. Owing to their low production costs, high stability, scalability, and multifunctionality, nanozymes have emerged as a prominent focus in antimicrobial research. Among various types of nanozymes, metal-based nanozymes offer several benefits, including broad-spectrum antimicrobial activity and robust catalytic properties. Specifically, copper-based nanozymes (CuNZs) have shown considerable potential in promoting wound healing. They exhibit strong antimicrobial effects, reduce inflammation, and enhance tissue regeneration, making them highly advantageous for use in wound care. This review describes the dual functions of CuNZs in combating infection and facilitating wound repair. Recent advancements in the design and synthesis of CuNZs, evaluating their antimicrobial efficacy, healing promotion, and biosafety both in vitro and in vivo on the basis of their core components, are critically important.

Study of the ability of polysaccharides isolated from Zizania latifolia to promote wound healing in mice via in vitro screening and in vivo evaluation

Swollen culms of Zizania latifolia possess a peculiar flavor, nutritional value and health-promoting effects. This study investigated the wound healing ability of polysaccharides isolated from Zizania latifolia (ZLP). Through in vitro assays, ZLP demonstrated negligible cytotoxicity and promoted the migration and phagocytosis of Staphylococcus aureus by macrophages where ZLP-2 had a significantly greater effect. Moreover, ZLP-2 has a higher purity and molecular weight, an integral and large lamellar morphology, and a larger particle size in solution, suggesting its ability to form films. Thus, ZLP-2 was fabricated as a gel formulation for topical application. The in vivo results showed that the ZLP-2 gel had significantly greater effects than did the autonomous healing process according to quantitative analysis of the wound closure area. The ZLP-2 gel decreased the levels of TNF-α and IL-6 in wounded tissue. Furthermore, the quantification of the molecular indexes via qRT-PCR revealed that the levels of tnf-α, tgf-β, mcp-1, ifn-γ, inos, and vegf in the treated group increased during the inflammatory and proliferation stages but decreased after wound closure. These results suggest that ZLP-2 has great potential in pharmaceutical applications for wound care.

Rat model evaluation for healing-promoting effectiveness and antimicrobial activity of electron beam synthesized (polyvinyl alcohol-pectin)- silver doped zinc oxide hydrogel dressings enriched with lavender oil

Ag/ZnO NPs and lavender oil (LVO) were incorporated into (polyvinyl alcohol/pectin) (PVA/Pet) dressings using electron beam irradiation technology. The Ag/ZnO NPs were prepared using the precipitation method and characterized using XRD, FTIR, and EDX techniques. TEM micrograph shows their spherical appearance with an average size of around 27.4 nm. The increase in the (PVA: Pet) feed solution concentration up to 30% enhances the gel content to 92%. The swelling degree reaches 1674% using 80 wt% pectin content. Meanwhile, increasing the irradiation dose up to 45 kGy increases the gel fraction and negatively affects the swelling capabilities. Incorporating Ag/ZnO NPs and LVO slightly decreased the gel fraction, the swelling degree, and the dressing's porosity reached 87%. In pseudo extracellular fluids, dressings with 10% LVO demonstrate 419% swelling capacities, and their WVTR reaches 271.1 g/m2h. Dressings show biocompatibility, antimicrobial potential, and excellent wound healing capacity towards the excisional wound model in rats, as confirmed by the histological and biochemical results. LVO-(PVA/Pet)-Ag/ZnO dressings may accelerate tissue granulation and remodeling by replacing lost collagen and cause the wound to constrict by upregulating markers associated with wound healing so that it can be recommended as a wound healing candidate.

Key wound healing genes as diagnostic biomarkers and therapeutic targets in uterine corpus endometrial carcinoma: an integrated in silico and in vitro study

BACKGROUND

Uterine Corpus Endometrial Carcinoma (UCEC) is a prevalent gynecologic malignancy with complex molecular underpinnings. This study identifies key woundhealing genes involved in UCEC and elucidates their roles through a comprehensive analysis.

METHODS

In silico and in vitro experiments.

RESULTS

Seventy wound healing-associated genes were extracted from the Gene Ontology (GO) database, and a protein-protein interaction (PPI) network was constructed using the STRING database. CytoHubba analysis in Cytoscape identified six pivotal hub genes: CD44, FGF2, FGF10, KDM6A, FN1, and MMP2. These genes exhibited significantly lower expression in UCEC cell lines compared to normal controls, as confirmed by RT-qPCR. Receiver Operating Characteristic (ROC) analysis demonstrated their potential as diagnostic biomarkers, with Area Under the Curve (AUC) values ranging from 0.94 to 1.00. Validation using TCGA datasets revealed consistent downregulation of these genes in UCEC samples, corroborated by immunohistochemical staining. Promoter methylation analysis showed significantly higher methylation levels in UCEC, correlating with decreased mRNA expression and poor survival outcomes. Genetic alteration analysis indicated frequent mutations in FN1 and KDM6A, although these did not significantly affect survival. Functional analysis using the CancerSEA database highlighted the involvement of these genes in critical cancer-related processes, including angiogenesis, apoptosis, and metastasis. Immune correlation studies revealed significant associations with immune inhibitor genes and distinct expression patterns across immune subtypes. Overexpression studies in UCEC cell lines demonstrated that CD44 and MMP2 reduce proliferative ability while enhancing migration and wound healing.

CONCLUSION

Collectively, these findings underscore the crucial roles of CD44, FGF2, FGF10, KDM6A, FN1, and MMP2 in UCEC pathogenesis, highlighting their potential as biomarkers and therapeutic targets in this malignancy.

Microfluidic oxygen gradient assay unveils metabolic shifts in HaCaT cell migration under diabetic conditions

Migration and scratch assays are helpful tools to investigate wound healing and tissue regeneration processes, especially under disease conditions such as diabetes. However, traditional migration (injury-free) assays and scratch (with injury) assays are limited in their control over cellular environments and provide only simplified read-outs of their results. On the other hand, microfluidic-based cell assays offer a distinct advantage in their integration and scalability for multiple modalities and concentrations in a single device. Additionally, in situ stimulation and detection helps to avoid variabilities between individual bioassays. To realize an enhanced, smarter migration assay, we leveraged our multilayered oxygen gradient (1%-16%) to study HaCaT migrations in diabetic conditions with spatial and metabolic read-outs. An analysis of spatial migration over time revealed a new dynamic between hypoxia (at 4.2%-9.1% O2) and hyperglycemia. Furthermore, in situ adenosine triphosphate (ATP) and reactive oxygen species (ROS) responses suggest that this dynamic represents a switch between stationary versus motile modes of metabolism. Thus, low glucose and hypoxia have synergistic effects promoting the migration of cells. These findings illustrate the benefits of spatial microfluidics for modeling complex diseases such as hypoxia and diabetes, where multimodal measurements provide a more deterministic view of the underlying processes.

Titanium dioxide nanoparticles: a promising candidate for wound healing applications

Effective wound management and treatment are crucial in clinical practice, yet existing strategies often fall short in fully addressing the complexities of skin wound healing. Recent advancements in tissue engineering have introduced innovative approaches, particularly through the use of nanobiomaterials, to enhance the healing process. In this context, titanium dioxide nanoparticles (TiO2 NPs) have garnered attention due to their excellent biological properties, including antioxidant, anti-inflammatory, and antimicrobial properties. Furthermore, these nanoparticles can be modified to enhance their therapeutic benefits. Scaffolds and dressings containing TiO2 NPs have demonstrated promising outcomes in accelerating wound healing and enhancing tissue regeneration. This review paper covers the wound healing process, the biological properties of TiO2 NPs that make them suitable for promoting wound healing, methods for synthesizing TiO2 NPs, the use of scaffolds and dressings containing TiO2 NPs in wound healing, the application of modified TiO2 NPs in wound healing, and the potential toxicity of TiO2 NPs.

Risk factors for poor outcomes in adult patients with lip through-and-through wounds

BACKGROUND

Risk factors associated with infection and traumatic lacerations affecting the face are still not fully understood. This study investigated risk factors for poor outcomes in adult patients with through-and-through lip wounds who underwent debridement and suturing.

METHODS

Patients with through-and-through lip wounds who underwent debridement in our emergency department between January 1, 2017, and December 31, 2021, were included. The effects of gender, age, wound age (time from injury to wound closure), antibiotic application, injury mechanism, diabetes, wound length, wound cleanliness, peripheral tissue damage, and postoperative wound blood scab on the poor outcome rate were assessed for all patients. Poor outcome was analyzed based on atraumatic wound dehiscence before suture removal, pus in the wound, and unhealed oral wounds with a length >1 cm or deeper than the muscle layer 5-6 days after surgery.

RESULTS

A total of 728 cases were included, with a poor outcome rate of 20.88 %. The univariable analysis showed that the proportion of poor outcomes was significantly associated with male gender, age (65-79 years old), bicycle/electric bicyble, antibiotic use, wound length of 4-8 cm, wound contamination, peripheral tissue damage, and scabs. Binary logistic analysis showed that the proportion of poor outcomes was significantly associated with older age (65-79 years old), wound length of 4-8 cm, peripheral tissue damage and wounds covered by scabs. In the binary logistic regression analysis, poor outcomes were not associated with gender, injury mechanism, wound contamination or the use of antibiotics.

CONCLUSION

Our findings provide valuable information on the risk factors for poor outcomes in adult patients with lip through-and-through wounds who underwent debridement and suturing.

Polysaccharides and Peptides With Wound Healing Activity From Bacteria and Fungi

Bacteria and fungi are natural sources of metabolites exhibiting diverse bioactive properties such as wound healing, antioxidative, antibacterial, antifungal, anti-inflammatory, antidiabetic, and anticancer activities. Two important groups of bacteria or fungi-derived metabolites with wound-healing potential are polysaccharides and peptides. In addition to bacteria-derived cellulose and hyaluronic acid and fungi-derived chitin and chitosan, these organisms also produce different polysaccharides (e.g., exopolysaccharides) with wound-healing potential. The most commonly used bacterial peptides in wound healing studies are bacteriocins and lipopeptides. Bacteria or fungi-derived polysaccharides and peptides exhibit both the in vitro and the in vivo wound healing potency. In the in vivo models, including animals and humans, these metabolites positively affect wound healing by inhibiting pathogens, exhibiting antioxidant activity, modulating inflammatory response, moisturizing the wound environment, promoting the proliferation and migration of fibroblasts and keratinocytes, increasing collagen synthesis, re-epithelialization, and angiogenesis. Therefore, peptides and polysaccharides derived from bacteria and fungi have medicinal importance. This study aims to overview current literature knowledge (especially within the past 5 years) on the in vitro and in vivo wound repair potentials of polysaccharides and peptides obtained from bacteria (Actinobacteria, Bacteroidetes, Cyanobacteria, Firmicutes, and Proteobacteria) and fungi (yeasts, filamentous microfungi, and mushrooms).

The Role of Puerarin in Chronic Wounds: A Review of its Mechanism of Action and Potential Novel Applications

Chronic wounds have a high disease burden and significantly influence patient quality of life. The development of chronic wounds is multifactorial and thus adequate management and care is often difficult to achieve. Chronic diseases, malnutrition, smoking, immune dysregulation, and age contribute to chronic wound development. Treatment options include adequately addressing underlying conditions and selecting appropriate topical preparations which enhance and promote healing of different wounds based on an understanding of wound healing pathophysiology. Puerarin, a naturally occurring flavinoid, may offer therapeutic potential for addressing etiologies as well as managing wound beds due to its anti-inflammatory, anti-oxidative, pro-angiogenic, and anesthetic properties.

Therapeutic Potential of Green Synthesized Silver Nanoparticles for Promoting Wound-Healing Process in Diabetic Mice

Diabetes is a serious metabolic disorder characterized by abnormal glucose levels in the body. Delayed wound healing is a severe diabetes complication. Nanotechnology represents the latest advancement in treating diabetic wounds through nanoparticles (NPs). In this study, silver nanoparticles (AgNPs) were synthesized using a green method involving cucumber pulp extract. The synthesis was confirmed using techniques including ultraviolet-visible spectrophotometry (UV-Vis), Fourier-transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy dispersive X-ray (EDX). To evaluate wound-healing properties, mouse models were utilized with wounds induced by excision on the dorsal surface. An ointment containing silver nanoparticles was applied to assess its healing potential. Additionally, antibacterial and antioxidant activities were examined using agar well diffusion and DPPH scavenging methods, respectively. The results demonstrated that the ointment prepared with green synthesized AgNPs effectively healed the wounds within 15 days, while also exhibiting antibacterial and antioxidant properties. Therefore, it can be concluded that due to its efficacy in biological activities, silver nanoparticles can be employed in the treatment of diabetic wounds.

Osteoradionecrosis of the Jaws and Management Strategies

Background

Osteoradionecrosis of the jaws (ORNJ) is a severe complication arising from radiotherapy for head and neck cancers. It results from irreversible damage to osteocytes, leading to nonhealing of exposed bone. The condition can cause substantial pain, swelling, trismus, and in severe cases, pathological fractures of the jaw, substantially impacting the patient's quality of life and increasing morbidity.

Aims

This review aims to describe the pathophysiology of ORNJ, evaluate current management strategies, and explore emerging therapies to provide a comprehensive understanding of this condition.

Methods

A comprehensive literature review was conducted to describe the pathophysiology, clinical presentation, and treatment of ORNJ.

Results

The pathophysiology of ORNJ involves multiple theories, including radiation‐induced fibrosis and the “hypoxia, hypocellular, and hypovascular” model. Management strategies include surgical debridement, hyperbaric oxygen therapy (HBOT), and emerging biological approaches such as tissue engineering and platelet‐rich plasma (PRP), which are all discussed.

Discussion

Radiotherapy significantly impairs wound healing, leading to chronic fibrosis and tissue necrosis. Although ORNJ is uncommon, its impact on patients is substantial. Current treatments offer limited success, necessitating a multidisciplinary approach and ongoing research into innovative therapies. Emerging treatments, including tissue engineering and PRP, offer potential but require further research.

Conclusion

ORNJ remains a challenging condition with substantial patient morbidity. Understanding its pathophysiology is crucial for patient education, early detection and developing effective management strategies.

Comprehensive developmental investigation on simvastatin enriched bioactive film forming spray using the quality by design paradigm: a prospective strategy for improved wound healing

The use of topical antimicrobials in wound healing presents challenges like risk of drug resistance and toxicity to local tissue. Simvastatin (SIM), a lipid-lowering agent which reduces the risk of cardiovascular events, is repurposed for its pleiotropic effect in wound healing. A bioactive bioadhesive polymer-based film forming spray (FFS) formulation of SIM was designed using chitosan, collagen, hyaluronic acid and optimised by employing the DoE approach. Optimised formulation demonstrated moderate viscosity (12.5 ± 0.3 cP), rapid film formation (231 ± 5.6 s), flexibility, tensile strength and sustained drug release (T80 - time for 80% drug release - 9.05 ± 0.7 h). Scanning electron microscopy (SEM) verified uniformly dispersed drug within the composite polymer matrix. SIM FFS demonstrated antimicrobial activity against gram positive and gram negative bacteria. In vivo excision wound model studies in mice affirmed the beneficent role of bioactive polymers and the efficacy of SIM FFS in wound contraction and closure, tissue remodelling and re-epithelization in comparison to standard antimicrobial preparation. Cytokines TNF- alpha, IL-6 were downregulated and IL-10 was upregulated. Biochemical markers; hydroxyproline, hexosamine and histopathology were consistent with wound contraction observed. This is an exploratory effort in repurposing SIM for wound healing in a novel dosage form, underscoring its potential as an alternative to conventional topical antimicrobials.

Exploring the potential of chitosan polyherbal hydrogel loaded with AgNPs to enhance wound healing A triangular study

Hydrogel wound dressings provide a moist environment, which promotes the formation of granulation tissue and epithelium in the wound area, accelerating the wound healing process. There have been numerous approaches to skin wound management and treatment, but the limitations of current methods highlight the need for more effective alternatives. A Chitosan polyherbal hydrogel integrated with AgNPs was synthesized to assess its wound-healing potential both in vitro and in vivo. The AgNPs were synthesized using Calotropis procera leaf extract and characterized via X-ray diffraction analysis (XRD), Scanning electron microscopy (SEM), and Fourier Transform Infrared Spectroscopy (FT-IR). In swelling kinetic analysis, the hydrogel's weight reached its maximum at 8 h of incubation and began to decrease from 12 h up to 72 h (49 % ± 6.04). The hydrogel formulation demonstrated strong antimicrobial potential against E. coli and S. aureus with an inhibition zone of 18 mm and 25 mm, respectively. Furthermore, in mice studies, the formulation exhibited significant wound size reduction within 12 days, supported by histopathology analysis revealing higher angiogenic potential compared to commercial hydrogels. The concentrations of IL-6 and TNF-α in CS-polyherbal/AgNPs hydrogel were 500 pg/ml and 125 pg/ml, respectively. Additionally, a network pharmacology approach identified 11 chemical constituents in Aloe vera, Azadirachta indica, and Alternanthera brasiliana extracts, along with 326 potential targets, suggesting the superior wound healing properties of this formulation compared to commercially available hydrogels.

Nanoetched Stainless Steel Architecture Enhances Cell Uptake of Biomacromolecules and Alters Protein Corona Abundancy

Nanotexture on biocompatible surfaces promotes cell adhesion and proliferation. High aspect ratio nanoachitecture serves as an ideal interface between implant materials and host cells that is well-suited for localized therapeutic delivery. Despite this potential, nanotextured surfaces have not been widely applied for biomacromolecule delivery. Here, we employed a low-cost, industrially relevant nanoetching process to modify the surface of biocompatible stainless steel 316 (SS316L), creating nanotextured SS316L (NT-SS316L) as a material for intracellular biomacromolecule delivery. As biomacromolecule cargoes are adsorbed to the steel and ultimately would be used in protein-rich environments, we performed serum protein corona analysis on unmodified SS316L and NT-SS316L using tandem mass spectrometry. We observed an increase in proteins associated with cell adhesion on the surface of NT-SS316L compared to that of SS316L, supporting literature reports of enhanced adhesion on nanotextured materials. For delivery to adherent cells, a "hard corona" of model biomacromolecule cargoes including superfolder green fluorescent protein (sfGFP) charge variants, cytochrome c, and siRNA was adsorbed on NT-SS316L to assess delivery. Nanotextured surfaces enhanced cellular biomacromolecule uptake and delivered cytosolic-functional proteins and nucleic acids through energy-dependent endocytosis. Collectively, these findings indicate that NT-SS316L holds potential as a surface modification for implants to achieve localized drug delivery for a variety of biomedical applications.

Comparative analysis of human and mouse transcriptomes during skin wound healing

Skin wound healing is a complex process which involves multiple molecular events and the underlying mechanism is not fully understood. We presented a comparative transcriptomic analysis of skin wound healing in humans and mice to identify shared molecular mechanisms across species. We analyzed transcriptomes from three distinct stages of the healing process and constructed protein-protein interaction networks to elucidate commonalities in the healing process. A substantial number of differentially expressed genes (DEGs) were identified in human transcriptomes, particularly upregulated genes before and after wound injury, and enriched in processes related to extracellular matrix organization and leukocyte migration. Similarly, the mouse transcriptome revealed thousands of DEGs, with shared biological processes and enriched KEGG pathways, highlighting a conserved molecular signature in skin wound healing. A total of 21 common DEGs were found across human comparisons, and 591 in mouse comparisons, with four genes (KRT2, MARCKSL1, MMP1, and TNC) consistently differentially expressed in both species, suggesting critical roles in mammalian skin wound healing. The expression trends of these genes were consistent, indicating their potential as therapeutic targets. The molecular network analysis identified five subnetworks associated with collagen synthesis, immunity, cell-cell adhesion, and extracellular matrix, with hub genes such as COL4A1, TLR7, TJP3, MMP13, and HIF1A exhibited significant expression changes before and after wound injury in humans and mice. In conclusion, our study provided a detailed molecular network for understanding the healing process in humans and mice, revealing conserved mechanisms that could help the development of targeted therapies across species.

Zinc-based Polyoxometalate Nanozyme Functionalized Hydrogels for optimizing the Hyperglycemic-Immune Microenvironment to Promote Diabetic Wound Regeneration

BACKGROUND

In diabetic wounds, hyperglycemia-induced cytotoxicity and impaired immune microenvironment plasticity directly hinder the wound healing process. Regulation of the hyperglycemic microenvironment and remodeling of the immune microenvironment are crucial.

RESULTS

Here, we developed a nanozymatic functionalized regenerative microenvironmental regulator (AHAMA/CS-GOx@Zn-POM) for the effective repair of diabetic wounds. This novel construct integrated an aldehyde and methacrylic anhydride-modified hyaluronic acid hydrogel (AHAMA) and chitosan nanoparticles (CS NPs) encapsulating zinc-based polymetallic oxonate nanozyme (Zn-POM) and glucose oxidase (GOx), facilitating a sustained release of release of both enzymes. The GOx catalyzed glucose to gluconic acid and (H₂O₂), thereby alleviating the effects of the hyperglycemic microenvironment on wound healing. Zn-POM exhibited catalase and superoxide dismutase activities to scavenge reactive oxygen species and H₂O₂, a by-product of glucose degradation. Additionally, Zn-POM induced M1 macrophage reprogramming to the M2 phenotype by inhibiting the MAPK/IL-17 signaling diminishing pro-inflammatory cytokines, and upregulating the expression of anti-inflammatory mediators, thus remodeling the immune microenvironment and enhancing angiogenesis and collagen regeneration within wounds. In a rat diabetic wound model, the application of AHAMA/CS-GOx@Zn-POM enhanced neovascularization and collagen deposition, accelerating the wound healing process.

CONCLUSIONS

Therefore, the regenerative microenvironment regulator AHAMA/CS-GOx@Zn-POM can achieve the effective conversion of a pathological microenvironment to regenerative microenvironment through integrated control of the hyperglycemic-immune microenvironment, offering a novel strategy for the treatment of diabetic wounds.

A rare phytosterol, stigmast-5-en-3β,7α,22α-triol and other secondary metabolites from Leea indica showing enhanced in vitro cell migration and proangiogenic activity

Leea indica (Burm. f.) Merr. (Vitaceae) is used for the treatment of wounds in traditional medicine practiced in Sri Lanka. The current study is carried out to investigate its wound healing potential in terms of in vitro cell migration and proangiogenic activity. The scratch wound assay (SWA) guided fractionation of dichloromethane extract of L. indica led to the isolation of a rare phytosterol, stigmast-5-en-3β,7α,22α-triol (1), betulin (2), lupeol (3), and β-sitosterol (4) all of which showed enhanced cell migration in SWA and significant proangiogenic response in chorioallantoic membrane (CAM) assay. The identities of compounds 1-4 were established by the analysis of NMR spectroscopic data and comparison with those reported. This is the first report of the occurrence of compounds 1 and 2 in L. indica.

A bioactive xyloglucan polysaccharide hydrogel mechanically enhanced by Pluronic F127 micelles for promoting chronic wound healing

Chronic wounds represent a formidable global healthcare challenge due to the bacteria infections and uncontrollable inflammation responses, while developing wound healing materials capable of resolving these issues remains a challenge. In this study, we integrated xyloglucan (XG) with Pluronic F127 diacrylate (F127DA)to develop a composite hydrogel for wound healing, where the XG introduced anti-inflammation and anti-bacterial properties to the construct, and F127DA provides the photocurable properties essential for hydrogel formation and robust mechanical characteristics to achieve physical strength that matches tissue regeneration. The material characterizations suggested that XG/F127DA hydrogels had great biostability, blood compatibility and antibacterial effects, which was suitable to be used as a wound healing material. The in vitro analysis by culturing L929 fibroblasts on the hydrogel surface demonstrated that the inclusion of XG could promote the cellular proliferation rate, migration rate, and re-epithelialization-related marker expression, while downregulate the inflammation process. The XG/F127DA hydrogel was further used for the full-thickness skin wound healing test on mice, where the inclusion of XG significantly increased the wound closure rate through reducing the inflammation responses, and promote re-epithelialization and angiogenesis. These results indicated that XG/F127DA hydrogel has great potential to be used for wound healing in future clinical translation.

The Potential of Fish Oil Components and Manuka Honey in Tackling Chronic Wound Treatment

Chronic wounds are becoming an increasing burden on healthcare services, as they have extended healing times and are susceptible to infection, with many failing to heal, which can lead ultimately to amputation. Due to the additional rise in antimicrobial resistance and emergence of difficult-to-treat Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. (ESKAPE pathogens), novel treatments will soon be required asides from traditional antibiotics. Many natural substances have been identified as having the potential to aid in both preventing infection and increasing the speed of wound closure processes. Manuka honey is already in some cases used as a topical treatment in the form of ointments, which in conjunction with dressings and fish skin grafts are an existing US Food and Drug Administration-approved treatment option. These existing treatment options indicate that fatty acids from fish oil and manuka honey are well tolerated by the body, and if the active components of the treatments were better understood, they could make valuable additions to topical treatment options. This review considers two prominent natural substances with established manufacturing and global distribution-marine based fatty acids (including their metabolites) and manuka honey-their function as antimicrobials and how they can aid in wound repair, two important aspects leading to resolution of chronic wounds.

Uncovering the Benefits of Povidone Iodine Compared to Other Therapeutic Agents in Wound Infection Prevention and Healing Outcomes: A Scoping Review

Background

The selection of an appropriate chemical solution in wound care reduces the severity of wounds and accelerates the healing process. Povidone-iodine (PV-I), a chemical solution popularly known as an antiseptic, is frequently used in studies of wound care to prevent wound infection and accelerate woud the process of wound healing.

Objective

To identify the latest evidence on the benefits of PV-I in wound infection prevention and healing in all areas.

Methods

This review is a scoping review by Arskey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) is used for reporting. The literature search used databases including PubMed, CINAHL, and search engines such as Scopus. This study was conducted using thematic analysis.

Results

This review yielded 19 out of 2109 studies that were identified in the initial search. Four outcomes comprised 20 sub-outcomes have been identified. Although strong evidence is lacking, PV-I in the form of foam is effective in improving wound healing, shortening healing time, and producing fewer adverse events than hydrocelluers. Moreover, saline and PV-I are effective as skin disinfectants when compared to saline alone in reducing surgical site infection (SSI), and they are also more effective than hypochlorous acid in improving wound healing. Nevertheless, there was no difference between PV-I and hypochlorous acid in the prevention of SSI and bacterial growth. In terms of healing time, silver foam and hyaluronic acid were more favorable than PV-I. Moreover, the use of chlorhexidine to improve SSI and silver dressing to improve hospital stay is more favorable than that of PV-I.

Conclusion

There is limited evidence regarding the effectiveness of wound care outcomes, and the efficacy of PV-I as a surface disinfectant for wound infection prevention remains controversial. Consequently, PV-I is not highly recommended for wound care, and further investigation into the effectiveness of PV-I as a surface disinfectant is required for various types of surgeries.

Commensal microbiome dysbiosis elicits interleukin-8 signaling to drive fibrotic skin disease

Wound healing is an intensely studied topic involved in many relevant pathophysiological processes, including fibrosis. Despite the large interest in fibrosis, the network that is related to commensal microbiota and skin fibrosis remains mysterious. Here, we pay attention to keloid, a classical yet intractable skin fibrotic disease to establish the association between commensal microbiota to scaring tissue. Our histological data reveal the presence of microbiota in the keloids. 16S rRNA sequencing characterizes microbial composition and divergence between the pathological and normal skin tissues. Moreover, the data show elevation of interleukin-8 (IL-8) in both the circulation and keloid tissue, which elicited the collagen accumulation and migratory program of dermal fibroblasts via CXCR1/2 receptor. Our research provides insights into the pathology of human fibrotic diseases, advocating commensal bacteria and IL-8 signaling as useful targets in future interventions of recurrent keloid disease.

Aloesin-loaded chitosan/cellulose-based scaffold promotes skin tissue regeneration

Skin wound healing and regeneration is very challenging across the world as simple or acute wounds can be transformed into chronic wounds or ulcers due to foreign body invasion, or diseases like diabetes or cancer. The study was designed to develop a novel bioactive scaffold, by loading aloesin to chitosan-coated cellulose scaffold, to cure full-thickness skin wounds. The physiochemical characterization of the scaffold was carried out using scanning electron microscopy (SEM) facilitated by energy-dispersive spectrophotometer (EDS), atomic force microscopy (AFM), and Fourier transform infrared spectroscopy (FTIR). The results indicated the successful coating of chitosan and aloesin on cellulose without any physical damage. The drug release kinetics confirmed the sustained release of aloesin by showing a cumulative release of up to 88 % over 24 h. The biocompatibility of the aloesin-loaded chitosan/cellulose (AlCsCFp) scaffold was evaluated by the WST-8 assay that confirmed the significantly increased adherence and proliferation of fibroblasts on the AlCsCFp scaffold. The in vivo wound healing study showed that both 0.05 % and 0.025 % AlCsCFp scaffolds have significantly higher wound closure rates (i.e. 88.2 % and 95.6 % approximately) as compared to other groups. This showed that novel composite scaffold has a wound healing ability. Furthermore, histological and gene expression analysis demonstrated that the scaffold also induced cell migration, angiogenesis, re-epithelialization, collagen deposition, and tissue granulation formation. Thus, it is concluded that the aloesin-loaded chitosan/cellulose-based scaffold has great therapeutic potential for being used in wound healing applications in the clinical setting in the future.

Graphene-silymarin-loaded chitosan/gelatin/hyaluronic acid hybrid constructs for advanced full-thickness burn wound management

Burn wounds (BWs) with extensive blood loss, along with bacterial infections and poor healing, may become detrimental and pose significant rehabilitation obstacles in medical facilities. Therefore, the freeze-drying method synthesized novel hemocompatible chitosan, gelatin, and hyaluronic acid infused with graphene oxide-silymarin (CGH-SGO) hybrid constructs for application as a BW patch. Most significantly, synthesized hybrid constructs exhibited an interconnected-porous framework with precise pore sizes (≈118.52 µm) conducive to biological functions. Furthermore, the FTIR and XRD analyses document the constructs' physiochemical interactions. Similarly, enhanced swelling ratios, adequate WVTR (736 ± 78 g m-2 hr-1), and bio-degradation rates were seen during the physiological examination of constructs. Following the in vitro investigations, SMN-GO added to constructs improved their anti-bacterial (against E.coli and S. aureus), anti-oxidant, hemocompatible, and bio-compatible characteristics in conjunction with prolonged drug release. Furthermore, in vivo, implanting constructs on wounds exhibited significant acceleration in full-thickness burn wound (FT-BW) healing on the 14th day (CGH-SGO: 95 ± 2.1 %) in contrast with the control (Gauze: 71 ± 4.2 %). Additionally, contrary to gauze, the in vivo rat tail excision model administered with constructs assured immediate blood clotting. Therefore, CGH-SGO constructs with an improved porous framework, anti-bacterial activity, hemocompatibility, and biocompatibility could represent an attractive option for healing FT-BWs.

Diamond-Like Carbon Depositing on the Surface of Polylactide Membrane for Prevention of Adhesion Formation During Tendon Repair

Post-traumatic peritendinous adhesion presents a significant challenge in clinical medicine. This study proposes the use of diamond-like carbon (DLC) deposited on polylactic acid (PLA) membranes as a biophysical mechanism for anti-adhesion barrier to encase ruptured tendons in tendon-injured rats. The results indicate that PLA/DLC composite membrane exhibits more efficient anti-adhesion effect than PLA membrane, with histological score decreasing from 3.12 ± 0.27 to 2.20 ± 0.22 and anti-adhesion effectiveness increasing from 21.61% to 44.72%. Mechanistically, the abundant C=O bond functional groups on the surface of DLC can reduce reactive oxygen species level effectively; thus, the phosphorylation of NF-κB and M1 polarization of macrophages are inhibited. Consequently, excessive inflammatory response augmented by M1 macrophage-originated cytokines including interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) is largely reduced. For biocompatibility evaluation, PLA/DLC membrane is slowly absorbed within tissue and displays prolonged barrier effects compared to traditional PLA membranes. Further studies show the DLC depositing decelerates the release of degradation product lactic acid and its induction of macrophage M2 polarization by interfering esterase and PLA ester bonds, which further delays the fibrosis process. It was found that the PLA/DLC membrane possess an efficient biophysical mechanism for treatment of peritendinous adhesion.

A review of the current state of natural biomaterials in wound healing applications

Skin, the largest biological organ, consists of three main parts: the epidermis, dermis, and subcutaneous tissue. Wounds are abnormal wounds in various forms, such as lacerations, burns, chronic wounds, diabetic wounds, acute wounds, and fractures. The wound healing process is dynamic, complex, and lengthy in four stages involving cells, macrophages, and growth factors. Wound dressing refers to a substance that covers the surface of a wound to prevent infection and secondary damage. Biomaterials applied in wound management have advanced significantly. Natural biomaterials are increasingly used due to their advantages including biomimicry of ECM, convenient accessibility, and involvement in native wound healing. However, there are still limitations such as low mechanical properties and expensive extraction methods. Therefore, their combination with synthetic biomaterials and/or adding bioactive agents has become an option for researchers in this field. In the present study, the stages of natural wound healing and the effect of biomaterials on its direction, type, and level will be investigated. Then, different types of polysaccharides and proteins were selected as desirable natural biomaterials, polymers as synthetic biomaterials with variable and suitable properties, and bioactive agents as effective additives. In the following, the structure of selected biomaterials, their extraction and production methods, their participation in wound healing, and quality control techniques of biomaterials-based wound dressings will be discussed.

The Role of Fish Skin Xenografts in Healing Complex Wounds: A Brief Case Report

Non-healing wounds profoundly impact patient quality of life and present a significant financial burden. The Kerecis™ fish skin xenograft is a decellularized skin matrix that has been introduced to treat complicated wounds. The objective of this presentation is to highlight the use of fish skin xenograft in the treatment of a complex right flank wound with stool contamination, necrotizing soft tissue infection due to perforated colon cancer, and sepsis. This presentation follows the wound healing for 28 days following the operation and demonstrates the efficacy of fish skin xenografts in improved wound healing. A 61-year-old female with a past medical history of colon cancer and recent chemotherapy treatment presented with colon perforation causing right flank cellulitis and sepsis with necrotic abdominal wall tissue extending into the hip joint. She was taken for an emergent exploratory laparotomy, drainage of abdominal and retroperitoneal abscesses, open right hemicolectomy, diverting ileostomy, abdominal washout, intra-abdominal omental patch, placement of Strattice mesh, and debridement of necrotizing soft tissue infection of the right flank. After extensive debridement of her 15x10cmx5cm deep wound and placement of a Kerecis™ fish skin xenograft, the wound had completely healed with excellent granulation tissue, and the patient was scheduled for placement of a skin graft 28 days following the initial procedure. The results after xenograft application were outstanding, supporting the use of polyunsaturated fatty acid (PUFA) based xenografts in wound treatment due to their anti-inflammatory and angiogenic properties. This is definitely an option that needs to be considered in expediting the healing process for complex wounds.

Multifunctional Therapeutic Nanodiamond Hydrogels for Infected-Wound Healing and Cancer Therapy

Wound infection and tumor recurrence are the two main threats to cancer patients after surgery. Although researchers have developed new treatment systems to address the two significant challenges simultaneously, the potential side effects of the heavy-metal-ion-based treatment systems still severely limit their widespread application in therapy. In addition, the wounds from tumor removal compared with general operative wounds are more complex. The tumor wounds mainly exhibit more hemorrhage, larger trauma area, greater vulnerability to bacterial infection, and residual tumor cells. Therefore, a multifunctional treatment platform is urgently needed to integrate rapid hemostasis, sterilization, wound healing promotion, and antitumor functions. In this work, nanodiamonds (NDs), a material that has been well proven to have excellent biocompatibility, are added into a solution of acrylic-grafted chitosan (CEC) and oxidized hyaluronic acid (OHA) to construct a multifunctional treatment platform (CEC-OHA-NDs). The hydrogels exhibit rapid hemostasis, a wound-healing-promoting effect, excellent self-healing, and injectable abilities. Moreover, CEC-OHA-NDs can effectively eliminate bacteria and inhibit tumor proliferation by the warm photothermal effect of NDs under tissue-penetrable near-infrared laser irradiation (NIR) without cytotoxicity. Consequently, we adopt a simple and convenient strategy to construct a multifunctional treatment platform using carbon-based nanomaterials with excellent biocompatibility to promote the healing of infected wounds and to inhibit tumor cell proliferation simultaneously.

Green Synthesis of Euphorbia tirucalli-Mediated Titanium Dioxide Nanoparticles Against Wound Pathogens

Background Wound infections caused by pathogens present a considerable global health challenge, resulting in extended healing durations, elevated healthcare expenses, and potential fatalities. Conventional approaches to managing wound pathogens have limitations such as antibiotic resistance, toxicity and allergic reactions. Consequently, there is a rising interest in exploring alternative strategies for preventing and treating wound infections. Titanium dioxide nanoparticles (TiO2NPs) have gained attention for their potential in wound healing, attributed to their distinctive properties, including antimicrobial and anti-inflammatory capabilities. Methods TiO2NPs synthesized through Euphorbia tirucalli were examined for their antibacterial potential against wound pathogens, using the Kirby-Bauer agar-well diffusion method and time-kill curve assay. Furthermore, the cytotoxic effect of the synthesized nanoparticles was evaluated through a brine shrimp lethality assay. Results Green-synthesized TiO2NPs demonstrated potent antimicrobial activity against tested wound pathogens, displaying a zone of inhibition against Pseudomonas aeruginosa (11 mm) and Escherichia coli (10 mm) at the highest concentration of 100 μg/mL. In the time-kill curve assay, the prepared TiO2NPs showed significant bactericidal activity against Pseudomonas aeruginosa followed by Escherichia coli. In the brine shrimp lethality assay, at the lowest concentration of 5 μg/mL of the prepared nanoparticles, 100% of the nauplii remained alive after 48 hours. Conclusion The results indicate that TiO2NPs synthesized using Euphorbia tirucalli extract exhibit potent antimicrobial activity against the tested wound pathogens. Moreover, the prepared nanoparticles exhibit lower toxicity, suggesting their potential use as an alternative to commercially available synthetic drugs.

In Vitro and In Vivo Evaluation of Bioactive Compounds from Berries for Wound Healing

Managing chronic wounds can be challenging and have a major impact on the quality of life, due to the significant financial and psychosocial burden on the affected individuals and their families. The need for safe, effective, and cost-efficient wound healing remedies has led to the identification of naturally occurring bioactive compounds with positive effects on tissue regeneration. Berry fruits are a promising source of such compounds and may therefore prove distinctively beneficial. Here, we present a qualitative review of the available evidence specifically investigating the effects of berry extracts on in vitro and in vivo models of wound healing. The evidence shows that a variety of berry extracts significantly promote wound healing through their antibacterial, antioxidant, and anti-inflammatory properties as well as their ability to stimulate collagen synthesis, re-epithelization, granulation, and vascularization pathways. However, data are still insufficient to pinpoint the differential effect that individual berries may have based on their nutrient and bioactive profile, the type and frequency of application, and the dosage required. Future research is needed in view of translating the available evidence into practice for clinical wound treatment.

Self-healing hydrogels based on biological macromolecules in wound healing: A review

The complete healing of skin wounds has been a challenge in clinical treatment. Self-healing hydrogels are special hydrogels formed by distinctive physicochemically reversible bonds, and they are considered promising biomaterials in the biomedical field owing to their inherently good drug-carrying capacity as well as self-healing and repair abilities. Moreover, natural polymeric materials have received considerable attention in skin tissue engineering owing to their low cytotoxicity, low immunogenicity, and excellent biodegradation rates. In this paper, we review recent advances in the design of self-healing hydrogels based on natural polymers for skin-wound healing applications. First, we outline a variety of natural polymers that can be used to construct self-healing hydrogel systems and highlight the advantages and disadvantages of different natural polymers. We then describe the principle of self-healing hydrogels in terms of two different crosslinking mechanisms-physical and chemical-and dissect their performance characteristics based on the practical needs of skin-trauma applications. Next, we outline the biological mechanisms involved in the healing of skin wounds and describe the current application strategies for self-healing hydrogels based on these mechanisms. Finally, we analyze and summarize the challenges and prospects of natural-material-based self-healing hydrogels for skin applications.

ROS-responsive hydrogels with spatiotemporally sequential delivery of antibacterial and anti-inflammatory drugs for the repair of MRSA-infected wounds

For the treatment of MRSA-infected wounds, the spatiotemporally sequential delivery of antibacterial and anti-inflammatory drugs is a promising strategy. In this study, ROS-responsive HA-PBA/PVA (HPA) hydrogel was prepared by phenylborate ester bond cross-linking between hyaluronic acid-grafted 3-amino phenylboronic acid (HA-PBA) and polyvinyl alcohol (PVA) to achieve spatiotemporally controlled release of two kinds of drug to treat MRSA-infected wound. The hydrophilic antibiotic moxifloxacin (M) was directly loaded in the hydrogel. And hydrophobic curcumin (Cur) with anti-inflammatory function was first mixed with Pluronic F127 (PF) to form Cur-encapsulated PF micelles (Cur-PF), and then loaded into the HPA hydrogel. Due to the different hydrophilic and hydrophobic nature of moxifloxacin and Cur and their different existing forms in the HPA hydrogel, the final HPA/M&Cur-PF hydrogel can achieve different spatiotemporally sequential delivery of the two drugs. In addition, the swelling, degradation, self-healing, antibacterial, anti-inflammatory, antioxidant property, and biocompatibility of hydrogels were tested. Finally, in the MRSA-infected mouse skin wound, the hydrogel-treated group showed faster wound closure, less inflammation and more collagen deposition. Immunofluorescence experiments further confirmed that the hydrogel promoted better repair by reducing inflammation (TNF-α) and promoting vascular (VEGF) regeneration. In conclusion, this HPA/M&Cur-PF hydrogel that can spatiotemporally sequential deliver antibacterial and anti-inflammatory drugs showed great potential for the repair of MRSA-infected skin wounds.

State-of-the-Art Review of Advanced Electrospun Nanofiber Composites for Enhanced Wound Healing

Wound healing is a complex biological process with four main phases: hemostasis, inflammation, proliferation, and remodeling. Current treatments such as cotton and gauze may delay the wound healing process which gives a demand for more innovative treatments. Nanofibers are nanoparticles that resemble the extracellular matrix of the skin and have a large specific surface area, high porosity, good mechanical properties, controllable morphology, and size. Nanofibers are generated by electrospinning method that utilizes high electric force. Electrospinning device composed of high voltage power source, syringe that contains polymer solution, needle, and collector to collect nanofibers. Many polymers can be used in nanofiber that can be from natural or from synthetic origin. As such, electrospun nanofibers are potential scaffolds for wound healing applications. This review discusses the advanced electrospun nanofiber morphologies used in wound healing that is prepared by modified electrospinning techniques.

In-vitro cell migration enhancing and pro-angiogenic active secondary metabolites from Jeffreycia zeylanica (L.) H. Rob., S.C. Keeley & Skvarla (Asteraceae)

Jeffreycia zeylanica (L.) H. Rob., S. C. Keeley & Skvarla is used for the treatment of wounds in indigenous medicine practiced in Sri Lanka. The scratch wound assay (SWA) guided fractionation of hexanes extract of J. zeylanica led to the isolation of ethuliacoumarin (1), stigmasterol (2), β-amyrin (3) and lupeol (4) and a non-resolved triterpene alcohol mixture HF5D1, all of which showed enhanced cell migration. The mixture HF5D1 contained glut-5-en-3β-ol (5) and friedelin-3β-ol (6). The identities of compounds 1-6 were established by the analysis of spectroscopic data and comparison of them with those reported. The compounds 1-4 and the non-resolved triterpene alcohol mixture, HF5D1 also exhibited significant proangiogenic response in chorioallantoic membrane (CAM) assay in addition to the enhanced cell migration. This is the first report of the occurrence of the compounds 1, 2, 4 and 5 in this plant.

Green Synthesis of Polycyclodextrin/Drug Inclusion Complex Nanofibrous Hydrogels: pH-Dependent Release of Acyclovir

The development of an approach or a material for wound healing treatments has drawn a lot of attention for decades and has been an important portion of the research in the medical industry. Especially, there is growing interest and demand for the generation of wound care products using eco-friendly conditions. Electrospinning is one of these methods that enables the production of nanofibrous materials with attractive properties for wound healing under mild conditions and by using sustainable sources. In this study, starch-derived cyclodextrin (hydroxypropyl-β-cyclodextrin (HPβCD)) was used both for forming an inclusion complex (IC) with acyclovir, a well-known antiviral drug, and for electrospinning of free-standing nanofibers. The nanofibers were produced in an aqueous system, without using a carrier polymer matrix and toxic solvent/chemical. The ultimate HPβCD/acyclovir-IC nanofibers were thermally cross-linked by using citric acid, listed in the generally regarded as safe (GRAS) category by the US Food and Drug Administration (FDA). The cross-linked HPβCD/acyclovir-IC nanofibers displayed stability in aqueous medium. The hydrogel-forming feature of nanofibers was confirmed with their high swelling profile in water in the range of ∼610-810%. Cellulose acetate (CA)/acyclovir nanofibers were also produced as the control sample. Due to inclusion complexation with HPβCD, the solubility of acyclovir was improved, so cross-linked HPβCD/acyclovir-IC nanofibrous hydrogels displayed a better release performance compared to CA/acyclovir nanofibers. Here, a pH-dependent release profile was obtained (pH 5.4 and pH 7.4) besides their attractive swelling features. Therefore, the cross-linked HPβCD/acyclovir-IC nanofibrous hydrogel can be a promising candidate as a wound healing dressing for the administration of antiviral drugs by holding the unique properties of CD and electrospun nanofibers.

Applications of drug delivery systems, organic, and inorganic nanomaterials in wound healing

The skin is known to be the largest organ in the human body, while also being exposed to environmental elements. This indicates that skin is highly susceptible to physical infliction, as well as damage resulting from medical conditions such as obesity and diabetes. The wound management costs in hospitals and clinics are expected to rise globally over the coming years, which provides pressure for more wound healing aids readily available in the market. Recently, nanomaterials have been gaining traction for their potential applications in various fields, including wound healing. Here, we discuss various inorganic nanoparticles such as silver, titanium dioxide, copper oxide, cerium oxide, MXenes, PLGA, PEG, and silica nanoparticles with their respective roles in improving wound healing progression. In addition, organic nanomaterials for wound healing such as collagen, chitosan, curcumin, dendrimers, graphene and its derivative graphene oxide were also further discussed. Various forms of nanoparticle drug delivery systems like nanohydrogels, nanoliposomes, nanofilms, and nanoemulsions were discussed in their function to deliver therapeutic agents to wound sites in a controlled manner.

Thermosensitive and antioxidant wound dressings capable of adaptively regulating TGFβ pathways promote diabetic wound healing

Various therapies have been utilized for treating diabetic wounds, yet current regiments do not simultaneously address the key intrinsic causes of slow wound healing, i.e., abnormal skin cell functions (particularly migration), delayed angiogenesis, and chronic inflammation. To address this clinical gap, we develop a wound dressing that contains a peptide-based TGFβ receptor II inhibitor (PTβR2I), and a thermosensitive and reactive oxygen species (ROS)-scavenging hydrogel. The wound dressing can quickly solidify on the diabetic wounds following administration. The released PTβR2I inhibits the TGFβ1/p38 pathway, leading to improved cell migration and angiogenesis, and decreased inflammation. Meanwhile, the PTβR2I does not interfere with the TGFβ1/Smad2/3 pathway that is required to regulate myofibroblasts, a critical cell type for wound healing. The hydrogel's ability to scavenge ROS in diabetic wounds further decreases inflammation. Single-dose application of the wound dressing significantly accelerates wound healing with complete wound closure after 14 days. Overall, using wound dressings capable of adaptively modulating TGFβ pathways provides a new strategy for diabetic wound treatment.