Challenges in the Treatment of Chronic Wounds

Programmed wound healing in aged skin may be enhanced by mesenchymal cell loaded gene-activated scaffolds

Aging can prolong the wound healing and is associated with decline in stem cells, delays in cellular migration, and lower vascularization. Tissue engineering has largely evolved to incorporate advanced three-dimensional wound dressings, scaffolds, and hydrogels that may be seeded with mesenchymal stromal cells (MSCs) to foster an environment conducive to regeneration and enhance the healing process. The effectiveness of stem cell-seeded scaffolds can be improved by incorporating activating agents such as nucleic acids resulting in gene-activated scaffolds (GAS), thereby facilitating targeted wound healing in aged patients. In this study, we assess the in vivo wound healing potential of a promising MSC seeded gene-activated collagen scaffold, containing the anti-fibrotic agent β-klotho and pro-angiogenic stromal derived factor (SDF-1α) in aged male Sprague Dawley rats (20-24 month old). A MSC cell loaded split skin model compared MSC only with the clinical standard dressing +Jelonet, MSCs +gene-free collagen scaffold, and MSCs +SDF-1α/β-klotho dual gene-activated collagen scaffold up to 21 days. Our results showed wound healing in all groups except in MSC +Jelonet which showed scab formation with exudate. MSC only group healed primarily via fibrotic contraction. In contrast, the scaffold groups showed host tissue integration and a redistribution of extracellular matrix proteins, less contraction, and complete re-epithelized wounds at day 21. The dual GAS displayed programmed wound healing with the greatest neo-vascularization CD31 expression. In conclusion, wound healing in aged rats can be effectively modulated when MSCs are loaded on biocompatible collagen scaffolds, particularly when these scaffolds are loaded with anti-fibrotic and pro-angiogenic factors. This approach enhances blood vessel formation while reducing fibrosis, suggesting a promising potential for programmed wound healing strategies in aged chronic wounds.

Understanding the regulation of chronic wounds by tissue inhibitors of matrix metalloproteinases through mathematical modelling

Understanding the biochemistry and pharmacodynamics of chronic wounds is of key importance, due to the millions of people in the UK affected and the significant cost to the NHS. Chronic wounds are characterised by elevated concentrations of matrix metalloproteinases (MMPs) that destroy the surrounding extracellular matrix (ECM). However, fibroblasts can produce tissue inhibitors of MMPs (TIMPs) in order to regulate wound healing. Therefore, the role of TIMPs in both acute and chronic wounds needs to be properly understood in order to develop therapeutic treatments. In this work, we propose a reaction-diffusion system of four partial differential equations that describe the interaction of the ECM, fibroblasts, MMPs, and TIMPs in a wound. We observe that, subject to parameter sets corresponding to both acute and chronic wound healing, this mathematical model gives rise to travelling wave solutions. Using bifurcation analysis, we demonstrate that excessive degradation of the ECM results in the emergence of chronic wounds, and the reversal of these chronic wounds is prohibited for lower TIMP production values. These results are replicated within a simplified model obtained via a parameter sensitivity analysis. This model is further extended to more realistic spatial domains where we demonstrate the effectiveness of a therapeutic hydrogel containing TIMPs as a treatment for chronic wounds.

Development of a bioactive hyaluronic acid hydrogel functionalised with antimicrobial peptides for the treatment of chronic wounds

Chronic wounds present significant clinical challenges due to delayed healing and high infection risk. This study presents the development and characterisation of acrylated hyaluronic acid (AcHyA) hydrogels functionalised with gelatin (G) and the antimicrobial peptide (AMP) PP4-3.1 to enhance cellular responses while providing antimicrobial activity. AcHyA-G and AcHyA-AMP hydrogels were formed via thiol-acrylate crosslinking, enabling in situ AcHyA hydrogel formation with stable mechanical properties across varying gelatin concentrations. Biophysical characterisation of AcHyA-G hydrogels showed rapid gelation, elastic behaviour, uniform mesh size, and consistent molecular diffusion across all formulations. Moreover, the presence of gelatin enhanced stability without affecting the hydrogel's degradation kinetics. AcHyA-G hydrogels supported the adhesion and spreading of key cell types involved in wound repair (dermal fibroblasts and endothelial cells), with 0.5% gelatin identified as the optimal effective concentration. Furthermore, the conjugation of the AMP conferred bactericidal activity against Staphylococcus aureus and Escherichia coli, two of the most prevalent bacterial species found in chronically infected wounds. These results highlight the dual function of AcHyA-AMP hydrogels in promoting cellular responses and antimicrobial activity, offering a promising strategy for chronic wound treatment. Further in vivo studies are needed to evaluate their efficacy, including in diabetic foot ulcers.

Chitosan and polyvinyl alcohol-based bilayer electrospun nanofibrous membrane incorporated with astaxanthin promotes diabetic wound healing by addressing multiple factors

Delayed diabetic wound regeneration can be attributed to multiple underlying factors, including bacterial infection, endogenous reactive oxygen species (ROS), impaired angiogenesis and exaggerated inflammatory response. Here, a bilayer electrospun nanofibrous membrane (ENM) was fabricated through sequential electrospinning to accelerate diabetic wound healing by addressing aforementioned challenges. For the purpose, nano Zinc Oxide was mixed into chitosan as the bottom layer of ENM (CS/ZnO NPs), while astaxanthin (AST) was encapsulated in a composite nanofibrous membrane of polyvinyl alcohol, chitosan and Ti3C2TX MXene (PVA/CS/MXene) as the upper layer, thus preparing the bilayer CZ/PCM@AST ENM, which reflected the therapeutic properties of spatial structure distribution and time series on diabetic wounds. The bilayer CZ/PCM@AST ENM was verified to possess sufficient biocompatibility and effective antibacterial properties on E. coli and S. aureus. Furthermore, the ENM facilitated sustained AST release at inflammatory sites, effectively scavenging excessive ROS and inhibiting inflammatory responses, ultimately accelerating diabetic wound healing, as demonstrated through both in vitro and in vivo evaluations. In summary, the multi-effect combination strategy improved complicated pathological microenvironment of wound sites, thereby presenting a promising method in diabetic wound treatment.

Collagen and chitosan-based biogenic sprayable gel of silver nanoparticle for advanced wound care

Silver nanoparticles have gained significant attention recently due to their unique antibacterial properties, making them promising candidates for wound care applications. This study proposes a novel approach for advanced wound care using a silver nanoparticle-impregnated biogenic spray hydrogel supplemented with collagen and chitosan. Silver nanoparticles were incorporated into the hydrogel (optimized by a QbD approach) to impart antimicrobial activity, crucial for combating wound infections and promoting faster healing. The study assessed the physical and chemical properties of the biogenic hydrogel, including its viscosity, pH, and nanoparticle dispersion characteristics. In vitro, antimicrobial efficacy against common wound pathogens and in vivo studies using chronic wound models in small animals portrayed the immense potential of the developed biogenic hydrogel in effectively reducing the bacterial load of broad-spectrum pathogens. The hydrogel exhibited excellent biocompatibility, supporting cell proliferation and tissue repair without toxic effects. It accelerated wound healing, improved collagen deposition, and enhanced tissue regeneration in the tested animals by reducing proinflammatory cytokines, ROS, and NF-kb levels. Overall, this innovative silver nanoparticle-impregnated biogenic spray hydrogel of collagen and chitosan presents a uniform spray pattern that proved efficient, showing a promising solution for advanced wound care. Its biocompatibility, safety, anti-inflammatory, antimicrobial efficacy, and wound healing properties hold great potential for improving the management of complex wounds, opening new avenues in wound care and regenerative medicine.

Refining a Multidisciplinary "Vasculoplastic" Approach to Limb Salvage: An Institutional Review Examining 300 Lower Extremity Free Flaps

BACKGROUND

The use of free tissue transfer (FTT) is effective for treatment of chronic nonhealing lower extremity (LE) wounds, requiring collaboration across plastic, vascular, podiatric, orthopedic, and infectious disease disciplines for comprehensive treatment plans to optimize limb salvage. The authors describe their vasculopathic approach with 300 LE FTTs, comparing outcomes between the first 200 LE FTTs and the most recent 100 procedures performed.

METHODS

A single-institution, retrospective review of 300 LE FTTs from July of 2011 to January of 2023 was performed. Patients were compared between the first 200 (group 1; July of 2011 through February of 2020) and last 100 flaps (group 2; February of 2020 through January of 2023) performed. Patient characteristics, preoperative management, intraoperative details, and outcomes were collected.

RESULTS

Group 2 patients had significantly higher rates of diabetes (67.0% versus 48.5%; P = 0.002), peripheral vascular disease (56.0% versus 24.5%; P < 0.001), history of venous thromboembolism (13.0% versus 6.0%; P = 0.039), venous reflux (81.9% versus 67.8%; P = 0.028), and preoperative venous thromboses on venous testing (25.5% versus 10.5%; P = 0.003) compared with group 1. Group 2 patients underwent more pre-FTT endovascular interventions (23.0% versus 16.5%; P = 0.039) and vascular bypasses (4.0% versus 0.0%; P = 0.012). Immediate flap success and amputation rates were similar between the groups, but group 2 had higher rates of partial flap necrosis (7% versus 3%; P = 0.012).

CONCLUSION

The adoption of a vasculoplastic approach allows LE FTT to remain successful and achieve long-term limb salvage despite a highly comorbid population.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

A review on smart dressings with advanced features

Wound care is a multifaceted and collaborative process, and chronic wounds can have significant repercussions on a patient's well-being and impose a financial burden on the healthcare industry. While traditional wound dressings can effectively facilitate healing, their limitations in addressing the intricacies of the wound healing process remain a formidable obstacle. Smart wound dressings have emerged as a promising solution to tackle this challenge, offering numerous advantages over conventional dressings, such as real-time monitoring of wound healing and enhanced wound care management. These advanced medical dressings incorporate microelectronic sensors that can monitor the wound environment and provide timely interventions for accelerated and comprehensive healing. Furthermore, advancements in drug delivery systems have enabled real-time monitoring, targeted therapy, and controlled release of medications. Smart wound dressings exhibit versatility, as they are available in various forms and can be utilised for treating different types of acute or chronic wounds. Ultimately, the development of innovative wound care technologies and treatments plays a vital role in addressing the complexities presented by wounds and enhancing patients' quality of life. This review sheds light on the diverse types of smart dressings and their distinctive features, emphasising their potential in advancing the field of wound care.

Fillet of toe flap coverage for non-traumatic foot amputations: A retrospective review of 70 patients

Fillet of toe flap (FTF) leverages the "spare parts" algorithm in reconstructive surgery-utilizing tissue from amputated or otherwise non-salvageable body parts, thus avoiding donor-site morbidity. This study assesses the efficacy of FTF coverage in non-traumatic foot amputations. A retrospective review of patients undergoing foot amputation with FTF coverage between January 2013 to August 2023 was conducted. Patient characteristics, operative details, and outcomes were collected. Primary outcome was FTF survival (no necrosis ≤7 days postoperatively). Secondary outcome was acute complications (≤42 days postoperatively). A total of 70 patients were included. Mean age was 65.0±13.7 years. Median Charlson Comorbidity Index was 6.0 (interquartile range [IQR]: 4.0-7.0). The most common wound location was the hallux (n=34). In 45 (64.2 %) patients with preoperative angiography, the patency rates were: first dorsal metatarsal artery (n=10, 22.2 %), lateral plantar artery (n=7, 15.6 %), medial plantar artery (n=6, 13.3 %), and dorsalis pedis artery (n=4, 8.9 %). Mean follow-up duration was 9.0 (IQR: 32) months. Fifteen (21.4 %) patients experienced at least one acute complication: deep surgical site infection (SSI; i.e., abscess, gangrenous necrosis; n=13, 18.6 %) and cellulitis (n=7, 10.0 %). Eleven (15.7 %) patients required reoperation for debridement (n=4, 5.7 %), wound closure (n=4, 5.7 %), flap necrosis (n=3, 4.3 %), incision and drainage (n=1, 1.4 %), split-thickness skin grafting (n=1, 1.4 %), and foreign body exploration (n=1, 1.4 %). FTF survival was 94.2 % (n=66). FTF facilitates reconstruction in complex cases and should be integrated into each chronic LE wound algorithm to avoid additional donor-site morbidity, and to facilitate stump-length preservation or limb salvage.

Chemical structure of antibiotics determines their release rate from drug-loaded poly(vinyl alcohol)/sodium sulfated alginate nanofibrous wound dressings

Antibiotics are widely used for treatment of infected wounds; however, their application through a local and controlled release system may cause more effectiveness and fewer side-effects. In this study, we fabricated drug-loaded poly(vinyl alcohol)/sodium sulfated alginate (PVA/SSA) nanofibrous mats incorporating cationic antibiotic drugs, i.e., salts of gentamicin, tetracycline, ciprofloxacin and minocycline, and examined their physicochemical and biological properties. The results of FTIR spectroscopy showed that cationic drugs have different interactions with carboxylate and sulfate functional groups of SSA depending on their chemical structure. Furthermore, the results of viscometry and conductivity analyses of the solutions revealed that the solutions with drugs with more electrical charge or/and higher functional groups resulted in a lower viscosity and conductivity compared to other drugs, due to the ability to form more hydrogen bonds. The release profiles of drug-loaded nanofibrous mats showed a burst release and then, a sustained release for 5 days, where the burst release of tetracycline (30.0 ± 0.3 %) from crosslinked mats was noticeably lower than other drugs. Biological assays confirmed the cytocompatibility, antibacterial activity and non-hemolytic behavior of all drug-loaded mats. Finally, ciprofloxacin-loaded nanofibrous mat was used as wound dressing for full-thickness wounds on rats and its efficacy was confirmed.

Real-world outcomes of acellular fish skin grafts for chronic wounds: A retrospective analysis of effectiveness and costs

Chronic wounds (CW) are a major public health problem. Acellular fish skin grafts (AFSG) are increasingly used in advanced wound care, but data on their effectiveness and costs in real-world settings are scarce. We therefore retrospectively analysed the wound surface area (WSA), pain scores, and AFSG-related costs in patients with CW over a 12-week follow-up period. In this single-centre observational study, we analysed two datasets of 34 (full dataset) and 22 (WSA-dataset) CW patients treated with AFSG in a university hospital. Of 34 AFSG-treated patients (mean age 75.9 ± 11.4 years, 44.0% females) with 50 CW of various aetiologies (median ulcer duration 32 weeks), 66.6% experienced pain improvement at 12 weeks. Of 22 patients, 19 (86.4%) showed a mean reduction in WSA of -60.7% ± 143.8% (p = 0.0025); 36.4% of CW were healed. AFSG-related costs were 1232.3 EUR/patient and 130.4 EUR/reduced cm2 (n = 22), which was 6.5 times more cost-effective compared to previous study results using living cellular skin substitutes. During 12 weeks of follow-up in a real-world setting, AFSG resulted in reduced WSA in most patients, improved pain in two-thirds, and healed CW in one-third. AFSG may be more cost-effective than other products, but prospective head-to-head comparisons are needed.

Advances in Designer Materials for Chronic Wound Healing

Significance: Nonhealing or chronic wounds represent a significant and growing global health concern, imposing substantial burdens on individuals, health care systems, and economies worldwide. Although the standard-of-care treatment involves the application of wound dressings, most dressing materials are not specifically designed to address the pathological processes underlying chronic wounds. This review highlights recent advances in biomaterial design tailored to chronic wound healing. Recent Advances: Chronic wounds are characterized by persistent inflammation, impaired granulation tissue formation, and delayed re-epithelialization. Newly developed designer materials aim to manage reactive oxygen species and extracellular matrix degradation to suppress inflammation while promoting vascularization, cell proliferation, and epithelial migration to accelerate tissue repair. Critical Issues: Designing optimal materials for chronic wounds remains challenging due to the diverse etiology and a multitude of pathological mechanisms underlying chronic wound healing. While designer materials can target specific aberrations, designing a materials approach that restores all aberrant wound-healing processes remains the Holy Grail. Addressing these issues requires a deep understanding of how cells interact with the materials and the complex etiology of chronic wounds. Future Directions: New material approaches that target wound mechanics and senescence to improve chronic wound closure are under development. Layered materials combining the best properties of the approaches discussed in this review will pave the way for designer materials optimized for chronic wound healing.

Methacrylated Chitosan Methacrylated Poly(vinyl alcohol)-Based Hydrogel Patch for Long-Term Electrochemical Wound pH Sensing

While every wound has the potential to become chronic, the risk is significantly higher in individuals with specific medical conditions. Given this inherent risk, continuous wound monitoring patches are beneficial for all wound types throughout the healing process, enabling the early detection and management of chronic wound development. In this work, we introduce an eco-friendly, hydrogel-integrated, capillary-driven wound patch designed for continuous pH monitoring. The hydrogel, synthesized from methacrylated chitosan and methacrylated poly(vinyl alcohol), provides antibacterial properties, tissue adhesion, and moisture retention, thereby supporting stable electrochemical pH detection. A paper-based, capillary-driven microfluidic layer facilitates fluid transport toward an evaporation pad, enhancing liquid uptake by approximately 4-fold after 2 h compared to the hydrogel alone. In vitro experiments demonstrated that the hydrogel-integrated sensor effectively monitored pH, exhibiting a near-linear voltage response of 16.92 mV per pH unit. The implementation of such a wound dressing represents a significant advancement in wound healing applications, combining functionality with environmental sustainability.

Modulation of Bacterial Iron Homeostasis to Enhance Cuproptosis-like Death for the Treatment of Infected Diabetic Wound

Cuproptosis, an emerging cell death pathway, offers an alternative approach for antimicrobial therapy, but it suffers from deficiencies and health risks. Here, we design hollow Cu-enriched Prussian blue-based nanostructures (Cu-HMPBs) and find that the infected microenvironment facilitates the release of Cu ions from Cu-HMPBs, leading to Cu overload in bacterial cells. Meanwhile, Fe ions in bacterial cells are highly selectively chelated, triggering iron starvation. As a result, the proteotoxic stress and redox imbalance induced by Cu overload are aggravated upon iron starvation, thus remarkably enhancing cuproptosis-like bacterial cell death at extremely low-dose (noncytotoxic) Cu ions. Moreover, we demonstrate the effectiveness of this iron starvation-augmented antimicrobial strategy, and its efficacy is further validated in a methicillin-resistant Staphylococcus aureus (MRSA)-infected diabetic mouse wound model. Collectively, these findings provide a promising and universal strategy on iron starvation sensitizing cuproptosis-like bacterial cell death for combating drug resistance.

Layer-by-layer assembly: advancing skin repair, one layer at a time

Skin wound management remains a critical global healthcare challenge, with annual costs exceeding £30 billion. Traditional treatments like autografts face limitations in cost, availability, and recovery times. This review explores spray-assisted Layer-by-Layer (LbL) technology as a transformative approach for wound healing, emphasising its ability to deposit natural- and synthetic-polyelectrolytes such as chitosan, alginate, hyaluronic acid, and collagen into nanoscale coatings. These biocompatible multilayers integrate therapeutic agents to accelerate healing, reduce infections, and mimic native extracellular matrix structures. The work highlights emerging spray device innovations that optimise spray parameters to enhance cell viability, coverage, and clinical outcomes. While LbL techniques demonstrate versatility across substrates and scalability via immersion, spray, and microfluidic methods, challenges persist in manufacturing uniformity and clinical translation. The review underscores the urgent need for clinical trials to validate Lbl-based coatings in real-world settings and addresses gaps in portable, sustainable device development. By bridging advanced materials science with clinical practice, spray-assisted LbL technology offers a roadmap to overcome current wound care limitations, prioritising biocompatibility, cost-efficiency, and improved patient safety in regenerative medicine.

Hierarchically structured conductive hydrogels for electrically programmable drug delivery in a diabetic wound healing electronic patch

Smart wound dressings that integrate advanced drug delivery strategies and electrical stimulation (ES) represent a revolutionary approach for improving diabetic wound healing. However, limited drug loading efficiency and delayed reactivity to electrical inputs make it difficult to practically implement ES-controlled drug release in hydrogel-coated electrodes. In order to address these limitations, we developed a hydrogel-based electronic wound dressing patch that enables highly programmable, ES-triggered drug delivery. In particular, a hierarchically architectrual conductive polymer hydrogel composed of PEDOT: CHC/silk was designed to be used as an electroresponsive matrix and a drug reservoir. This hydrogel exhibited a high encapsulation efficiency (>90 %) for the hydrophobic drug ibuprofen and demonstrated exceptional mechanical resilience and electrochemical stability. Through systematic optimization of ES parameters such as voltage, frequency, and waveform, the system achieved precise spatiotemporal modulation of drug release. Notably, the integration of the hydrogel into interdigitated electrode arrays significantly enhanced delivery performance through improved field distribution and release control. In addition, the multifunctional patch also exhibited intrinsic antibacterial activity and biocompatibility, making it well-suited for clinical application. This work cumulatively introduces a wearable, electroceutical, and long-term active wound dressing system that is integratively assembled with wound protection, electrical treatment, and stimulus-sensitive drug delivery, hence being a promising approach to enhance diabetic wound healing through intelligent bioelectric treatment.

pH and Glucose Dual-Responsive Hydrogels Promoted Diabetic Wound Healing by Remodeling the Wound Microenvironment

The microenvironment of diabetic wounds is complicated and characterized by hyperglycemia, hyperinflammation, persistent infection, hypoxia, and ischemia, making wound restoration and healing extremely challenging. Therefore, functional hydrogel dressings with the ability to regulate the microenvironment of diabetic wounds are a promising strategy for the treatment of diabetic wounds. In this study, a pH/glucose dual-responsive hydrogel based on phenylboric acid-modified carboxymethyl chitosan (CMCSPBA), aldehyde-terminated polyethylene glycol (PEGCHO), and polyvinyl alcohol (PVA) has been developed for diabetic wound treatment via Schiff base and phenylboric ester interactions. Glucose oxidase (GOX), catalase (CAT), and deferoxamine mesylate (DFO) are incorporated into the hydrogel to endow it with multi-functionality. In the hyperglycemic environment of diabetic wounds, a benign feedback loop is formed through the synergistic action of each component of the hydrogel, which enables the reshaping of the microenvironment of diabetic wounds by adjusting the pH and glucose, alleviating oxidative stress and hypoxia, regulating the inflammatory response, inhibiting bacterial infection, and promoting angiogenesis, thus accelerating diabetic wound healing in streptozotocin (STZ)-induced diabetic mice.

Investigating the Therapeutic Potential of Salvianolic Acid B in Ischemic Wound Healing: In Vivo and In Vitro Study

BACKGROUND

Ischemic wounds pose a challenge to conventional treatments due to insufficient blood and oxygen supply, exacerbating patient distress and often rendering traditional treatments ineffective. Thus, improving the healing rate of ischemic wounds remains a significant challenge requiring further research and solutions.

METHODS

HaCaT and HUVEC were exposed to Sal-B under hypoxic conditions in vitro to assess proliferation, migration, and angiogenesis. Further, the mechanisms of action were investigated. In vivo, a mouse ischemic wound model was treated with Sal-B topically, with group comparisons including control (PBS), VEGF (100 ng/ml), and Sal-B (50 μmol/L, 100 μmol/L) utilizing immunofluorescence and H&E staining.

RESULTS

Salvianolic acid B notably increased HaCaT and HUVEC proliferation, migration, and tube formation in vitro and improved ischemic wound healing rates in vivo. It modulated crucial factors such as HIF-1α, TGF-β, MMP2, and bFGF.

CONCLUSION

This study indicates that salvianolic acid B promotes the healing of ischemic wounds under hypoxic conditions through multiple mechanisms. Specifically, salvianolic acid B effectively reduces the expression of HIF-1α while increasing the levels of TGF-β and bFGF, which are crucial for cell proliferation and new blood vessel formation during the wound healing process. Additionally, salvianolic acid B significantly enhances the proliferation, migration, and tube formation of HaCaT and HUVEC, accelerating wound closure, validating its potential for clinical application and highlighting new treatment strategies.

NO LEVEL ASSIGNED

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Low-Irradiance Antimicrobial Blue Light-Bathing Therapy for Wound Infection Control

The prevalence of antibiotic resistance and tolerance in wound infection management poses a serious and growing health threat, necessitating the exploration of alternative approaches. Antimicrobial blue light therapy offers an appealing, non-pharmacological solution. However, its practical application has been hindered by the requirement for high irradiance levels (50-200 mW/cm2), which particularly raises safety concerns. Here, a light-bathing strategy is introduced that employs prolonged, continuous exposure to blue light at an irradiance range lower by more than an order of magnitude (5 mW/cm2). This method consistently applies bacteriostatic pressure, keeping wound bioburden low, all while minimizing photothermal risks. Leveraging tailor-made, wearable light-emitting patches, preclinical trials on rat models of wound infection are conducted, demonstrating its safety and efficacy for suppressing infections induced by methicillin-resistant Staphylococcus aureus (S. aureus) and multidrug-resistant Pseudomonas aeruginosa (P. aeruginosa). The results pave a new way for the application of blue light therapy in wound care.

Naringenin-loaded SBMA/GelMA hydrogel: Restoring immune balance and promoting angiogenesis via the PPARα/STING pathway in diabetic wounds

The impaired wound-healing process in diabetic patients poses a significant clinical challenge due to local immune dysregulation and impaired angiogenesis. This study introduces a novel therapeutic approach using an SBMA/GelMA hydrogel loaded with naringenin (NRN) to restore the immune environment and promote angiogenesis in diabetic wounds. The hydrogel, synthesized via photo-crosslinking, exhibits excellent biocompatibility and inherent antibacterial properties, creating an optimal environment for wound healing. By incorporating NRN, a natural compound with therapeutic potential, the hydrogel enables sustained and controlled release of NRN, ensuring prolonged therapeutic effects. In vitro studies showed that the NRN-loaded SBMA/GelMA hydrogel effectively activated PPARα, suppressing the Sting pathway. This led to enhanced M2 macrophage polarization and increased angiogenesis. In vivo experiments with diabetic wound models further validated the hydrogel's therapeutic potential. The hydrogel significantly accelerated wound healing, evidenced by reduced wound size, enhanced re-epithelialization, and increased angiogenesis. Immunohistochemical analysis demonstrated a shift towards an anti-inflammatory M2 macrophage phenotype within the wound microenvironment. This study provides valuable insights into the mechanisms of wound healing in diabetic conditions and offers new avenues for developing advanced materials for diabetic wound management.

Development of a VEGF-activated scaffold with enhanced angiogenic and neurogenic properties for chronic wound healing applications

Chronic wounds remain in a state of disrupted healing, impeding neurite outgrowth from injured nerves and poor development of new blood vessels by angiogenesis. Current therapeutic approaches primarily focus on the restoration of vascularization and overlook the need of nerve regeneration for complete healing. Vascular endothelial growth factor (VEGF) is a critical growth factor supporting angiogenesis in wound healing, promoting vascularization and has also demonstrated neuro-protective capabilities in both central and peripheral nervous system. While the delivery of pro-regenerative recombinant growth factors has shown promise, gene delivery offers greater stability, reduced off-target side effects, diminished cytotoxicity, and lower production costs. In this context, the overarching goal of this study was to develop a VEGF-activated scaffold with the potential to provide a multifaceted response that enhances both angiogenesis and nerve repair in wound healing through the localized delivery of plasmid encoding VEGF (pVEGF) encapsulated within the GET peptide system. Initially, delivery of pVEGF/GET nanoparticles to dermal fibroblasts led to higher VEGF protein expression without a compromise in cell viability. Transfection of dermal fibroblasts and endothelial cells on the VEGF-activated scaffolds resulted in enhanced VEGF expression, improved endothelial cell migration and organization into vascular-like structures. Finally, the VEGF-activated scaffolds consistently displayed enhanced neurogenic ability through improved neurite outgrowth from neural cells in in vitro and ex vivo models. Taken together, the VEGF-activated scaffold demonstrates multifaceted outcomes through the induction of pro-angiogenic and neurogenic responses from dermal, vascular and neural cells, illustrating the potential of this platform for the healing of chronic wounds.

Immunomarker profiling in human chronic wound swabs reveals IL-1 beta/IL-1RA and CXCL8/CXCL10 ratios as potential biomarkers for wound healing, infection status and regenerative stage

BACKGROUND

Chronic wounds, such as diabetic foot ulcers, venous leg ulcers, and post-surgical wound healing disorders pose a significant challenge due to prolonged healing, risk of infection, and impaired quality of life. Persistent inflammation and impaired tissue remodeling are common in these wounds. Traditional diagnostic methods, including visual inspection and microbiological cultures, offer limited insight into the wound micro-environment. Immunomarker profiling could provide a deeper understanding of the molecular mechanisms underpinning wound healing, offering potential biomarkers for infection status and healing progression.

METHODS

This observational, multi-center cohort study, part of the 'Wound-BIOME' project, analyzed 110 swab samples from patients with acute and chronic wounds using multiplex immunoassays. Clinical parameters such as wound type, healing status, regeneration stage, and microbial burden were recorded. Total protein concentration was assessed, and 35 key immunomarkers, including cytokines (e.g. IL- 1α, IL- 1β), chemokines (CCL2, CXCL8, CXCL10), growth factors (FGF- 2, VEGF) and matrix metalloproteinases (MMP- 7, MMP- 9, MMP- 13), were quantified. Statistical analyses were performed to correlate immunomarker levels with clinical outcomes.

RESULTS

Pro-inflammatory markers, such as IL- 1β, IL- 18 and chemokines like CCL2 and CXCL8, were significantly elevated in non-healing and infected wounds compared to healing wounds. The study identified two new immunomarker ratios - IL- 1β/IL- 1RA and CXCL8/CXCL10 - as potential predictors of wound healing status. The IL- 1β/IL- 1RA ratio showed the highest accuracy for distinguishing healing from non-healing wounds (AUC = 0.6837), while the CXCL8/CXCL10 ratio was most effective in identifying infection (AUC = 0.7669).

CONCLUSIONS

Immunomarker profiling via wound swabbing offers valuable insights into the wound healing process. Elevated levels of pro-inflammatory cytokines and MMPs are associated with chronic inflammation and impaired healing. The IL- 1β/IL- 1RA and CXCL8/CXCL10 ratios emerge as promising biomarkers to distinguish between infection and inflammation, with potential in targeted wound care. Further studies are needed to validate these findings and implement them in clinical practice.

Drop-In Wound Care: Calgary's Wound Care Model Centred Around People Experiencing Homelessness

People experiencing housing insecurities or homelessness face significant barriers to equitable healthcare. A drop-in wound care service was established to mitigate social barriers and improve accessibility. This model facilitates direct access to a multidisciplinary team of trauma-informed medical staff on a walk-in basis. A retrospective chart review was performed on patients seen at the drop-in clinic from January 2021 to December 2021. A total of 119 patients were serviced over 798 visits, with 254 unique wounds managed. 82.8% of patients were living unsheltered, in emergency shelters or in provisional accommodation at the time of assessment. Trauma wounds, lower leg ulcers and frostbites represented the top three complaints. 69.7% of all patients returned to service for at least a second visit, with a median of 4 visits per patient over 42.5 days. Unsheltered patients were most likely to return to service (87.5%) but were most likely to be lost prior to wound closure (68.8%). Timely access to care with consistent follow-up is essential for quality wound care. Our drop-in service presents a working model for providing equitable wound care to socially disadvantaged patient populations. The effectiveness of this model is highlighted by the continual expansion serving 909 and 1029 visits in subsequent years.

Type 2 diabetes as a risk factor for promoting hypertrophic scar formation after wound healing: a two-sample mendelian randomization study

Individuals with type 2 diabetes mellitus (T2DM) not only face the risk of difficult wound healing after trauma or surgery but also struggle with scar formation after wound healing. However, the relationship between T2DM and hypertrophic scars (HS) remains unclear. First, the data sets related to T2DM and HS were downloaded from the OpenGWAS database. Second, the inverse variance-weighted (IVW) technique was employed to assess the causal impact of T2DM on HS utilizing mendelian randomization (MR). Finally, sensitivity analyses and reverse MR analyses were performed to determine the robustness of the findings and to examine the potential for reverse causation. A positive causal relationship between T2DM and HS was observed. Three suitable datasets for T2DM analysis were obtained using the ids ebi-a-GCST006867, ebi-a-GCST007515, and ebi-a-GCST007516 (A total of 206,572 cases and 753,191 controls were included). The HS (finn-b-L12_HYPETROPHICSCAR) dataset comprised 766 cases and 207,482 controls. The IVW model results showed odds ratio (OR) of 1.213 (95% confidence interval (CI): 1.04-1.41, p = 0.0137), 1.300 (95% CI: 1.05-1.61, p = 0.017), and 1.284 (95% CI: 1.03-1.60, p = 0.0276), respectively. The analysis results were stable without any significant bias or reverse causality. This study systematically explored the causal relationship between T2DM and the risk of HS for the first time, and provided a quantitative effect assessment. The results showed consistency, which indicated the potential biological mechanism and clinical intervention direction.

Breast cancer wound imaging: evaluation of the cross-localisation method

OBJECTIVE

Wound image acquisition has been widely used in wound care; however, there are few reports on scientifically accurate technology in wound image acquisition for wound evaluation. This study compared the effectiveness of a cross-localisation method with a direct photographic method for image acquisition of breast cancer wounds.

METHOD

The wounds of eligible patients were assessed by direct measurement, direct photography, and by a cross-localisation method using the Bates-Jensen Wound Assessment Tool (BWAT) with 13 items. After four months, the wound images were re-evaluated and re-recorded for consistency assessment.

RESULTS

The experimental cohort comprised 150 patients. The consistency of the total BWAT score between the direct photograph acquisition and direct measurement methods was poor (Kappa=0.375). Only wound size, induration and exudate type presented general consistency. There was a good consistency between the cross-localisation image method and the direct measurement method (Kappa=0.786). The wound size, depth, oedema, induration and granulation tissue demonstrated complete consistency between the direct measurement and cross-localisation methods (Kappa=1.000).

CONCLUSION

Wound imaging using direct photography does not present the wound characteristics with complete clarity; however cross-localisation with an objective reference showed optimal performance in this study. The cross-localisation method can provide more specific and accurate wound evaluation.

Advancing Chronic Wound Healing through Electrical Stimulation and Adipose-Derived Stem Cells

Chronic cutaneous wounds are a major clinical challenge worldwide due to delayed healing, recurrent infections, and resistance to conventional therapies. Adipose-derived stem cells (ASCs) have shown promise as a cell-based therapy, but their therapeutic efficacy is often compromised by the harsh microenvironment of chronic wounds. Recent advances in bioengineering, particularly the application of electrical stimulation (ES), offer an innovative approach to enhancing the regenerative properties of ASCs. By restoring the natural electrical current in the wound, ES provides a strong stimulus to the cells involved in healing, thereby accelerating the overall wound-healing process. Recent studies show that ASCs can be significantly activated by ES, which increases their viability, proliferation, migration, and secretory capacity, all of which are crucial for the proper healing of chronic wounds. This review examines the synergistic effects of ES and ASCs on wound healing, focusing on the biological mechanisms involved. The review also highlights novel self-powered systems and other emerging technologies such as advanced conductive materials and devices that promise to improve the clinical translation of ES-based treatments. By summarizing the current state of knowledge, this review aims to provide a framework for future research and clinical application of ES and ASCs in wound care.

Mechanically robust, mouldable, dynamically crosslinked hydrogel flap with multiple functionalities for accelerated deep skin wound healing

Deep cutaneous wounds, which are difficult to heal and specifically occur on dynamic body surfaces, remain a substantial healthcare challenge in clinical practice because of multiple underlying factors, including excessive reactive oxygen species, potential bacterial infection, and extensive degradation of the extracellular matrix (ECM) which further leads to the progressive deterioration of the wound microenvironment. Any available individual wound therapy, such as antibiotic-loaded cotton gauze, cannot address all these issues. Engineering an advanced multifunctional wound dressing is the current need to promote the overall healing process of such wounds. Here, we report a multifunctional hydrogel flap primarily composed of biodegradable polymers gelatin (G) and poly-methyl vinyl ether-alt-maleic acid (MA) as the base material. The hydrogel physically incorporates tannic acid (TA) and vancomycin (V), for added functionality. The resulting hydrogel flap, gelatin- poly-methyl vinyl ether-alt-maleic acid-tannic acid-vancomycin (G-MA-TA-V/E-N), is formed through a chemical crosslinking process using EDC (E) and NHS (N). Thus, the hydrogel flap reveals multiple ideal properties that support its ease of application, including stretchability, porous microstructure (honey-comb structure), mouldability, and adhesiveness to multiple surfaces, including wet biological surfaces. The in vitro studies demonstrated strong antioxidant, antibacterial, and absorption properties essential for accelerated wound-healing applications. In vivo studies further reveal accelerated wound contraction and enhanced healing kinetics, promoting re-epithelialization, angiogenesis, and formation of apocrine glands. These findings underscore the efficacy and cost-effectiveness of fabricated hydrogel flaps as viable therapeutic options for treating deep skin wounds and make it worthwhile to integrate them with medical devices for tissue adhesion.

Anti-inflammatory and antibacterial hydrogel based on a polymerizable ionic liquid

In the present era, the treatment of skin-infected wounds and their associated inflammation constitutes a significant challenge. These infections have the potential to impede the healing process and become a life-threatening pathology, particularly due to the rise of bacterial resistance. Hydrogels could successfully address this issue due to their unique capabilities and versatility. Among them, natural polymer-based hydrogels are especially advantageous as they resemble the extracellular matrix (ECM) and mechanical properties of natural tissues. In this study, we propose a dual-action hydrogel composed of methacrylated gelatin as a matrix and a salicylate (Sal) anion-exchanged polymerizable ionic liquid (PIL) to achieve anti-inflammatory and antibacterial activities. This material facilitated cell attachment and colonization with mouse endothelial fibroblasts. A flow cytometry assay was conducted to evaluate the anti-inflammatory effect, and demonstrated the differentiation of mouse macrophages to an M2 (reparative) phenotype. Therefore, the levels of TNF-α, interleukin-6 (IL-6), and interleukin (IL-10) were quantified to further evaluate this effect, demonstrating an inhibition on the pro-inflammatory ones. The inherent antibacterial capacity of the PIL was demonstrated against Staphylococcus aureus and Escherichia coli, thereby corroborating its potential as a wound dressing. To the best of our knowledge, this is the first reported hydrogel incorporating an anion-exchanged polymerizable ionic liquid that is capable of promoting macrophage differentiation into a reparative phenotype, of reducing pro-inflammatory cytokines, and of simultaneously retaining antibacterial activity. These features open the gate to the potential application of this hydrogel as a wound dressing. STATEMENT OF SIGNIFICANCE: Bacterial wound infections may lead to severe problems due to their associate tissue inflammation and the emergence of bacterial resistance. In this sense, local therapies such as hydrogels have gathered much attention as alternative therapies for these pathologies. In this work, we have developed a natural polymer-based hydrogel copolymerized with a polymerizable ionic liquid containing salicylate as an anion. The hydrogel was shown to be biocompatible, and promoted macrophage differentiation to a reparative phenotype, while reducing the levels of pro-inflammatory cytokines. Finally, the high antibacterial capability against both gram-positive and gram-negative bacteria makes it a promising candidate for use in wound dressings.

Negative-pressure wound therapy compared with advanced moist wound therapy: A comparative study on healing efficacy in diabetic foot ulcers

OBJECTIVE

This randomized controlled trial aimed to compare the efficacy of negative-pressure wound therapy with advanced moist wound therapy in managing diabetic foot ulcers.

METHODS

A total of 450 participants with diabetic foot ulcers were randomized to receive either negative-pressure wound therapy (n = 204) or advanced moist wound therapy (n = 246) over 18 months. The primary outcome was complete ulcer closure, with secondary outcomes including time to closure, wound size reduction, infection rates, recurrence, and amputation rates. Wound dimensions were measured using digital planimetry, and Kaplan-Meier survival analysis was applied to assess time to closure.

RESULT

Analysis revealed statistically significant differences in clinical outcomes between treatment modalities. In the negative-pressure wound therapy group (n = 204), complete ulcer closure was achieved in 177 patients (87%), which was significantly greater than the advanced moist wound therapy group (n = 246) with 72 patients (29%) (P < .001). Although the mean time to wound closure was marginally extended in the negative-pressure wound therapy group (73 ± 45 days vs 64 ± 49 days; P = .045), this cohort demonstrated substantially more significant wound area reduction (48% ± 15 vs 25% ± 30; P < .001). Secondary outcome analysis revealed that negative-pressure wound therapy was associated with markedly reduced adverse events: wound infection (40 patients [20%] vs 95 patients [39%]; P < .001), ulcer recurrence (40 patients [20%] vs 113 patients [46%]; P < .001), and amputation rates (30 patients [15%] vs 132 patients [54%]; P < .001). Longitudinal assessment through Kaplan-Meier survival analysis demonstrated significantly greater wound closure probability and reduced complication risk in the negative-pressure wound therapy group throughout the follow-up period (log-rank P < .001).

CONCLUSION

Negative-pressure wound therapy is significantly more effective than advanced moist wound therapy in treating diabetic foot ulcers, demonstrating superior outcomes in wound closure, infection control, and amputation prevention. This study highlights negative-pressure wound therapy as the preferred treatment option for complex diabetic foot ulcers, warranting further research into its long-term benefits and cost-effectiveness.

Metal-organic cages based catalytic hybrid hydrogels for enhanced wound healing: Antibacterial and regenerative effects of Zr-MOC/chitosan composites hydrogel

Metal-organic cages (MOCs), assembled by the coordination of metal nodes with organic ligands, offer excellent solvent dispersion, functionalization potential, and abundant binding sites, making them ideal for hybrid hydrogel synthesis. Herrin, a novel Zr-MOC/CS hybrid hydrogel was developed by crosslinking Zr-based metal-organic cages (Zr-MOC) and chitosan (CS) using dibenzaldehyde-functionalized polyethylene glycol (DF-PEG) as crosslinker, marking the first instance of incorporating Zr-MOC into a hydrogel matrix. The composite hydrogel leverages the catalytic activity of Zr-MOC to convert trace H2O2 into hydroxyl radicals (·OH), delivering enhanced antibacterial performance. Characterization via XRD, FT-IR, XPS, SEM and SEM-EDS confirmed the successful integration of Zr-MOC within the hydrogel matrix. Antibacterial assays demonstrated superior efficacy against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) compared to conventional hydrogels. Cytotoxicity tests (MTT and live-dead staining) confirmed excellent biocompatibility. Furthermore, in vivo experiments using an infected wound model revealed that the Zr-MOC/CS hydrogel significantly accelerated wound healing. These results highlight the potential of Zr-MOC/CS hydrogel as a multifunctional wound dressing material for antibacterial therapy in clinical applications.

Genetic Evidence of Obesity-Induced Chronic Wounds Mediated by Inflammatory Biomarkers

Background: Obese patients are increasingly recognized as being at higher risk for skin diseases, particularly chronic wounds. While the exact mechanisms remain unclear, obesity is suspected to influence the development of chronic injuries via inflammatory biomarkers. Single nucleotide polymorphisms (SNPs) may further influence gene expression, protein function, and levels of inflammatory biomarkers through various mechanisms, thereby modulating inflammatory responses that contribute to wound pathogenesis. Methods: A two-sample two-step Mendelian Randomization (MR) was employed to explore the causal relationship between obesity and chronic wounds, focusing on the mediating role of inflammatory biomarkers. SNPs were used as instrumental variables (IVs) to infer causality. Obesity-related genetic data were sourced from the UK Biobank and GIANT consortium. Genome-wide association studies provided data on 92 inflammatory biomarkers, involving 14,824 and 575,531 individuals. Pressure injuries, lower limb venous ulcers, and diabetic foot ulcer data were obtained from FinnGen R10 and the Pan-UK Biobank. Results: Obesity significantly increased the risk of pressure injuries, lower limb venous ulcers, and diabetic foot ulcers. CCL19, hGDNF, IL-12B, and TNFRSF9 were identified as mediators in obesity-induced lower limb venous ulcers. Conclusion: This study provides genetic evidence that obesity leads to lower limb venous ulcers via inflammatory biomarkers, suggesting potential therapeutic targets for intervention.

Recent Research Progress of Wound Healing Biomaterials Containing Platelet-Rich Plasma

Platelet-Rich Plasma (PRP) is a plasma product obtained by centrifuging autologous blood, containing a high concentration of platelets, white blood cells, and fibrin. PRP is enriched with various growth factors, such as Transforming Growth Factor-beta (TGF-β), Platelet-Derived Growth Factor (PDGF), Epidermal Growth Factor (EGF), Insulin-Like Growth Factor (IGF), and Vascular Endothelial Growth Factor (VEGF), all of which promote tissue growth and repair. Currently, PRP has been widely applied in the clinical field of wound repair and has achieved certain therapeutic effects. Biomaterials, as an important direction in the treatment of wounds, combined with PRP, provide new possibilities to enhance the regenerative repair of wounds by PRP. This article reviews the latest research progress of biomaterials combined with PRP in the treatment of wounds, aiming to provide references for PRP wound treatment, as well as to provide ideas for the development of subsequent medical materials.

Insights into Liposomal and Gel-Based Formulations for Dermatological Treatments

Dermatological diseases pose a significant challenge due to their chronic nature, complex pathophysiology, and the need for effective, patient-friendly treatments. Recent advancements in liposomal and gel-based formulations have played a crucial role in improving drug delivery, therapeutic efficacy, and patient compliance. Liposomal formulations have garnered considerable attention in dermatology due to their ability to encapsulate both hydrophilic and lipophilic compounds, enabling controlled drug release and enhanced skin penetration. However, challenges such as formulation complexity, stability issues, and regulatory constraints remain. Similarly, gel-based formulations are widely used due to their ease of application, biocompatibility, and ability to retain active ingredients. However, they also face limitations, including restricted penetration depth, susceptibility to microbial contamination, and challenges in achieving sustained drug release. The integration of liposomal and gel-based technologies offers a promising strategy to overcome current challenges and optimize dermatological drug delivery. This review explores both well-established therapies and recent innovations, offering a comprehensive overview of their applications in the treatment of prevalent dermatological conditions. Ultimately, continued research is essential to refine these formulations, expanding their clinical utility and enhancing therapeutic effectiveness in dermatology.

Antimicrobial and anti-inflammatory effects of polyethyleneimine-modified polydopamine nanoparticles on a burn-injured skin model

Chronic infections involving bacterial biofilms pose significant treatment challenges due to the resilience of biofilms against existing antimicrobials. Here, we introduce a nanomaterial-based platform for treating Staphylococcus epidermidis biofilms, both in isolation and within a biofilm-infected burn skin model. Our approach leverages biocompatible and photothermal polydopamine nanoparticles (PDNP), functionalized with branched polyethyleneimine (PEI) and loaded with the antibiotic rifampicin, to target bacteria dwelling within biofilms. A key innovation of our method is its ability to not only target planktonic S. epidermidis but also effectively tackle biofilm-embedded bacteria. We demonstrated that PDNP-PEI interacts effectively with the bacterial surface, facilitating laser-activated photothermal eradication of planktonic S. epidermidis. In a 3D skin burn injury model, PDNP-PEI demonstrates anti-inflammatory and reactive oxygen species (ROS)-scavenging effects, reducing inflammatory cytokine levels and promoting healing. The rifampicin-loaded PDNP-PEI (PDNP-PEI-Rif) platform further shows significant efficacy against bacteria inside biofilms. The PDNP-PEI-Rif retained its immunomodulatory activity and efficiently eradicated biofilms grown on our burn-injured 3D skin model, effectively addressing the challenges of biofilm-related infections. This achievement marks a significant advancement in infection management, with the potential for a transformative impact on clinical practice.

Cell-matrix feedback controls stretch-induced cellular memory and fibroblast activation

Mechanical stretch can activate long-lived changes in fibroblasts, increasing their contractility and initiating phenotypic transformations. This activation, critical to wound healing and procedures such as skin grafting, increases with mechanical stimulus for cells cultured in two-dimensional but is highly variable in cells in three-dimensional (3D) tissue. Here, we show that static mechanical stretch of cells in 3D tissues can either increase or decrease fibroblast activation depending upon recursive cell-extracellular matrix (ECM) feedback and demonstrate control of this activation through integrated in vitro and mathematical models. ECM viscoelasticity, signaling dynamics, and cell mechanics combine to yield a predictable, but nonmonotonic, relationship between mechanical stretch and long-term cell activation. Results demonstrate that feedback between cells and ECM determine how cells retain memory of mechanical stretch and have direct implications for improving outcomes in skin grafting procedures.

Three-dimensional bio-derived materials for biomedical applications: challenges and opportunities

Three-dimensional (3D) bio-derived materials are emerging as a promising approach to enhance wound healing therapies. These innovative materials can be tailored to meet the specific needs of various wound types and patients, facilitating the controlled release of therapeutic agents such as growth factors and antibiotics, which promote cell growth and tissue regeneration. Despite their potential, significant challenges remain in achieving optimal biocompatibility, ensuring structural integrity, and maintaining precise release mechanisms. Additionally, issues such as scalability, cost-effectiveness, and regulatory compliance pose substantial barriers to widespread use. However, recent advances in materials science and interdisciplinary research offer new opportunities to overcome these challenges. This review provides a comprehensive analysis of the current state of 3D bio-derived materials in biomedical applications, highlighting the types of materials available, their advantages and limitations, and the progress made in their design and development. It also outlines new directions for future research aimed at bridging the gap between scientific discoveries and their practical applications in injury healing strategies. The findings of this review underscore the significant potential of 3D bio-derived materials in revolutionizing wound healing and advancing personalized therapeutic approaches.

Characterization of a Bioactive Chitosan Dressing: A Comprehensive Solution for Different Wound Healing Phases

Wound management has made significant advances over the past few decades, particularly with the development of advanced dressings that facilitate autolytic debridement, the absorption of wound exudate, and protection from external bacteria. However, finding a single dressing that effectively addresses all four phases of wound healing─hemostasis, inflammation, proliferation, and remodeling─remains a major challenge. Additionally, biofilms in chronic wounds pose a substantial obstacle by shielding microbes from topical antiseptics and antibiotics, thereby delaying the healing process. This study evaluates the wound-healing properties of a commercially available bioactive microfiber gelling (BMG) dressing made from chitosan alongside commercially available silver-loaded carboxymethyl cellulose (CMC-Ag) dressing, carboxymethyl cellulose dressing (CMC) and cotton gauze. In vitro testing demonstrated that the BMG dressing significantly exhibited superior fluid absorption and exudate-locking properties compared with the CMC-Ag dressing. Additionally, the BMG dressing effectively sequestered and eradicated wound-relevant pathogenic microorganisms, including drug-resistant bacteria. Its bioactive properties were further highlighted by its ability to enhance platelet-derived growth factor (PDGF) expression and sequester matrix metalloproteases (MMPs). Overall, this study highlights the effectiveness of the BMG dressing in wound management, particularly in exudate absorption and antimicrobial activity, demonstrating its relevance in wound care.

Comprehensive review on diabetic foot ulcers and neuropathy: Treatment, prevention and management

Diabetic foot (DF) is a major public health concern. As evident from numerous previous studies, supervision of DF ulcer (DFU) is crucial, and a specific quality check-up is needed. Patients should be educated about glycaemic management, DFUs, foot lesions, proper care for injuries, diet, and surgery. Certain reasonably priced treatments, such as hyperbaric oxygen and vacuum-assisted closure therapy, are also available for DFUs, along with modern wound care products and techniques. Nonetheless, DF care (cleaning, applying antimicrobial cream when wounded, and foot reflexology), blood glucose monitoring to control diabetes, and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs. Between 50% and 80% of DF infections are preventable. Regardless of the intensity of the lesion, it needs to be treated carefully and checked daily during infection. Tissue regeneration can be aided by cleaning, dressing, and application of topical medicines. The choice of shoes is also important because it affects blood circulation and nerve impulses. In general, regular check-ups, monitoring of the patient's condition, measuring blood glucose levels, and providing frequent guidance regarding DFU care are crucial. Finally, this important clinical problem requires involvement of multiple professionals to properly manage it.

Nanomanaging Chronic Wounds with Targeted Exosome Therapeutics

Chronic wounds pose a significant healthcare challenge, impacting millions of patients worldwide and burdening healthcare systems substantially. These wounds often occur as comorbidities and are prone to infections. Such infections hinder the healing process, complicating clinical management and proving recalcitrant to therapy. The environment within the wound itself poses challenges such as lack of oxygen, restricted blood flow, oxidative stress, ongoing inflammation, and bacterial presence. Traditional systemic treatment for such chronic peripheral wounds may not be effective due to inadequate blood supply, resulting in unintended side effects. Furthermore, topical applications are often impervious to persistent biofilm infections. A growing clinical concern is the lack of effective therapeutic modalities for treating chronic wounds. Additionally, the chemically harsh wound microenvironment can reduce the effectiveness of treatments, highlighting the need for drug delivery systems that can deliver therapies precisely where needed with optimal dosages. Compared to cell-based therapies, exosome-based therapies offer distinct advantages as a cell-free approach for chronic wound treatment. Exosomes are of endosomal origin and enable cell-to-cell communications, and they possess benefits, including biocompatibility and decreased immunogenicity, making them ideal vehicles for efficient targeting and minimizing off-target damage. However, exosomes are rapidly cleared from the body, making it difficult to maintain optimal therapeutic concentrations at wound sites. The hydrogel-based approach and development of biocompatible scaffolds for exosome-based therapies can be beneficial for sustained release and prolong the presence of these therapeutic exosomes at chronic wound sites. Engineered exosomes have been shown to possess stability and effectiveness in promoting wound healing compared to their unmodified counterparts. Significant progress has been made in this field, but further research is essential to unlock their clinical potential. This review seeks to explore the benefits and opportunities of exosome-based therapies in chronic wounds, ensuring sustained efficacy and precise delivery despite the obstacles posed by the wound environment.

Diabetic foot attack: Managing severe sepsis in the diabetic patient

Diabetic foot attack (DFA) is the most severe presentation of diabetic foot disease, with the patient commonly displaying severe sepsis, which can be limb or life threatening. DFA can be classified into two main categories: Typical and atypical. A typical DFA is secondary to a severe infection in the foot, often initiated by minor breaches in skin integrity that allow pathogens to enter and proliferate. This form often progresses rapidly due to the underlying diabetic pathophysiology of neuropathy, microvascular disease, and hyperglycemia, which facilitate infection spread and tissue necrosis. This form of DFA can present as one of a number of severe infective pathologies including pyomyositis, necrotizing fasciitis, and myonecrosis, all of which can lead to systemic sepsis and multi-organ failure. An atypical DFA, however, is not primarily infection-driven. It can occur secondary to either ischemia or Charcot arthropathy. Management of the typical DFA involves prompt diagnosis, aggressive infection control, and a multidisciplinary approach. Treatment can be guided by the current International Working Group on the Diabetic Foot/Infectious Diseases Society of America guidelines on diabetic foot infections, and the combined British Orthopaedic Foot and Ankle Society-Vascular Society guidelines. This article highlights the importance of early recognition, comprehensive management strategies, and the need for further research to establish standardized protocols and improve clinical outcomes for patients with DFA.

The Role of Illness Perception and Help-Seeking Attitudes on Positive Psychological Well-Being and Quality of Life in People With Chronic Wounds

Chronic wounds are a substantial health burden, adversely affecting patients' overall quality of life. This study explored the association between positive psychological well-being and quality of life and the mediating roles of illness perceptions and attitudes toward medical help-seeking among people with chronic wounds. A total of 208 people with chronic wounds from three hospitals in China were recruited. Data were collected using the Brief Illness Perception Questionnaire, Attitudes Toward Medical Help-Seeking Scale, the Well-being in Wounds Inventory, and the Questionnaire on Quality of Life with Chronic Wounds. Participants reported poor health-related quality of life. The structural equation model revealed that the overall indirect impact of positive psychology on quality of life was 38.93%. This impact was divided into three components: disease perception accounted for 26.67% of the total indirect effect, attitude toward medical care accounted for 8.50%, and the combined effect of both factors accounted for 3.75%. This suggests that higher positive psychological well-being may lead to higher quality of life by reducing illness perception and improving attitudes toward medical help-seeking.

The impact of semaglutide on wound healing in diabetes related foot ulcer patients: A TriNetX database study

IntroductionDiabetes related foot ulcers (DFUs) are common complications of type 2 diabetes mellitus (T2DM), affecting 15-25% of individuals living with diabetes and significantly contributing to healthcare costs ($9-13 billion annually in the U.S.). Without effective management, these wounds often lead to severe outcomes like amputations. This study aims to examine the association of semaglutide on DFU management.MethodsThis retrospective cohort study utilized TriNetX US Research Network data to assess the impact of semaglutide, a GLP-1 receptor agonist, on DFU outcomes between 2013 and 2023. The study compared outcomes between semaglutide users with DFU (Cohort A, N = 6329) and non-users with DFU (Cohort B, N = 118,821) across 64 healthcare organizations. We matched participants by age, gender, race, and ethnicity; however, we excluded patients with certain co-morbidities. Statistical analysis, such as chi-square analysis and risk ratio, using TriNetX software evaluated different complication outcomes.ResultsSemaglutide users with DFU demonstrated lower relative risks for complications compared to non-users. Within 1 year, semaglutide users were associated with lower relative risks for wound healing complications (0.19% vs 0.38%), chronic non-healing wounds (0.75% vs 1.23%), chronic pain (4.44% vs 8.06%), wound care (2.42% vs 4.86%), wound dehiscence (0.26% vs 0.56%), and amputation (2.34% vs 5.21%) (p < .05). Similar trends persisted over 5 years. While these findings highlight potential benefits of semaglutide with patients with DFU, causation cannot be inferred due to the study's observational design.ConclusionSemaglutide use was associated with favorable outcomes in patients with diabetes-related foot ulcers, including reductions in wound-related complications. While these findings suggest potential benefits of semaglutide as an adjunct in DFU management, further research is needed to confirm these associations and to better understand the mechanisms involved.

The Prevalence, Aetiology and Healing Trajectories of Hard-To-Heal Wounds in South Africa

The incidence of hard-to-heal wounds is rising globally with adverse effects on quality of life. Yet, there is no reliable data available on hard-to-heal wound prevalence, aetiology, and outcomes in a low-to-middle income country without improper care being a confounding factor. In this retrospective study of 460 individuals (876 wounds) that received appropriate standard of care at a specialised wound care clinic in the Kwazulu-Natal province of South Africa, acute/traumatic wounds were most prevalent (230/460, 50%) followed by ulcers (173/460, 38%) (DFUs 13%, VLUs 12%, PIs 11%, MLUs < 1%, ALUs < 1%) and atypical wounds (55/460, 12%) (atypical wounds 8%, vectors 4%). Definitions for wound aetiologies are provided. Delayed referral for specialised wound care was evident for individuals with ulcers. 103/460 (22%) individuals did not respond to the standard of care and were classified as hard-to-heal (< 40% wound closure after 4 weeks and/or > 12 weeks of the standard of care). Diabetes mellitus (45/103, 44%) and wound infection (44/103, 43%) accounted for poor healing trajectories in the hard-to-heal cohort, whereas 14/103 (13%) individuals had other comorbidities. High prevalence rates of hard-to-heal wounds in the heterogenous South African population necessitate recognition of wound management as a specialty in South Africa.

Unfolded protein responses: Dynamic machinery in wound healing

Skin wound healing is a dynamic process consisting of multiple cellular and molecular events that must be tightly coordinated to repair the injured tissue efficiently. The healing pace is decided by the type of injuries, the depth and size of the wounds, and whether wound infections occur. However, aging, comorbidities, genetic factors, hormones, and nutrition also impact healing outcomes. During wound healing, cells undergo robust processes of synthesizing new proteins and degrading multifunctional proteins. This imposes an increasing burden on the endoplasmic reticulum (ER), causing ER stress. Unfolded protein response (UPR) represents a collection of highly conserved stress signaling pathways originated from the ER to maintain protein homeostasis and modulate cell physiology. UPR is known to be beneficial for tissue healing. However, when excessive ER stress exceeds ER's folding potential, UPR pathways trigger cell apoptosis, interrupting tissue regeneration. Understanding how UPR pathways modulate the skin's response to injuries is critical for new interventions toward the control of acute and chronic wounds. Herein, in this review, we focus on the participation of the canonical and noncanonical UPR pathways during different stages of wound healing, summarize the available evidence demonstrating UPR's unique position in balancing homeostasis and pathophysiology of healing tissues, and highlight the understudied areas where therapeutic opportunities may arise.

Chronic Wounds and Dressings: An Overview of Management and Effectiveness

Chronic wounds are complex conditions categorized into pressure injuries, diabetic foot ulcers, venous leg ulcers, and arterial ulcers. In managing these wounds, the selection of appropriate wound care products is of critical importance. Commonly used dressings include hydrocolloid, hydrogel, alginate, foam, and silver-containing dressings. Effective wound management requires addressing systemic causes, selecting suitable wound care products, and fostering collaboration within a multidisciplinary team. Looking ahead, nanotechnology and biotechnological innovations promise to revolutionize chronic wound care.

Evaluating the Effectiveness and Safety of Theruptor Novo Dressing Pad in Managing Diabetic Foot Ulcer: A Prospective Study

BACKGROUND

Diabetic foot ulcers are chronic complications of diabetes that frequently result in infection and may necessitate limb amputation. Despite various existing treatments like hyperbaric oxygen therapy and revascularization, a significant need remains for innovative solutions to manage wounds effectively. Theruptor novo dressing pad (Healthium Medtech Limited, India) has been designed to promote healing and potentially advance wound care. This study aims to evaluate the effectiveness and safety of the Theruptor novo dressing pad in managing Diabetic foot ulcers.

METHODOLOGY

This prospective, single-arm, multicenter study was conducted from February 2023 to March 2024 at FootSecure Clinics, Bangalore, Karnataka, India. Theruptor novo dressing pad was used, and patients were followed up for eight weeks. Patient demographics, wound features, vital signs, reduction in wound size, pain score, subject satisfaction score, and Resultados Esperados de la Cicatrización de las Heridas Crônicas (RESVECH) 2.0 score were assessed. In addition, correlation analysis between HbA1c, pain score, and ankle-brachial index (ABI) with RESVECH 2.0 score was performed.

RESULTS

A total of 49 patients with the mean age of 59.14 ± 12.42 years were recruited. Most of the ulcers in patients were located on the foot area (n=20 (40.8%)). We observed significant reductions in wound dimensions and RESVECH 2.0 scores every week from Visit 1 to Visit 9 (p<0.05). Notably, 22 (45%) patients achieved complete healing before eight weeks of follow-up. Further, the mean pain score significantly decreased from 2.83 ± 1.59 at Visit 2 to 0.72 ± 0.88 at Visit 9 (p=0.0023), while subject satisfaction scores increased from 2.75 ± 0.78 at Visit 2 to 4.45 ± 0.91 at Visit 9 (p=0.013). Correlation analysis revealed a statistically significant and positive correlation between total RESVECH 2.0 score and pain score (r=0.392; p=0.02) at Visit 2 only.

CONCLUSION

Theruptor Novo dressing pad was found effective in reducing wound dimensions, improving RESVECH 2.0 scores, alleviating pain, and achieving complete wound healing.

Preparation of thermoresponsive & enzymatically crosslinkable gelatin-gellan gum bioink: A protein-polysaccharide hydrogel for 3D bioprinting of complex soft tissues

Developing superior bioinks present several challenges in achieving ideal properties such as biocompatibility, viscosity, degradation rates & mechanical properties which are required to make functional tissue constructs. Various attempts have been made to prepare excellent bioink compositions that are suitable to address the above challenges. Herein, a versatile combination of gelatin (GL) - gellan gum (GG) bioink was successfully formulated & the bioink 7.5GL/2GG was found to be ideal for printing complex and highly intricate structures with excellent shape fidelity. Two different crosslinkers namely transglutaminase (TG) and calcium chloride (CaCl2) were utilized for crosslinking. The rheological properties of GL/GG bioink indicated that TG and dual (TG + CaCl2) crosslinked constructs had storage modulus equivalent to the that of native skin. Direct and indirect cytotoxicity assays revealed that the developed constructs were cytocompatible as well as hemocompatible. The 3D bioprinted GL/GG constructs crosslinked with only TG showed better cell viability, proliferation, cell spreading and wound healing efficiency in vitro compared to dual crosslinked constructs. In conclusion, TG crosslinking of 7.5GL/2GG bioink was ideal for bioprinting of skin tissue constructs for regenerative medicine applications. By altering the concentrations & printing conditions, this bioink may be tuned for other soft tissue engineering applications.

The Printed Path to Healing: Advancing Wound Dressings through Additive Manufacturing

Wound care challenges healthcare systems worldwide as traditional dressings often fall short in addressing the diverse and complex nature of wound healing. Given conventional treatments limitations, innovative alternatives are urgent. Additive manufacturing (AM) has emerged as a distinct and transformative approach for developing advanced wound dressings, offering unprecedented functionality and customization. Besides exploring the AM processes state-of-the-art, this review comprehensively examines the application of AM to produce cellular-compatible and bioactive, therapeutic agent delivery, patient-centric, and responsive dressings. This review distinguishes itself from the published literature by covering a variety of wound types and by summarizing important data, including used materials, process/technology, printing parameters, and findings from in vitro, ex vivo, and in vivo studies. The prospects of AM in enhancing wound healing outcomes are also analyzed in a translational and cost-effective manner.

Bioactivity, Efficacy, and Safety of a Wound Healing Ointment With Medicinal Plant Bioactives: In Vitro and In Vivo Preclinical Evaluations

Chronic wounds have a significant impact on patients' quality of life, necessitating the management of pain, infection, bleeding, and emotional challenges. Debridement, which involves the removal of nonviable tissue, is crucial for promoting wound healing. In addition to surgical methods, cost-effective alternatives such as local solutions and ointments with biological properties have been explored. The use of natural compounds with anti-inflammatory, antibacterial, and collagen-synthesizing abilities holds promise for wound healing. This in vitro and in vivo preclinical study aimed to assess the safety and effectiveness of a wound healing ointment containing bioactive ingredients derived from medicinal plants (extracts, essential oils, and vegetable oils). The chemical composition of the ointment was characterized using Fourier transform infrared (FTIR) spectroscopy to gain insights into its synergistic action. Preclinical tests were conducted following standardized protocols. FTIR analysis revealed similarities between the product's spectrum and that of bioactive compounds. The in vitro tests demonstrated that all formulations of the ointment induced no cell death, DNA damage, or acute toxicity in cell cultures (p < 0.05). No lethal dose was observed, indicating the safety of the ointment at all concentrations. The ointment also stimulated a notably more organized, significantly higher collagen production compared to control groups (p < 0.05). In vivo preclinical analyses also demonstrated no adverse responses being effective in the healing process compared to the control group (silver sulfadiazine) in terms of wound contraction and ulcer re-epithelization (p < 0.05). Significantly higher means of wound contraction were observed in the groups treated with the bioactive-containing ointment when compared to both the positive control group (sulfadiazine) and the control untreated groups (p < 0.05). The regenerative ointment exhibited excellent biocompatibility and bioactivity in in vitro and in vivo studies, contributing to the development of innovative and sustainable wound management therapies.

aFGF gene-modified adipose-derived mesenchymal stem cells promote healing of full-thickness skin defects in diabetic rats

BACKGROUND

Chronic diabetic wounds pose a significant clinical challenge due to the limited efficacy of current treatments. This study aimed to investigate the role and potential mechanisms of adipose-derived mesenchymal stem cells (ADSCs) overexpressing acidic fibroblast growth factor (aFGF) in diabetic wound healing in a rat model.

METHODS

ADSCs were genetically modified to achieve stable overexpression of aFGF. Varying doses of aFGF-ADSCs (1 × 106, 2 × 106, 3 × 106, 4 × 106) were injected into the muscular tissue surrounding diabetic rat wounds. We assessed aFGF expression and its impact on various stages of wound healing, including angiogenesis, inflammatory response, epithelialization, and collagen deposition. Transcriptomic sequencing was performed to explore the underlying mechanisms driving enhanced wound healing.

RESULTS

Lentiviral transduction successfully induced stable aFGF overexpression in ADSCs. In vivo experiments revealed that varying doses of aFGF-ADSCs markedly enhanced wound healing in diabetic rats in a dose-dependent manner. The dose of 3 × 10⁶ aFGF-ADSCs demonstrated the most significant effect. In the 3 × 106 aFGF-ADSCs group, expression levels of aFGF, CD31, and CD163 were significantly higher than in other groups (p < 0.05), while CD86 expression was significantly lower (p < 0.05).

CONCLUSION

Single doses of aFGF-ADSCs comprehensively improved various aspects of wound repair in diabetic rats, offering a potential new approach for treating chronic diabetic wounds. The mechanism of action involves promoting angiogenesis, modulating inflammatory responses, accelerating epithelialization, and optimizing collagen deposition.

Investigation of the Zingerone's effects on wound healing in induced diabetic rats model

The prevalence of diabetic wound patients is increasing, rendering the management of these chronic wounds both costly and challenging. Zingerone a bioactive compound derived from ginger (Zingiber officinale) has antidiabetic and antioxidant properties. This study evaluated the therapeutic effects of Zingerone, alone and in combination with metformin, on diabetic wound healing in a rat model. The experimental groups: control wound (C), diabetic plus wound (D + W), plus Metformin (D + W + M), plus Zingerone (D + W + Z), and plus Metformin and Zingerone (D + W + M + Z). On the seventh, fourteenth, and twenty-first days of the study histological examinations (H&E, Masson Trichrome staining), immunohistochemistry for growth factors, collagen markers, and cytokeratin. biochemical analyses of oxidative stress, antioxidant enzyme levels and level of inflammation (ELISA) were conducted. In addition to lowering oxidative stress and inflammation, the results showed that the groups treated with Zingerone considerably improved tissue regeneration, angiogenesis, collagen formation, tissue maturation, and keratinization. Zingerone enhanced these therapeutic effects when used with metformin. These results demonstrate Zingerone's promise as a therapeutic agent in the therapy of diabetic wounds and its capacity to improve healing results, especially when combined with metformin.