Latest advance anti-inflammatory hydrogel wound dressings and traditional Lignosus rhinoceros used for wound healing agents

Wound healing is a physiological process occurring after the onset of a skin lesion aiming to reconstruct the dermal barrier between the external environment and the body. Depending on the nature and duration of the healing process, wounds are classified as acute (e.g., trauma, surgical wounds) and chronic (e.g., diabetic ulcers) wounds. The latter, often affect millions of people globally, take months to heal or not heal non-healing chronic wounds, are typically susceptible to microbial infection, and are a major cause of morbidity. Wounds can be treated with a variety of non-surgical (topical formulations, wound dressings) and surgical (debridement, skin grafts/flaps) methods. Three-dimensional (3D)-(bio) printing and traditional wound dressings are two examples of modern experimental techniques. This review focuses on several types of anti-inflammatory wound dressings, especially focusing on hydrogels and traditional macro-fungi like L. rhinocerotis as agents that promote wound healing. In this study, we introduced novel anti-inflammatory hydrogel dressings and offered innovative methods for application and preparation to aid in the healing. Additionally, we summarize the key elements required for wound healing and discuss our analysis of potential future issues. These findings suggest that L. rhinocerotis and various anti-inflammatory hydrogels can be considered as conventional and alternative macro-fungi for the treatment of non-communicable diseases. We summarized the development of functional hydrogel dressings and traditional Lignosus rhinoceros used for wound healing agents in recent years, as well as the current situation and future trends, in light of their preparation mechanisms and functional effects.

Using patient-reported experiences to inform the use of foam dressings for hard-to-heal wounds: perspectives from a wound care expert panel

Caring for patients with hard-to-heal (chronic) wounds requires a multifaceted approach that addresses their diverse needs, which can contribute to the complexity of care. Wound care providers must have a comprehensive understanding of the patient's comorbid conditions and psychosocial issues to provide personalised and effective treatment. Key quality indicators for effective wound care involves not only selecting appropriate local wound care products, such as foam dressings, but also addressing individual patient experiences of wound-related pain, odour, itch, excessive wound drainage, and self-care needs. The purpose of this review is to inculcate the wound care practice community, research scientists and healthcare industry with a sense of accountability in order to work collaboratively in addressing these unmet care needs.

Bilayer hydrogel with a protective film and a regenerative hydrogel for effective diabetic wound treatment

Diabetic foot ulcers (DFUs) are one of the most serious complications of diabetes, often leading to necrosis and amputation. DFU is caused by the intricate diabetic microenvironment, including ischemia, hypoxia, hyperinflammation, reduced angiogenesis, and persistent infection. Traditional wound dressings made of single or mixed materials often struggle to meet all the requirements for effective diabetic wound healing. In contrast, multilayer dressings comprising more than single layers have the potential to address these challenges by combining their diverse chemical and physical properties. In this study, we developed a bilayer hydrogel comprising a GelMA-ALG-nano-ZnO protective film and a COL1-PRP regenerative hydrogel for facilitating diabetic wound healing. We demonstrated the protective properties against bacterial infection of the protective film, while highlighting the regenerative potential of the COL1-PRP hydrogel in promoting fibroblast and MUVEC migration, extracellular matrix secretion and deposition, and angiogenesis. Importantly, the bilayer hydrogel exhibited superior efficacy in promoting full-thickness wound healing in a diabetic rat model compared to its single-layer hydrogel counterparts. This multi-layer approach offers a promising strategy for addressing the complexities of diabetic foot treatment and improving clinical outcomes.

Recent Progress of Electrospun Nanofiber Dressing in the Promotion of Wound Healing

The nanofiber materials of three-dimensional spatial structure synthesized by electrospun have the characteristics of high porosity, high specific surface area, and high similarity to the natural extracellular matrix (ECM) of the human body. These are beneficial for absorbing wound exudate, effectively blocking the invasion of external bacteria, and promoting cell respiration and proliferation, which provides an ideal microenvironment for wound healing. Moreover, electrospun nanofiber dressings can flexibly load drugs according to the condition of the wound, further promoting wound healing. Recently, electrospun nanofiber materials have shown promising application prospects as medical dressings in clinical. Based on current research, this article reviewed the development history of wound dressings and the principles of electrospun technology. Subsequently, based on the types of base material, polymer-based electrospun nanofiber dressing and electrospun nanofiber dressing containing drug-releasing factors were discussed. Furthermore, the application of electrospun nanofiber dressing on skin tissue is highlighted. This review aims to provide a detailed overview of the current research on electrospun nanomaterials for wound healing, addressing challenges and suggesting future research directions to advance the field of electrospun dressings in wound healing.

Enhanced exploration of the mode of action of a five-layer foam dressing: critical properties to support wound healing

OBJECTIVE

The aim of this in vitro experimental series was to explore the mode of action of a hydrocellular polyurethane foam dressing (HPFD) and how its advanced features support beneficial interactions with the wound bed to address common barriers to wound healing, thus supporting improved clinical outcomes.

METHOD

Multiple in vitro microbiological tests were performed, assessing prevention of bacterial ingress, surface removal of bacteria, bacterial sequestration and retention into the dressing in a clinically relevant environment. Odour molecule concentrations were measured using gas chromatography and further assays explored matrix metalloproteinase (MMP)-9 retention in the dressing using enzyme linked immunosorbent assay.

RESULTS

The HPFD demonstrated marked reductions in bioburden levels across multiple tests. These included prevention of bacterial ingress for seven days, removal of surface bacteria and absorption into the dressing. Further tests identified that most bacteria were sequestered into the hyperabsorbent layer (90.5% for Pseudomonas aeruginosa and 89.6% for meticillin-resistant Staphylococcus aureus). Moreover, the majority of bacteria (99.99% for both test organisms) were retained within the dressing, even upon compression. Additional tests demonstrated a marked reduction of odour molecules following incubation with HPFD and total retention of protease MMP-9 within the dressing.

CONCLUSIONS

Proactive management of the wound environment with an appropriate advanced wound dressing, such as the HPFD examined in these in vitro investigations, can not only help to minimise the barriers to healing, as observed across this test series by direct interaction with the wound bed, but may, as a result, provide an ideal environment for wound progression with minimal disturbance.

A single-centre RetrospeCtive sTudy Investigating patient-reported outcomeS of extended dressing wear time for incisional healing following orthopaedic surgery: the ARCTIS study

OBJECTIVE

Orthopaedic surgery is an effective intervention for treating the symptoms of degenerative joint disease or osteoarthritis (OA). Frequent wound dressing changes, unless clinically indicated, can disrupt the healing process and increase the occurrence of incision site contamination. Protection from contamination is critical for surgical incisions and, therefore, undisturbed wound healing (UWH) in surgical wound management is vital. This article describes a retrospective study reporting the clinical performance of a self-adherent, absorbent postoperative dressing, with a focus on dressing wear time.

METHOD

A single-centre, retrospective electronic medical record review of a convenience sample of adult patients treated with a dressing (Mepilex Border Post Op; Mölnlycke, Sweden) following elective hip or knee replacement was undertaken. Data relating to dressing wear time, rationale for dressing changes and patient-reported outcomes were extracted from a mobile health application moveUP Therapy (moveUP NV, Belgium). Health-related quality of life assessment was conducted using the EQ-5D-5L questionnaire and orthopaedic-specific quality of life (QoL) indicator tools.

RESULTS

Of the 558 records reviewed, 151 respondents (27.1%) reported outcomes relating to dressing wear time and frequency of dressing change. The average wear time of the first dressing was 13.6 days (second dressing: 5.3 days). The proportion of patients who wore the first dressing for 1-7 days, 8-13 days and for ≥14 days was 17.2%, 13.2% and 69.5%, respectively. Data from the completed questionnaires revealed improvement in QoL over time.

CONCLUSION

The results of this study are a good indicator of the suitability of the postoperative dressing for a 14-day wear time, in line with the principles of UWH.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

How Should Clinical Wound Care and Management Translate to Effective Engineering Standard Testing Requirements from Foam Dressings? Mapping the Existing Gaps and Needs

Significance: Wounds of all types remain one of the most important, expensive, and common medical problems, for example, up to approximately two-thirds of the work time of community nurses is spent on wound management. Many wounds are treated by means of dressings. The materials used in a dressing, their microarchitecture, and how they are composed and constructed form the basis for the laboratory and clinical performances of any advanced dressing. Recent Advances: The established structure/function principle in material science is reviewed and analyzed in this article in the context of wound dressings. This principle states that the microstructure determines the physical, mechanical, and fluid transport and handling properties, all of which are critically important for, and relevant to the, adequate performances of wound dressings. Critical Issues: According to the above principle, once the clinical requirements for wound care and management are defined for a given wound type and etiology, it should be theoretically possible to translate clinically relevant characteristics of dressings into physical test designs resulting specific metrics of materials, mechanical, and fluid transport and handling properties, all of which should be determined to meet the clinical objectives and be measurable through standardized bench testing. Future Directions: This multidisciplinary review article, written by an International Wound Dressing Technology Expert Panel, discusses the translation of clinical wound care and management into effective, basic engineering standard testing requirements from wound dressings with respect to material types, microarchitecture, and properties, to achieve the desirable performance in supporting healing and improving the quality of life of patients.

Three-Dimensional Membranes of Natural Polymer Complex Nanoparticle for Potential Medical Applications

Skin wound healing is a complex biological process of tissue regeneration in which the wound dressing is crucial for rapid healing; it must protect the wound keep an adequate level of moisture and prevent infections. Alginate (AL), a polysaccharide from brown algae, has been extensively studied for wound treatment, and aloe vera gels (AVGs) have also been used in the treatment of skin. The AVG main bioactive polysaccharide was combined with AL for the preparation of membranes. Two-dimensional membranes were prepared by casting and, for comparison, transparent nanoparticle 3D membranes were produced by high-intensity ultrasonication followed by ionotropic crosslinking. The effects of the amount of AVG, ionotropic gelation, and the structure (2D or 3D) of the AL-AVG membranes were compared. Scanning electron microscopy (SEM) showed higher surface roughness on 3D membranes. Three-dimensional membranes showed a higher swelling ratio, and swelling increased with AVG content and decreased with higher calcium concentration and longer gelation times. The degradation of the membranes was evaluated with and without a lysozyme at pH 5.5, 7.5, and 8.5, to simulate different skin conditions; the results evidence that pH had a higher effect than the enzyme. The cytotoxicity of the membranes was evaluated with ATCC CCL 163 and ATCC CCL 81 cells, and an excellent biocompatibility of both cell types (>90% of cell viability after 48 h incubation) was observed for all AL-AVG membranes.

Three-Dimensional Printed Cellulose for Wound Dressing Applications

Wounds are skin tissue damage due to trauma. Many factors inhibit the wound healing phase (hemostasis, inflammation, proliferation, and alteration), such as oxygenation, contamination/infection, age, effects of injury, sex hormones, stress, diabetes, obesity, drugs, alcoholism, smoking, nutrition, hemostasis, debridement, and closing time. Cellulose is the most abundant biopolymer in nature which is promising as the main matrix of wound dressings because of its good structure and mechanical stability, moisturizes the area around the wound, absorbs excess exudate, can form elastic gels with the characteristics of bio-responsiveness, biocompatibility, low toxicity, biodegradability, and structural similarity with the extracellular matrix (ECM). The addition of active ingredients as a model drug helps accelerate wound healing through antimicrobial and antioxidant mechanisms. Three-dimensional (3D) bioprinting technology can print cellulose as a bioink to produce wound dressings with complex structures mimicking ECM. The 3D printed cellulose-based wound dressings are a promising application in modern wound care. This article reviews the use of 3D printed cellulose as an ideal wound dressing and their properties, including mechanical properties, permeability aspect, absorption ability, ability to retain and provide moisture, biodegradation, antimicrobial property, and biocompatibility. The applications of 3D printed cellulose in the management of chronic wounds, burns, and painful wounds are also discussed.

Effectiveness of wound contact layers in enabling undisturbed wound management: a case series

OBJECTIVE

Wound contact layers (WCLs) are intended to protect and support wounds during the healing process. An open, non comparative, case series clinical evaluation was undertaken to assess the impact of these dressings on establishing an undisturbed wound environment that supports effective wound management, and to allow the establishment of limits of duration of the wear time for the experimental WCLs.

METHOD

The primary objectives of this clinical evaluation were to assess the ability of the WCLs to prevent tissue disturbance to the wound and surrounding skin and for the clinicians to have confidence to extend the wear time of the WCL dressings. For them to have confidence in leaving the dressings in place for extended periods, the assessment of the wound and periwound skin condition and an assessment of patient comfort was performed: assessment of wound and periwound condition in relation to tissue adherence of the dressing to the wound resulting in tissue damage/bleeding (to wound and/or periwound skin) and cellular infiltration into the WCL; assessment of patient wearing comfort and satisfaction; assessment of WCL wear time, relating to times between dressing changes as judged by the clinician.

RESULTS

Based upon five parameters used to assess the extent to which the WCLs Atrauman, Atrauman Silicone and Atrauman Ag (HARTMANN, Germany) disturbed the underlying tissues-bleeding, wound tissue damage, periwound skin damage, tissue ingrowth and dressing adherence-the majority (>95%) of assessments indicated low or no disturbance of tissue. Over the 14 days of study assessment, the mean (±standard deviation) wear time was 7.3±1.2 days for the Atrauman group, 9.9±2.8 days for the Atrauman Silicone group, and 5.8±1.0 days for the Atrauman Ag group. All dressings were well tolerated by patients and rated highly in terms of in-use dressing performance.

CONCLUSION

The results indicate that Atrauman WCLs are suitable for the management of a variety of wounds as they promote an undisturbed wound environment, including extended wear time.

Evaluation of a chitosan dressing in the management of hard-to-heal wounds

It is vital that as tissue viability teams, we are constantly striving to improve service delivery, healing rates and positive patient outcomes. In 2021 the author's team were introduced to a unique bioactive microfibre gelling (BMG) dressing, MaxioCel®, which uses chitosan to maintain a cohesive structure to increase fluid handling, antimicrobial and wound-healing properties.

METHOD

Following Isle of Wight NHS Foundation Trust guidelines and with patient consent, 11 patients with chronic wounds of various aetiologies and wound durations were enrolled in a multicentre, clinical 4-week evaluation.

RESULTS

Over a 4-week evaluation period, all patients showed a significant improvement in wound healing parameters including average tissue type, condition of periwound skin, patient comfort, exudate levels. The assessments demonstrated a significant decrease in necrotic and sloughy tissue (from >75% at the start of treatment), replaced with healthy granulation and epithelial tissue (>80% by week 4). Significant reduction in pain score was also reported in all patients, with average pain score at the start of the evaluation reducing from 5.8 ± 2.7 to a score of 2.5 ± 1.9 within 3 weeks.

CONCLUSION

The complicated wounds seen in this study were previously non-healing and MaxioCel, with BMG technology, demonstrated both significant clinical improvement and a positive impact on patient quality of life within just 4 weeks, resulting in its addition to the team's woundcare formulary.

A New Dressing System for Wound in Enhanced-Recovery Total Hip Arthroplasty: A Randomized and Controlled Trial

BACKGROUND

Currently, there is a paucity of recommendations in regards to dressing selection within the enhanced recovery after surgery protocol. We devised a new dressing system to accelerate the recovery after total hip arthroplasty (THA). We aimed to present our experience with this new dressing system as an adjunct to wound management in THA and to evaluate its performance.

METHODS

From September 2020 to August 2021, we prospectively enrolled 124 patients who underwent a primary THA. The patients were randomly assigned to the intervention (the new dressing system group) or the control (the traditional gauze dressing) group. The primary outcome measures of this study were numbers of dressing changes, postoperative lengths of stay, wound scores including the Stony Brook Scar Evaluation Scale and ASEPSIS scores and wound-related complications. The secondary outcomes include satisfaction scores, dressing-related costs, and pain and functional recovery scores.

RESULTS

The intervention group numbers of dressing changes and postoperative lengths of stay were significantly less than the control group (P < .001, P < .001). During the one-month follow-up, the Stony Brook Scar Evaluation Scale in the intervention group was significantly better than that in the control group (P < .001). The intervention group satisfaction was significantly higher than that in the control group (P < .001). There were no statistically significant differences between the two groups in terms of dressing-related costs and pain and function scores.

CONCLUSION

The new dressing system could significantly reduce the number of dressing changes and postoperative lengths of stay and increase patient satisfaction scores, which can be an ideal adjunct to wound management in enhanced-recovery THA.

[Treatment of 52 patients with a self-adhesive siliconised superabsorbent dressing: a multicentre observational study]

OBJECTIVE

To provide 'in use' clinical data to support exudate management in patients with moderately to highly exuding wounds with bordered superabsorbent wound dressing with a silicone adhesive interface Zetuvit Plus Silicone Border (Paul Hartmann Ltd., Germany).

MATERIALS AND METHODS

This study was an open-labelled non-comparative study. Patients included in the study were selected by the clinical investigator(s) according to whether the patient required a dressing for the management of moderately to highly exuding wounds such as pressure ulcers, diabetic foot ulcers, venous leg ulcer and arterial ulcers The patients were treated with A superabsorbent sterile wound dressing with bordered superabsorbent wound dressing with a silicone adhesive interface Zetuvit Plus Silicone Border (Paul Hartmann Ltd., Germany).

RESULTS

The Zetuvit Plus Silicone Border dressing had met the clinical objectives relating to exudate management, affirmed by the health professionals with a yes response in 94% of cases. Additionally, the health professionals rated the handling of exudate as excellent/good (78%) and most (80%) reported that they would use the superabsorbent wound dressing with a silicone adhesive interface again. Allied to this was the fact that the dressing improved the wound edge and periwound skin conditions (29% and 36% of patients, respectively). The dressing retained its position in 72% of patients. For wear time, the largest proportion of dressing changes, both pre-study and during the evaluation period, was every third day (45% and 44%, respectively). But there was a shift to extended wear time with use of the superabsorbent wound dressing with a silicone adhesive interface with 72% of patients' dressing changes being every third day or longer.

CONCLUSION

The superabsorbent silicone border dressing was successful in managing wound exudate in moderately to highly exuding wounds and consequently this had a beneficial impact on the wound edge and periwound skin. Overall, there was a positive effect on wound bed preparation and in turn the healing response was progressive.

Anti-inflammatory hydrogel dressings and skin wound healing

Hydrogels are promising and widely utilized in the biomedical field. In recent years, the anti-inflammatory function of hydrogel dressings has been significantly improved, addressing many clinical challenges presented in ongoing endeavours to promote wound healing. Wound healing is a cascaded and highly complex process, especially in chronic wounds, such as diabetic and severe burn wounds, in which adverse endogenous or exogenous factors can interfere with inflammatory regulation, leading to the disruption of the healing process. Although insufficient wound inflammation is uncommon, excessive inflammatory infiltration is an almost universal feature of chronic wounds, which impedes a histological repair of the wound in a predictable biological step and chronological order. Therefore, resolving excessive inflammation in wound healing is essential. In the past 5 years, extensive research has been conducted on hydrogel dressings to address excessive inflammation in wound healing, specifically by efficiently scavenging excessive free radicals, sequestering chemokines and promoting M1 -to-M2 polarization of macrophages, thereby regulating inflammation and promoting wound healing. In this study, we introduced novel anti-inflammatory hydrogel dressings and demonstrated innovative methods for their preparation and application to achieve enhanced healing. In addition, we summarize the most important properties required for wound healing and discuss our analysis of potential challenges yet to be addressed.

A desiccation compound as a biofilm- and necrosis-removing agent: a case series

Objective:

A new compound, Debrichem (DEBx Medical BV, the Netherlands), a topical desiccation agent (TDA), is an active gel that contains an acidic species with a potent hygroscopic action. When in contact with microorganisms and necrosis, rapid desiccation and carbonisation of the proteins in these microorganisms, as well as of the extracellular matrix of biofilms and necrosis, occurs. The resulting ‘precipitate’ rapidly dislodges from the wound bed, resulting in a clean wound which granulates, which is a prerequisite for healing by secondary intention.

Method:

In a retrospective study, a series of mostly large and hard-to-heal lesions of different aetiologies were treated with a one-time application of the TDA, followed by weekly dressing changes.

Results:

Of the total of 54 lesions included in this case series, 22 were diagnosed as venous leg ulcers (VLUs), 20 as diabetic foot ulcers (DFUs), nine as post-traumatic, hard-to-heal lesions, two as vascular ulcers and one as an ischaemic ulcer. All of the VLUs, 75% of the DFUs and all of the other lesions reached complete granulation.

Conclusion:

The use of a TDA may contribute to the consistent, fast and easy removal of both biofilms and necrosis, and hence to wound healing.

A randomised, open-label, parallel-group, multicentre, comparative study to compare the efficacy and safety of Exufiber® with Aquacel® Extra™ dressings in exuding venous and mixed aetiology leg ulcers

The performance and safety of Exufiber® gelling fibre and Aquacel® Extra™ Hydrofiber® wound dressings were compared for the management of chronic, exuding leg ulcers. The 6‐week study (≤ 24 weeks in a subgroup of subjects) was a randomised, open‐label, parallel‐group, multicentre, non‐inferiority design. Adults (n = 248, 30–97 years of age) were randomised to either Exufiber® or Aquacel® Extra™ dressing. The dressings were applied at baseline and evaluations of wound condition and performance of the dressing were recorded at 1, 2, 3, 4, and 6 weeks. The primary efficacy endpoint was the percentage reduction in wound area at 6 weeks relative to baseline, in the per protocol (PP) population. A median relative reduction of 50% for Exufiber® (n = 100) vs 42% for Aquacel® Extra™ (n = 107) was demonstrated in the PP population (P = 0.093) and confirmed in the intention‐to‐treat population. As the mean and 95% confidence interval for the difference in relative wound area reduction between groups at 6 weeks was −29.4% (−63.5; 3.2), and the lower limit did not exceed 12%, non‐inferiority of Exufiber® was concluded. Both dressings were well tolerated and no safety concerns were identified in both groups. Clinicians' satisfaction with the dressings was higher for Exufiber® than for Aquacel® Extra™ in terms of ease of use and management of exudate, slough, and blood.

The importance of periwound skin in wound healing: an overview of the evidence

DECLARATION OF INTEREST

The authors have no conflicts of interest.

HydroTac-a hydro-responsive wound dressing: a review of the in vitro evidence

AIM

The aim of this review is to identify and summarise the key in vitro evidence available to support the use of HydroTac (HRWD-2) to address specific aspects associated with the treatment of both acute and hard-to-heal wounds.

BACKGROUND

The provision of a moist wound healing environment to support optimal wound healing has been a basic tenet in wound care since the pioneering work on the benefits of occlusion to support wound healing. Modern wound dressings have adopted the benefits of moist healing through their innovative development. HRWD-2 has been shown in clinical studies to enable and support good healing outcomes and the in vitro evidence in support of this dressing is presented in this article.

METHOD

An online literature search (supplemented with a manual search of resources not available online) was conducted to identify articles and studies describing in vitro evidence in support of HRWD-2 in aspects important for promoting a healing response in the clinical environment.

RESULTS

In vitro studies showed that HRWD-2 contributes to balancing moisture levels and enhances the availability of growth factors known to be important for re-epithelialisation. Pre-clinical studies indicate that HRWD-2 enhances wound re-epithelialisation. Together these results suggest that HRWD-2 promotes a moist healing environment leading to the dressing supporting re-epithelialisation. In vitro data indicating an intrinsic lower in vitro adherence of HRWD-2 likely translate clinically to the benefits of an atraumatic wound dressing, including reduced pain (specifically at dressing change).

CONCLUSION

The in vitro evidence presented in this review supports the successful clinical results reported for HRWD-2 in terms of fluid management, wound healing and pain reduction at dressing change.

Anti-Swelling, Robust, and Adhesive Extracellular Matrix-Mimicking Hydrogel Used as Intraoral Dressing

Due to the wet and dynamic environment of the oral cavity, the healing of intraoral wounds, such as tooth extraction wounds, requires stable and firm wound dressings. In clinical practice, cotton balls and gauzes, sponge plugs, or sutures are used to treat extraction wounds, but none of these means can continuously isolate the wound from the intraoral environment and facilitate ideal healing conditions. Herein, inspired by the natural extracellular matrix, a family of wound dressings is developed for intraoral wound repair. Infiltrating a ductile long-chain hydrogel network into a prefabricated, sturdy macromolecular meshwork and in situ crosslinking endowed the composite hydrogel with controllable swelling behaviors and robust mechanical properties. The macromolecular meshwork functioned as the backbone to support the composite and restricts the swelling of the long-chain hydrogel network. In vitro tests verified that this wound dressing can provide durable protection for intraoral wounds against complex irritations. Furthermore, accelerated wound healing occurred when the wound dressing is applied in vivo on a canine tooth extraction model, due to the effective reduction of acute inflammation. These results suggest that this family of bioinspired hydrogels has great potential for application as intraoral wound dressing.

Functional Hydrogels for Treatment of Chronic Wounds

Chronic wounds severely affect 1-2% of the population in developed countries. It has been reported that nearly 6.5 million people in the United States suffer from at least one chronic wound in their lifetime. The treatment of chronic wounds is critical for maintaining the physical and mental well-being of patients and improving their quality of life. There are a host of methods for the treatment of chronic wounds, including debridement, hyperbaric oxygen therapy, ultrasound, and electromagnetic therapies, negative pressure wound therapy, skin grafts, and hydrogel dressings. Among these, hydrogel dressings represent a promising and viable choice because their tunable functional properties, such as biodegradability, adhesivity, and antimicrobial, anti-inflammatory, and pre-angiogenic bioactivities, can accelerate the healing of chronic wounds. This review summarizes the types of chronic wounds, phases of the healing process, and key therapeutic approaches. Hydrogel-based dressings are reviewed for their multifunctional properties and their advantages for the treatment of chronic wounds. Examples of commercially available hydrogel dressings are also provided to demonstrate their effectiveness over other types of wound dressings for chronic wound healing.

An advanced transparent hydropolymer wound dressing for undisturbed post‐op management of surgical wounds following hip and knee replacement: A prospective observational series

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are standardised surgical procedures for patients with complex comorbidities. The enhanced recovery after surgery (ERAS) protocol has shown reduced lengths of hospital stay and reduced postoperative complications. Currently, there is a paucity of recommendations in regards to dressing selection for postoperative wound care within the ERAS protocol. The aim of this study was to investigate the usefulness of a transparent hydropolymer wound dressing in suit for 14 days in 20 orthopaedic patients following hip or knee arthroplasty under the ERAS protocol. The majority of participants (90%) had a wear time of 14 days without the need for dressing removal. Clinicians rated the dressing very easy to apply with very good visibility of the incision line (100%). All participants reported the dressing to be ‘very comfortable’ (95%, n = 19) or ‘comfortable’ (5%, n = 1). Overall, the transparent hydropolymer dressing provided sufficient incision site visibility, reducing the need for dressing changes. To the best of our knowledge, this is the first study to show that the use of a transparent hydropolymer dressing in situ for 14 days to allow undisturbed wound healing.

Hydro-responsive wound dressings for treating hard-to-heal wounds: a narrative review of the clinical evidence

A break in skin integrity must be repaired as quickly as possible to avoid excess blood and fluid loss, and to minimise the onset of infection. Hard-to-heal wounds, in which the progression of the wound healing response is compromised, present several challenges to healing (for example, the presence of devitalised tissue acting as a physical barrier to healing and as a focus for bacterial contamination with the potential for subsequent infection). The objective of this article is to present, as a narrative review, the clinical evidence supporting the use of a unique hydro-responsive wound dressing (HydroClean, HRWD1, PAUL HARTMANN AG, Germany). The dressing provides a simple treatment option to address a number of clinical challenges clinicians must overcome in order to facilitate wound healing progression. These studies demonstrated that this product supported successful debridement/cleansing of a wide variety of wounds, including hard-to-heal wounds, enabled wound bed preparation, and lead to positive healing outcomes, including in wounds that previously had failed to heal. The simplicity of using HRWD1 as a single dressing can help clinicians overcome a variety of challenges when treating both acute and hard-to-heal wounds, which, with the benefit of proven patient outcomes, could make it an ideal choice for a first-line treatment.

Moisture sensor for exudative wounds - A pilot study

BACKGROUND

Exudative wounds cause discomfort for patients. Introduction of a moisture sensor to dressings could facilitate change of dressings only when needed. The aim of this pilot study was to evaluate the ability of a newly developed moisture sensor to detect moisture in relation to the absorbing capacity of the dressing.

MATERIALS AND METHODS

In five patients, with one leg ulcer each, three dressing changes per patient were observed. Interval of dressing change was according to clinical need and healthcare professional's decision. Sensor activation, dressing weight and complications were registered. To investigate the effect of dressing on sensor activation, half of the observations were made without an extra layer of non-woven between the dressing and sensor (Variant A), and half with (Variant B).

RESULTS

The sensor indicated time for dressing change in six out of fifteen observations. Variants A and B did not differ regarding activation or the timing of the activation.

CONCLUSIONS

The addition of a moisture sensor for facilitating management of exudative wounds is promising. We recommend future larger studies evaluating the potential clinical benefits and risks of the addition of a moisture sensor. We also recommend evaluation of potential home monitoring of wounds by a moisture sensor.

A prospective, randomized, controlled, crossover study comparing three multilayered foam dressings for the management of chronic wounds

Aim: Compare foam dressings - Mepilex Border Flex (MxBF), Allevyn Life (AL) and Optifoam Gentle EX (OGEX) - in treatment of chronic wounds. Materials & methods: Prospective, randomized, controlled trial (crossover design). Subjects received one dressing for 2 weeks, then comparator dressing for following 2 weeks. Wound/periwound characteristics evaluated weekly at dressing change. Primary end point: dressing durability (incidence of exudate strikethrough). Results: Higher incidence of intact dressings (no strikethrough) at Day 7 (Week 1) with MxBF (6/17; 35.3%) compared with AL (1/18; 5.6%), and with MxBF (7/16; 43.8%) compared with OGEX (2/16; 12.5%; p < 0.05). No significant differences between groups regarding wound size reduction. Conclusion: MxBF had statistically greater durability than AL/OGEX during first critical week of treatment.

Treatment of 52 patients with a self-adhesive siliconised superabsorbent dressing: a multicentre observational study

Objective:

To provide ‘in use’ clinical data to support exudate management in patients with moderately to highly exuding wounds with bordered superabsorbent wound dressing with a silicone adhesive interface.

Method:

This study was an open-labelled non-comparative study. Patients included in the study were selected by the clinical investigator(s) according to whether the patient required a dressing for the management of moderately to highly exuding wounds.

Results:

The primary aim of this study was to evaluate the clinical objective in relation to exudate handling (moderate to high) with a superabsorbent silicone border dressing (Zetuvit Plus Silicone Border; SAP silicone border dressing; designated RespoSorb Silicone Border in some countries). The SAP border dressing had met the clinical objectives relating to exudate management, affirmed by the health professionals with a yes response in 94% of cases. Additionally, the health professionals rated the handling of exudate as excellent/good (78%) and most (80%) reported that they would use the SAP silicone border dressing again. Allied to this was the fact that the SAP silicone border dressing improved the wound edge and periwound skin conditions (29% and 36% of patients, respectively). Regarding dressing retention, the SAP silicone border dressing retained its position in 72% of patients. For wear time, the largest proportion of dressing changes, both pre-study and during the evaluation period, was every third day (45% and 44%, respectively). But there was a shift to extended wear time with use of the SAP silicone border dressing with 72% of patients' dressing changes being every third day or longer.

Conclusion:

The SAP silicone border dressing was successful in managing wound exudate in moderately to highly exuding wounds and consequently this had a beneficial impact on the wound edge and periwound skin. Overall, there was a positive effect on wound bed preparation and in turn the healing response was progressive. This study has shown that the SAP silicone border dressing successfully controlled exudate and provided positive benefits when used in the treatment of patients with moderately to highly exuding wounds.

Evaluation of a superabsorbent wound dressing, patient and clinician perspective: a case series

Objective:

The primary objective of this study was to evaluate the fluid management capabilities of a superabsorbent wound dressing (Zetuvit Plus Silicone), with secondary objectives related to parameters that support whether the dressing enables undisturbed healing.

Method:

This study was an open labelled non-comparative study. Patients included in the study were selected by the clinical investigator(s) according to whether the patient required a dressing for the management of moderately to highly exuding wounds.

Results:

A total of 50 patients were included in the study. Results related to the primary objective demonstrated that the superabsorbent wound dressing was able to absorb all levels of exudate across the range (low to high). At each assessment time point these results show that in 98% of assessments the superabsorbent dressing was rated as ‘very good’ (91%) or ‘good’ (7%) at exudate management. Secondary objectives relating to wound bed preparation, healing and management of pain were also positive. Additionally, at the end of each patient treatment, the dressing's fluid management capabilities were rated overall as ‘excellent’ (100% of cases). There was little pain associated with the wound or at dressing change throughout the study and its flexibility/conformability allowed for comfort and patient satisfaction aligned with increased quality of life. Additionally, inclusion of a silicone adhesive layer allowed painless and atraumatic removal of the dressing, increasing patient comfort, both during wear and at dressing removal, and supported the description of enabling undisturbed wound healing.

Conclusion:

The superabsorbent wound dressing achieved the primary objective relating to wound exudate management in all the assessments undertaken in this study. In addition, the silicone interface allowed for undisturbed healing as evidenced by little or no adherence of the dressing to underlying tissue, preventing damage to periwound skin. Overall, the superabsorbent wound dressing with the addition of the silicone interface could offer advantages over other superabsorbent polymer dressings (that might adhere to the wound surface) or silicone wound dressings (that might not have the absorbent properties of this type of dressing).

Nurses' Education, Confidence, and Competence in Appropriate Dressing Choice

BACKGROUND

Wound assessment and treatment are essential aspects of nursing care. Dressing-associated complications can delay wound healing, causing unnecessary patient distress. Despite evidence suggesting that dressings should be changed infrequently, there still remains a tendency for healthcare professionals to remove dressings regularly, increasing the risk of complications and the cost of wound care.

OBJECTIVE

To understand the experiences and current practices of tissue viability nurses (TVNs) involved in wound care and dressing wear time in the acute and community settings.

METHODS

This quality improvement project used a mixed-methods design. A retrospective audit was undertaken to establish nurse rationale for the renewal of foam dressings on patients with acute/chronic wounds. Semistructured qualitative interviews were conducted with registered TVNs (n = 12) working in acute and community care settings and focused on their experiences with all dressing types.

MAIN RESULTS

The analysis identified several key themes, including Training and Education (including the subthemes of TVN Experience and TVN Training), Knowledge and Information, Lack of Confidence (including the subthemes Reasons for Dressing Change and Ritualistic Practice), and Dressing Choice.

CONCLUSIONS

Fundamental changes in staff attitudes and beliefs about dressing wear time are essential to optimizing dressing performance and increasing patient quality of care. Flexible community services that are reflective of the needs of the service are central to changing practice and increasing dressing wear time in these settings.

Chronic wounds: the challenges of appropriate management

The immense burden imposed by chronic wounds-those persisting over 6 weeks despite active intervention-on patients and health services is well recognised. There are various reasons for why a wound fails to progress towards closure, and clinicians must investigate the underlying cause of wound chronicity, as this information guides the management of such wounds. The TIME framework (T=tissue; I=infection/inflammation; M=moisture balance; E=wound edges) is a useful tool for practitioners to systematically undertake wound assessment and product selection. This article discusses chronic wound management based on the TIME framework, examining the aspects to be considered when managing chronic wounds. It also describes the process of dressing selection for overcoming the various barriers to wound healing, specifically discussing the AQUACEL family of dressings.

Dual-functional core-shell electrospun mats with precisely controlled release of anti-inflammatory and anti-bacterial agents

Acute wounds are worldwide problems affecting millions of people and causing heavy economic burden to national healthcare systems. Herein, we describe novel wound dressing materials relying on core/shell electrospun mats incorporated with flurbiprofen and vancomycin for achieving programmable release of anti-inflammatory and anti-bacterial agents. The shell matrix of nanofibers consisted of polyethylene oxide while the core matrix was made from a blend of silk and collagen. Several optimal mat architectures were engineered with distinct configurations, of which release profiles displayed an exponential trend, which indicates a first-order process following Fickian diffusion behavior. The flurbiprofen release lasted from 2 to 6 days, which was much faster compared to the one of vancomycin prolonged up to about 20 days. Mechanical data indicated tensile modulus, tensile strength, elongation before break of core/shell electrospun mats became enhanced or comparable to those for human skin after methanol vapor treatment. Desirable release kinetics and mechanical characteristics achieved by novel core/shell electrospun mats were attributable to induced enrichment of β-sheet phase in silk via methanol vapor treatment as well as water annealing process with time and judicious selections for matrix materials and mat configurations. The design principles considered in this study successfully addressed a range of inflammation and infection requirements in wound healing, potentially guiding construction of other biomedical coatings and devices.

Encapsulation of Satureja khuzistanica extract in alginate hydrogel accelerate wound healing in adult male rats

BACKGROUND

Finding the best dressing for a specific wound had continued from the past to present. The aim of this study was to evaluate the effect of encapsulated extract of Satureja khuzistanica in hydrogel alginate at wound healing.

METHODS

Thirty-two male Wistar rats with a puncture wound in the back of the neck skin were divided randomly into four groups including a control group, Satureja khuzistanica-treated group, hydrogel alginate-treated group, and Satureja khuzistanica encapsulated in hydrogel alginate-treated group. Rats were treated for 22 days. The skin samples were taken on 3rd, 7th, 14th, and 22nd days after treatment for light microscopy. Results were analyzed in accordance with Kruskal-Wallis and Friedman test (for histopathology analysis) by using SPSS v.22 software.

RESULTS

Macroscopically evaluations and measurement of wound size showed increased wound healing process in the treated groups. The complete improvement was created on the 14th day. The wound site was not observed on the 22nd day. But the wound site was observed on the 22nd day in the control group. Also, comparison of the percentage of wound healing between the treated and control groups on 3rd, 7th, 14th, and 22nd days showed a significant difference (p < 0.05). Comparison of the H&E stained sections in the studied groups showed that treated groups were effective on wound healing in comparison with the control group.

CONCLUSIONS

Encapsulated extract of Satureja khuzistanica in hydrogel alginate may accelerate wound improvement and increase the rate of wound healing without scar formation.

Recent advances of on-demand dissolution of hydrogel dressings

Wound management is a major global challenge and a big financial burden to the healthcare system due to the rapid growth of chronic diseases including the diabetes, obesity, and aging population. Modern solutions to wound management include hydrogels that dissolve on demand, and the development of such hydrogels is of keen research interest. The formation and subsequent on-demand dissolution of hydrogels is of keen interest to scientists and clinicians. These hydrogels have excellent properties such as tissue adhesion, swelling, and water absorption. In addition, these hydrogels have a distinctive capacity to form in situ and dissolve on-demand via physical or chemical reactions. Some of these hydrogels have been successfully used as a dressing to reduce bleeding in hepatic and aortal models, and the hydrogels remove easily afterwards. However, there is an extremely wide array of different ways to synthesize these hydrogels. Therefore, we summarize here the recent advances of hydrogels that dissolve on demand, covering both chemical cross-linking cases and physical cross-linking cases. We believe that continuous exploration of dissolution strategies will uncover new mechanisms of dissolution and extend the range of applications for hydrogel dressings.

A randomised, controlled, non-inferiority trial comparing the performance of a soft silicone-coated wound contact layer (Mepitel One) with a lipidocolloid wound contact layer (UrgoTul) in the treatment of acute wounds

Wound contact layer (WCL) dressings are intended to protect tissue during the healing process. A randomised controlled trial was undertaken to compare 2 such dressings. Outpatients with acute wounds were randomly allocated to treatment with either a soft silicone-coated WCL (intervention group, n = 59) or a lipidocolloid-impregnated WCL (control group, n = 62). At the first dressing removal (day 3), 89.8% of patients in the intervention group experienced non-painful dressing removal (defined as a pain rating <30 mm on a 100 mm visual analogue scale), compared with 73.6% of patients in the control group (P = .017) (per protocol population). At day 21, wounds were considered as healed in 66.1% of patients in the intervention group compared with 43.5% in the control group (P = .012) (intention-to-treat population). Both dressings were well tolerated and rated highly in terms of in-use characteristics, although the soft silicone-coated WCL was rated significantly higher than the lipidocolloid-impregnated WCL in terms of its ability to remain in place (P= .016). The results indicate that the soft silicone-coated WCL is suitable for the management of acute wounds as it can minimise dressing-associated pain and support healing.

A wearable wound moisture sensor as an indicator for wound dressing change: an observational study of wound moisture and status

Wound moisture is known to be a key parameter to ensure optimum healing conditions in wound care. This study tests the moisture content of wounds in normal practice in order to observe the moisture condition of the wound at the point of dressing change. This study is also the first large-scale observational study that investigates wound moisture status at dressing change. The WoundSense sensor is a commercially available moisture sensor which sits directly on the wound in order to find the moisture status of the wound without disturbing or removing the dressing. The results show that of the 588 dressing changes recorded, 44·9% were made when the moisture reading was in the optimum moisture zone. Of the 30 patients recruited for this study, 11 patients had an optimum moisture reading for at least 50% of the measurements before dressing change. These results suggest that a large number of unnecessary dressing changes are being made. This is a significant finding of the study as it suggests that the protocols currently followed can be modified to allow fewer dressing changes and less disturbance of the healing wound bed.

Negative pressure wound therapy in complex trauma of perineum

OBJECTIVE

To review the experience (2011 and 2012) of Wound Center of Plastic Surgery Service, Clinics Hospital, Faculty of Medicine, University of São Paulo, with treatment of complex traumatic wounds in the perineal region with the association of negative pressure wound therapy followed by a surgical skin coverage procedure.

METHODS

This was retrospective analysis of ten patients with complex wound in the perineum resulting from trauma assisted by the Department of Plastic Surgery in HC-USP. Negative pressure was used as an alternative for improving local conditions, seeking definitive treatment with skin grafts or flaps.

RESULTS

Negative pressure was used to prepare the wound bed. In patients, the mean time of use of negative pressure system was 25.9 days, with dressing changes every 4.6 days. After negative pressure therapy, 11 local flaps were performed in nine patients, with fasciocutaneous anterolateral thigh flap used in four of these. Mean hospital stay was 58.2 days and accompaniment in Plastic Surgery was 40.5 days.

CONCLUSION

The use of negative pressure therapy led to improvement of local wound conditions faster than traditional dressings, without significant complications, proving to be the current best alternative as an adjunct for the treatment of this type of injury, always followed by surgical reconstruction with grafts and flaps.

Systemic Evaluation of Electrical Stimulation for Ischemic Wound Therapy in a Preclinical In Vivo Model

Objective: In a systematic preclinical investigation of ischemic wound healing, we investigated the hypothesis that electrical stimulation (ES) promotes the healing of ischemic wounds. Approach: The effects of varying clinically relevant ES variables were evaluated using our modified version of the Gould F344 rat ischemic wound model. Stimulation was delivered using the novel lightweight integrated, single-channel, current-controlled modular surface stimulation (MSS) device. Stepwise variation allowed the effects of five different stimulation paradigms within an appropriate current density range to be studied. Within each group, 8-10 animals were treated for 28 days or until the ischemic wounds were healed and 5 animals were treated for 12 days. Eight rats received sham devices. A quantitative multivariable outcomes assessment procedure was used to evaluate the effects of ES. Results: Ischemic wounds treated with a decreased interpulse interval (IPI) had the highest rate of complete wound closure at 3 weeks. Wounds treated with decreased pulse amplitude (PA) had a lower proportion of closed wounds than sham ischemic wounds and showed sustained inflammation with a lack of wound contraction. Innovation: Our systematic study of varying ES paradigms using the novel MSS device provides preliminary insight into potential mechanisms of ES in ischemic wound healing. Conclusion: Clinically appropriate ES can more than double the proportion of ischemic wounds closed by 3 weeks in this model. Ninety percent of wounds treated with a decreased IPI healed by 21 days compared with only 29% of ischemic wounds treated with decreased PA, which appears to inhibit healing.

OPSITE Flexifix Gentle: preventing breakdown in vulnerable skin

For decades, the intact skin of patients has been at risk of damage from exposure to pressure or friction from devices used to support their treatment while in hospital. Device-related skin injury is a common cause of skin breakdown in the acute hospital environment. The use of clinical devices exposes patients to repetitive friction and light pressure that, if not recognised early, can lead to skin breakdown. Compounding this challenge of protecting skin is the use of adhesive tape that can cause skin stripping. A new dressing product called OPSITE Flexifix Gentle (OFG) is now available on the market. This product may support friction relief in these critical areas and prevent skin stripping and pressure ulcer formation while maintaining moisture balance and a healthy skin environment. This product focus outlines the clinical benefits from this silicone-based film roll. The performance of the product on a 34-bed cardiothoracic intensive care unit will be reviewed through three case studies.

Mepitel One: a wound contact layer with Safetac technology

This article examines the use of Mepitel One, a wound contact layer that promotes wound healing by using the clinical benefits of Safetac technology. A wide range of clinical evidence shows that dressings with Safetac prevent trauma, minimise wound pain and associated psychological stress, while facilitating undisturbed wound healing. Mepitel One has been developed as a highly transparent wound contact layer with Safetac on the wound contact surface alone; this makes it easy to apply without sticking to gloves, and allows it to be used with a choice of secondary dressings. The dressing can stay in place for up to 14 days and allows examination of the wound without removal. The clinical evidence reviewed here shows that Mepitel One is a versatile option for use on a wide range of wound types to promote undisturbed healing and minimise pain at dressing changes.