Innovative Multilayer Electrospun Patches for the Slow Release of Natural Oily Extracts as Dressings to Boost Wound Healing

Electrospinning is an advanced manufacturing strategy used to create innovative medical devices from continuous nanoscale fibers that is endowed with tunable biological, chemical, and physical properties. Innovative medical patches manufactured entirely by electrospinning are discussed in this paper, using a specific plant-derived formulation "1 Primary Wound Dressing©" (1-PWD) as an active pharmaceutical ingredient (API). 1-PWD is composed of neem oil (Azadirachta indica A. Juss.) and the oily extracts of Hypericum perforatum (L.) flowers, according to the formulation patented by the ENEA of proven therapeutic efficacy as wound dressings. The goal of this work is to encapsulate this API and demonstrate that its slow release from an engineered electrospun patch can increase the therapeutic efficacy for wound healing. The prototyped patch is a three-layer core-shell membrane, with a core made of fibers from a 1-PWD-PEO blend, enveloped within two external layers made of medical-grade polycaprolactone (PCL), ensuring mechanical strength and integrity during manipulation. The system was characterized via electron microscopy (SEM) and chemical and contact angle tests. The encapsulation, release, and efficacy of the API were confirmed by FTIR and LC-HRMS and were validated via in vitro toxicology and scratch assays.

Phytotherapy in paediatric skin disorders- a systematic literature review

OBJECTIVES

Although skin disorders in children and adolescents are increasingly treated with phytotherapies in practice, there are very few studies investigating this topic, and no systematic review exists that summarizes the current state of research. This review examines which herbal medicines show to be effective to treat atopic dermatitis, diaper dermatitis, and skin lesions or wounds.

METHODS

Clinical studies were searched according to PRISMA-guidelines in the medical databases of PubMed, EMBASE, and CINAHL and summarised in a systematic review.

RESULTS

Among the 429 articles screened, 17 studies with a total of 2358 participants were identified that suited our inclusion criteria. Thereof seven studies each on the treatment of atopic dermatitis and skin lesions or wounds and three on diaper dermatitis. The phytotherapeutics investigated were based on the following herbs: Evening primrose, blackcurrant, polypodium leucotomos, calendula, aloe vera, chamomile, comfrey, hamamelis, olive, hypericum, neem, white oak, and myrrh. They have mainly been analysed in randomized controlled trials, but also in (long-term) observational studies, prospective trials and case series.

CONCLUSIONS

Based on the application of the Jadad score, eight out of 17 of the studies examined were of low quality. Yet we found some indication that evening primrose oil may be effective for treating atopic dermatitis in children, while comfrey appears to have a positive effect on wound healing. Interestingly, none of the studies found positive effects for treating skin disorders with aloe vera or chamomile.

The Potential of Medicinal Plants and Natural Products in the Treatment of Burns and Sunburn-A Review

Treating burns remains a challenge for modern medicine, especially in developing countries that cannot afford expensive, advanced therapies. This review article summarises clinical and animal model studies of botanical preparations and their mixtures in treating burn wounds and sunburn. Articles available in electronic databases such as PubMed, Scopus, Web of Science, Science Direct and Google Scholar, published in English in 2010-2022, were considered. In the described clinical trials, it was shown that some herbal preparations have better effectiveness in treating burn wounds, including shortening the healing time and reducing inflammation, than the conventional treatment used hitherto. These herbal preparations contained extracts from Albizia julibrissin, Alkanna tinctoria, Aloe vera, Arnebia euchroma, Betula pendula and Betula pubescens, Centella asiatica, Hippophaë rhamnoides, Juglans regia, Lawsonia inermis, and mixtures of Matricaria chamomilla and Rosa canina. Research on animal models shows that many extracts may potentially benefit the treatment of burn wounds and sunburn. Due to the diverse mechanism of action, antibacterial activity, the safety of use and cost-effectiveness, herbal preparations can compete with conventional treatment. The growing interest in alternative medicine and herbal medicine encourages further research. Not only single preparations but also their mixtures should be taken into account because the research conducted so far often suggests a synergistic effect of the ingredients.

Efficiency of hypericum perforatum, povidone iodine, tincture benzoin and tretinoin on wound healing

Different topical agents have been used to accelerate wound healing. The purpose of this study is to compare the safety and efficacy of topical application of the extract of Hypericum perforatum (HPE), povidone iodine (PI), tincture benzoin (TB) and tretinoin (T) on surgical wound healing. Ten adult female, Wistar albino rats were included in the study. HPE, PI, TB and T solutions were applied on the wounds. After seven days, tissue samples were collected and inflammatory cells, re-epithelialization, granulation tissue, angiogenesis, collagen accumulation, hemorrhage and lysis of cells were investigated histopathologically. No dermal toxicity was noted. HPE, TB, PI have all showed good epithelialization and granulation, but HPE showed the most advanced stage of healing within a short period of time. HPE had significantly higher values of re-epithelialization and collagen accumulation, but lower inflammatory cell count and granulation tissue. TB had the second best in re-epithelialization, collagen accumulation and the highest granulation tissue. PI induced better reepithelialization and granulation than the control group with remarkable cell lysis. As a result, HPE can be a safe, effective, and cheap agent that can be used for surgical wounds.

Hypericum and neem oil for dehisced post-surgical wounds: a randomised, controlled, single-blinded phase III study

OBJECTIVE

To evaluate the clinical efficacy of a hypericum and neem oil dressing, Primary Wound Dressing [ONE] (1PWD) (Kerecis AG, Switzerland), in a patient population with dehiscence of surgical wounds with critical colonisation/infection. Efficacy was defined as resolution of inflammatory/infective symptoms.

METHOD

A randomised, controlled, single-blinded, parallel-arms phase III study was conducted comparing the experimental medication to silver-based dressings. All patients were evaluated at enrolment, on days 7, 14, 21 and 28. Improvement of inflammatory/infective symptoms was measured by detecting seven items of the Bates-Jensen Wound Assessment Tool (BWAT). Pain was assessed using the Numeric Rating Scale (NRS).

RESULTS

The study enrolled 99 patients. Follow-up was completed in 49 patients in the experimental group and 48 patients in the control group. Overall BWAT evaluation demonstrated similar outcomes between the groups: t=0.23, p-value=0.81, 95% confidence interval (CI): -13.3-10.8. Furthermore, when evaluating the seven items of the BWAT relating to inflammatory signs, there was not a significant difference between the groups: t=0.38, p=0.35, 95% CI: -2.8-2.7. However, when an analysis using the NRS pain scale was performed, a statistically significant pain reduction was demonstrated in favour of the experimental group: t=7.8, p<0.0001, 95% CI: 2.918-4.8819.

CONCLUSION

This randomised controlled trial confirmed the efficacy of 1PWD, an investigational product, in the management of surgical dehiscence with critical colonisation or infection, with the added benefit of significant pain reduction when compared with a silver-based dressing.

A systematic review of intervention studies demonstrates the need to develop a minimum set of indicators to report the presence of burn wound infection

INTRODUCTION

Burn wound infections result in delayed healing and increased pain, scarring, sepsis risk and healthcare costs. Clinical decision making about burn wound infection should be supported by evidence syntheses. Validity of evidence from systematic reviews may be reduced if definitions of burn wound infectionvary between trials. This review aimed to determine whether burn wound infectionis defined, and whether there is variation in the indicators used to define burn wound infectionacross studies testing interventions for patients with burns.

METHOD

Searches were carried out in four databases (Ovid Medline, Ovid Embase, Cinahl, Cochrane Register of Trials) to identify studies evaluating interventions for patients with burns and reporting a burn wound infection outcome. Pre-defined inclusion and exclusion criteria were systematically applied to select relevant studies. Data were systematically extracted and reported narratively.

RESULTS

2056 studies were identified, of which 72 met the inclusion criteria, comprising 71 unique datasets. 52.1% of studies were randomised controlled trials. Twenty-eight (38.0%) studies reporting a burn wound infection outcome did not report how they had defined it. In the methods of included studies, 59 studies (83.1%) reported that they planned to measure burn wound infection as an outcome. Of these, 44 studies (74.6%) described how they had defined burn wound infection; 6 studies (13.6%) reported use of a previously developed consensus-informed definition of burn wound infection, and 41 studies (69.5%) described the specific indicators used to define it. Studies used between one (11 studies; 26.8%) and nine indicators (2 studies; 4.9%) to define burn wound infection (median = 3, inter-quartile range = 2). The most commonly used indicator was presence of bacteria in the wound (61.0% of studies). Only 13 studies (31.7%) defined burn wound infection using the same indicators as at least one other study.

DISCUSSION AND CONCLUSIONS

Within intervention studies reporting burn wound infection outcomes, a definition of this outcome is commonly not provided, or it varies between studies. This will prevent evidence synthesis to identify effective treatments for patients with burn injuries. Since there is no objective method for assessing burn wound infection, expert consensus is needed to agree a minimum set of indicators (Core Indicator Set) reported in all trials reporting burn wound infection as an outcome.

Topical medicines for wound healing: A systematic review of Unani literature with recent advances

ETHNOPHARMACOLOGICAL RELEVANCE

Wound healing is an important area of research in contemporary medicine. Unani is a traditional medicine system based on hundreds of years of observations and experiences. Wounds are described under the headings qarha (arabic) and jarāhat (persian) in classical Unani texts. Several drugs of herbal, mineral and animal origin are described in Unani texts as having wound healing properties. Many of these drugs have been screened on various scientific parameters but the potential of most drugs remains unexplored.

METHODOLOGY

The study was aimed at summarizing the topical wound healing drugs mentioned in classical Unani books. The topical wound healing drugs were first identified in classical texts. Then 20 drugs were selected for detailed review on the basis of clinical relevance and wide availability.

OBSERVATIONS AND RESULTS

Seventy drugs were identified in Unani texts after removal of duplicacy. Most of the drugs (85.71%) were of herbal origin, while 10% were of mineral origin and the rest 4.28% were of animal origin. Most of the herbal drugs belonged to the Fabaceae (10%) and Rosaceae (8.33%) families. Biologically active compounds such as phenols, sterols, hydrocarbons, anthocyanidins, flavonoids and tannins have been identified in almost all drugs which support classical literature.

CONCLUSION

Unani system of medicine has a rich legacy of effective wound healing drugs, which is reinforced by modern researches. Most drugs exert their action on multiple phases of wound healing. In addition, most drugs have no reported adverse effects in laboratory and clinical studies. Hence, Unani medicine may offer the much-needed affordable and effective wound care in a wide range of clinical settings.

Carrier oils in dermatology

Wounds are a common medical infliction. With the increase in microbial resistance and a shift of interest towards complementary medicines, essential oils have been shown to be beneficial in suppressing microbial growth. However, in practice, essential oils are more often diluted into a base due to the risk of topical adverse effects, such as dermatitis. There is a lack of collated evidence-based information on toxicity and efficacy of carrier oils. The current information on the subject matter is restricted to generic, aroma-therapeutic books and pamphlets, based on anecdotal evidence rather than an experimental approach. Therefore, this review aimed at identifying the recommended carrier oils used in dermatology and thereafter collating the scientific evidence to support the use of carrier oils together with essential oils recommended for dermatological use. Aloe vera gel had multiple studies demonstrating the ability to enhance wound healing; however, several other carrier oils have been largely neglected. It was observed that the extracts for certain plant species had been used to justify the use of the carrier oils of the same plant species. This is an inaccurate cross assumption due to the difference in chemical composition and biological activities. Lastly, despite these carrier oils being recommended as a base for essential oils, very little data was found on the interactive profile of the carrier oil with the essential oil. This review provides a platform for further studies, especially if essential oils are to receive credence in the scientific field.

Evaluation of the Effect of Topical Hypericum perforatum Oil on Excisional Palatal Wound Healing in Rabbits

Aim: The aim of this study was to evaluate the effect of Hypericum perforatum (HP) oil on wound-healing process in rabbit palatal mucosa. Materials and Methods: Thirty-six New Zealand albino rabbits were randomly allocated to following groups; (1) HP oil (test, n = 18) and (2) olive oil (control, n = 18). Palatinal excisional wounds were created and the oils were topically applied (0.1 ml, 30 s, twice a day). Gingival biopsies were excised, and analyzed for re-epithelialization (RE) and granulation tissue maturation (GTM) on days 3, 7, and 14 after surgery. Levels of vascular endothelial growth factor (VEGF) and fibroblast growth factor 2 (FGF-2) were assessed using the immunohistochemical method. Apoptotic cells (ACs) were evaluated using TUNEL staining. Enzyme-linked immunosorbent assay was used to assess tissue catalase (CAT) and malondialdehyde (MDA) levels. Results: RE and GTM were completed earlier in the HP oil group than in the control group. The number of positively stained cells/vessels was higher in olive oil than in the test group on day 3 for FGF-2 and on days 3 and 7 for VEGF (p < 0.05). In contrast, on day 14, a higher number of vessels was observed in the HP oil group than in the control group. HP oil treatment reduced the number of ACs compared to olive oil (p < 0.05), but the difference during the healing period did not reach significance. Tissue CAT and MDA levels between groups were not different, and also the results were the same when the levels were analyzed by the evaluated time periods (p > 0.05). Conclusions: The results of this study demonstrated that topical HP oil treatment did not provide an additional benefit to its base, olive oil, in the early phase of secondary wound healing.

Hypericum perforatum (St John's wort) beyond depression: A therapeutic perspective for pain conditions

ETHNOPHARMACOLOGICAL RELEVANCE

Hypericum perforatum L. (Hypericaceae), popularly called St. John's wort (SJW), has a rich historical background being one of the oldest used and most extensively investigated medicinal herbs. Many bioactivities and applications of SJW are listed in popular and in scientific literature, including antibacterial, antiviral, anti-inflammatory. In the last three decades many studies focused on the antidepressant activity of SJW extracts. However, several studies in recent years also described the antinociceptive and analgesic properties of SJW that validate the traditional uses of the plant in pain conditions.

AIM OF THE REVIEW

This review provides up-to-date information on the traditional uses, pre-clinical and clinical evidence on the pain relieving activity of SJW and its active ingredients, and focuses on the possible exploitation of this plant for the management of pain.

MATERIALS AND METHODS

Historical ethnobotanical publications from 1597 were reviewed for finding local and traditional uses. The relevant data on the preclinical and clinical effects of SJW were searched using various databases such as PubMed, Science Direct, Scopus, and Google Scholar. Plant taxonomy was validated by the database Plantlist.org.

RESULTS

Preclinical animal studies demonstrated the ability of low doses of SJW dry extracts (0.3% hypericins; 3-5% hyperforins) to induce antinociception, to relieve from acute and chronic hyperalgesic states and to augment opioid analgesia. Clinical studies (homeopathic remedies, dry extracts) highlighted dental pain conditions as a promising SJW application. In vivo and in vitro studies showed that the main components responsible for the pain relieving activity are hyperforin and hypericin. SJW analgesia appears at low doses (5-100mg/kg), minimizing the risk of herbal-drug interactions produced by hyperforin, a potent inducer of CYP enzymes.

CONCLUSION

Preclinical studies indicate a potential use of SJW in medical pain management. However, clinical research in this field is still scarce and the few studies available on chronic pain produced negative results. Prospective randomized controlled clinical trials performed at low doses are needed to validate its potential efficacy in humans.

Comparison of Systemic and Topical Hypericum Perforatum on Diabetic Surgical Wounds

BACKGROUND

Surgical wounds in diabetic patients still remain a problem till the present day. As a common plant found around the world, Hypericum perforatum L. (Hypericaceae) is traditionally prepared as an oily extract and used as a folk remedy for various diseases such as wounds, burns, cuts, etc. This study aims to evaluate the effect of St. John's wort (Hypericum perforatum) on problematic wounds while comparing oral and topical applications.

METHODS

Incisional and excisional wound models were made on the dorsal regions of 54 diabetic Spraque-Dawley rats. The rats were divided into the following six groups (n = 9): Group 1: control, Group 2: diabetic, Group 3: diabetic oral Hypericum perforatum, Group 4: diabetic topical Hypericum perforatum, Group 5: diabetic oral olive oil, and Group 6: diabetic topical olive oil.

RESULTS

Groups 3 and 4 had significantly higher tensile strength, tissue hydroxyproline concentration, and collagen density compared with Group 2. Inflammatory cell density and collagen density on day 3 were significantly higher in Groups 3 and 6 compared with Group 2. On day 21, Groups 3 and 6 had significantly higher fibroblastic activity compared with Group 2.

CONCLUSIONS

This study has proved that oral St. John's wort has more positive effects on problematic wounds compared with topical St. John's wort and olive oil, which is a vehicle. Hypericum perforatum results with faster inflammatory response and better healing. These results could be an addition to literature about the clinical usage of Hypericum perforatum on diabetic wounds.

Management of severe head injury with brain exposure in three loggerhead sea turtles Caretta caretta

The loggerhead Caretta caretta is the most common sea turtle in the Mediterranean. Currently, sea turtles are considered endangered, mainly due to the impact of human activities. Among traumatic lesions, those involving the skull, if complicated by brain exposure, are often life-threatening. In these cases, death could be the outcome of direct trauma of the cerebral tissue or of secondary meningoencephalitis. This uncontrolled study aims to evaluate the use of a plant-derived dressing (1 Primary Wound Dressing®) in 3 sea turtles with severe lesions of the skull exposing the brain. Following surgical curettage, the treatment protocol involved exclusive use of the plant-derived dressing applied on the wound surface as the primary dressing, daily for the first month and then every other day until the end of treatment. The wound and peri-wound skin were covered with a simple secondary dressing without any active compound (non-woven gauze with petroleum jelly). Data presented herein show an excellent healing process in all 3 cases and no side effects due to contact of the medication with the cerebral tissue.

Review: African medicinal plants with wound healing properties

ETHNOPHARMACOLOGICAL RELEVANCE

Wounds of various types including injuries, cuts, pressure, burns, diabetic, gastric and duodenal ulcers continue to have severe socio-economic impact on the cost of health care to patients, family and health care institutions in both developing and developed countries. However, most people in the developing countries, especially Africa, depend on herbal remedies for effective treatment of wounds. Various in vitro and in vivo parameters are used for the evaluation of the functional activity of medicinal plants by using extracts, fractions and isolated compounds. The aim of the review is to identify African medicinal plants with wound healing properties within the last two decades.

MATERIALS AND METHODS

Electronic databases such as PubMed, Scifinder(®) and Google Scholar were used to search and filter for African medicinal plants with wound healing activity. The methods employed in the evaluation of wound healing activity of these African medicinal plants comprise both in vivo and in vitro models. In vivo wound models such as excision, incision, dead space and burn wound model are commonly employed in assessing the rate of wound closure (contraction), tensile strength or breaking strength determination, antioxidant and antimicrobial activities, hydroxyproline content assay and histological investigations including epithelialisation, collagen synthesis, and granulation tissue formation. In in vitro studies, single cell systems are mostly used to study proliferation and differentiation of dermal fibroblasts and keratinocytes by monitoring typical differentiation markers like collagen and keratin.

RESULTS

In this study, 61 plants belonging to 36 families with scientifically demonstrated or reported wound healing properties were reviewed. Various plant parts including leaves, fruits, stem bark and root extracts of the plants are used in the evaluation of plants for wound healing activities.

CONCLUSION

Although, a variety of medicinal plants for wound healing can be found in literature, there is a need for the isolation and characterization of the bioactive compounds responsible for the wound healing properties. Also, cytotoxicity studies should be performed on the promising agents or bioactive fractions or extracts.

A multidisciplinary approach to scars: a narrative review

The purpose of this article is to carry out a narrative review regarding the approach to scars through complementary and alternative medicine focusing on osteopathy, naturopathy, and other minor methods and traditional rehabilitative medicines, such as physiotherapy and manual therapies. We analyzed the existing literature regarding the possible influences of techniques relaxing the diaphragm – both manual and psychophysical relaxing techniques – and the consequent local response to events leading to scar tissue healing. The objective of the study is to become a useful instrument of knowledge for those manual therapists and professionals who deal with patients affected by discontinuity of the skin surface due to trauma or surgery. This article also intends to stimulate research in order to find and propose new methods of scar treatment, taking into consideration the information gained so far from other complementary and alternative disciplines.