Implementing the Triangle of Wound Assessment framework to transform the care pathway for diabetic foot ulcers

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.

HEALS-A and GRADES: Novel Histological and Clinical Scales for Assessing Skin Regeneration in Murine Wound Healing Models

Background: Wounds affect approximately 15 out of every 1000 individuals, representing a significant healthcare challenge. The preclinical evaluation of novel wound treatments is important for advancing therapies that promote effective skin regeneration and improve healing outcomes. Methods: In this study, we integrated existing knowledge from the literature on murine wound healing models, histological features of the skin, and clinical scores described in humans to propose two complementary assessment tools: the HEALS-A histological score (healing, epithelialization, angiogenesis, leukocytes, scar tissue, appendages) and the GRADES clinical score (granulation tissue, redness/edema, appearance of wound, devitalized tissue). Results: These scales combine real-time clinical observation with detailed histological analysis, providing a practical and comprehensive approach to assessing wound healing. Unlike existing wound assessing approaches, HEALS-A does not require specialized software and considers regenerated tissue structures, ensuring a broader and more-detailed evaluation. Conclusions: The assessment of wound closure over time, combined with clinical evaluation and histological analysis of skin, provides a comprehensive approach to determining the true impact of new treatments on skin regeneration and the recovery of its functions in wounds.

Grade IV Radiation Skin Injury on the Neck of a Patient with Tonsillar Carcinoma: A Case Report

ABSTRACT

Radiation therapy is often accompanied by skin toxicity in the irradiated area and radiation-induced DNA damage to skin tissue cells in the surrounding pigmented area. This case report describes a patient with radiation-induced skin injury who received wound treatment and psychological intervention with satisfactory results. A 60-year-old woman was admitted to the authors' hospital on January 18, 2021, with radiation-induced skin injury caused by carbon ion radiotherapy for tonsillar carcinoma. The patient underwent wound repair combined with psychological intervention (30 minutes per dressing change). Over a period of 1 month, the wound area was reduced from 11 × 12 cm2 to 1 × 1 cm2, and wound symptoms (exudate, blood odor, wound infection, wound edge dehydration and curling, periwound skin peeling, dryness, and hyperkeratosis) improved. The patient's anxiety factor scores decreased from 18 to 1, and her depression factor scores decreased from 16 to 3. When the patient was discharged from the hospital after 1 month of treatment, she had a satisfactory self-image and normal social activities.

Modern Approaches in Wounds Management

Wound management represents a well-known continuous challenge and concern of the global healthcare systems worldwide. The challenge is on the one hand related to the accurate diagnosis, and on the other hand to establishing an effective treatment plan and choosing appropriate wound care products in order to maximize the healing outcome and minimize the financial cost. The market of wound dressings is a dynamic field which grows and evolves continuously as a result of extensive research on developing versatile formulations with innovative properties. Hydrogels are one of the most attractive wound care products which, in many aspects, are considered ideal for wound treatment and are widely exploited for extension of their advantages in healing process. Smart hydrogels (SHs) offer the opportunities of the modulation physico-chemical properties of hydrogels in response to external stimuli (light, pressure, pH variations, magnetic/electric field, etc.) in order to achieve innovative behavior of their three-dimensional matrix (gel-sol transitions, self-healing and self-adapting abilities, controlled release of drugs). The SHs response to different triggers depends on their composition, cross-linking method, and manufacturing process approach. Both native or functionalized natural and synthetic polymers may be used to develop stimuli-responsive matrices, while the mandatory characteristics of hydrogels (biocompatibility, water permeability, bioadhesion) are preserved. In this review, we briefly present the physiopathology and healing mechanisms of chronic wounds, as well as current therapeutic approaches. The rational of using traditional hydrogels and SHs in wound healing, as well as the current research directions for developing SHs with innovative features, are addressed and discussed along with their limitations and perspectives in industrial-scale manufacturing.

When the dressing does not fit: choosing the right dressing for the right patient

There is a lot of literature about selecting a primary dressing for a wound. However, not much is made available on the selection of a secondary dressing, which is just as important, as it allows the primary dressing to remain in place. This article looks at selecting a secondary dressing that is appropriate for a patient, considering the patient's mobility or immobility, where the wound is located, how exudate can cause dressings to become detached, controlling a wound's odour, selecting a secondary dressing that will not damage a patient's skin and how nurses can keep themselves up-to-date with dressings.