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

Addressing the Dressings: Wound Care in Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) wounds are complex and have unique characteristics that complicate dressing selection. Proper wound care assists with wound healing and contributes to improved quality of life. Ideal dressings are comfortable while maintaining a wound-healing environment. Antimicrobial dressings should target dysbiosis and biofilms. Absorptive dressings are needed for control of exudate. Pain control is best achieved with nonadhesive dressings and contact layers. Agents targeting anaerobic bacteria are effective at odor reduction. Surgery may be indicated for management of refractory wounds. Overall, there is a need for increased research and education on both routine and postsurgical wound care in HS.

A systematic in vitro study of the effect of normoglycaemic and hyperglycaemic conditions on the biochemical and cellular interactions of clinically-available wound dressings with different physicochemical properties

Diabetic foot, leg ulcers and decubitus ulcers affect millions of individuals worldwide leading to poor quality of life, pain and in several cases to limb amputations. Despite the global dimension of this clinical problem, limited progress has been made in developing more efficacious wound dressings, the design of which currently focusses on wound protection and control of its exudate volume. The present in vitro study systematically analysed seven types of clinically-available wound dressings made of different biomaterial composition and engineering. Their physicochemical properties were analysed by infrared spectroscopy, swelling and evaporation tests and variable pressure scanning electron microscopy. These properties were linked to the interactions with inflammatory cells in simulated normoglycaemic and hyperglycaemic conditions. It was observed that the swelling behaviour and evaporation prevention at different glucose levels depended more on the engineering of the fibres than on the hydrophilicity and hydrophobicity of their biomaterials. Likewise, the data show that the engineering of the dressings as either non-woven or woven or knitted fibres seems to determine the swelling behaviour and interactions with inflammatory cells more than their polymer composition. Dressings presenting absorbent layers made of synthetic, non-woven fibres supported the adhesion of monocytes macrophages and stimulate the release of factors known to play a role in the chronic inflammation. Non-woven absorbent layers based on carboxymethyl cellulose mainly stimulating the iNOS, an enzyme producing free radicals; in the case of Kerracel this was combined with a swelling of fibres preventing the penetration of cells. Kaltostat, an alginate-based wound dressing, showed the higher level of swelling and supporte the adhesion of inflammatory cells with limited activation. Knitted dressings showed a limited adhesion of inflammatory cells. In conclusion, this work offers insights about the interactions of these wound dressings with inflammatory cells upon exudate changes thus providing further criteria of choice to clinicians.

Harnessing the Interactions of Wound Exudate Cells with Dressings Biomaterials for the Control and Prognosis of Healing Pathways

The global socioeconomic challenge generated by wounds requires an understanding of healing and non-healing pathways in patients. Also, the interactions occurring between the wound dressing biomaterials with cells relevant to the healing process have not been sufficiently investigated, thus neglecting the role that wound dressing composition can play in healing. Through the study of six cases of acute surgical wounds, the present work analyses the early (24 h post-surgery) interactions of biochemical and cellular components with (i) Atrauman, a device made of knitted woven synthetic polymeric fibre when used as a primary dressing, and (ii) Melolin, a hydrocolloid engineered as two layers of synthetic and cellulose non-woven fibres when used as a secondary dressing. A pathway towards healing could be observed in those cases where endoglin-expressing cells and M2 macrophages were retained by Atrauman fibres at the interface with the wound bed. On the contrary, cases where the secondary dressing Melolin absorbed these cell phenotypes in its mesh resulted in a slower or deteriorating healing process. The data obtained indicate that a subtraction of progenitor cells by Melolin may impair the healing process and that the analysis of the retrieved wound dressings for biomarkers expressed by cells relevant to wound healing may become an additional tool to determine the patient's prognosis.

Cytotoxicity and concentration of silver ions released from dressings in the treatment of infected wounds: a systematic review

Introduction

Silver-releasing dressings are used in the treatment of infected wounds. Despite their widespread use, neither the amount of silver released nor the potential in vivo toxicity is known. The aim of this study was to evaluate the cytotoxic effects and the amount of silver released from commercially available dressings with infected wounds.

Methods

The review was conducted according to the PRISMA statement. The Web of Science, PubMed, Embase, Scopus, and CINAHL databases were searched for studies from 2002 through December 2022. The criteria were as follows: population (human patients with infected wounds); intervention (commercial dressings with clinical silver authorized for use in humans); and outcomes (concentrations of silver ions released into tissues and plasma). Any study based on silver-free dressings, experimental dressings, or dressings not for clinical use in humans should be excluded. According to the type of study, systematic reviews, experimental, quasi-experimental, and observational studies in English, Spanish, or Portuguese were considered. The quality of the selected studies was assessed using the JBI critical appraisal tools. Studies that assessed at least 65% of the included items were included. Data were extracted independently by two reviewers.

Results

740 articles were found and five were finally selected (all of them quasi-experimental). Heterogeneity was found in terms of study design, application of silver dressings, and methods of assessment, which limited the comparability between studies.

Conclusion

In vivo comparative studies of clinical dressings for control of infection lack a standardized methodology that allows observation of all the variables of silver performance at local and systemic levels, as well as evaluation of its cytotoxicity. It cannot be concluded whether the assessed concentrations of released silver in commercial dressings for the topical treatment of infected wounds are cytotoxic to skin cells.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022351041, PROSPERO [CRD42022351041].