Selection of Appropriate Wound Dressing for Various Wounds

Enhancement of wound healing by a bilayer hydrogel and nanofiber scaffold infused with Calophyllum inophyllum oil and Platostoma palustre aqueous extract

Natural wound dressings have attracted substantial interest among researchers due to their biocompatible, bioactive, and eco-friendly properties. This paper focuses on introducing the bio-engineered bilayer design, fabrication, and characterizations of a Calophyllum inophyllum seed oil (CIO) - loaded scaffold within a polyvinyl alcohol/sodium alginate (PVA/SA) matrix, fortified with Hsiantsao aqueous extract. The scaffold - consisting of a semi-hydrophobic hydrogel and a hydrophilic nanofiber - was successfully synthesized using polymerization and centrifugal electrospinning techniques. Engineered to create a synergistic effect; physiologically, the fabricated bilayer scaffold demonstrated increased flexibility in the stress-strain curve via elongation; it also exhibited prompt high water absorption and maintained a neutral pH value (7.125 to 7.325). Chemically, the scaffold showed superior biocompatibility, robust antioxidants (82.19 % ± 0.08 in DPPH scavenging, 90.23 % ± 0.22 in ABTS scavenging), and confirmed antimicrobial activities. In a rat wound model, the CIO-loaded PVA/SA/Hsiantsao scaffold markedly improved wound healing by day 15, reaching a wound closure rate of 98.22 % ± 0.82. Also, the scaffold degraded up to 47 % in vitro within a month, indicating its eco-friendly characteristics. From these findings, this study underscores the potential of the bilayer CIO-loaded PVA/SA/Hsiantsao scaffold as an advanced wound care dressing, setting the stage for prospective clinical applications.

Evaluation of Shear Force Redistribution and Microclimate in Foam Dressings Indicated for Pressure Injury Prevention

OBJECTIVE

To understand the performance of a border and silicone version of a next-generation multilayered foam dressing (dressings A and B) compared with three commercially available wound dressings (dressings C, D, and E) in bench tests relevant for pressure injuries.

METHODS

Two methods were used. The first measured shear force transmission through dressings in low- and high-shear force scenarios compared with a control with no dressing. The second measured the dressings' microclimate (heat and moisture) compared with two controls: one with high moisture output and one with no moisture output. Statistical significance was determined using a 95% CI and t test with α = .05.

RESULTS

In the low-shear scenario, dressing A showed the lowest force transmission, whereas dressing B was not significantly different from dressings C and E. In the high-shear scenario, dressing D had a significantly higher percentage of transmitted forces compared with the other dressings, with dressing A showing the lowest force transmission but no significant differences among the other three dressings. Regarding microclimate, dressing A showed no significant difference in relative humidity in the dressing-indenter and dressing-surface interfaces, suggesting good breathability. Dressing E had the highest temperature at the indenter-dressing interface, significantly different from the other dressings ( P < .05).

CONCLUSIONS

The study found that a next-generation foam dressing (dressing A) had better breathability and lower shear force transmission than other available dressings. This study emphasized the importance of understanding the physical properties of dressings to choose the most appropriate product based on individual patient needs, wound characteristics, and environmental conditions.

Injectable ADM temperature-sensitive hydrogel loaded with bFGF in diabetic rat wound healing study

Background: Diabetic wound is one of the most common diabetic chronic complications. Effective treatments of diabetic wound remain limited. Here, we explored the effects of basic fibroblast growth factor (bFGF)-acellular dermal matrix (ADM) hydrogel on the diabetic wound. Methods: The bFGF-ADM hydrogel was manufactured by mixing 180 µL ADM hydrogel and 20 µL bFGF aqueous solution (10 mg/mL). The morphology of ADM hydrogel and bFGF-ADM hydrogel was observed under scanning electron microscope. The release property of bFGF-ADM hydrogel was determined by ELISA. CCK-8 assay was utilized to estimate the cell viability of mouse skin fibroblasts. The diabetes mellitus (DM) model was established in rats. The four wounds on the back of each DM rat were treated with the ADM hydrogel, bFGF-ADM hydrogel, bFGF aqueous solution and no solution (control), respectively. The wound healing rate of each rat was estimated. The traumatized skin tissue of each rat was observed by H&E staining and Sirius red staining. Results: The bFGF-ADM hydrogel displayed an interconnected pore structure and bFGF was gradually released from the bFGF-ADM hydrogel over time. The bFGF-ADM hydrogel could enhance the cell viability of skin fibroblasts and promote the wound healing rate, the re-epithelialization of wound and increase the collagen fiber content of dermis. And the bFGF-ADM hydrogel exhibited better therapeutic effects of diabetic wound than either bFGF or ADM alone. Conclusions: Our study revealed that the bFGF-ADM hydrogel could promote diabetic wound healing.

Disparities in Medication Prescriptions and Post-Tracheostomy Outcomes in Pediatric Patients

BACKGROUND

Granulation tissue formation and tracheitis are common pediatric tracheostomy complications. Ciprofloxacin/dexamethasone is frequently prescribed, but the influence of social determinants on this topic is unexplored.

METHODS

This study extends a prior cohort study of pediatric tracheostomy patients at a single academic institution from 2016 to 2020. Social determinants of health, including race, insurance status, and residence characteristics, including Area Deprivation Index (ADI), were evaluated. Logistic regression, Wilcoxon rank-sum, and log-rank tests (α = .05) analyzed relationships between these determinants and prescriptions and post-tracheostomy outcomes.

RESULTS

This cohort included 182 patients; 98/182 (53.9%) were male, and 140/182 (76.9%) were White, non-Hispanic. Non-White race was associated with increased odds of receiving nebulized ciprofloxacin/dexamethasone (OR = 2.80, 95% CI = 1.25-6.29). In those with tracheal culture results available (n = 63), Staphylococcus aureus was more common with public insurance (29/47, 7 with MRSA, 61.7%) compared with private (5/16, 3 with MRSA, 31.3%; OR = 3.54, 95% CI = 1.05-11.9). ADI was greater in the 7 patients with Streptococcus pneumoniae (median = 95, IQR = 88-99) compared to without (median = 77, IQR = 65-81, P = .003). Patients with tracheitis lived further from our center (median = 44.7 miles, IQR = 27.7-91.4 miles) compared with those who did not develop tracheitis (median = 33.4 miles, IQR = 12.0-85.2 miles, P = .02). Antibiotic resistance was more prevalent in children discharged home (14/35, 40.0%) than to transitional care (3/28, 10.7%; OR = 5.56, 95% CI = 1.40-22.0) and was associated with longer hospital stays (median = 70 days, range = 34-152 vs median = 35 days, range = 15-75 days, P = .02). Non-White patients experience increased odds of decannulation over time compared with White patients (HR = 2.85, 95% CI = 1.21-6.70). Discharge locations and ADI were associated with dressing choice post-tracheostomy.

DISCUSSION

This study revealed racial disparities in ciprofloxacin/dexamethasone usage, residence-related differences in tracheal culture results, and ADI-related dressing choices, which highlight the need for tailored, equitable care to optimize outcomes.

LEVEL OF EVIDENCE

4.

Pressure Distribution Properties in Wound Dressings Using Heel and Sacrum Indenters Under Clinically Relevant Loads

OBJECTIVE

To understand the pressure distribution characteristics of a border and silicone version of a next-generation multilayered foam dressing (A and B) compared with three commercially available dressings (C, D, and E) using a novel pressure distribution model with clinically relevant pressures.

METHODS

The testing setup included a support surface analog of K45 foam covered with polyurethane fabric, a high-resolution pressure mapping system, and a silicone layer to simulate overlying tissue. The dressing was exposed to clinically relevant loads of 30 and 80 mm Hg for 60 seconds using new sacral and heel indenters. A control was conducted using the same setup without a dressing. Statistical significance was determined using a 95% CI and t test with α = .05.

RESULTS

All dressings decreased pressure and increased contact area compared with the control ( P < 0.05). Dressings A and B had lower peak pressures than dressings C and E for both indenters. Dressings D and B had the largest contact areas and lowest pressures in the heel indenters, whereas dressing E had the smallest contact area and the highest pressures for both indenters. The results also demonstrated a strong negative correlation between the average pressure and the contact area for both indenters.

CONCLUSIONS

Using anatomically accurate indenters and clinically relevant pressures, the study demonstrated that dressings A and B significantly reduced interface pressure compared with no dressing, suggesting potential advantages for pressure redistribution in vulnerable areas. Additional clinical research in various care settings is needed to validate this study's findings.

Pd@Au Nanoframe Hydrogels for Closed-Loop Wound Therapy

In this work, a multifunctional Pd@Au nanoframe hydrogel was designed to detect uric acid (UA) for in situ monitoring of wound infection and enhance wound healing by a chemo-photothermal strategy. In acidic conditions, the Pd@Au nanoframe hydrogels show high peroxidase-like activity by catalyzing H2O2 to produce reactive oxygen species (ROS) to damage RNAs of bacteria and enhance antibacterial activity. Under Near-infrared (NIR) laser irradiation, the Pd@Au nanoframe hydrogels exhibit photothermal conversion performance; i.e., the color of Pd@Au nanoframe hydrogel solution varies from deep blue (0 s, 25.4 °C) to red (300 s, 50.1 °C) in infrared thermography. After loading the antibacterial mupirocin (M), the as-obtained M Pd@Au nanoframe hydrogels show a maximum cumulative release rate exceeding 90% for mupirocin, as controlled by NIR laser irradiation. In antimicrobial experiments in vitro, M Pd@Au nanoframe hydrogels exhibit NIR laser-driven antibacterial ability; i.e., 98% Escherichia coli are effectively killed in 10 min. After coating rabbit wounds with a UA sensing patch of M Pd@Au nanoframe hydrogels, wound status can be monitored in real time by detecting UA concentration, leading to rapid wound healing in 4 days by a new synergistic effect of chemo-photothermal strategy. This approach successfully confirms a closed-loop strategy, i.e., real-time monitoring the status of a wound and efficiently perform chemo-photothermal wound therapy, for wound healing by combining functional hydrogels, NIR laser irradiation, and pharmaceutical antibacterials.

Recent advances in structural and functional design of electrospun nanofibers for wound healing

The global prevalence of acute and chronic wounds has surged, escalating healthcare burdens and necessitating advanced therapeutic strategies for effective wound management. Electrospun nanofibers have emerged as promising biomimetic platforms for tissue engineering and drug delivery, due to their structural resemblance to the native extracellular matrix (ECM), high porosity, and tunable surface-to-volume ratio. Recent advances in structural design have expanded their applications from conventional two-dimensional (2D) wound dressings to multifunctional three-dimensional (3D) architectures, enabling enhanced mechanical adaptability, bioactive molecule loading, and spatiotemporal control over wound microenvironments. These innovations leverage nanofibers' customizable topography and composition to recapitulate critical ECM cues, thereby fostering cell proliferation, angiogenesis, and immunomodulation during tissue regeneration. This review systematically evaluates cutting-edge strategies focusing on optimizing 2D arrangements and the structural design of multilayered and functionally patterned 3D electrospun nanofibers in wound healing applications. We further present the advantages and limitations of various nanofiber structures, along with the key challenges and future directions for advancing electrospun nanofibers specifically designed for enhanced wound healing.

Advances in biomedical applications of bacterial cellulose: from synthesis mechanisms to commercial innovations

Bacterial cellulose (BC) has various unique properties, such as sustainability and biocompatibility, which make it a "rising star" in biomedical applications. This comprehensive review delves into the intricacies of BC production and elucidates the pivotal role of rosette terminal complexes in the synthesis of BC. Moreover, it explores the diverse range of in-situ and ex-situ modifications, such as coating, genetic modification, and esterification, that can enhance its performance in biomedical applications, notably in tissue engineering, drug delivery and wound healing applications Beginning with an in-depth examination of BC synthesis mechanisms, this review sheds light on the fundamental processes underlying its unique structure and properties and subsequently delves into the vast landscape of modification strategies, encompassing techniques such as chemical functionalization, surface patterning, and composite formation. Of particular significance are the insights provided into commercial products derived from BC, which offers a comprehensive overview of their features and applications, followed by several recent case studies. By consolidating knowledge from the basic principles of BC synthesis to cutting-edge advancements in the field, this review illuminates the transformative impact of BC on the landscape of health and medical breakthroughs, paving the way for future advancements in biomedicine.

Innovating chitosan-based bioinks for dermal wound healing: Current progress and future prospects

The field of three-dimensional (3D) bio/printing, known as additive manufacturing (AM), heavily relies on bioinks possessing suitable mechanical properties and compatibility with living cells. Among the array of potential hydrogel precursor materials, chitosan (CS) has garnered significant attention due to its remarkable physicochemical and biological attributes. These attributes include biodegradability, nontoxicity, antimicrobial properties, wound healing promotion, and immune system activation, making CS a highly appealing hydrogel-based bioink candidate. This review explores the transformative potential of CS-based bioink for enhancing dermal wound healing therapies. We highlight CS's unique qualities that make it an optimal choice for bioink development. Advancements in 3D bio/printing technology for tissue engineering (TE) are discussed, followed by an examination of strategies for CS-based bioink formulation and their impacts on wound healing. To address the progress in translating advanced wound healing from lab to clinic, we highlight the current and ongoing research in CS-based bioink for 3D bio/printing in skin wound healing applications. Finally, we explore current evidence, commercialization prospects, emerging innovations like 4D printing, and the challenges and future directions in this promising field.

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

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

Hydroxypropyl methylcellulose reinforced collagen/PVA composite hydrogel wound dressing with self-adaptive, hemostasis and antibacterial ability for wound healing

Nowadays, hydrogels have been extensively and increasingly applied in the field of wound dressings in terms of their high biocompatibility and adjustable functionality. Bacterial infection can serious hinder wound healing the incomplete contact between hydrogel and wound increased the risk of infection. Thus, hydrogel wound dressings with antibacterial and can self-adapt to wound are urgently desired and still a challenge. Herein, a series of hydroxypropyl methylcellulose (HPMC) reinforced hydrogel wound dressings (CPH hydrogels) based on collagen/polyvinyl alcohol (COL/PVA) were designed and constructed, which with polyhexamethylene biguanide (PHMB) as antibacterial agent and borax as crosslinking agent. The dynamic cross-linking of reversible borate ester bond and hydrogen bonds endowed the CPH hydrogels with high adaptability and dynamic self-healing properties. The hydrogel exhibited good blood and cell biocompatibility, which with hemolysis rate lower than 5.0 % and cell survival rate higher than 90 %. The hydrogel also possessed excellent antibacterial ability for both E. coli and S. aureus by destroying the integrity of bacterial membrane. More importantly, the hydrogel with the formulation of 5 % COL, 5 %/PVA, 4 % borax and 1.75 % HPMC successfully achieved in promoting wound healing and accelerated collagen deposition, which provided a promising candidate to serve as wound dressing for wound healing.

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.

Development of multifunctional agar/κ-carrageenan/kaolinite hydrogels: Role of tetracycline and marshmallow extract loading in antibacterial and controlled release properties

This study introduces an innovative CAK hydrogel composite enhanced with tetracycline (TC) and Althaea Officinalis Extract (AOE), designed to address key challenges in wound dressing applications. The novelty lies in the hydrogel's unique dual-drug incorporation and micelle-based delivery approach, which significantly improves drug release control and mechanical properties. Incorporation of bioactive AOE and optimization using Triton X - 100 at its critical micelle concentration (CMC) lead to distinct structural transformations, such as spherical aperture formation and matrix expansion, enabling superior swelling and controlled drug release behavior. Advanced modeling, including the Korsmeyer-Peppas and Higuchi models, reveals non-Fickian diffusion mechanisms, while Response Surface Methodology (RSM) identifies optimal hydrogel parameters, achieving substantial drug release over extended durations. Mechanical evaluations highlight the drug-loaded hydrogel's exceptional tensile strength, elasticity, and energy absorption, surpassing conventional formulations and offering a mechanically robust solution. Antibacterial testing further confirms its efficacy against Gram-positive and Gram-negative bacteria, supporting its potential as a next-generation wound dressing material.

Material Design, Fabrication Strategies, and the Development of Multifunctional Hydrogel Composites Dressings for Skin Wound Management

The skin is fragile, making it very vulnerable to damage and injury. Untreated skin wounds can pose a serious threat to human health. Three-dimensional polymer network hydrogels have broad application prospects in skin wound dressings due to their unique properties and structure. The therapeutic effect of traditional hydrogels is limited, while multifunctional composite hydrogels show greater potential. Multifunctional hydrogels can regulate wound moisture through formula adjustment. Moreover, hydrogels can be combined with bioactive ingredients to improve their performance in wound healing applications. Stimulus-responsive hydrogels can respond specifically to the wound environment and meet the needs of different wound healing stages. This review summarizes the material types, structure, properties, design considerations, and formulation strategies for multifunctional hydrogel composite dressings used in wound healing. We discuss various types of recently developed hydrogel dressings, highlights the importance of tailoring their physicochemical properties, and addresses potential challenges in preparing multifunctional hydrogel wound dressings.

Nanoparticle-Enhanced Collagen Hydrogels for Chronic Wound Management

Chronic wound infections present a persistent medical challenge; however, advancements in wound dressings and antimicrobial nanomaterials offer promising solutions for improving healing outcomes. This study introduces a hydrothermal synthesis approach for producing zinc oxide (ZnO) and copper oxide (CuO) nanoparticles, subsequently incorporated into PLGA microspheres and embedded within collagen hydrogels. The nanoparticles' physicochemical properties were characterized using X-ray diffraction (XRD) to confirm crystalline structure, scanning electron microscopy (SEM) for surface morphology, and Fourier-transform infrared spectroscopy (FT-IR) to verify functional groups and successful hydrogel integration. The hydrogels were tested for antimicrobial activity against Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans, which are key pathogens in chronic wounds. Biocompatibility was assessed using the human HaCat keratinocyte cell line. Both ZnO- and CuO-loaded hydrogels exhibited broad-spectrum antimicrobial efficacy. Cytocompatibility tests demonstrated that both ZnO- and CuO-loaded hydrogels sustain cell viability and proliferation, highlighting their biocompatibility and suitability for chronic wound healing applications, with superior biological performance of ZnO-loaded hydrogels. Furthermore, the distinct antimicrobial profiles of ZnO and CuO hydrogels suggest their tailored use based on wound microbial composition, with CuO hydrogels excelling in antibacterial applications and ZnO hydrogels showing potential for antifungal treatments. These results underscore the potential of nanoparticle-based collagen hydrogels as innovative therapeutic tools for managing chronic wounds.

Biomedical applications ofBombyx morisilk in skin regeneration and cutaneous wound healing

A mere glance at the foundation of the sericulture industry to produce silk and the consequent establishment of the Silk Road to transport it; elucidates the significant role that this material has played in human history. Owing to its exceptional robustness, silk was introduced into medicine as a surgical suture approximately two millennia ago. During the last decades, silk has garnered attention as a possible source of biological-based materials that can be effectively used in regenerative medicine. Silk's unique characteristics, like its low immunogenicity, suitable adhesive properties, exceptional tensile strength, perfect hemostatic properties, adequate permeability to oxygen and water, resistance to microbial colonization, and most importantly, excellent biodegradability; make it an outstanding choice for biomedical applications. Although there are many different types of silk in nature,Bombyx mori(B. mori) silk accounts for about 90% of global production and is the most thoroughly investigated and the most commonly used. Silk fibroin (SF) and silk sericin (SS) are the two main protein constituents of silk. SF has been manufactured in various morphologic forms (e.g. hydrogels, sponges, films, etc) and has been widely used in the biomedical field, especially as a scaffold in tissue engineering. Similarly, SS has demonstrated a vast potential as a suitable biomaterial in tissue engineering and regenerative medicine. Initial studies on SF and SS as wound dressings have shown encouraging results. This review aims to comprehensively discuss the potential role of silk proteins in refining wound healing and skin regeneration.

Therapeutic potential of Brazilian green propolis and oregano (Origanum vulgare) extracts in collagen hydrogel for pressure ulcer repair: an experimental study in an animal model

This study investigated the effects of incorporating Brazilian green propolis ethanolic extract and oregano (Origanum vulgare) methanolic extract into type I collagen hydrogel to enhance pressure ulcer healing in mice. Forty-four mice were divided into four groups: untreated control, plain collagen hydrogel, collagen hydrogel with 1% green propolis extract, and collagen hydrogel with 1% oregano extract. Pressure ulcers were induced on their dorsal skin, followed by a 14-day assessment of wound area, contraction, re-epithelialization, dermal collagen density, and levels of reactive oxygen species and nitrite. Results showed significant tissue repair promotion by both propolis and oregano extracts, with oregano exhibiting superior wound contraction. These hydrogels also facilitated skin layer reorganisation and reduced reactive oxygen species and nitrite production. Collagen hydrogels containing these extracts show promising therapeutic potential for pressure ulcer treatment.

Multiple-Layer Chitosan-Based Patches Medicated With LTX-109 Antimicrobial Peptide for Modulated Local Therapy in the Management of Chronic Wounds

In response to the critical issue of chronic wound management, this research explores the development of a multiple-layer biomaterial loaded with LTX-109 a novel broad-spectrum topical antimicrobial peptide currently investigated for the treatment of bacterial skin infections. The novel patch is conceived to load and preserve the function of LTX-109, release it on site in a progressive manner, and therefore make available a device for simultaneous wounds disinfection and tissues healing. Chitosan, tannic acid and glycerol along with the solvent casting process are selected for the development of a multilayer structure in which each single layer is designed by choosing a specific composition and stability to tune its behavior and function. On the top, a protective layer to protect the wound from external contaminations, in the middle a medicated layer loaded with LTX-109 and at the bottom a multifunctional layer to modulate the release of LTX-109. Extensive characterizations show that the patch meets the essential requirements for creating an effective wound healing environment, such as absorption of exudate, maintenance of good oxygen and moisture permeability, biodegradability, biocompatibility, and sustained release of LTX-109 with fully retained antibacterial activity as demonstrated by MIC values obtained against reference bacteria.

Multifunctional Janus nanofibrous membrane with unidirectional water transport and pH-responsive color-changing for wound dressing

Chronic wounds often produce a significant volume of exudate, posing a substantial obstacle to healing. Consequently, there is a pressing demand for a versatile dressing capable of effectively managing exudate in chronic wounds. In this context, a Janus smart dressing is proposed, featuring unidirectional water transport and a pH-responsive color-changing for exudate management and wound monitoring. The dressing's mechanisms for unidirectional water transport and color changing are elucidated. The Janus dressing consists of a polyacrylonitrile (PAN)/sodium polyacrylate (SPA)/anthocyanin (An) hydrophilic layer with antioxidant and pH-sensitive functions and a poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) hydrophobic layer, enabling unidirectional exudate drainage without reverse osmosis. Studies indicate that the Janus dressing exhibits excellent air permeability, moisture permeability, mechanical properties, cytocompatibility, and antioxidant performance while promptly responding to color variations in solutions of varying pH levels. In vivo studies demonstrated the excellent wound healing ability of Janus PHBV-PAN/SPA/An membrane. Consequently, this study provides a promising solution to develop wound dressings that can effectively manage excessive wound exudate and dressing changes.

3D printed skin dressings manufactured with spongin-like collagen from marine sponges: physicochemical properties andin vitrobiological analysis

The search for innovative materials for manufacturing skin dressings is constant and high demand. In this context, the present study investigated the effects of a 3D printed skin dressing made of spongin-like collagen (SC) extract from marine sponge (Chondrilla caribensis), used in 3 concentrations of SC and alginate (C1, C2, C3). For this proposal, the physicochemical, morphological andin vitrobiological results were investigated. The results demonstrated that, after immersion, C2 presented a higher mass loss and C3 present a higher pH in experimental periods. Also, a higher porosity was observed for C1 and C2 skin dressings, with a higher swelling ratio for C2. For Fourier transform infrared, peaks of Amide A, -CH2, -COOH and C-O-C were seen. Moreover, the macroscopic image demonstrated a skin dressing with rough surface and grayish color that is naturally observed inChondrilla caribensis. For scanning electron microscopy analysis the presence of pores could be observed for all skin dressings, with fibers disposed in layers. Thein vitroanalyses demonstrated the viability of HFF-1 and L929 cell lines 70% of the values found for cell proliferation compared to Control Group. Furthermore, the cell adhesion analysis demonstrated that both cell lines adhered to the 3 different skin dressings and non-cytotoxicity was observed. Taking together, all the results suggest that the skin dressings are biocompatible and present non-cytotoxicity in thein vitrostudies, being considered a suitable material for tissue engineering proposals.

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.

Comparison of surgical wound infection and dehiscence following the use of two methods of nylon sutures and skin staples in staples in diabetic mellitus patients undergoing total knee arthroplasty surgery: a randomized clinical trial study

OBJECTIVE

Timely and complete surgical wound healing substantially affects the patient's performance and satisfaction with surgery outcomes. Sutures and staples are two common wound closure methods in total knee arthroplasty; however, their role in reducing the rate of surgical wound infections and dehiscence in diabetic patients is unclear. Therefore, this study was conducted to investigate the rate of infection and post-closure dehiscence in wounds closed with either nylon sutures or skin staples in diabetic patients undergoing total knee arthroplasty (TKA).

METHODS

This is a single-blind randomized clinical trial including 70 diabetic mellitus patients undergoing TKA. Patients were selected using a restricted random sampling method and haphazardly assigned to study groups using the permuted block randomization technique, including the suture-closed (n = 35) and staple-closed (n = 35) groups. The follow-up was 2 to 8 weeks after the surgery, evaluation of wound infection and dehiscence was performed.

RESULTS

The present study showed that there was no significant correlation between wound infection rate (P-value = 0.254) and wound dehiscence (P-value = 0.324) with the method of wound closure (i.e., sutures or staples). However, surgical wound dehiscence revealed a significant correlation with body mass index (BMI) (P-value = 0.044), Glycosylated hemoglobin (HbA1c) (P-Value = 0.001), and fasting blood glucose (FBS) (P-Value = 0.012) in diabetic mellitus patients.

CONCLUSION

The use of the staple technique compared to suture had no difference in the rate of wound opening and infection, but from a clinical point of view, the prevalence of wound opening after TKA in patients with the suture method was higher than that of staples. Further research is needed to confirm these findings and the long-term efficacy of each method.

CLINICAL TRIAL REGISTRATION

The present study was registered at the Iranian Registry of Clinical Trails (No. IRCT20230928059543N1, Trial Id:74754, approved on 12/01/2024, https://irct.behdasht.gov.ir/user/trial/74754/view ) and conducted according to Consolidated Standards of Reporting Trials (CONSORT) guidelines.

Films Based on Chitosan/Konjac Glucomannan Blend Containing Resveratrol for Potential Skin Application

Biopolymers represent a significant class of materials with potential applications in skin care due to their beneficial properties. Resveratrol is a natural substance that exhibits a range of biological activities, including the scavenging of free radicals and anti-inflammatory and anti-aging effects. In this study, chitosan/konjac glucomannan resveratrol-enriched thin films were prepared. The enrichment of biomaterials with active ingredients is a common practice, as it allows the desired properties to be obtained in the final product. To characterize the films, several analyses were performed, including infrared spectroscopy, imaging of the samples by SEM and AFM techniques, swelling analysis in pH 5.5 and 7.4, mechanical and antioxidant assays, contact angle measurements, and determination of the resveratrol release profile under the skin mimicking conditions. Resveratrol incorporation into the matrices resulted in modifications to the chemical structure and film morphology. The mechanical characteristics of films with additives were found to undergo deterioration. The sample containing 10% of resveratrol exhibited a higher swelling degree than other films. The resveratrol-modified films demonstrated a notable antioxidant capacity, a reduced contact angle, and enhanced wettability. The resveratrol release occurred rapidly initially, with a maximum of 84% and 56% of the substance released depending on the sample type. Thus, the proposed formulations have promising properties, in particular good swelling capacity, high antioxidant potential, and improved wettability, and may serve as skin dressings after further investigation.

Global Hotspots and Trends of Diabetic Foot Ulcer Therapy: A Bibliometric Analysis from 2004 and 2023

Diabetic foot ulcer (DFU) is a common complication of diabetes, associated with increased rates of amputation and mortality. In recent years, great progress has been made in the treatment of DFU, but there is still a lack of bibliometric research on the treatment of DFU.DFU therapy publications published between 1 January 2004 and 31 December 2023 were retrieved from the Web of Science Core Collection (WoSCC) database for analysis using VOSviewer and CiteSpace analytics. A total of 4833 publications on DFU from 2004 to 2023 were included in the WoSCC database. The United States had the highest productivity with 1463 papers, accounting for 30.27% of the total production, followed by China with 907 papers (18.77%) and England with 438 papers (9.06%). In terms of research institutions and journals, the University of Texas System and Journal of Wound Care published the highest number of papers. High-frequency keywords in the field of DFU therapy mainly concentrated on management, wound healing, and amputation. This study conducted a systematic bibliometric analysis of DFU therapy publications from 2004 and 2023. Improving DFU management, promoting wound healing, and reducing amputation rates are the hotspots and future trends in this field. Our work provides valuable insights into the research trajectory and future avenues of exploration in the field of DFU therapy. These findings provide strong support for academic research and clinical practice.

Asymmetric natural wound dressing based on porous chitosan-alginate hydrogel/electrospun PCL-silk sericin loaded by 10-HDA for skin wound healing: In vitro and in vivo studies

An asymmetric wound dressing introduced, inspired by the skin structure made of chitosan and alginate hydrogel as the bottom layer and electrospun PCL-silk sericin (PCL-SS) as the top layer. In addition, an anti-inflammatory, bactericidal and immunomodulatory substance, 10-hydroxydecanoic acid (10-HDA), known as queen bee acid, was loaded in inner layer. The wound dressing was thoroughly characterized and confirmed to meet the criteria of a standard wound dressing through in vitro and in vivo studies. Although the mesoporous hydrogel layer shows 175 % swelling after being immersed in PBS (pH = 7.4) for 60 min and 80 % degradation after 14 days, the top layer shows 28 % swelling and 19 % degradation in the same time intervals. The hydrogel layer supports rapid wound healing, while the top layer offers protection against infection and physical threats. The dressing demonstrated antibacterial properties and enhanced cell proliferation at 1 % 10-HDA. Finally, the wound healing performance of the complete dressing was investigated in vivo using wistar rat. Clinical and histopathological assessments, along with the analysis of biophysical parameters of the skin healing, confirm that wound dressing with 10-HDA significantly accelerates wound healing compared to control groups, without any inflammatory side effects.

An Objective Assessment of Long-term Postoperative Hyperpigmentation in Patients With Apocrine Gland-eliminated Osmidrosis Surgery

Background

Radical surgery is the best treatment for axillary osmidrosis to eliminate the apocrine glands. However, marked postoperative hyperpigmentation may occur. Clinicians need an objective skin pigmentation examination to identify and treat hyperpigmentation. In this study, we aimed to use the Taylor Hyperpigmentation Scale (an objective visual scale) for evaluating long-term hyperpigmentation after osmidrosis surgery.

Methods

Twenty female patients with Fitzpatrick skin type III-IV who had undergone osmidrosis surgery were included in this study.

Results

The findings demonstrated that although there is an initial variation in the intensity of hyperpigmentation, in the majority of patients, there is a peak in hyperpigmentation between the third and sixth months after surgery. This is then followed by a gradual decline over the ensuing months. Some patients resolve hyperpigmentation completely, suggesting reversibility.

Conclusions

These results can help guide patient expectations and provide suitable postoperative management, thereby improving patient satisfaction and overall quality of life.

Polymer- and Lipid-Based Nanostructures Serving Wound Healing Applications: A Review

Management of hard-to-heal wounds often requires specialized care that surpasses the capabilities of conventional treatments. Even the most advanced commercial products lack the functionality to meet the needs of hard-to-heal wounds, especially those complicated by active infection, extreme bleeding, and chronic inflammation. The review explores how supramolecular nanovesicles and nanoparticles-such as dendrimers, micelles, polymersomes, and lipid-based nanocarriers-can be key to introducing advanced wound healing and monitoring properties to address the complex needs of hard-to-heal wounds. Their potential to enable advanced functions essential for next-generation wound healing products-such as hemostatic functions, transdermal penetration, macrophage polarization, targeted delivery, and controlled release of active pharmaceutical ingredients (antibiotics, gaseous products, anti-inflammatory drugs, growth factors)-is discussed via an extensive overview of the recent reports. These studies highlight that the integration of supramolecular systems in wound care is crucial for advancing toward a new generation of wound healing products and addressing significant gaps in current wound management practices. Current strategies and potential improvements regarding personalized therapies, transdermal delivery, and the promising critically evaluated but underexplored polymer-based nanovesicles, including polymersomes and proteinosomes, for wound healing.

Trends in protein derived materials for wound care applications

Natural resource based polymers, especially those derived from proteins, have attracted significant attention for their potential utilization in advanced wound care applications. Protein based wound care materials provide superior biocompatibility, biodegradability, and other functionalities compared to conventional dressings. The effectiveness of various fabrication techniques, such as electrospinning, phase separation, self-assembly, and ball milling, is examined in the context of developing protein-based materials for wound healing. These methods produce a wide range of forms, including hydrogels, scaffolds, sponges, films, and bioinspired nanomaterials, each designed for specific types of wounds and different stages of healing. This review presents a comprehensive analysis of recent research that investigates the transformation of proteins into materials for wound healing applications. Our focus is on essential proteins, such as keratin, collagen, gelatin, silk, zein, and albumin, and we emphasize their distinct traits and roles in wound care management. Protein-based wound care materials show promising potential in biomedical engineering, offering improved healing capabilities and reduced risks of infection. It is crucial to explore the potential use of these materials in clinical settings while also addressing the challenges that may arise from their commercialization in the future.

Konjac glucomannan exerts regulatory effects on macrophages and its applications in biomedical engineering

Konjac glucomannan (KGM) molecular chains contain a small amount of acetyl groups and a large number of hydroxyl groups, thereby exhibiting exceptional water retention and gel-forming properties. To meet diverse requirements, KGM undergoes modification processes such as oxidation, acetylation, grafting, and cationization, which reduce its viscosity, enhance its mechanical strength, and improve its water solubility. Researchers have found that KGM and its derivatives can regulate the polarization of macrophages, inducing their transformation into classically activated M1-type macrophages or alternatively activated M2-type macrophages, and even facilitating the interconversion between M1 and M2 phenotypes. Concurrently, the modulation of macrophage polarization states holds significant importance for chronic wound healing, inflammatory bowel disease (IBD), antitumor therapy, tissue engineering scaffolds, oral vaccines, pulmonary delivery, and probiotics. Therefore, KGM has the advantages of both immunomodulatory effects (biological activity) and gel-forming properties (physicochemical properties), giving it significant advantages in a variety of biomedical engineering applications.

Multifunctional poloxamer-based thermo-responsive hydrogel loaded with human lactoferricin niosomes: In vitro study on anti-bacterial activity, accelerate wound healing, and anti-inflammation

Chronic wound infections are attributed to delayed tissue repair, which remains a major clinical challenge in long-term health care. Particularly, infections with antibiotic resistance have more serious effects on health, often resulting in unsuccessful treatments. Thus, antimicrobial peptide (AMP)-based therapy holds promise as a potential therapeutic approach to overcoming drug resistance. Conventional wound dressing is a passive strategy for wound care that is not capable of eradicating pathogens and promoting tissue repair. In this study, we aim to construct an advanced wound dressing; a thermo-responsive hydrogel incorporated with lactoferricin (Lfcin) niosome (Lfcin-Nio/hydrogel) for bacterial pathogen treatment. The Lfcin-loaded niosome (Lfcin-Nio) has a particle size of 396.91 ± 20.96 nm, 0.38 ± 0.01 of PdI, -10.5 ± 0.3 mV of ζ potential, and 72.30 ± 7.05 % Lfcin entrapment efficiency. Lfcin-Nio exhibited broad antibacterial activity on both drug-susceptible and drug-resistant strains, and also on bacteria residing in the biofilm matrix. The Lfcin-Nio/hydrogel was fabricated from 0.5 % w/v poloxamer 188-20 % w/v poloxamer 407, and supplemented with Lfcin-Nio and epidermal growth factor (EGF). The physical properties of Lfcin-Nio/hydrogels showed elasticity, swelling ability, and strong injectability with responsiveness to 33-37 °C temperatures. The biological properties of Lfcin-Nio/hydrogels exhibited a bactericidal effect against drug-resistant strains of S. aureus and P. aeruginosa, and showed less toxicity to the human skin fibroblast. It also promoted the healing of scratches by 55 % within 6 h, compared to the wound closure rate of 20 % in the cell control. The inflammatory response of the Lfcin-Nio/hydrogel-treated cells was reduced via suppression of IL-1β and COX-2 mRNA expressions. From this study, Lfcin-Nio/hydrogels can be suggested as a modern wound dressing that possesses multifunctional and beneficial properties for the management of chronic wound infections.

Two Novel Membranes Based on Collagen and Polyphenols for Enhanced Wound Healing

Two novel membranes based on collagen and two polyphenols, taxifolin pentaglutarate (TfG5) and a conjugate of taxifolin with glyoxylic acid (DfTf), were prepared. Fourier transform infrared spectroscopy examination confirmed the preservation of the triple helical structure of collagen. A scanning electron microscopy study showed that both materials had a porous structure. The incorporation of DfTf into the freeze-dried collagen matrix increased the aggregation of collagen fibers to a higher extent than the incorporation of TfG5, resulting in a more compact structure of the material containing DfTf. It was found that NIH/3T3 mouse fibroblasts were attached to, and relatively evenly spread out on, the surface of both newly obtained membranes. In addition, it was shown that the membranes enhanced skin wound healing in rats with a chemical burn induced by acetic acid. The treatment with the materials led to a faster reepithelization and granulation tissue formation compared with the use of other agents (collagen without polyphenols and buffer saline). It was also found that, in the wound tissue, the level of thiobarbituric acid reactive substances (TBARS) was significantly higher and the level of low-molecular-weight SH-containing compounds (RSH) was significantly lower than those in healthy skin, indicating a rise in oxidative stress at the site of injury. The treatment with collagen membranes containing polyphenols significantly decreased the TBARS level and increased the RSH level, suggesting the antioxidant/anti-inflammatory effect of the materials. The membrane containing TfG5 was more effective than other ones (the collagen membrane containing DfTf and collagen without polyphenols). On the whole, the data obtained indicate that collagen materials containing DfTf and TfG5 have potential as powerful therapeutic agents for the treatment of burn wounds.

Cord Blood Platelet Lysate-Loaded Thermo-Sensitive Hydrogels for Potential Treatment of Chronic Skin Wounds

BACKGROUND/OBJECTIVES

Chronic skin wounds (CSWs) are a worldwide healthcare problem with relevant impacts on both patients and healthcare systems. In this context, innovative treatments are needed to improve tissue repair and patient recovery and quality of life. Cord blood platelet lysate (CB-PL) holds great promise in CSW treatment thanks to its high growth factors and signal molecule content. In this work, thermo-sensitive hydrogels based on an amphiphilic poly(ether urethane) (PEU) were developed as CB-PL carriers for CSW treatment.

METHODS

A Poloxamer 407®-based PEU was solubilized in aqueous medium (10 and 15% w/v) and added with CB-PL at a final concentration of 20% v/v. Hydrogels were characterized for their gelation potential, rheological properties, and swelling/dissolution behavior in a watery environment. CB-PL release was also tested, and the bioactivity of released CB-PL was evaluated through cell viability, proliferation, and migration assays.

RESULTS

PEU aqueous solutions with concentrations in the range 10-15% w/v exhibited quick (within a few minutes) sol-to-gel transition at around 30-37 °C and rheological properties modulated by the PEU concentration. Moreover, CB-PL loading within the gels did not affect the overall gel properties. Stability in aqueous media was dependent on the PEU concentration, and payload release was completed between 7 and 14 days depending on the polymer content. The CB-PL-loaded hydrogels also showed biocompatibility and released CB-PL induced keratinocyte migration and proliferation, with scratch wound recovery similar to the positive control (i.e., CB-PL alone).

CONCLUSIONS

The developed hydrogels represent promising tools for CSW treatment, with tunable gelation properties and residence time and the ability to encapsulate and deliver active biomolecules with sustained and controlled kinetics.

Endogenous/exogenous stimuli‐responsive smart hydrogels for diabetic wound healing

Diabetes significantly impairs the body's wound‐healing capabilities, leading to chronic, infection‐prone wounds. These wounds are characterized by hyperglycemia, inflammation, hypoxia, variable pH levels, increased matrix metalloproteinase activity, oxidative stress, and bacterial colonization. These complex conditions complicate effective wound management, prompting the development of advanced diabetic wound care strategies that exploit specific wound characteristics such as acidic pH, high glucose levels, and oxidative stress to trigger controlled drug release, thereby enhancing the therapeutic effects of the dressings. Among the solutions, hydrogels emerge as promising due to their stimuli‐responsive nature, making them highly effective for managing these wounds. The latest advancements in mono/multi‐stimuli‐responsive smart hydrogels showcase their superiority and potential as healthcare materials, as highlighted by relevant case studies. However, traditional wound dressings fall short of meeting the nuanced needs of these wounds, such as adjustable adhesion, easy removal, real‐time wound status monitoring, and dynamic drug release adjustment according to the wound's specific conditions. Responsive hydrogels represent a significant leap forward as advanced dressings proficient in sensing and responding to the wound environment, offering a more targeted approach to diabetic wound treatment. This review highlights recent advancements in smart hydrogels for wound dressing, monitoring, and drug delivery, emphasizing their role in improving diabetic wound healing. It addresses ongoing challenges and future directions, aiming to guide their clinical adoption.

Synthesis of Carboxylate-Dialdehyde Cellulose to Use as a Component in Composite Thin Films for an Antibacterial Material in Wound Dressing

Wound infections can lead to life-threatening infection and death. Antibacterial materials from biopolymers in the form of films are a promising strategy for wound dressings. Carboxylate-dialdehyde cellulose (CDAC) is a proper candidate for use as an antibacterial material due to its biocompatibility, nontoxicity, and antibacterial property. Additionally, CDAC can be synthesized from cellulose through environmentally friendly and nontoxic methods. Thus, this study aims to synthesize CDAC from microcrystalline cellulose (MCC) PH102 and use it in composite films for an antibacterial application. The CDAC was synthesized using Fe2+/H2O2, followed by NaIO4 oxidation. The obtained CDAC was characterized in terms of carboxylate and aldehyde content as well as FTIR and XRD spectra. The CDAC was mixed with HPMC in different ratios to prepare films. To determine the optimal formulation for clindamycin HCl loading, the films were evaluated for morphology, mechanical properties, and swelling ratio. Finally, the films containing clindamycin HCl were evaluated for drug loading content, in vitro drug release, and antibacterial activity. This study found that CDAC contained 2.1 ± 0.2 carboxylate and 4.15 ± 0.2 mmol/g of aldehyde content. The FTIR spectra confirmed the successful synthesis. X-ray diffractograms indicated that CDAC was less crystalline than MCC. The film, consisting of CDAC and HPMC E50 in the ratio of 2:1 (D2H1), was identified as the most suitable for clindamycin HCl loading due to its superior appearance, mechanical strength, and swelling properties compared to other formulations. D2H1 exhibited a high drug loading capacity (91.49 ± 5.48%) and demonstrated faster drug release than the film composed only of HPMC because of the higher swelling ratio and lower mechanical strength. This formulation was effective against Staphylococcus aureus (MSSA), S. aureus (MRSA), and Pseudomonas aeruginosa. Furthermore, the D2H1 film containing clindamycin HCl showed a larger inhibition zone against these bacteria, likely due to a synergistic effect. This study found that CDAC has the potential to be applied as an antibacterial material for wound dressing.

Advances and impact of human amniotic membrane and human amniotic-based materials in wound healing application

Wound healing is a complicated process, especially when surgical, traumatic, burn, or pathological injury occurs, which requires different kinds of dressing covers including hydrogels, hydrocolloids, alginates foams and films for treatment. The human amniotic membrane (hAM) is a biodegradable extracellular matrix with unique and tailorable physicochemical and biological properties, generated by the membrane itself or other cells that are located on the membrane surface. It is noted as a promising aid for wound healing and tissue regeneration due to the release of growth factors and cytokines, and its antibacterial and immunosuppressive properties. Moreover, hAM has optimal physical, biological, and mechanical properties, which makes it a much better option as a regenerative skin treatment than existing alternative materials. In addition, this layer has a structure with different layers and cells with different functions, which act as a regenerative geometry and reservoir of bioactive substances and cells for wound healing. In the present work, the structural and biological features of hAM are introduced as well as the application of this layer in different forms of composites to enhance wound healing. Future studies are recommended to detect possible further functionalization to enhance the hAM effectiveness on wound healing.

Silk fibroin/chitosan/montmorillonite sponge dressing: Enhancing hemostasis, antimicrobial activity, and angiogenesis for advanced wound healing applications

Open wounds present a significant challenge in healthcare, requiring careful management to prevent infection and promote wound healing. Advanced wound dressings are critical need to enhance their hemostatic capabilities, antimicrobial properties, and ability to support angiogenesis and sustained moisture for optimal healing. This study introduces a flexible hemostatic dressing designed for open wounds, integrating chitosan (CS) for hemostasis and biocompatibility, silk fibroin (SF) for mechanical strength, and montmorillonite (MMT) for enhanced drug transport. The CSSF@MMT dressings showed promising mechanical strength and swift hemostasis. The CIP-loaded CSSF@MMT demonstrated sustained release for up to one week, exhibiting antibacterial properties against both Gram-positive and Gram-negative bacteria. In vitro cell migration assay demonstrated that erythropoietin-loaded CSSF@MMT dressings promoted the proliferation and migration of endothelial cells. Similarly, the chick embryo chorioallantoic membrane study indicated the same dressings exhibited a significant increase in vascular regeneration. This research suggests that the CSSF@MMT sponge dressing, incorporated with CIP and erythropoietin, holds promise in effectively halting bleeding, creating a protective environment, diminishing inflammation, and fostering wound tissue regeneration. This potential makes it a significant advancement in open wound care, potentially lowering the need for limb amputation and decreasing wound care burden worldwide.

Comparison of different modern wound dressings on full-thickness murine cutaneous wound healing with wild-type and type-2 diabetes db/db mice

BACKGROUND

To evaluate the process of cutaneous wound healing, experiments have been conducted. However, to date, what modern wound dressings are suitable remains unclear. Therefore, this study aimed to compare the healing process in different modern wound dressings to determine their suitability in experimental acute wound and chronic diabetic wound.

MATERIALS AND METHODS

Twelve C57BL/6J mice and eleven db/db mice were subjected to full-thickness wound injuries. The mice were divided into the following four groups: hydrocolloid, form, film, and gauze groups in both wild-type and db/db mice. Wound healing was assessed until day 14.

RESULTS

In the wild-type groups, all wounds were healed and completed re-epithelialization by day 14. However, the wound surface was dry, and the periwound was hypercontracted in the wild-type-form and wild-type-gauze groups. In the db/db groups, wounds were not healed until day 14. Wound exudates in the db/db-hydrocolloid group were abundant and gradually increased until day 14. Wound exudates in the db/db-film group were present until day 14. Conversely, in the db/db-form and db/db-gauze groups, the wound surface was dry, and the periwound was hypercontracted.

CONCLUSION

These results showed that hydrocolloid and film dressings are suitable modern wound dressings for the mice wound models of acute wound and chronic diabetic wound. Moreover, using either hydrocolloid or film dressing depending on the purpose of the study on cutaneous wound healing in diabetes is necessary.

Enhanced healing of burn wounds by multifunctional alginate-chitosan hydrogel enclosing silymarin and zinc ‎oxide ‎nanoparticles

Multifunctional wound dressings have been applied for burn injuries to avoid complications and promote tissue regeneration. In the present study, we fabricated a natural alginate-chitosan hydrogel comprising silymarin and green-synthesized zinc ‎oxide ‎nanoparticles (ZnO NPs). Then, the physicochemical attributes of ZnO NPs and loaded hydrogels were analyzed. Afterward, wound healing efficacy was evaluated in a rat model of full-thickness dermal burn wounds. The findings indicated that ZnO NPs were synthesized via reduction with phytochemicals from Elettaria cardamomum seeds extract. The microscopic images exhibited fairly spherical ZnO NPs (35-45 nm), and elemental analysis verified the relevant composition. The hydrogel, containing silymarin and biosynthesized ZnO NPs, displayed a uniform appearance, smooth surfaces, and a porous structure. Moreover, infrared spectroscopy ‎identified functional groups, confirming the successful loading without adverse interactions. The obtained hydrogel exhibited great water absorption, high porosity, sustainable degradation for several days, and enhanced antioxidant capability of the combined loaded component. In vivo studies revealed faster and superior wound healing, achieving nearly complete closure by day 21. Histopathology confirmed improved cell growth, tissue regeneration, collagen deposition, and neovascularization. It is believed that this multifunctional hydrogel-based wound dressing can be applied for effective burn wound treatment.

Trends and prospects in nursing care for diabetic foot: A bibliometric analysis from 2003 to 2023

BACKGROUNDS

Diabetic foot (DF) is a globally significant concern, with complications like diabetic foot ulcers (DFUs) posing major challenges despite medical advancements. Effective nursing strategies are crucial to preventing DF progression and reducing disability risk. However, nursing research in DF care is fragmented, necessitating a comprehensive bibliometric analysis to identify key trends, influential contributors, and critical research areas.

PURPOSE

This study explored current trends in nursing methods for DF care and their impact on patient outcomes, utilizing CiteSpace, VOSviewer, and Bibliometrix to identify key contributors, influential countries, and noteworthy topics, aiming to provide valuable insights for healthcare professionals and researchers in the field.

METHODS

Relevant publications from the Web of Science (WOS) Core Collection Science Citation Index Expanded were retrieved for the period between 2003 and 2023. We included peer-reviewed original articles or reviews related to diabetic foot (DF) and nursing. The following criteria were used for exclusion: ① conference abstracts or corrigendum documents, ② unpublished articles, ③ repeated publications, ④ unrelated articles, ⑤ case reports, and ⑥ qualitative studies. CiteSpace was employed to identify top authors, institutions, countries, keywords, co-cited authors, journals, references, and research trends. VOSviewer was used to generate a network of authors, journals, and references. Bibliometrix was utilized to create maps of cooperating countries and keyword frequency charts, as well as a Sankey diagram illustrating the relationship between authors, keywords, and countries.

RESULTS

A total of 305 relevant articles were included in this study. The research pertaining to nursing aspects of diabetic foot care exhibited a noticeable upward trend. The analysis in this study revealed that "amputation" held the highest centrality, indicating a critical area of focus in nursing interventions to prevent severe outcomes. "Diabetic foot ulcer" ranked first in terms of citation rate, emphasizing the ongoing challenges in managing DFUs through nursing care. In recent years, there was a shift in focus towards keywords such as "pressure ulcers", "burden", and "chronic wound" highlighting the evolving priorities in nursing research to address complex wound care, patient burden, and long-term management strategies.

CONCLUSIONS

The current primary research focuses in nursing care for diabetic foot (DF) include wound management, offloading techniques, sensory protection, anti-infective treatment, education and self-management, and multidisciplinary teamwork. Future research should prioritize developing innovative nursing interventions tailored to individual patient needs, integrating advanced technologies like telemedicine and wearable devices for continuous monitoring, and exploring the psychological aspects of DFU management to improve patient adherence and outcomes. Additionally, more longitudinal studies are needed to assess the long-term effectiveness of various nursing strategies on patient quality of life.

Tannic acid-reinforced soy protein/oxidized tragacanth gum-based multifunctional hemostatic film for regulation of wound healing

With recent advances in the field of tissue engineering, composite films with biocompatibility, antimicrobial properties, and wound healing properties have gained potential applications in the field of wound dressings. In this research work, composite films of soy protein (S)/oxidized tragacanth gum (G) were successfully made using the solution casting process. The metal-organic framework containing curcumin (MOF) with concentrations of 5 and 10 wt% and tannic acid (TA) with concentrations of 6 and 12 wt% were entered into the polymer film. Surface morphology with scanning electron microscope (FE-SEM), thermal stability, mechanical properties, chemical structure, antioxidant, water absorption, cell viability, antibacterial activity, and biodegradability of the prepared films were investigated in laboratory conditions. In addition, the toxicity of the films in the cell environment was investigated, and the results showed that cell growth and proliferation improved in the presence of the prepared films, especially films SG/MOF10/TA6 and SG/MOF10/TA12 due to the presence of TA and MOF containing curcumin. Also, the antibacterial activity of the films showed that the presence of tannic acid and curcumin in the structure of the films increases their ability against pathogens. According to the obtained results, the newly produced nanocomposite film (SG/MOF10/TA12) has a high potential to be used for wound dressing due to its favorable characteristics and was considered the optimal film.

Material Technologies for Improved Diabetic Foot Ulcer (DFU) Treatment: A Questionnaire Study of Healthcare Professionals' Needs

Background/Objectives: Diabetic foot ulcers (DFUs) are a common and severe complication of diabetic patients, with significant global prevalence and associated health burdens, including high recurrence rates, lower-limb amputations, and substantial associated economic costs. This study aimed to understand the user needs of healthcare professionals treating diabetic foot ulcers for newly developed material technologies. Methods: An open-ended questionnaire was used to identify user needs, identify the limitations of current treatments, and determine the specific requirements for ideal treatment. This information was used to develop a list of key considerations for creating innovative material technologies to improve diabetic wound treatment results. Results: Most respondents indicated that they followed published treatment guidelines for DFUs but noted that treatment often required a case-specific approach. Antibiotics and surgical debridement were commonly used for infection control. The participants showed a strong preference for wound dressings with lasting antibacterial properties. Respondents identified ideal properties for new products, including ease of use, enhanced antibacterial properties, affordability, and targeted biological activity. The respondents also highlighted the importance of a holistic approach to DFU management, integrating product development with comprehensive care strategies and patient education. Conclusions: This study highlights the complexity of DFU care, emphasizing that no single product can address all treatment needs. Future materials could focus on combination therapies and specific use cases. Additionally, understanding global variations in treatment practices and educating users on the proper application of newly developed material technologies is crucial for improving the management of DFUs and patient outcomes.

Physically Cross-Linked PVA Hydrogels as Potential Wound Dressings: How Freezing Conditions and Formulation Composition Define Cryogel Structure and Performance

Objectives: Hydrogels produced using the freeze-thaw method have demonstrated significant potential for wound management applications. However, their production requires precise control over critical factors including freezing temperature and the choice of matrix-forming excipients, for which no consensus on the optimal conditions currently exists. This study aimed to address this gap by evaluating the effects of the above-mentioned variables on cryogel performance. Methods: Mechanical properties, absorption capacity, and microstructure were assessed alongside advanced analyses using differential scanning calorimetry (DSC) and low-field nuclear magnetic resonance relaxometry (LF TD NMR). Results: The results demonstrated that fully hydrolyzed polyvinyl alcohol (PVA) with a molecular weight above 61,000 g/mol is essential for producing high-performance cryogels. Among the tested formulations, an 8% (w/w) PVA56-98 solution (Mw~195,000; DH = 98.0-98.8%) with 10% (w/w) propylene glycol (PG) provided the best balance of stretchability, durability, and low adhesion. Notably, while -25 °C is often used for cryogel preparation, freezing the gel precursor at -80 °C yielded superior results, producing materials with more open, interconnected structures and enhanced mechanical strength and elasticity-deviating from conventional practices. Conclusions: The designed cryogel prototypes exhibited functional properties comparable to or even surpassing commercial wound dressings, except for absorption capacity, which remained lower. Despite this, the cryogel prototypes demonstrated potential as wound dressings, particularly for use in dry or minimally exuding wounds. All in all, this study provides a comprehensive analysis of the physicochemical and functional properties of PVA cryogels, establishing a strong foundation for the development of advanced wound dressing systems.

Advances in Mussel Adhesion Proteins and Mussel-Inspired Material Electrospun Nanofibers for Their Application in Wound Repair

Mussel refers to a marine organism with strong adhesive properties, and it secretes mussel adhesion protein (MAP). The most vital feature of MAP is the abundance of the 3,4-dihydroxyphenylalanine (DOPA) group and lysine, which have antimicrobial, anti-inflammatory, antioxidant, and cell adhesion-promoting properties and can accelerate wound healing. Polydopamine (PDA) is currently the most widely used mussel-inspired material characterized by good adhesion, biocompatibility, and biodegradability. It can mediate various interactions to form functional coatings on cell-material surfaces. Nanofibers based on MAP and mussel-inspired materials have been exerting a vital role in wound repair, while there is no comprehensive review presenting them. This Review introduces the structure of MAPs and their adhesion mechanisms and mussel-inspired materials. Second, it introduces the functionalized modification of MAPs and their inspired materials in electrospun nanofibers and application in wound repair. Finally, the future development direction and coping strategies of MAP and mussel-inspired materials are discussed. Moreover, this Review can offer novel strategies for the application of nanofibers in wound repair and bring about new breakthroughs and innovations in tissue engineering and regenerative medicine.

Advancements in wound management: integrating nanotechnology and smart materials for enhanced therapeutic interventions

Wound management spans various techniques and materials tailored to address acute and chronic non-healing wounds, with the primary objective of achieving successful wound closure. Chronic wounds pose additional challenges, often necessitating dressings to prepare the wound bed for subsequent surgical procedures like skin grafting. Ideal dressing materials should not only expedite wound healing but also mitigate protein, electrolyte, and fluid loss while minimizing pain and infection risk. Nanotechnology has emerged as a transformative tool in wound care, revolutionizing the landscape of biomedical dressings. Its application offers remarkable efficacy in accelerating wound healing and combating bacterial infections, representing a significant advancement in wound care practices. Integration of nanotechnology into dressings has resulted in enhanced properties, including improved mechanical strength and controlled drug release, facilitating tailored therapeutic interventions. This review article comprehensively explores recent breakthroughs in wound healing therapies, with a focus on innovative medical dressings such as nano-enzymes. Additionally, the utilization of smart materials, like hydrogels and electroactive polymers, in wound dressings offers dynamic functionalities to promote tissue regeneration. Emerging concepts such as bio-fabrication, microfluidic systems, bio-responsive scaffolds, and personalized therapeutics show promise in expediting wound healing and minimizing scarring. Through an in-depth exploration of these advancements, this review aims to catalyze a paradigm shift in wound care strategies, promoting a patient-centric approach to therapeutic interventions.

Clinical efficacy and safety of a silver ion-releasing foam dressing on hard-to-heal wounds: a meta-analysis

OBJECTIVE

Delayed or stalled healing in open wounds can result from persisting chronic inflammation related to infection and/or persistent bacterial colonisation and biofilm. Treatment of hard-to-heal wounds focuses on debridement and exudate management, but also on infection prevention and control. Silver dressings have been evaluated in randomised clinical trials (RCTs); this meta-analysis evaluated the efficacy and safety of a silver ion-releasing foam dressing (Biatain Ag; Coloplast A/S, Denmark) to treat hard-to-heal wounds.

METHOD

Literature databases (PubMed and Cochrane Library) were searched for studies on silver ion-releasing foam dressings in the treatment of hard-to-heal wounds. Individual patient data from four RCTs were obtained and included in the meta-analysis.

RESULTS

Findings showed that treatment with the silver ion-releasing foam dressing was associated with a significantly higher relative reduction in wound area after four (least squares-mean difference (LS-MD): -12.55%, 95% confidence interval (CI): (-15.95, -9.16); p<0.01) and six weeks of treatment (LS-MD: -11.94%, 95%CI: (-17.21, -6.68); p<0.01) compared with controls. Significant benefits were also observed for time to disappearance of odour (hazard ratio: 1.61, 95%CI: (1.31, 1.98); p<0.01), relative reduction of exudate (LS-MD: -5.15, 95%CI: (-7.36, -2.94); p<0.01), proportion of patients with periwound erythema (relative risk (RR): 0.81, 95%CI: (0.69; 0.94); p<0.01), and less pain at dressing removal (LS-MD: -0.35, 95%CI: (-0.63, -0.06); p=0.02). No differences regarding safety outcomes were identified.

CONCLUSION

This meta-analysis has demonstrated beneficial outcomes and a good tolerability profile for silver ion-releasing foam dressings in the treatment of moderate-to-highly exuding wounds with delayed healing compared with control dressings.

Evaluation of MDR-specific phage Pɸ-Mi-Pa loaded mucoadhesive electrospun nanofibrous scaffolds against drug-resistant Pseudomonas aeruginosa- induced wound infections in an animal model

Given the escalating prevalence of drug-resistant wounds, there is a justified imperative to explore innovative and more efficacious therapies that diverge from conventional, ineffective wound healing approaches. This research has introduced a strategy to address multi-drug resistant (MDR) Pseudomonas aeruginosa infections in a chronic wound model, employing MDR-specific phage Pɸ-Mi-Pa loaded onto mucoadhesive electrospun scaffolds. A cocktail of three isolates of P. aeruginosa-specific lytic phages, Pɸ-Mi-Pa 51, Pɸ-Mi-Pa 120, and Pɸ-Mi-Pa 133 were incorporated into varying ratios of fabricated PCL-PVP polymer. These formulations were assessed for their therapeutic efficacy in achieving bacterial clearance in P. aeruginosa-induced wound infections. The study encompassed biological characterization through in vivo wound healing assessments, histology, and histomorphometry. Additionally, morphological, mechanical, and chemical analyses were conducted on the fabricated PCL-PVP electrospun nanofibrous scaffolds. Three clonal differences of the MDR P. aeruginosa-specific phages (Pɸ-Mi-Pa 51, Pɸ-Mi-Pa 120, and Pɸ-Mi-Pa 133) produced lytic activity and were seen to produce distinct and clear zones of inhibition against MDR P. aeruginosa strains Pa 051, Pa 120 and Pa 133 respectively. The average porosity of the nanofibrous scaffolds PB 1, PB 2, PB 3, and PB 4 were 12.2 ± 0.3 %, 22.1 ± 0.7 %, 31.1 ± 2.4 %, 28.0 ± 0.8 % respectively. In vitro cumulative release of MDR-specific phage Pɸ-Mi-Pa from the mucoadhesive electrospun nanofibrous scaffolds was found to be 70.91 % ± 1.02 % after 12 h of incubation after an initial release of 42.8 % ± 3.01 % after 1 h. Results from the in vivo wound healing study revealed a substantial reduction in wound size, with formulations PB 2 and PB 3 exhibiting the most significant reduction in wound size, demonstrating statistically significant results on day 5 (100 % ± 31.4 %). These findings underscore the potential of bacteriophage-loaded electrospun PCL-PVP nanofibrous scaffolds for treating drug-resistant wounds, generating tissue substitutes, and overcoming certain limitations associated with conventional wound care matrices.

Silk Fibroin Nanofibers: Advancements in Bioactive Dressings through Electrospinning Technology for Diabetic Wound Healing

BACKGROUND

Non-healing diabetic wounds represent a significant clinical challenge globally, necessitating innovative approaches in drug delivery to enhance wound healing. Understanding the pathogenesis of these wounds is crucial for developing effective treatments. Bioactive dressings and polymeric nanofibers have emerged as promising modalities, with silk biomaterials gaining attention for their unique properties in diabetic wound healing.

PURPOSE OF REVIEW

The purpose of this review is to examine the challenges and innovations in treating non-healing diabetic wounds, emphasizing the global burden and the need for effective solutions. This review explores the complex mechanisms of wound healing in diabetes and evaluates the therapeutic potential of bioactive dressings and polymeric nanofibers. Special focus is given to the application of silk biomaterials, particularly silk fibroin, for wound healing, detailing their properties, mechanisms, and clinical translation. This review also describes various nanofiber fabrication methods, especially electrospinning technology, and presents existing evidence on the effectiveness of electrospun silk fibroin formulations.

RECENT FINDINGS

Recent advancements highlight the potential of silk biomaterials in diabetic wound healing, owing to their biocompatibility, mechanical strength, and controlled drug release properties. Electrospun silk fibroin-based formulations have shown promising results in preclinical and clinical studies, demonstrating accelerated wound closure and tissue regeneration.

SUMMARY

Non-healing diabetic wounds present a significant healthcare burden globally, necessitating innovative therapeutic strategies. Bioactive dressings and polymeric nanofibers, particularly silk-based formulations fabricated through electrospinning, offer promising avenues for enhancing diabetic wound healing. Further research is warranted to optimize formulation parameters and validate efficacy in larger clinical trials.

Advancements in diabetic foot ulcer research: Focus on mesenchymal stem cells and their exosomes

Diabetes represents a widely acknowledged global public health concern. Diabetic foot ulcer (DFU) stands as one of the most severe complications of diabetes, its occurrence imposing a substantial economic burden on patients, profoundly impacting their quality of life. Despite the deepening comprehension regarding the pathophysiology and cellular as well as molecular responses of DFU, the current therapeutic arsenal falls short of efficacy, failing to offer a comprehensive remedy for deep-seated chronic wounds and microvascular occlusions. Conventional treatments merely afford symptomatic alleviation or retard the disease's advancement, devoid of the capacity to effectuate further restitution of compromised vasculature and nerves. An escalating body of research underscores the prominence of mesenchymal stem cells (MSCs) owing to their paracrine attributes and anti-inflammatory prowess, rendering them a focal point in the realm of chronic wound healing. Presently, MSCs have been validated as a highly promising cellular therapeutic approach for DFU, capable of effectuating cellular repair, epithelialization, granulation tissue formation, and neovascularization by means of targeted differentiation, angiogenesis promotion, immunomodulation, and paracrine activities, thereby fostering wound healing. The secretome of MSCs comprises cytokines, growth factors, chemokines, alongside exosomes harboring mRNA, proteins, and microRNAs, possessing immunomodulatory and regenerative properties. The present study provides a systematic exposition on the etiology of DFU and elucidates the intricate molecular mechanisms and diverse functionalities of MSCs in the context of DFU treatment, thereby furnishing pioneering perspectives aimed at harnessing the therapeutic potential of MSCs for DFU management and advancing wound healing processes.

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.

Advances in Electrospun Nanofiber Membranes for Dermatological Applications: A Review

In recent years, a wide variety of high-performance and versatile nanofiber membranes have been successfully created using different electrospinning methods. As vehicles for medication, they have been receiving more attention because of their exceptional antibacterial characteristics and ability to heal wounds, resulting in improved drug delivery and release. This quality makes them an appealing choice for treating various skin conditions like wounds, fungal infections, skin discoloration disorders, dermatitis, and skin cancer. This article offers comprehensive information on the electrospinning procedure, the categorization of nanofiber membranes, and their use in dermatology. Additionally, it delves into successful case studies, showcasing the utilization of nanofiber membranes in the field of skin diseases to promote their substantial advancement.