Advances in Wound Management

Construction of 3D-fabric-based triple-decker agar/sodium alginate/Ca2+ dual-network composite for wound dressing

This study designed a novel multifunctional Janus structure dressing (DNCD dressing) composed of spacer fabric, agar/sodium alginate/calcium ion dual-network aerogel, methylene blue, and AgNO3-added thermoplastic polyurethane nanofiber membrane. The unidirectional liquid transport and absorbency tests prove that the DNCD dressing can unidirectionally transport liquids within just two seconds and possesses a liquid absorption ratio of 875.3 %. The unique open structure formed by the spacer fabric and liquid transport channels provides excellent air permeability as well as a suitable water vapor transmission rate, reaching 584.96 mm/s, 10.3 L/min, and 1104.82 g/m2/24 h, respectively. The exceptional compressive strength (216.78 kPa) and compressive modulus (515.23 kPa) of the dressing can provide protection for the wound. Antibacterial tests demonstrate that the silver ion-added DNCD dressing can eradicate >99 % of Escherichia coli and Staphylococcus aureus, while the added methylene blue can effectively monitor the survival status of bacteria. The low BCI value and the hemolysis ratio of <5 % indicate that the DNCD dressing has a certain hemostatic ability and does not cause hemolysis. The results of cytotoxicity tests and full-thickness skin defect models show that the DNCD dressing has good cytocompatibility and the potential to promote wound healing.

New experimental model to evaluate the effect of negative pressure wound therapy and viscosity exudates in foam dressings using confocal microscopy

Negative pressure wound therapy is currently one of the most popular treatment approaches that provide a series of benefits to facilitate healing, including increased local blood perfusion with reduced localized oedema and control of wound exudate. The porous foam dressing is a critical element in the application of this therapy and its choice is based on its ability to manage exudate. Industry standards often employ aqueous solutions devoid of proteins to assess dressing performance. However, such standardized tests fail to capture the intricate dynamics of real wounds, oversimplifying the evaluation process. This study aims to evaluate the technical characteristics of two different commercial polyurethane foam dressings during negative pressure wound therapy. We introduce an innovative experimental model designed to evaluate the effects of this therapy on foam dressings in the presence of viscous exudates. Our findings reveal a proportional increase in dressing fibre occupancy as pressure intensifies, leading to a reduction in dressing pore size. The tests underscore the pressure system's diminished efficacy in fluid extraction with increasing fluid viscosity. Our discussion points to the need of establishing standardized guidelines for foam dressing selection based on pore size and the necessity of incorporating real biological exudates into industrial standards.

Improving outcomes for patients with hard-to-heal wounds following adoption of the Wound Hygiene Protocol: real-world evidence

OBJECTIVE

To evaluate the impact of a four-step biofilm-based wound care strategy, Wound Hygiene Protocol (WHP: cleanse, debride, refashion, and dress), on hard-to-heal wounds.

METHOD

This was a prospective, real-world analysis of hard-to-heal wounds managed with the WHP that incorporated Aquacel Ag+ (Convatec Ltd., UK) dressings. Data were captured electronically between April 2021 and December 2022. The primary endpoint was change in wound volume from baseline to final assessment.

RESULTS

A total of 693 wounds in 669 patients (median patient age: 74 years) were included in the analysis with a median treatment time of 31 days. Most health professionals were general nurses (50%) or nurse practitioners (38%). Patient homes (27%) and community clinics (27%) were the most common clinical settings. Venous leg ulcers (26%) and pressure ulcers/injuries (17%) were the most common wound type. Duration was >12 months in 21% of wounds. At baseline, the mean wound volume was 57.8cm3. At the final assessment, mean wound volume was 17.2cm3, corresponding to an 80% reduction from baseline; p<0.001). At baseline, 66% of wounds were static or deteriorating. At final assessment, this had decreased to 5%, and 94% had improved or healed. Exudate levels were moderate or high in 69% of wounds at baseline which decreased to 25% at final assessment (p<0.001). Suspected biofilm and local wound infection decreased from 79% and 43%, respectively, at baseline, to 18% and 3%, respectively, at final assessment (p<0.001 for both).

CONCLUSION

The WHP is a new proposed standard of care that successfully treated hard-to-heal wounds by addressing the key local barriers to wound healing.

The Effect of Virtual Reality Application on Pain During Wound Care Dressing Change: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

To evaluate the effect of virtual reality application on pain during a wound care dressing change.

DESIGN

Systematic review and meta-analysis DATA SOURCES: PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL (EBSCOhost), and YÖKTEZ REVIEW/ANALYSIS METHODS: The last screening of all databases was performed on 20.07.2022. Parallel-group RCTs suitable for the research subject were included in the study. The "Cochrane risk-of-bias tool" was used to measure the risk of bias. A heterogeneity test was done with the I2 value and the p value for the Q statistics. Five methods were employed to assess publication bias. Sensitivity analysis was performed for studies with a high risk of bias.

RESULTS

As a result of the screening, 13 RCTs involving 882 wound care patients were included in the study. It was determined that the virtual reality application reduced pain moderately during a wound care dressing change (SMD= -0.60; 95% CI= -0.73 and -0.46; p < .001). The fixed effect model was used because the value of heterogeneity (I2 = 0%, p = 0.796) was low in the analysis. No significant results were obtained in the moderator analysis.

CONCLUSION

It was found that the virtual reality application moderately reduced pain during a wound dressing change and was a reliable application. However, it was suggested that the virtual reality application alone was insufficient to reduce pain during wound care and should be applied together with analgesic or anesthetic drugs included in the standard wound care procedure.

Sanchi-mediated inactivation of IL1B accelerates wound healing through the NFκB pathway deficit

Context

Sanchi promotes wound healing by repressing fibroblast proliferation.

Objective

This study examined the effect of Sanchi on keratinocytes (KCs) and microvascular endothelial cells (MECs) and rats with skin injury.

Materials & methods

Hydrogels containing different concentrations of Sanchi extract were prepared to observe wound closure over 10 days. SD rats were divided into the control, Hydrogel, 5% Hydrogel, 10% Hydrogel, 10% Hydrogel + Ad5-NC, and 10% Hydrogel + Ad5-IL1B groups. KCs and MECs were induced with H2O2 for 24 h. Cell viability, apoptosis, and the levels of inflammation- and oxidative stress-related factors were examined. The effect of IL1B on wound healing was also evaluated.

Results

Compared to the Control group (83% ± 7.4%) or Hydrogel without Sanchi extract (84% ± 8.5%), Hydrogel with 5% (95% closure ± 4.0%) or 10% Sanchi extract (98% ± 1.7%) accelerated wound healing in rats and attenuated inflammation and oxidative stress. Hydrogels containing Sanchi extract increased collagen deposition and CD31 expression in tissues. H2O2 (100 μM) induced injury in KCs and MECs, whereas Sanchi rescued the viability of KCs and MECs. Sanchi inhibited cell inflammation and oxidative stress and decreased apoptosis. As Sanchi blocked the NFκB pathway via IL1B, IL1B mitigated the therapeutic effect of Sanchi.

Discussion and conclusion

Sanchi demonstrated therapeutic effects on wound healing in rats by promoting KCs and MECs activity. These findings provide valuable information for the clinical application of Sanchi, which needs to be validated in future clinical trials.

Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain

BACKGROUND AND OBJECTIVE

In orthopedic surgery, it is clear that an optimal standardized closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyze the clinical practice of surgical wound closure in orthopedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain.

METHOD

an ad hoc group of specialists in orthopedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings.

RESULTS

A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence).

CONCLUSIONS

There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.

[Translated article] Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain

BACKGROUND AND OBJECTIVE

In orthopaedic surgery, it is clear that an optimal standardised closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyse the clinical practice of surgical wound closure in orthopaedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain.

MATERIAL AND METHOD

An ad hoc group of specialists in orthopaedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings.

RESULTS

A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence).

CONCLUSIONS

There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.

Assessment of nurses' level of knowledge of the management of chronic wounds

BACKGROUND

Chronic wounds are a challenge and a major cause of morbidity. A wound is considered chronic if healing does not occur within the expected time frame depending on the etiology and location of the wound.

OBJECTIVE

To assess the level of knowledge about chronic wound management of postgraduate nurses in different areas of the health system and their previous satisfaction with the training received during their undergraduate studies.

DESIGN

Cross-sectional study of a health system of 95,000 inhabitants and 557 nursing professionals working in it.

PARTICIPANTS

Nurses working in the study health system and in areas with care for patients with chronic wounds in social, primary and hospital care.

RESULTS

Survey results described a low knowledge of chronic wound management in general. Data on knowledge according to area of work showed that nurses in primary care had the highest knowledge of wound etiology. Nurses working in health and social care were most knowledgeable in diagnostic knowledge. Hospital nurses showed the lowest knowledge overall. A relationship was observed when nurses had a master's degree followed by an expert with better knowledge in the test. In addition, nurses reported little training in chronic wounds during their university studies (69.73 %, n = 106).

CONCLUSIONS

Therefore, a review of this point should be considered to improve the management of chronic wounds and their correct approach among nursing students. A review of continuing and even specialised training needs in the clinical care setting should also be considered.

Platelet-derived mitochondria transfer facilitates wound-closure by modulating ROS levels in dermal fibroblasts

Platelets are known to improve the wound-repair capacity of mesenchymal stem cells (MSCs) by transferring mitochondria intercellularly. This study aimed to investigate whether direct transfer of mitochondria (pl-MT) isolated from platelets could enhance wound healing in vitro using a cell-based model. Wound repairs were assessed by 2D gap closure experiment in wound scratch assay using human dermal fibroblasts (hDFs). Results demonstrated that pl-MT were successfully internalized into hDFs. It increased cell proliferation and promoted the closure of wound gap. Importantly, pl-MT suppressed both intracellular and mitochondrial ROS production induced by hydrogen peroxide, cisplatin, and TGF-β in hDFs. Taken together, these results suggest that pl-MT transfer might be used as a potential therapeutic strategy for wound repair.

Combining Chitosan, Stearic Acid, and (Cu-, Zn-) MOFs to Prepare Robust Superhydrophobic Coatings with Biomedical Multifunctionalities

There is an urgent need to develop a series of multifunctional materials with good biocompatibility, high mechanical strength, hemostatic properties, antiadhesion, and anti-infection for applications in wound care. However, successfully developing multifunctional materials is challenging. In this study, two superhydrophobic composite coatings with good biocompatibility, high mechanical strength, strong antifouling and blood repellency, fast hemostasis, and good antibacterial activity are prepared on cotton fabric surface by simple, green, and low-cost one-step dip-coating technology. The results discussed in the manuscript reveals that the two superhydrophobic composite coatings can maintain good mechanical stability, strong water repellency, and durability under various types of mechanical damage, high-temperature treatment, and long-term strong light irradiation. The coatings also exhibit good repellency to various solid pollutants, highly viscous liquid pollutants, and blood. In vitro and in vivo hemostatic experiments show that both composite coatings have good hemostatic and anticlot adhesion properties. More importantly, this superhydrophobic coating prevents bacterial adhesion and growth and released Cu2+ and Zn2+ ions and chitosan to achieve bactericidal properties, thereby protecting injured skin from bacterial infection. The two superhydrophobic coatings enhance the antifouling, antiadhesion, hemostatic, and antibacterial functions of blood-repellent dressings and therefore have broad application prospects in medical and textile fields.

Negative Pressure Wound Therapy in Closed Colorectal Surgical Incisions: A Systematic Review and Meta-Analysis

The utilization of negative pressure wound therapy (NPWT) in lowering the incidence of infections in closed colorectal surgical incisions has not been thoroughly established, and recent trials have had conflicting results. This meta-analysis was conducted to synthesize the findings of available trial data and carefully evaluate the effectiveness of this intervention in colorectal surgery. The databases PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were combed for randomized controlled trials (RCTs) that compared negative pressure wound therapy to standard dressing in closed wounds of patients undergoing colorectal surgery. The incidence of surgical site infections (SSIs) was the primary outcome. Secondary outcomes included the occurrence of seroma and hematoma. The trial results were represented as odds ratios (OR) with a 95% confidence interval (CI), and a fixed-effects model was used. Nine studies found eligible were included, and the pooled results revealed that negative pressure wound therapy significantly reduced the incidence of surgical site infections (OR: 0.70; 95% CI: 0.53, 0.93; P= 0.02). Furthermore, there was a significant reduction in seroma (OR: 0.27; 95% CI: 0.08, 0.95; P = 0.04) and hematoma (OR: 0.20; 95% CI: 0.04, 0.96; P = 0.04). The use of negative pressure wound therapy for primarily closed incisions has been increasing, and our results indicate that it is superior to standard surgical dressings in preventing surgical site infections and other wound complications in colorectal surgeries.

Plastic Surgery Roles in Wound Centers in the Northeastern United States

INTRODUCTION

Wound care is a substantial industry costing nearly $19 billion USD, and dedicated wound care centers play a critical role via a multidisciplinary team-based approach. At the same time, plastic surgeons are often considered experts in evaluation and management of wounds, particularly chronic and complex wounds. However, the extent of direct involvement of plastic surgeons in wound care centers is unclear. In this study, we sought to evaluate the presence of plastic surgeons and other specialties in wound care centers across all Northeastern states Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Jersey, New York, New Hampshire, Pennsylvania, Rhode Island, Virginia, West Virginia, and Vermont.

METHODS

A comprehensive list of wound care clinics in northeastern United States was obtained from the Healogics website. For each site, information was gathered via website listings, including number of providers and the professional certification/specialization for each provider. Providers were those with qualifications including Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Doctor of Physical Therapy (DPT), Doctor of Podiatric Medicine (DPM), Certified Registered Nurse Anesthetist (CRNA), Certified Registered Nurse Practitioner (CRNP), Physician Associate (PA), and Physical Therapist (PT).

RESULTS

A total of 118 Healogics wound care clinics and 492 providers were located across 14 northeastern states including District of Columbia. After researching each location, updated in November 2022, plastic surgeons were only 3.7% (18 of 492) providers employed. Specialties such as internal medicine (90 of 492 [18%]), general surgery (76 of 492 [15%]), podiatry (68 of 292 [13.8% ]), and other midlevel providers such as nurse practitioners (35 of 492 [7.1%]) were more frequently employed over plastic surgery. All plastic surgeons were board certified the American Board of Plastic Surgery.

CONCLUSIONS

Wound care requires collaboration between specialties, with significant repercussions on health care costs and patient outcomes. Plastic surgery provides unique surgical services for the healing of wounds, and the natural expectation would be that plastic surgery should be heavily involved at wound care centers. However, the data do not reflect significant involvement at an official level. Further studies will investigate causes and the societal, financial, and patient impacts of this lack of direct engagement. Although many plastic surgeons may not desire the majority of their practice to be wound care management, it stands to reason that some affiliation, at least for patient awareness and referral, may be warranted.

Dermal Regenerative Templates in Orthopaedic Surgery

Management of soft-tissue injuries is a critical principle in the treatment of orthopaedic trauma. Understanding the options for soft-tissue reconstruction is vital for successful patient outcomes. Application of dermal regenerative templates (DRTs) in traumatic wounds has created a new rung in the reconstructive ladder bridging the gap between skin graft and flap coverage. There are multiple DRT products with specific clinical indications and mechanisms of action. This review outlines the up-to-date specifications and uses of DRT in commonly seen orthopaedic injuries.

Effect of Chitosan-Diosgenin Combination on Wound Healing

The difficult-to-heal wounds continue to be a problem for modern medicine. Chitosan and diosgenin possess anti-inflammatory and antioxidant effects making them relevant substances for wound treatment. That is why this work aimed to study the effect of the combined application of chitosan and diosgenin on a mouse skin wound model. For the purpose, wounds (6 mm diameter) were made on mice's backs and were treated for 9 days with one of the following: 50% ethanol (control), polyethylene glycol (PEG) in 50% ethanol, chitosan and PEG in 50% ethanol (Chs), diosgenin and PEG in 50% ethanol (Dg) and chitosan, diosgenin and PEG in 50% ethanol (ChsDg). Before the first treatment and on the 3rd, 6th and 9th days, the wounds were photographed and their area was determined. On the 9th day, animals were euthanized and wounds' tissues were excised for histological analysis. In addition, the lipid peroxidation (LPO), protein oxidation (POx) and total glutathione (tGSH) levels were measured. The results showed that ChsDg had the most pronounced overall effect on wound area reduction, followed by Chs and PEG. Moreover, the application of ChsDg maintained high levels of tGSH in wound tissues, compared to other substances. It was shown that all tested substances, except ethanol, reduced POx comparable to intact skin levels. Therefore, the combined application of chitosan and diosgenin is a very promising and effective medication for wound healing.

Zn2+-Loaded adhesive bacterial cellulose hydrogel with angiogenic and antibacterial abilities for accelerating wound healing

Background

Wound healing is a process that requires angiogenesis and antibacterial activities and it remains a challenge for both experimental and clinical research worldwide. Zn²⁺ has been reported to be widely involved in angiogenesis and exerts antibacterial effects, making it suitable as a treatment to promote wound healing. Therefore Zn²⁺-loaded adhesive bacterial cellulose hydrogel was designed to observe its angiogenic and antibacterial abilities in the wound healing process.

Methods

The characterization, tensile strength, swelling behaviors and antibacterial activity of bacterial cellulose/polydopamine/zeolitic imidazolate framework-8 (BC/PDA/ZIF8) hydrogels were tested. Cell-Counting-Kit-8 (CCK8), transwell, tube formation and real time qunantitative PCR (qRT-PCR) assays were performed to evaluate the cell compatibility of BC/PDA/ZIF8 hydrogels in vitro. A full-thickness defect wound model and histological assays were used to evaluate the BC/PDA/ZIF8 hydrogels in vivo.

Results

The prepared BC/PDA/ZIF8 hydrogels exhibited suitable mechanical strength, excellent swelling properties, good tissue adhesion, efficient angiogenic and antibacterial effects and good performance as a physical barrier. In vivo experiments showed that the BC/PDA/ZIF8 hydrogels accelerated wound healing in a full-thickness defect wound model by stimulating angiogenesis.

Conclusions

This study proved that BC/PDA/ZIF8 hydrogels possess great potential for promoting satisfactory wound healing in full-thickness wound defects through antibacterial effects and improved cell proliferation, tissue formation, remodeling and re-epithelialization.

Efficient angiogenesis-based wound healing through hydrogel dressing with extracellular vesicles release

Wound healing and angiogenesis remain challenges for both clinical and experimental research worldwide. Periosteum-derived extracellular vesicles (P-sEVs) delivered by hydrogel dressings provide a potential strategy for wound defects to promote fast healing. In this study, we designed a NAGA/GelMA/Laponite/glycerol hydrogel wound dressing that can release P-sEVs to accelerate angiogenesis and wound healing (named P-sEVs@hydrogel) (N-acryloyl glycinamide, NAGA). The wound dressing showed multiple functions, including efficient angiogenesis, tissue adhesion and a physical barrier. P-sEVs significantly enhanced the proliferation, migration, and tube formation of endothelial cells in vitro. The results of in vivo experiments showed that P-sEVs@hydrogel accelerates the healing of a full-thickness defect wound model by stimulating the angiogenic process. The improved cell proliferation, tissue formation, remodeling, and re-epithelialization possibly resulted in the fast healing. This study shows that multifunctional hydrogel dressing combined with bioactive molecules can achieve fast and satisfactory wound healing in full-thickness wound defects and other related wounds.

Antileukemic, Antioxidant, Anti-Inflammatory and Healing Activities Induced by a Polyphenol-Enriched Fraction Extracted from Leaves of Myrtus communis L

Natural products have offered a number of exciting approaches in cancer treatment over the years. In this study, we investigated the prophylactic and therapeutic effects of the polyphenol-enriched fraction extracted from Myrtus communis (PEMC) on acute and chronic leukemia. According to the UHPLC-MSⁿ, the fraction is rich in flavonoids. Protective activity of the PEMC was assessed by evaluating the antioxidant, anti-inflammatory, wound healing, and hemolysis potential in a series of in vivo and in vitro assays, while the therapeutic approach consisted of the evaluation of cytotoxic activity of the PEMC against HL60 and K562 leukemia cell lines. Safety of the fraction was also evaluated on a non-cancerous Vero cell line and by an acute toxicity test performed in mice. The PEMC demonstrated a significant anti-inflammatory and healing potential. The activities found at the dose of 100 mg/kg were better than those observed using a reference drug. The PEMC demonstrated a significant antioxidant effect and a specific cytotoxicity towards HL60 (IC₅₀ = 19.87 µM) and K562 (IC₅₀ = 29.64 µM) cell lines being non-toxic to the Vero cell line. No hemolytic activity was observed in vitro and no toxicity effect was found in mice. Thus, the PEMC has a pharmacological potential as both preventive and therapeutic agent. However, further research is necessary to propose its mechanism of action.

Negative pressure wound therapy on complex extremity wounds requiring coverage with a meshed bilayer wound matrix: a retrospective analysis

OBJECTIVE

The treatment of complex extremity wounds is technically challenging. In this 5-year retrospective review, we compared the use of Integra Meshed Bilayer Wound Matrix (IMBWM; Integra LifeSciences, US) followed by a split-thickness skin graft (STSG) combined with negative pressure wound therapy (NPWT) versus IMBWM followed by STSG alone for the management of these wounds.

METHOD

Data from patients undergoing management using IMBWM for a complex extremity wound coverage were collected.

RESULTS

Among the 109 patients studied, the wounds of 62 patients were managed using IMBWM and NPWT, and 47 were managed using IMBWM alone. The most common aetiology of these injuries was trauma. Wound size and location were similar for each group, ranging in size from 2-30cm² and being primarily on the forearm, followed by the leg and arm. There was a significantly greater take of the IMBWM+STSG with NPWT (96.8%) compared to without NPWT (85.1%, p=0.03). There were significantly fewer reapplications of the dermal matrix required in the NPWT group (3.2%) versus the non-NPWT group (14.9%, p=0.03). There were significantly fewer postoperative complications, prior to STSG, in the NPWT group (3.2%) versus the non-NPWT group (14.9%, p=0.03).

CONCLUSION

The combination of IMBWM with NPWT leads to a higher success rate, and can reduce the number of dermal matrix reapplications and postoperative complications, in the setting of complex extremity wounds. The use of IMBWM in combination with NPWT has the potential to improve both surgical procedures and patient outcomes in this setting.

Nanomaterials for application in wound Healing: current state-of-the-art and future perspectives

Nanoparticles are the gateway to the new era in drug delivery of biocompatible agents. Several products have emerged from nanomaterials in quest of developing practical wound healing dressings that are nonantigenic, antishear stress, and gas-exchange permeable. Numerous studies have isolated and characterised various wound healing nanomaterials and nanoproducts. The electrospinning of natural and synthetic materials produces fine products that can be mixed with other wound healing medications and herbs. Various produced nanomaterials are highly influential in wound healing experimental models and can be used commercially as well. This article reviewed the current state-of-the-art and briefly specified the future concerns regarding the different systems of nanomaterials in wound healing (i.e., inorganic nanomaterials, organic and hybrid nanomaterials, and nanofibers). This review may be a comprehensive guidance to help health care professionals identify the proper wound healing materials to avoid the usual wound complications.

Wound Closure Following Intervention for Closed Orthopedic Trauma

The method of skin closure and post-operative wound management has always been important in orthopedic surgery and plays an even larger role now that surgical site infection (SSI) is a national healthcare metric for both surgeons and hospitals. Wound related issues remain some of the most feared complications following orthopedic trauma procedures and are associated with significant morbidity. In order to minimize the risk of surgical site complications, surgeons must be familiar with the physiology of wound healing as well as the patient and surgical factors affecting healing potential. The goal of all skin closure techniques is to promote rapid healing with acceptable cosmesis, all while minimizing risk of infection and dehiscence. Knowledge of the types of closure material, techniques of wound closure, surgical dressings, negative pressure wound therapy, and other local modalities is important to optimize wound healing. There is no consensus in the literature as to which closure method is superior but the available data can be used to make informed choices. Although often left to less experienced members of the surgical team, the process of wound closure and dressing the wound should not be an afterthought, and instead must be part of the surgical plan. Wounds that are in direct communication with bony fractures are particularly at risk due to local tissue trauma, resultant swelling, hematoma formation, and injured vasculature.

Cold Atmospheric Pressure Microplasma Pipette for Disinfection of Methicillin-Resistant Staphylococcus aureus

Microbial infections should be controlled and prevented for successful wound healing and tissue regeneration. Various disinfection methods exist that use antibiotics, ultraviolet (UV), heat, radiation, or chemical disinfectants; however, cold atmospheric pressure plasma has exhibited a unique and effective antibacterial ability that is not affected by antibiotic resistance or pain. This study develops a cold atmospheric pressure microplasma pipette (CAPMP) that outputs an Ar plasma plume through a tube with an inner radius of 180 μm for disinfection in a small area. The CAPMP was evaluated using Staphylococcus aureus and methicillin-resistant Staphylococcus aureus diluted in liquid media, spread on solid agar, or covered by dressing gauze. An increase in the treatment time of CAPMP resulted in a decrease in the number of colonies of the grown microorganism (colony forming unit) and an increase in the disinfected area for both bacteria. The disinfection ability of CAPMP was observed when the bacteria were covered with dressing gauze and was dependent on the number of gauze layers.

Wound healing properties of flavonoids: A systematic review highlighting the mechanisms of action

BACKGROUND

Flavonoids are a class of compounds with a wide variety of biological functions, being an important source of new products with pharmaceutical potential, including treatment of skin wounds.

PURPOSE

This review aimed to summarize and evaluate the evidence in the literature in respect of the healing properties of flavonoids on skin wounds in animal models.

STUDY DESIGN

This is a systematic review following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

METHODS

This was carried out through a specialized search of four databases: PubMed, Scopus, Web of Science and Embase. The following keyword combinations were used: "flavonoidal" OR "flavonoid" OR "flavonoidic" OR "flavonoids" AND "wound healing" as well as MeSH terms, Emtree terms and free-text words.

RESULTS

Fifty-five (55) articles met the established inclusion and exclusion criteria. Flavonoids presented effects in respect of the inflammatory process, angiogenesis, re-epithelialization and oxidative stress. They were shown to be able to act on macrophages, fibroblasts and endothelial cells by mediating the release and expression of TGF-β1, VEGF, Ang, Tie, Smad 2 and 3, and IL-10. Moreover, they were able to reduce the release of inflammatory cytokines, NFκB, ROS and the M1 phenotype. Flavonoids acted by positively regulating MMPs 2, 8, 9 and 13, and the Ras/Raf/MEK/ERK, PI3K/Akt and NO pathways.

CONCLUSION

Flavonoids are useful tools in the development of therapies to treat skin lesions, and our review provides a scientific basis for future basic and translational research.

The Role of Antioxidants on Wound Healing: A Review of the Current Evidence

(1) Background: Reactive oxygen species (ROS) play a crucial role in the preparation of the normal wound healing response. Therefore, a correct balance between low or high levels of ROS is essential. Antioxidant dressings that regulate this balance are a target for new therapies. The purpose of this review is to identify the compounds with antioxidant properties that have been tested for wound healing and to summarize the available evidence on their effects. (2) Methods: A literature search was conducted and included any study that evaluated the effects or mechanisms of antioxidants in the healing process (in vitro, animal models or human studies). (3) Results: Seven compounds with antioxidant activity were identified (Curcumin, N-acetyl cysteine, Chitosan, Gallic Acid, Edaravone, Crocin, Safranal and Quercetin) and 46 studies reporting the effects on the healing process of these antioxidants compounds were included. (4) Conclusions: this review offers a map of the research on some of the antioxidant compounds with potential for use as wound therapies and basic research on redox balance and oxidative stress in the healing process. Curcumin, NAC, quercetin and chitosan are the antioxidant compounds that shown some initial evidence of efficacy, but more research in human is needed.

Effectiveness of Different Wound Dressings in the Reduction of Blisters and Periprosthetic Joint Infection After Total Joint Arthroplasty: A Systematic Review and Network Meta-Analysis

BACKGROUND

The optimal type of dressing in the setting of total joint arthroplasty (TJA) remains uncertain. The aim of this network meta-analysis was to compare various wound dressings and identify the optimal type of dressings for blister reduction and prevention of periprosthetic joint infection (PJI) in patients after TJA.

METHODS

Studies comparing 2 or more dressing groups after TJA (hip or knee) were systematically searched on PubMed, Embase, and Scopus. Two authors performed the study selection, risk of bias assessment, and data extraction. Both outcomes were assessed using odds ratios (OR) with 95% confidence intervals (CI) and were ranked using surface under the cumulative ranking curve (SUCRA) probabilities to determine a hierarchy of dressings. A sensitivity analysis was performed to reduce the effect of intransitivity between studies.

RESULTS

A total of 21 studies, consisting of 12 dressing types in 7293 TJAs, were included in the final analysis. The highest incidence of blisters occurred when using negative-pressure wound therapy (OR 9.33, 95% CI 3.51-24.83, vs gauze). All dressings ranked better than gauze in infection rate except for hydrofiber (OR 1.46, 95% CI 0.02-112.53) and fabric dressings (OR 1.46, 95% CI 0.24-9.02). For blister reduction, alginate (SUCRA = 87.7%) and hydrofiber with hydrocolloid (SUCRA = 92.3%) were ranked as the optimal dressings before and after a sensitivity analysis, respectively. Antimicrobial dressing (SUCRA = 83.7%) demonstrated the most efficacy for preventing PJI.

CONCLUSION

Based on the evidence from our analysis, an antimicrobial dressing is the optimal dressing to prevent PJI. If negative-pressure wound therapy is used, surgeons should be aware of an increased incidence of blister formation. Further studies should focus on the alginate versus hydrofiber and hydrocolloid dressing to determine the optimal dressing to reduce blisters.

Comparison of closed incision negative pressure wound therapy with conventional dressing for reducing wound complications in emergency laparotomy

OBJECTIVE

The aim of this study was to compare the post-operative effects of closed incision negative pressure wound therapy with conventional dressing in emergency laparotomy.

METHODS

This study was conducted from 1st November 2018 to 31st March 2020 in ABVIMS &amp; Dr. R.M.L. Hospital, New Delhi. The potential candidates for the study were patients of 18 years and above who were admitted in surgical emergency and underwent emergency laparotomy by a midline incision. Fifty random patients were alternatively allotted to group A (25 patients) and group B (25 patients). In the patients of group A, closed incision negative pressure wound therapy (ciNPWT) was applied on midline closed wound after an exploratory laparotomy procedure. The patients in group B, standard dry gauze dressing was done.

RESULTS

The mean age of patients in group A and group B were 46.76±12.20 and 41.96±8.33 years, respectively (p-value-0.11). The wound infection was present in 12% of cases in group A and 32% in group B, but when we calculate the p-value, it was found to be statistically non-significant (p-value-0.08). Similarly, seroma formation and wound dehiscence were found less in group A as compared to group B but not reached up to a statistically significant limit (p-value 0.55 and 0.38 respectively). The frequency of dressing change was 1-2 per week in 92% of cases in group A while it was 3-4 per week in 68% of cases in group B. The mean time of the frequency of dressing change was 1.24±0.72 per week and 4.28±1.90 per week in both the groups respectively (p-value &lt;0.001). There was no significant (p&gt;0.05) difference in the duration of hospital stay between group A (mean hospital stay 8.20±2.34 days) and group B (mean hospital stay 8.21±3.37 days).

CONCLUSION

Closed incision negative pressure wound therapy has no advantages over conventional dressing in terms of post-operative complications and hospital stay. However, it reduces the frequency of dressing change significantly, which reduces the mental stress of the patient and the burden of changing daily dressing.

Bioaerogels: Promising Nanostructured Materials in Fluid Management, Healing and Regeneration of Wounds

Wounds affect one's quality of life and should be managed on a patient-specific approach, based on the particular healing phase and wound condition. During wound healing, exudate is produced as a natural response towards healing. However, excessive production can be detrimental, representing a challenge for wound management. The design and development of new healing devices and therapeutics with improved performance is a constant demand from the healthcare services. Aerogels can combine high porosity and low density with the adequate fluid interaction and drug loading capacity, to establish hemostasis and promote the healing and regeneration of exudative and chronic wounds. Bio-based aerogels, i.e., those produced from natural polymers, are particularly attractive since they encompass their intrinsic chemical properties and the physical features of their nanostructure. In this work, the emerging research on aerogels for wound treatment is reviewed for the first time. The current scenario and the opportunities provided by aerogels in the form of films, membranes and particles are identified to face current unmet demands in fluid managing and wound healing and regeneration.

Functional Dissection of CD26 and Its Pharmacological Inhibition by Sitagliptin During Skin Wound Healing

BACKGROUND Skin fibroblasts are primary mediators underlying wound healing and therapeutic targets in scar prevention and treatment. CD26 is a molecular marker to distinguish fibroblast subpopulations and plays an important role in modulating the biological behaviors of dermal fibroblasts and influencing skin wound repair. Therapeutic targeting of specific fibroblast subsets is expected to reduce skin scar formation more efficiently. MATERIAL AND METHODS Skin burn and excisional wound healing models were surgically established in mice. The expression patterns of CD26 during wound healing were determined by immunohistochemical staining, real-time RT-PCR, and western blot assays. Normal fibroblasts from intact skin (NFs) and fibroblasts in wounds (WFs) were isolated and sorted by fluorescence-activated cell sorting (FACS) into 4 subgroups - CD26⁺ NFs, CD26⁻ NFs, CD26⁺ WFs, and CD26⁻ WFs - for comparisons of their capacities of proliferation, migration, and collagen synthesis. Pharmacological inhibition of CD26 by sitagliptin in skin fibroblasts and during wound healing were further assessed both in vitro and in vivo. RESULTS Increased CD26 expression was observed during skin wound healing in both models. The CD26⁺ fibroblasts isolated from wounds had significantly stronger abilities to proliferate, migrate, and synthesize collagen than other fibroblast subsets. Sitagliptin treatment potently diminished CD26 expression, impaired the proliferation, migration, and collagen synthesis of fibroblasts in vitro, and diminished scar formation in vivo. CONCLUSIONS Our data reveal that CD26 is functionally involved in skin wound healing by regulating cell proliferation, migration, and collagen synthesis in fibroblasts. Pharmacological inhibition of CD26 by sitagliptin might be a viable strategy to reduce skin scar formation.

Graphene Oxide/Copper Nanoderivatives-Modified Chitosan/Hyaluronic Acid Dressings for Facilitating Wound Healing in Infected Full-Thickness Skin Defects

PURPOSE

Wound healing, especially of infected wounds, remains a clinical challenge in plastic surgery. This study aimed to manufacture a novel and multifunctional wound dressing by combining graphene oxide/copper nanocomposites (GO/Cu) with chitosan/hyaluronic acid, providing significant opportunities for the therapy of wound repair in wounds with a high risk of bacterial infection.

METHODS

In this study, GO/Cu-decorated chitosan/hyaluronic acid dressings (C/H/GO/Cu) were prepared using sodium trimetaphosphate (STMP) crosslinking and the vacuum freeze-drying method, and chitosan/hyaluronic acid dressings (C/H) and GO-incorporated chitosan/hyaluronic acid dressings (C/H/GO) served as controls. The surface characterization, in vitro degradation under various pH values, antimicrobial potential, cytocompatibility and in vivo therapeutic efficacy in a bacteria-infected full-thickness skin defect model were systematically evaluated.

RESULTS

Our experimental results indicated that the acidic environment facilitated the release of copper (CuNPs and Cu2+) from the dressings, and prepared C/H/GO/Cu dressings exhibited significant in vitro antimicrobial activities against the two tested bacterial strains (ATCC35984 and ATCC25923). All three dressings showed satisfactory cytocompatibility with mouse fibroblasts (NIH/3T3-L1). Moreover, remarkably accelerated wound healing was found in the C/H/GO/Cu group, with controlled inflammatory infiltration and improved angiogenesis in granulation tissues. In addition, no pathological damage was noted in the tissue structures of the tested organs (heart, lung, liver and kidney) in any of the four groups.

CONCLUSION

Collectively, GO/Cu-incorporated chitosan/hyaluronic acid dressings suggested a synergistic antimicrobial efficacy and acceptable biocompatibility both in vitro and in vivo, as well as a significantly accelerated healing process of bacteria-infected wounds. Thus, the multifunctional C/H/GO/Cu composite is expected to be a potential alternative for wound dressings, especially for the management of intractable wounds caused by bacterial infection.

General practitioners' knowledge of leg ulcer treatment in primary healthcare: an interview study

Aim:

To describe general practitioners’ (GPs’) knowledge and the development of their knowledge regarding leg ulcer treatment when treating patients with leg ulceration at primary healthcare centers.

Background:

Earlier research regarding GPs’ knowledge of leg ulcer treatment in a primary healthcare context has focused primarily on the assessment of wounds and knowledge of wound care products. Less is known about GPs’ understandings of their own knowledge and knowledge development regarding leg ulceration in the everyday clinical context. This study, therefore, sets out to highlight these aspects from the GPs’ perspective.

Methods:

Semi-structured interviews were conducted with 16 individual GPs working at both private and county council run healthcare centers. The data were analyzed inductively using a thematic analysis.

Results:

Four themes were identified. ‘Education and training’ describe the GPs’ views regarding their knowledge and knowledge development in relation to leg ulcer treatment. ‘Experience’ refers to GPs’ thoughts about the importance of clinical experience when treating leg ulcers. ‘Prioritization’ describes the issues GPs raised around managing the different knowledge areas in their clinical work. ‘Time constraints’ explore the relationship between GPs’ sense of time pressure and their opportunities to participate in professional development courses.

Conclusions:

The study shows that the GPs working in primary healthcare are aware of the need for ongoing competence development concerning leg ulceration. They describe their current knowledge of leg ulcer treatment as insufficient and point to the lack of relevant courses that are adapted for their level of knowledge and the limited opportunities for clinical training.

Preparation and Properties of Minocycline-Loaded Carboxymethyl Chitosan Gel/Alginate Nonwovens Composite Wound Dressings

As derivatives from marine natural biomaterials, alginate-based and chitosan-based biomaterials are commonly used in wound dressings. Calcium alginate fiber (CAF) dressings possess excellent absorption and unique gel forming performance, but the low bioactivity limits its application in wound healing. Carboxymethyl chitosan (CM-Chit) has excellent antibacterial activity, but the gel structure with weak mechanical properties restricts its application. In this study, minocycline (Mino)/CM-Chit solution was coated on the surface of plasma treated CAF needle-punched nonwovens, and then Mino loaded CM-Chit gel/CAF nonwovens composite dressings were fabricated by EDC/NHS (1-3-(3-dimethylaminopropyl)-3-ethylcarbodiimide hydrochloride/N-hydroxysuccinimide) crosslinking. The dressings had a porous composite structure, which allowed them to quickly absorb and store a large number of wound exudates. Skin-like tensile performance allowed the dressings to provide a better healing environment. Antibacterial assay against Escherichia coli and Staphylococcus aureus indicated that the addition of Mino significantly improved the antibacterial activity of the wound dressings. The tight structure of CM-Chit gel prevented the burst release of Mino so that the dressings had antibacterial activity in a certain period of release time. Cell culture assay showed that the dressings had excellent cell biocompatibility. As new functional dressings, the prepared composite dressings had excellent potential in the clinical healing of wounds.

Emerging progress on the mechanism and technology in wound repair

Normal wound repair is a dynamic and complex process involving multiple coordinated interactions between growth factors, cytokines, chemokines, and various cells. Any failure during the repair process may cause chronic wounds or scar formation, which increase the financial burden of patients due to repetitive treatments and considerable medical expenditures, and affect their quality of life. Nowadays, extensive efforts have been made to develop novel therapeutics for wound repair. Genetic engineering technology, tissue engineering technology, stem cell-based therapy, physical and biochemical technology, and vacuum-assisted closure technique have been proposed to be beneficial for wound repair, and shown considerable potential for improving the rate and quality of wound healing and skin regeneration. However, challenges remain as applying these techniques. As the development of cell biology and molecular biology, the understanding of the mechanism under wound repair has gradually deepened. As the growth of interdisciplinary research on physics, chemistry, biology, tissue engineering, and materials, the concept and technique relating wound repair for clinical application have rapidly developed. This article reviews the latest progress on the mechanism and technique in wound repair.