Progress in Wound-Healing Products Based on Natural Compounds, Stem Cells, and MicroRNA-Based Biopolymers in the European, USA, and Asian Markets: Opportunities, Barriers, and Regulatory Issues

Wounds are breaks in the continuity of the skin and underlying tissues, resulting from external causes such as cuts, blows, impacts, or surgical interventions. Countless individuals suffer minor to severe injuries, with unfortunate cases even leading to death. In today's scenario, several commercial products are available to facilitate the healing process of wounds, although chronic wounds still present more challenges than acute wounds. Nevertheless, the huge demand for wound-care products within the healthcare sector has given rise to a rapidly growing market, fostering continuous research and development endeavors for innovative wound-healing solutions. Today, there are many commercially available products including those based on natural biopolymers, stem cells, and microRNAs that promote healing from wounds. This article explores the recent breakthroughs in wound-healing products that harness the potential of natural biopolymers, stem cells, and microRNAs. A comprehensive exploration is undertaken, covering not only commercially available products but also those still in the research phase. Additionally, we provide a thorough examination of the opportunities, obstacles, and regulatory considerations influencing the potential commercialization of wound-healing products across the diverse markets of Europe, America, and Asia.

Prevalence of Skin Injuries in Beach Volleyball Athletes in Greece

Background: Skin injuries often affect the sports community. Almost every type of athletic activity is associated with traumatic skin injuries, such as surface wounds, bruising, abrasions, subcutaneous hematomas, blunt trauma, nail injuries, friction burns, and blisters. Methods: The aim of this study was to assess the rates, location sites, and seasons of appearance of skin injuries in beach volleyball athletes in Greece. Seven hundred and eighty-five beach volleyball athletes participated in this study. The average age was 28.4 years. Skin injuries included superficial wounds (erosions, incisions, lacerations), deep wounds, hematomas, nail lacerations, friction burns, and friction blisters. The recorded variables encompassed gender, age, the time of year when athletes might be at higher risk of injuries, and the specific body regions affected. Additionally, data regarding training details such as years of practice, weekly training frequency, and daily training duration were also documented. Results: Incidence rates correlated to gender: (a) superficial wounds (p < 0.001), (b) years of training: hematomas (p < 0.001), and (c) average hours of daily training: superficial wounds (p < 0.001), deep wounds (p < 0.001), and friction blisters (p < 0.001). Conclusions: Although early detection, recognition, and treatment are essential, the prevention of skin injuries can also be linked to health and athletic performance.

Technical Evaluation of a New Medical Device Based on Rigenase in the Treatment of Chronic Skin Lesions

Chronic wound is characterized by slow healing time, persistence, and abnormal healing progress. Therefore, serious complications can lead at worst to the tissue removal. In this scenario, there is an urgent need for an ideal dressing capable of high absorbency, moisture retention and antimicrobial properties. Herein we investigate the technical properties of a novel advanced non-woven triple layer gauze imbibed with a cream containing Rigenase, an aqueous extract of Triticum vulgare used for the treatment of skin injuries. To assess the applicability of this system we analyzed the dressing properties by wettability, dehydration, absorbency, Water Vapor Transmission Rate (WVTR), lateral diffusion and microbiological tests. The dressing showed an exudate absorption up to 50%. It created a most environment allowing a proper gaseous exchange as attested by the WVTR and a controlled dehydration rate. The results candidate the new dressing as an ideal medical device for the treatment of the chronic wound repairing process. It acts as a mechanical barrier providing a good management of the bacterial load and proper absorption of abundant wound exudate. Finally, its vertical transmission minimizes horizontal diffusion and side effects on perilesional skin as maceration and bacterial infection.

Characteristics of skin injuries caused by power drill

Skin injuries caused by power drills have been rarely reported. A case is described of a 51-year-old woman who was found dead on a motorway after committing suicide by jumping from a bridge. The body showed a total of nine circular/oval penetrating injuries of the chest and abdomen with very regular, smooth margins, and particular features due to the presence of "skin islands" inside the lesion and "short radial linear abrasions" around the margins. These injuries were caused by a power drill, which was later found in the woman's apartment. For comparison, experimental tests were carried out with the same drill and different bits on pig skin, whose appearance resembled those found on the body. Especially skin islands were also reproduced in the experimental tests. The presented case shows the possibility of this rare method of suicide (or suicide attempt) and the typical characteristics of such peculiar skin lesions that pose problems of differential diagnosis with other injuries such as gunshot injuries.

Severe skin lesions caused by persistent bites of the stable fly Stomoxys calcitrans (Diptera: Muscidae) in a donkey sanctuary of western Spain

Animal sanctuaries are important organisations that promote animal welfare and health as well as social awareness. Following the appearance of several donkeys with severe and distinctive skin lesions in a sanctuary from western Spain in 2021, a multicomponent study was performed to rule out the possible causes. The lesions were mainly concentrated on the extremities and, to a lesser extent, on the face and/or chest. The use of cotton leggings on their extremities as an external barrier to prevent them from bites and treatments with antiparasitic, antiseptic washes and dermatitis lotion showed to be effective measures to improve the donkey lesions. Skin scraping was negative for any relevant causative agents. Histopathological examination of the lesions showed an inflammatory infiltrate at the superficial dermal level, compatible with diffuse chronic dermatitis. A field entomological study was conducted from May to October 2021 to ascertain if any Diptera was responsible for these lesions. Considerable numbers of the stable fly Stomoxys calcitrans were recorded in both sticky traps and decomposing straw bedding. Several species of haematophagous Diptera were also recorded in lower numbers in other traps placed on the farm facilities. According to the entomological data, the location of the bites and clinical signs, it was concluded that S. calcitrans was the main cause of the skin lesions in the donkeys. To our best knowledge, this is the first clinical case of donkeys affected by the stable fly in Spain. For differential diagnosis, a brief discussion of the evidence caused by other biting Diptera groups is provided.

Skin injuries associated with severe life-threatening situations: A new conceptual framework

PURPOSE

To create a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time. To name and classify these types of skin injuries. To describe the clinical features of the different types of skin injuries that may occur in terminally ill and/or dying patients.

DESIGN

A sequential design with several different phases (a literature review, a nominal group, and a consensus conference) was used.

METHODS

Six experts with extensive knowledge of these types of injuries were selected for the nominal group. The traditional eight-phase nominal group technique was followed. The consensus conference consisted of participants voting on different options based on the statements elaborated with the expert panel summarizing the best scientific evidence available.

FINDINGS

Using all these elements, a conceptual framework was constructed to identify skin injuries associated with severe life-threatening situations (SI-SLTSs), defined as unpredictable and therefore unpreventable injuries indicating a serious threat to life or even imminent death. These injuries can occur in two forms: (a) as skin injuries associated with multiple organ dysfunction syndrome (SI-MODSs) or (b) as skin injuries associated with severe vasoconstriction (SI-ESVs). SI-MODSs develop very quickly and suddenly. They progress from superficial to deep stages abruptly, even within hours. The severity of the injuries does not reflect the care provided to the patient. Individuals suffering from these injuries have an irreversible clinical condition. SI-ESVs also appear in individuals who are in a very critical, even terminal, clinical condition. They are frequently treated in the ICU and may exhibit severe vasoconstriction due to their disease process (e.g., shock), sometimes exacerbated by vasoconstriction caused by various drugs (e.g., noradrenaline).

CONCLUSIONS

We have developed a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time and have named them SI-SLTSs, distinguishing between SI-MODSs and SI-ESVs.

CLINICAL RELEVANCE

This new conceptual framework may help clinicians understand the mechanisms and the pathophysiology of skin injuries that develop in terminally ill and/or dying patients associated with multi-organ failure. Through this new framework these injuries can be identified and differentiated from pressure injuries or other dependence-related skin lesions.

Current Advanced Therapies Based on Human Mesenchymal Stem Cells for Skin Diseases

Skin disease may be related with immunological disorders, external aggressions, or genetic conditions. Injuries or cutaneous diseases such as wounds, burns, psoriasis, and scleroderma among others are common pathologies in dermatology, and in some cases, conventional treatments are ineffective. In recent years, advanced therapies using human mesenchymal stem cells (hMSCs) from different sources has emerged as a promising strategy for the treatment of many pathologies. Due to their properties; regenerative, immunomodulatory and differentiation capacities, they could be applied for the treatment of cutaneous diseases. In this review, a total of thirteen types of hMSCs used as advanced therapy have been analyzed, considering the last 5 years (2015-2020). The most investigated types were those isolated from umbilical cord blood (hUCB-MSCs), adipose tissue (hAT-MSCs) and bone marrow (hBM-MSCs). The most studied diseases were wounds and ulcers, burns and psoriasis. At preclinical level, in vivo studies with mice and rats were the main animal models used, and a wide range of types of hMSCs were used. Clinical studies analyzed revealed that cell therapy by intravenous administration was the advanced therapy preferred except in the case of wounds and burns where tissue engineering was also reported. Although in most of the clinical trials reviewed results have not been posted yet, safety was high and only local slight adverse events (mild nausea or abdominal pain) were reported. In terms of effectiveness, it was difficult to compare the results due to the different doses administered and variables measured, but in general, percentage of wound's size reduction was higher than 80% in wounds, Psoriasis Area and Severity Index and Severity Scoring for Atopic Dermatitis were significantly reduced, for scleroderma, parameters such as Modified Rodnan skin score (MRSC) or European Scleroderma Study Group activity index reported an improvement of the disease and for hypertrophic scars, Vancouver Scar Scale (VSS) score was decreased after applying these therapies. On balance, hMSCs used for the treatment of cutaneous diseases is a promising strategy, however, the different experimental designs and endpoints stablished in each study, makes necessary more research to find the best way to treat each patient and disease.

Personal Protective Equipment (PPE) in COVID 19 Pandemic: Related Symptoms and Adverse Reactions in Healthcare Workers and General Population

OBJECTIVES

To assess prevalence of Personal Protective Equipment (PPE)-related symptoms and adverse reactions during Coronavirus Disease 2019 pandemics.

METHODS

We conducted an observational study among people exposed to various degree of infectious risk. Data were collected with a self-administered online questionnaire.

RESULTS

The entire cohort complained about a wide range of adverse reactions: respiratory symptoms affected 80.3% of respondents, 68.5% referred pressure-related skin lesions, fewer manifested a dermatosis of different grade or ocular symptoms. Most of the affected individuals belonged to healthcare staff and manifestations were predicted by wearing time (more than 6 h/d). Moreover, symptoms were higher in the healthcare staff wearing N95/FFP2 respirator mask.

CONCLUSIONS

Given the crucial role of PPE to contain the pandemic infection, more attention has to be paid to exposed categories, establishing preventive measure of side effects to ensure total safety.

Impact of Ergothioneine, Hercynine, and Histidine on Oxidative Degradation of Hyaluronan and Wound Healing

A high-molecular weight hyaluronan is oxidatively degraded by Cu(II) ions and ascorbate—the so called Weissberger biogenic oxidative system—which is one of the most potent generators of reactive oxygen species, namely ^•OH radicals. Ergothioneine, hercynine, or histidine were loaded into chitosan/hyaluronan composite membranes to examine their effect on skin wound healing in ischemic rabbits. We also explored the ability of ergothioneine, hercynine, or histidine to inhibit hyaluronan degradation. Rotational viscometry showed that ergothioneine decreased the degree of hyaluronan radical degradation in a dose-dependent manner. While histidine was shown to be potent in scavenging ^•OH radicals, however, hercynine was ineffective. In vivo results showed that the addition of each investigated agent to chitosan/hyaluronan membranes contributed to a more potent treatment of ischemic skin wounds in rabbits compared to untreated animals and animals treated only with chitosan/hyaluronan membranes.

Investigating Nurses' Views on Care of Mentally Ill Patients with Skin Injuries

Background: Individuals with mental illness are at increased risk of skin injuries. The role of nurses in skin injury prevention and management is crucial and therefore their views on wound care may provide useful information for improving the quality of the care provided. Aim: To investigate nurses’ views on care of mentally ill patients with skin injuries. Method: A qualitative research design based on the principles of grounded theory approach was followed. Unstructured interviews were conducted with seven nurses working in psychiatric wards with frequent skin injuries. Data were analyzed using the constant comparative method of analysis. Results: Two main themes were emerged from data analysis. The first main theme, namely factors affecting the care of patients with skin injuries, included seven categories: (a) shortage of hospital supplies, equipment and services (b) staff shortages, (c) lack of knowledge, (d) nurses’ resistance to change, (e) difficulty in collaborating with patients, (f) patients’ physical conditions and (g) nurses’ attitudes as an obstacle to care. The second main theme, namely nurses’ suggestions for optimizing care, included five categories: (a) need for additional staff, (b) need for increasing hospital supplies and equipment availability, (c) need for training (d) need of changing nurses’ attitudes towards care and (e) need of changing the patients’ approach to collaboration. Conclusion: The care of mentally ill patients with skin injuries is affected by multidimensional factors that have a direct impact on the quality of nurses’ work and patients’ hospitalization. Specific efforts are needed to overcome the obstacles that hinder the care provided and to improve clinical practice.

Comparison of three different farrowing systems: skin lesions and behaviour of sows with special regard to nursing behaviour in a group housing system for lactating sows

While group housing (GH) is mandatory in the European Union for the greater part of pregnancy, single housing in farrowing crates (FCs) during lactation that restrict sows in most of their natural behaviour patterns is still practised on a large scale. Research is urgently needed to develop alternative farrowing systems that improve sows' welfare. Therefore, sows in three different farrowing systems - pens with FC, loose housing (LH) pens and GH for six sows - were compared regarding the level of skin injuries and their active and resting behaviour. A skin injury score was assessed for 15 body parts of 102 sows in six batches on 3 days (days 1, 14 and 34). In total, the active and resting behaviour of 77 sows in six batches was examined on 3 days (days 18, 25 and 32) between 0700 h and 1900 h by means of a scan sampling method. The suckling behaviour and the level of cross-suckling were analysed in GH by means of direct observation in four batches during three 4-h sampling periods (days 17, 24 and 31). No significant differences were found in total skin injuries when the sows entered the systems (day 1), but GH sows showed significantly higher total skin injuries compared to FC and LH sows in the middle (day 14) and at the end (day 34) of the lactation period. A significant difference between FC and LH sows was never seen. Differences were found for the proportion of different body postures between the three systems. The odds for lying in lateral recumbency versus standing and sitting versus standing were significantly higher for FC and LH sows compared to GH sows. Additionally, sows were significantly more likely to be standing as opposed to lying in lateral recumbency as the lactation period progressed. Cross-suckling was a frequent behaviour in GH, seen in 35.0% of all successful suckling bouts. However, only an average of 0.56 piglets per successful suckling bout was observed cross-suckling, suggesting only a few piglets were engaged in cross-suckling. In conclusion, the skin injury score was only moderately increased in GH compared to FC and LH and comparable to pregnant group-housed sows, both free farrowing systems seemed to be an environmental enrichment for lactating sows and good management cannot prevent the occurrence of cross-suckling in a GH system, but can probably reduce it.

Overview of Silk Fibroin Use in Wound Dressings

Recently, biomimetic wound dressings were introduced as potential replacements for treating skin injuries. Although there are some clinically available skin replacements, the range of wound types and locations necessitates a broader range of options for the clinic. Natural polymeric-based dressings are of central interest in this area due to their outstanding biocompatibility, biodegradability, low toxicity, and non-allergenic nature. Among them, silk fibroin (SF) has exceptional characteristics as a wound dressing. SF-based dressings can also be used as carriers for delivering drugs, growth factors, and bioactive agents to the wound area, while providing appropriate support for complete healing. In this review, we describe recent advances in the development of SF-based wound dressings for skin regeneration.