Biomedical materials for wound dressing: recent advances and applications

Scrutinizing the effect of rGO-cuttlefish bone hydroxyapatite composite infused carrageenan membrane towards wound reconstruction

Carrageenan is an emerging biopolymer for wound healing and regenerative applications. In this study, reduced graphene oxide (rGO) and hydroxyapatite (HAp) nano-composites infused carrageenan bioactive membrane was fabricated. Here, hydroxyapatite was synthesized from cuttlefish bone (CF-HAp) and its properties were compared with that of chemically synthesized HAp. Crystalline Ca5(PO4)3(OH) and Ca3(PO4)2) phases were obtained in cuttlefish bone derived HAp. Reduced graphene oxide was synthesized and composites were prepared with chemical HAp and CF-HAp. FT-IR spectral analysis showed the imprints of hydroxyapatite on the membrane and also nano-structured particles were evident through morphological estimations that confirm the distribution of nano-particles on the carrageenan membrane. Nano-particulates infused carrageenan membrane showed the maximum tensile strength, in which graphene incorporated carrageenan bioactive membrane showed highest stability of 15.26 MPa. The contact angle of chemical HAp infused carrageenan membrane (CAR-HAp) showed more hydrophilic in nature (48.63° ± 7.47°) compared to control (61.77° ± 1.28°). Bio-compatibility features enunciate the optimal compatibility of fabricated bioactive membrane with fibroblast cell line; simultaneously, CAR-rGO-CF-HAp showed tremendous wound healing behavior with zebrafish model. Hence, fabricated bioactive membrane with the infusion of rGO- hydroxyapatite derived from cuttlefish bone was found to be a versatile biopolymer membrane for wound healing application.

Oncological Surgical Wound Care: A Comparison of Theruptor NXT Non-adherent Dressing and the Current Standard of Care

Background Oncological surgeries pose an elevated risk of surgical site infections (SSIs) due to their complexity and various associated treatments, impacting patient outcomes and healthcare costs. This has prompted a focus on advanced wound dressings that provide microbial protection, exudate absorption, and improved product performance, enhancing patient satisfaction. Our study aimed to compare the efficacy and safety of Theruptor NXT with the current standard of care (SOC) practice involving cotton/povidone/micropore dressings in the postoperative wound management of oncological surgeries. Methodology A total of 102 patients who underwent oncological surgeries in the Department of Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India between May and September 2023 were randomized to Theruptor NXT and SOC dressing groups (51 patients each). The incidence of SSIs, wound pain score, cosmetic appearance of the wound, and adverse events were assessed in the two groups at various intervals, i.e., post-surgery day 2 ± 1, day of discharge, and post-surgery day 30 ± 7. Further, the subject satisfaction and product usage were evaluated on post-surgery day 2 ± 1. Results The baseline characteristics were found to be comparable in both groups, i.e., Theruptor NXT and SOC groups. Further, the SSI rates, scar outcomes, and physiological parameters were also similar between the Theruptor NXT and SOC groups, indicating a similar safety profile of both dressings (p > 0.05). However, the product usage assessment revealed statistically significant differences, favoring Theruptor NXT in terms of superior ease of application, stretchability, exudate management, breathability, and non-adherence properties (p < 0.05). Conclusions Our findings suggest that Theruptor NXT wound dressing is a promising, effective, and user-friendly alternative to SOC wound dressing in diverse clinical settings.

Highly Absorbent Egg White/Carbomer-940 Hydrofilm as a Potential Diabetic Wound Dressing

Diabetic foot ulcer (DFU) is the most critical problem in diabetic patients. Managing exudate in this kind of wound presents significant challenges in clinics. Advanced wound dressings serve as the most effective approach to managing DFU. Herein, a highly absorbent hydrofilm is presented through a combination of egg white (EW) and Carbomer-940, benefiting from the bioactivity of the EW component and superabsorption capacity of Carbomer-940. The crystallinity of samples rises due to the presence of Carbomer-940. Regarding the high water absorption capacity of Carbomer-940, the swelling ratio and water-holding capacity of samples are also improved via its incorporation of up to 1005%. In contrast, the transmission of water vapor and in vitro degradation rate decreases as Carbomer-940 powers the crystallinity of hydrofilms. Carbomer-940 incorporation in the EW structure accelerates protein release during the time, while this acceleration is partially compensated by the crystallization effect. The cell viability assay demonstrates no toxicity as well as high human foreskin fibroblast cell proliferation for the hybrid hydrofilm sample, where the cell migration is positively affected in the presence of the bioactive components extracted from the dressing. Taken together, the optimized hybrid hydrofilm could be suggested as a promising wound dressing for managing DFUs.

Fabrication of a core-shell nanofibrous wound dressing with an antioxidant effect on skin injury

Oxidative stress is one of the obstacles preventing wound regeneration, especially for chronic wounds. Herein, designing a wound dressing with an anti-oxidant function holds great appeal for enhancing wound regeneration. In this study, a biocompatible and degradable nanofiber with a core-shell structure was fabricated via coaxial electrospinning, in which polycaprolactone (PCL) was applied as the core structure, while the shell was composed of a mixture of silk fibroin (SF) and tocopherol acetate (TA). The electrospun PST nanofibers were proven to have a network structure with significantly enhanced mechanical properties. The PSTs exhibited a diameter distribution with an average of 321 ± 134 nm, and the water contact angle of their surface is 124 ± 2°. The PSTs also exhibited good tissue compatibility, which can promote the adhesion and proliferation of L929 cells. Besides, the dissolution of silk fibroin encourages the release of TA, which could play a synergistic effect and regulate the oxidative stress effect in the damaged area, for it promotes the adhesion and proliferation of skin fibroblasts (L929), reduces the cytotoxicity of hydrogen peroxide to cells, and lowers the level of reactive oxygen species. The animal experiment indicated that the PSTs would promote the reconstruction of skin. These nanofibers are expected to repair skin ulcers related to diabetes.

Recent Developments in 3D-(Bio)printed Hydrogels as Wound Dressings

Wound healing is a physiological process occurring after the onset of a skin lesion aiming to reconstruct the dermal barrier between the external environment and the body. Depending on the nature and duration of the healing process, wounds are classified as acute (e.g., trauma, surgical wounds) and chronic (e.g., diabetic ulcers) wounds. The latter take several months to heal or do not heal (non-healing chronic wounds), are usually prone to microbial infection and represent an important source of morbidity since they affect millions of people worldwide. Typical wound treatments comprise surgical (e.g., debridement, skin grafts/flaps) and non-surgical (e.g., topical formulations, wound dressings) methods. Modern experimental approaches include among others three dimensional (3D)-(bio)printed wound dressings. The present paper reviews recently developed 3D (bio)printed hydrogels for wound healing applications, especially focusing on the results of their in vitro and in vivo assessment. The advanced hydrogel constructs were printed using different types of bioinks (e.g., natural and/or synthetic polymers and their mixtures with biological materials) and printing methods (e.g., extrusion, digital light processing, coaxial microfluidic bioprinting, etc.) and incorporated various bioactive agents (e.g., growth factors, antibiotics, antibacterial agents, nanoparticles, etc.) and/or cells (e.g., dermal fibroblasts, keratinocytes, mesenchymal stem cells, endothelial cells, etc.).

Development of nanocomposites based on chitosan/reduced graphene oxide for wound healing application

Nanocomposites containing different effective materials have various effects, such as antioxidant, and anti-inflammatory activity, which are desirable for wound dressing. Herein, nanocomposites based on chitosan/reduced graphene oxide (CS/rGO) containing curcumin (CS/rGO/Cur), curcumin and papain (CS/rGO/Cur/Pa), curcumin, papain, and collagen peptide (CS/rGO/CP/Cur/Pa), prepared using ionic gelation method and characterized by Fourier Transform Infrared (FTIR), Differential Light Scattering (DLS), X-ray diffraction (XRD), and Scanning Electron Microscope (SEM). Subsequently, the nanocomposite's potential for wound healing was studied through parameters such as porosity, swelling, degradability, anti-inflammatory, antioxidant, antibacterial, cell viability, and in-vivo. The results of FTIR, XRD, SEM, and DLS showed that the nanocomposites synthesized properly with an almost spherical morphology, an average diameter of below 100 nm (mostly 40-85 nm), and a hydrodynamic diameter of 455-616 nm. The various tests demonstrated the nanocomposite's effectiveness in wound healing. The results showed that CS/rGO/CP/Cur/Pa increased the anti-inflammatory and cell viability up to 99.7 % and 395 %, respectively, which is higher than others. Animal tests on rats showed that CS/rGO/CP/Cur/Pa accelerated the wound healing rate up to 70 %. In conclusion, the results showed that the nanocomposites based on CS/rGO significantly improve wound healing, and the presence of collagen peptides boost their wound healing potency.

In Situ Formation of Hydrogel Wound Dressing Based on Carboxymethyl Chitin/Tannic Acid for Promoting Skin Wound Healing

Triggering the healing process of drug-resistant bacteria-infected wounds has attracted great attention due to global morbidity that may induce gangrene, amputation, and even death. Here, a chitin derivative, carboxymethyl chitosan (CMC), tannic acid (TA), and Cu2+ were used for hydrogel engineering. Using sodium bicarbonate as the neutralizer and reductant, hydrogen bonds between CMC and TA and in situ Cu(OH)2 generation via ion coordination force between Cu2+ and TA facilitated the synthesis of CMC/TA/Cu hydrogel. Cu2+ and TA release, cytotoxicity, in vitro cell migration, angiogenesis, and antidrug-resistant bacteria were measured. Besides, wound closure was evaluated in vivo using the methicillin-resistant Staphylococcus aureus (MRSA)-infected excisional dermal wound mouse model. Negligible toxicity was observed both in vitro and in vivo. Dermal cell migration and angiogenesis were significantly enhanced. In vivo, the CMC/TA/Cu hydrogel induced effective re-epithelialization, collagen deposition, inflammatory alleviation, and MRSA inhibition during wound repair in mice. All these results confirmed that the CMC/TA/Cu hydrogel is a promising novel dressing for chronic wound healing in clinic.

Advancements and applications of upconversion nanoparticles in wound dressings

Wound healing is a complex process that requires effective management to prevent infections and promote efficient tissue regeneration. In recent years, upconversion nanoparticles (UCNPs) have emerged as promising materials for wound dressing applications due to their unique optical properties and potential therapeutic functionalities. These nanoparticles possess enhanced antibacterial properties when functionalized with antibacterial agents, helping to prevent infections, a common complication in wound healing. They can serve as carriers for controlled drug delivery, enabling targeted release of therapeutic agents to the wound site, allowing for tailored treatment and optimal healing conditions. These nanoparticles possess the ability to convert near-infrared (NIR) light into the visible and/or ultraviolet (UV) regions, making them suitable for therapeutic (photothermal therapy and photodynamic therapy) and diagnostic applications. In the context of wound healing, these nanoparticles can be combined with other materials such as hydrogels, fibers, metal-organic frameworks (MOFs), graphene oxide, etc., to enhance the healing process and prevent the growth of microbial infections. Notably, UCNPs can act as sensors for real-time monitoring of the wound healing progress, providing valuable feedback to healthcare professionals. Despite their potential, the use of UCNPs in wound dressing applications faces several challenges. Ensuring the stability and biocompatibility of UCNPs under physiological conditions is crucial for their effective integration into dressings. Comprehensive safety and efficacy evaluations are necessary to understand potential risks and optimize UCNP-based dressings. Scalability and cost-effectiveness of UCNP synthesis and manufacturing processes are important considerations for practical applications. In addition, efficient incorporation of UCNPs into dressings, achieving uniform distribution, poses an important challenge that needs to be addressed. Future research should prioritize addressing concerns regarding stability and biocompatibility, efficient integration into dressings, rigorous safety evaluation, scalability, and cost-effectiveness. The purpose of this review is to critically evaluate the advantages, challenges, and key properties of UCNPs in wound dressing applications to provide insights into their potential as innovative solutions for enhancing wound healing outcomes. We have provided a detailed description of various types of smart wound dressings, focusing on the synthesis and biomedical applications of UCNPs, specifically their utilization in different types of wound dressings.

Use of over-the-counter mouthwashes as an additional measure in individual oral prophylaxis on adults with plaque-induced gingivitis: a double-blind, parallel, randomized controlled trial

BACKGROUND

Plaque-induced gingivitis is a chronic inflammatory condition characterized by complete reversibility of tissue damage once the periodontal biofilm has been disorganised. The aim of this study was to evaluate the efficacy of two commercially available mouthwashes (MWs) versus a chlorhexidine (CHX) 0.12% MW in reducing gingival bleeding (GB) in adults with plaque-induced gingivitis.

METHODS

The present study was a double-blind, parallel, randomized controlled trial involving 6492 gingival sites (i.e. 39 subjects × 28 teeth × 6 sites/tooth) aged 18-75 years. During a 2-week period, subjects were randomized to receive MWs: a control CHX 0.12% MW (group C, 1818 sites); a MW test containing CHX 0.09% + Citrox®/P complex (group CX, 2628 sites); a MW test based on natural compounds (group P, 2016 sites). GB was assessed at the inclusion visit (T0) and after 2 weeks of MW use (T1). Analyses of GB were compared between groups and then restricted to subjects with bleeding sites between 10 and 30% (moderate gingivitis) or ≥ 30% (severe gingivitis) at T0. Pairwise comparisons were made between groups and logistic regression was used to identify correlates of GB (T1).

RESULTS

For total bleeding site analysis, GB reduction between T0 and T1 ranged from 23% (C), 26% (CX) and 36% (P), respectively (all p < 0.05). Multiple comparison between groups showed that group C was significantly less effective (p < 0.05) than groups CX and P. Splitting the analysis, in patients with severe gingivitis (≥ 30% bleeding sites at T0), all MWs had a positive effect on GB with a reduction at T1 of 36% (C), 33% (CX) and 42% (P), respectively. While GB reduction between T0 and T1, was significant for all groups, the comparison among groups showed no significant difference between group C and CX, whereas the improvement was significant for group P. On the other hand, in adults with moderate gingivitis (< 30% bleeding sites at T0), only CX and P had a positive effect on GB reduction at T1(9% in CX and 2% in P, respectively), although the differences between the three groups were not significant.

CONCLUSION

The daily use of MWs with natural components (groups P and CX) for 2 weeks should be considered positively as an adjunct to individual oral prophylaxis to reduce GB compared to the control MW containing CHX 0.12% (group C) in healthy adults with plaque-induced gingivitis. For subjects with severe gingivitis, it is advisable to first use natural MW (P) and then MW based on CHX 0.09% with natural components (CX), compared to MW with CHX 0.12% (C). For adults with moderate gingivitis, P and CX can be advisable, even if no definitive recommendations can be drawn.

TRIAL REGISTRATION

ACTRN12622000215729, 07/02/2022.

Stimuli-responsive polysaccharide-based smart hydrogels for diabetic wound healing: Design aspects, preparation methods and regulatory perspectives

Diabetes adversely affects wound-healing responses, leading to the development of chronic infected wounds. Such wound microenvironment is characterized by hyperglycaemia, hyperinflammation, hypoxia, variable pH, upregulation of matrix metalloproteinases, oxidative stress, and bacterial colonization. These pathological conditions pose challenges for the effective wound healing. Therefore, there is a paradigm shift in diabetic wound care management wherein abnormal pathological conditions of the wound microenvironment is used as a trigger for controlling the drug release or to improve properties of wound dressings. Hydrogels composed of natural polysaccharides showed tremendous potential as wound dressings as well as stimuli-responsive materials due to their unique properties such as biocompatibility, biodegradability, hydrophilicity, porosity, stimuli-responsiveness etc. Hence, polysaccharide-based hydrogels have emerged as advanced healthcare materials for diabetic wounds. In this review, we presented important aspects for the design of hydrogel-based wound dressings with an emphasis on biocompatibility, biodegradability, entrapment of therapeutic agents, moisturizing ability, swelling, and mechanical properties. Further, various crosslinking methods that enable desirable properties and stimuli responsiveness to the hydrogels have been mentioned. Subsequently, state-of-the-art developments in mono- and multi- stimuli-responsive hydrogels have been presented along with the case studies. Finally regulatory perspectives, challenges for the clinical translation and future prospects have been discussed.

Degradable Polymeric Bio(nano)materials and Their Biomedical Applications: A Comprehensive Overview and Recent Updates

Degradable polymers (both biomacromolecules and several synthetic polymers) for biomedical applications have been promising very much in the recent past due to their low cost, biocompatibility, flexibility, and minimal side effects. Here, we present an overview with updated information on natural and synthetic degradable polymers where a brief account on different polysaccharides, proteins, and synthetic polymers viz. polyesters/polyamino acids/polyanhydrides/polyphosphazenes/polyurethanes relevant to biomedical applications has been provided. The various approaches for the transformation of these polymers by physical/chemical means viz. cross-linking, as polyblends, nanocomposites/hybrid composites, interpenetrating complexes, interpolymer/polyion complexes, functionalization, polymer conjugates, and block and graft copolymers, are described. The degradation mechanism, drug loading profiles, and toxicological aspects of polymeric nanoparticles formed are also defined. Biomedical applications of these degradable polymer-based biomaterials in and as wound dressing/healing, biosensors, drug delivery systems, tissue engineering, and regenerative medicine, etc., are highlighted. In addition, the use of such nano systems to solve current drug delivery problems is briefly reviewed.

Biogenic Vaterite Calcium Carbonate-Silver/Poly(Vinyl Alcohol) Film for Wound Dressing

Vaterite, a spherical polymorph of CaCO3, shows potential as a carrier for the stable and controlled release of silver nanoparticles (AgNPs), preventing their aggregation or loss of efficacy during application. Furthermore, the embedding of CaCO3-Ag in a poly(vinyl alcohol) (PVA) matrix helps effectively encapsulate and protect the CaCO3-Ag microspheres and provides mechanical stability for better contact with the wound surface. This article focuses on the fabrication of an antimicrobial and biocompatible absorbent film embedded with precipitated biogenic vaterite CaCO3-Ag microspheres. The impact of vaterite CaCO3-Ag on the physical, chemical, nanomechanical, biocompatibility, and antimicrobial properties of the PVA films was investigated. The morphology study revealed a bilayer film structure with an inactive and active surface containing homogeneously distributed vaterite CaCO3-Ag. The X-ray photoelectron spectroscopy (XPS) analysis of the spin-orbit splitting in the Ag 3d5/2 and Ag 3d3/2 peaks indicated the presence of both metallic and ionic states of silver in vaterite CaCO3-Ag prior to its incorporation into the PVA polymer matrix. However, upon embedding in the PVA matrix, a subsequent transformation to solely ionic states was observed. The nanomechanical properties of PVA improved, and the reduced modulus and hardness increased to 14.62 ± 5.23 and 0.64 ± 0.29 GPa, respectively. The films demonstrate a significant activity toward Gram-negative Escherichia coli bacteria. The release of AgNPs was studied in both open and closed systems at pH 6, mimicking the pH environment of the wound, and it demonstrated a dependency on the type of capping agent used for synthesis and loading of AgNPs. The results further revealed the biocompatibility of the prepared films with human dermal fibroblast cells at a concentration of ≤5 mg/mL, making them applicable and functional for wound dressing applications.

Chitosan bioactive glass scaffolds for in vivo subcutaneous implantation, toxicity assessment, and diabetic wound healing upon animal model

This study aims to develop chitosan-bioactive glass (BG) scaffolds for diabetic wound healing, toxicity valuation, and subcutaneous implantation in animals for biocompatibility assessment. The scaffolds were prepared by lyophilization technique. In specific BG without sodium (Na), composited with chitosan for better biological activities. The equipped scaffolds were studied for their physiochemical, biological, in vitro and in vivo performances. The chitosan and chitosan-BG (Na free) scaffolds show reliable biocompatibility, cytocompatibility, anti-oxidant, and tissue regeneration. The biocompatibility, toxicity assessments, and diabetic skin wound healing experiments were examined through in vivo studies using Sprague Dawley rats. The extracted tissue samples were analyzed using hematoxylin-eosin- (H and E) and Masson's trichrome staining. Further, tissue excised after scaffold implantation declared non-toxic, non-allergic, and anti-inflammatory nature of chitosan scaffolds. Moreover, the total ribonucleic acid (RNA) expression levels were measured using reverse transcription-polymerase chain reaction (RT-PCR) for the scaffolds against vascular endothelial growth factor (VEGF), and collagen type one (Col-1) primers. Admirably, the scaffolds achieved the best level of skin wound healing via tissue regeneration by increasing epithetical cell formation and collagen deposition. Thus, the biocompatibility, non-toxicity, anti-inflammatory, and wound healing efficiency proved that the chitosan-BG (Na free) scaffold can be readily substantial for wound healing.

Recent progress in polysaccharide and polypeptide based modern moisture-retentive wound dressings

Wounds were considered as defects in the tissues of the human skin and wound healing is said to be a tedious process as there are possibilities of infection or inflammation due to microorganisms. Modern moisture-retentive wound dressing (MMRWD) is opening a new window toward wound therapy. It comprises different types of wound dressing that has classified based on their functionality. Selective polysaccharide-polypeptide fiber composite materials such as hydrogels, hydrocolloids, hydro fibers, transparent-film dressing, and alginate dressing are discussed in this review as a type of MMRWD. The highlight of this polysaccharide and polypeptide based MMRWD is that it supports and enhances the healing of different types of wounds by moisture absorption thus preventing infection. This study has given enlightenment on the application of selected polysaccharide and polypeptide based MMRWD that enhances wound healing actions still it has been observed that the composite wound healing dressing is more effective than the single one. The nano-sized materials (synthetic nano drugs and phyto drugs) were found to increase the efficiency of healing action while coated in the wound dressing material. Future research is required to find out more possibilities of the different composite types of wound dressing in the healing action.

Biomolecules based hydrogels and their potential biomedical applications: A comprehensive review

The need for biocompatible drug carriers has been significantly increased from the past few years. Researchers show great interest in the development of more versatile and sophisticated biomaterials based drug carriers. Hydrogels are beneficial drug carriers and easily release the controlled amount of drug at target site due to its tunable structure. The hydrogels made-up of potent biological macromolecules including collagen, gelatin, fibrin, elastin, fibroin, chitosan, starch, alginate, agarose and carrageenan have been proven as versatile biomaterials. These are three-dimensional polymeric networks, synthesized by crosslinking of hydrophilic polymers. The biological macromolecules based hydrogels containing therapeutic substances are used in a wide range of biomedical applications including wound healing, tissue engineering, cosmetics and contact lenses. However, many aspects related to hydrogels such as the mechanism of cross-linking and molecular entanglement are not clear. So, there is a need to do more research and exploration toward the extensive and cost-effective use of hydrogels. The present review article elaborately discusses the biomolecules based hydrogels and their possible biomedical applications in different fields.

Organic and Biogenic Nanocarriers as Bio-Friendly Systems for Bioactive Compounds' Delivery: State-of-the Art and Challenges

"Green" strategies to build up novel organic nanocarriers with bioperformance are modern trends in nanotechnology. In this way, the valorization of bio-wastes and the use of living systems to develop multifunctional organic and biogenic nanocarriers (OBNs) have revolutionized the nanotechnological and biomedical fields. This paper is a comprehensive review related to OBNs for bioactives' delivery, providing an overview of the reports on the past two decades. In the first part, several classes of bioactive compounds and their therapeutic role are briefly presented. A broad section is dedicated to the main categories of organic and biogenic nanocarriers. The major challenges regarding the eco-design and the fate of OBNs are suggested to overcome some toxicity-related drawbacks. Future directions and opportunities, and finding "green" solutions for solving the problems related to nanocarriers, are outlined in the final of this paper. We believe that through this review, we will capture the attention of the readers and will open new perspectives for new solutions/ideas for the discovery of more efficient and "green" ways in developing novel bioperformant nanocarriers for transporting bioactive agents.

Bioactive Composite Cryogels Based on Poly (Vinyl Alcohol) and a Polymacrolactone as Tissue Engineering Scaffolds: In Vitro and In Vivo Studies

In light of the increasing resistance of pathogenic microorganisms to the action of antibiotics, essential oils extracted from plants with therapeutic activity provide a significant alternative to obtaining dressings for the treatment of skin wounds. The encapsulation of essential oils in an amphiphilic gel network allows better dispersion and preservation of hydrophobic bioactive substances while promoting their prolonged release. In this study, we focused on the development of a poly (vinyl alcohol) (PVA)/poly (ethylene brassylate-co-squaric acid) (PEBSA) platform embedded with thymol (Thy), and α-tocopherol (α-Tcp) as a co-drug structure with prospective use for the treatment and healing of skin wounds. The new complex bioactive system was prepared through repeated freeze-thaw processes. The influence of the composition on surface topography, hydrophilic/hydrophobic character, and in vitro interaction with simulated body fluids was evidenced. BALB/3T3 fibroblast cell culture demonstrated the cryogel scaffolds' cytocompatibility. Tests on Wistar rats confirmed their biocompatibility, integration with host tissue, and the absence of inflammatory processes. The bioactive compound significantly enhanced the healing process of full-thickness excision wounds in a rat model. Further investigations on in vivo infection models would assess the potential of the PVA/PEBSA platform with dual bioactive activity for clinical antimicrobial and wound healing therapy.

Fish Scale Gelatin Nanofibers with Helichrysum italicum and Lavandula latifolia Essential Oils for Bioactive Wound-Healing Dressings

Essential oils are valuable alternatives to synthetic antibiotics that have the potential to avoid the pathogen resistance side effects generated by leather. Helichrysum italicum and Lavandula latifolia essential oils combined with fish scale gelatin were electrospun using a coaxial technique to design new bioactive materials for skin wound dressings fabrication. Fish scale gelatins were extracted from carp fish scales using two variants of the same method, with and without ethylenediaminetetraacetic acid (EDTA). Both variants showed very good electrospinning properties when dissolved in acetic acid solvent. Fish scale gelatin nanofibers with Helichrysum italicum and Lavandula latifolia essential oil emulsions ensured low microbial load (under 100 CFU/g of total number of aerobic microorganisms and total number of yeasts and filamentous fungi) and the absence of Staphylococcus aureus ATCC 6538, Escherichia coli ATCC 10536, and Candida albicans ATCC 1023 as compared to fish scale gelatin without essential oils, which recommends them for pharmaceutical or topical applications. A scratch-test performed on human dermal fibroblasts proved that the biomaterials contributing to the wound healing process included fish scale gelatin nanofibers without EDTA (0.5% and 1%), fish scale gelatin nanofibers without EDTA and Lavandula latifolia essential oil emulsion (1%), fish scale gelatin nanofibers with EDTA (0.6%), and fish scale gelatin nanofibers with EDTA with Helichrysum italicum essential oil emulsion (1% and 2%).

Multifunctional Hydrogels Based on Cellulose and Modified Lignin for Advanced Wounds Management

Considering the complex process of wound healing, it is expected that an optimal wound dressing should be able to overcome the multiple obstacles that can be encountered in the wound healing process. An ideal dressing should be biocompatible, biodegradable and able to maintain moisture, as well as allow the removal of exudate, have antibacterial properties, protect the wound from pathogens and promote wound healing. Starting from this desideratum, we intended to design a multifunctional hydrogel that would present good biocompatibility, the ability to provide a favorable environment for wound healing, antibacterial properties, and also, the capacity to release drugs in a controlled manner. In the preparation of hydrogels, two natural polymers were used, cellulose (C) and chemically modified lignin (LE), which were chemically cross-linked in the presence of epichlorohydrin. The structural and morphological characterization of CLE hydrogels was performed by ATR-FTIR spectroscopy and scanning electron microscopy (SEM), respectively. In addition, the degree of swelling of CLE hydrogels, the incorporation/release kinetics of procaine hydrochloride (PrHy), and their cytotoxicity and antibacterial properties were investigated. The rheological characterization, mechanical properties and mucoadhesion assessment completed the study of CLE hydrogels. The obtained results show that CLE hydrogels have an increased degree of swelling compared to cellulose-based hydrogel, a better capacity to encapsulate PrHy and to control the release of the drug, as well as antibacterial properties and improved mucoadhesion. All these characteristics highlight that the addition of LE to the cellulose matrix has a positive impact on the properties of CLE hydrogels, confirming that these hydrogels can be considered as potential candidates for applications as oral wound dressings.

Wound Healing Performance in a Moist Environment of Crystalline Glucose/Mannose Film as a New Dressing Material Using a Rat Model: Comparing with Medical-Grade Wound Dressing and Alginate

Although medical wound dressings produced using hydrocolloids and alginate were effective in wound healing, adhesion at the wound site and the resulting delayed healing have been a problem. As a new wound dressing material, crystalline wound dressings produced from glucose/mannose were used in this study, which aimed to clarify the properties, adhesion reduction, and wound healing performance of a new wound dressing. Crystalline glucose/mannose films were obtained via alkali treatment using the solution casting method. The structure of the crystalline glucose/mannose films was analogous to the cellulose II polymorph, and the crystallinity decreased with time in hydrated conditions. The crystalline glucose/mannose films had adequate water absorption of 34 × 10-4 g/mm3 for 5 min. These allowed crystalline glucose/mannose films to remove excess wound exudates while maintaining a moist wound healing condition. This in vivo study demonstrated the healing effects of three groups, which were crystalline glucose/mannose group > alginate group > hydrocolloid group. At 1 week, the crystalline glucose/mannose group was also found to be non-adhesive to the portion of wound healing. This was evidenced by the earlier onset of the healing process, which assisted in re-epithelization and promotion of collagen formation and maturation. These results implied that crystalline glucose/mannose films were a promising candidate that could accelerate the wound healing process, compared with medical-grade wound dressing and alginate.

Antiseptic pyolytics and warming wet compresses improve the prospect of healing chronic wounds

Infection and suppuration of chronic wounds reduce the effectiveness of their treatment with a course of antibiotics and antiseptics combined with frequently renewed dressings. Therefore, daily short-term procedures of cleaning wounds from purulent-necrotic masses by mechanical methods, including the use of cleansing solutions and necrophage fly larvae, are also part of the general practice of chronic wound treatment. But even they do not always provide rapid healing of chronic wounds. In this connection, it is suggested to supplement the treatment of chronic wounds with preparations dissolving dense pus and wound dressings made in the form of warm moist compresses creating a local greenhouse effect in the wounds. Solutions of 3% hydrogen peroxide and 2–10% sodium bicarbonate heated to a temperature of 37°–45°С, possessing alkaline activity at рН 8.4–8.5 and enriched with dissolved carbon dioxide or oxygen gas (due to overpressure of 0.2 atm were suggested as pyolytic drugs. The first results of the use of pyolytics and warm moist dressings-compresses in the treatment of chronic wounds demonstrate a wound-healing effect. It is suggested to consider sanitizing therapy with pyolytics and warm moist wound dressings-compresses as an alternative to the use of modern cleansing solutions and artificial introduction of larvae of the necrophage fly into the purulent masses of chronic wounds to dissolve dense pus and accelerate the healing process.

Challenges of current treatment and exploring the future prospects of nanoformulations for treatment of atopic dermatitis

Atopic dermatitis (AD) is a predominant and deteriorating chronic inflammation of the skin, categorized by a burning sensation and eczematous lesions in diverse portions of the body. The treatment of AD is exclusively focused to limit the itching, reduce inflammation, and repair the breached barrier of the skin. Several therapeutic agents for the treatment and management of AD have been reported and are in use in clinics. However, the topical treatment of AD has been an unswerving challenge for the medical fraternity owing to the impaired skin barrier function in this chronic skin condition. To surmount the problems of conventional drug delivery systems, numerous nanotechnology-based formulations are emerging as alternative new modalities for AD. Latter enhances the bioavailability and delivery to the target disease site, improves drug permeation and therapeutic efficacy with reduced systemic and off-target side effects, and thus improves patient health and promotes compliance. This review aims to describe the various pathophysiological events involved in the occurrence of AD, current challenges in treatment, evidence of molecular markers of AD and its management, combinatorial treatment options, and the intervention of nanotechnology-based formulations for AD therapeutics.

A Transparent, Tough and Self-Healable Biopolymeric Composites Hydrogel for Open Wound Management

Modern healthcare engineering requires a wound dressing solution supported by materials with outstanding features such as high biological compatibility, strong mechanical strength, and higher transparency with effective antibacterial properties. Here, we present a unique hydrogel technology consisting of two negatively charged biopolymers and a positively charged synthetic polymer. The interaction between charged polymers through hydrogen bonds has been created, which are revealed in the simulation by density functional theory and Fourier transform infrared spectra of individual polymers and the hydrogel film. The transparent hydrogel film dressings showed excellent stretchability, a higher water swelling ratio (60%), and strong mechanical strength (∼100 MPa) with self-healing abilities (85-90%). The fabricated hydrogel film showed stable blood clots (within 119 ± 15 s) with rapid hemostasis (<2%) properties and effective antibacterial studies against E. coli and S. aureus bacterial strains. In addition, the obtained hydrogel film also showed excellent cell viability on mouse fibroblast cells. With their enormous amenability to modification, these hydrogel films may serve as promising biomaterials for wound dressing applications.

Highly absorbent bio-sponge based on carboxymethyl chitosan/poly-γ-glutamic acid/platelet-rich plasma for hemostasis and wound healing

Stopping bleeding at an early stage and promoting wound healing are of great significance for efficient wound management. In this study, a carboxymethyl chitosan (CMCS)/poly-γ-glutamic acid (γ-PGA)/platelet-rich plasma (PRP) hydrogel (CP-PRP hydrogel) was firstly prepared by crosslinking of CMCS with γ-PGA and the enzymatic coagulation of PRP. Then, the CP-PRP hydrogel was freeze-dried and transformed into a sponge (CP-PRP sponge). A series of safety experiments with cells, blood, and tissues proved the biocompatibility of the CP-PRP sponge. Importantly, the CP-PRP sponge was able to adhere and condense red blood cells, which accelerated blood clotting. Therefore, the CP-PRP sponge showed an enhanced hemostasis effect compared to SURGIFLO® Hemostatic Matrix. Moreover, in vitro and in vivo experiments showed that the sponge was able to release epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF). Thus, in a mouse model of full-thickness skin defects, the wounds of the sponge-treated mice were significantly healed within two weeks. These results proved the transforming potential of the CP-PRP sponge as a novel bioactive wound dressing.

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.

Recent Advances of Natural-Polymer-Based Hydrogels for Wound Antibacterial Therapeutics

Hydrogels have a three-dimensional network structure and high-water content, are similar in structure to the extracellular matrix, and are often used as wound dressings. Natural polymers have excellent biocompatibility and biodegradability and are commonly utilized to prepare hydrogels. Natural-polymer-based hydrogels can have excellent antibacterial and bioactive properties by loading antibacterial agents or being combined with therapeutics such as phototherapy, which has great advantages in the field of treatment of microbial infections. In the published reviews of hydrogels used in the treatment of infectious wounds, the common classification criteria of hydrogels include function, source of antibacterial properties, type of antibacterial agent, etc. However, there are few reviews on the classification of hydrogels based on raw materials, and the description of natural-polymer-based hydrogels is not comprehensive and detailed. In this paper, based on the principle of material classification, the characteristics of seven types of natural polymers that can be used to prepare hydrogels are discussed, respectively, and the application of natural-polymer-based hydrogels in the treatment of infectious wounds is described in detail. Finally, the research status, limitations, and prospects of natural-polymer-based hydrogels are briefly discussed.

Polymer-Based Hydrogel Loaded with Honey in Drug Delivery System for Wound Healing Applications

Excellent wound dressings should have crucial components, including high porosity, non-toxicity, high water absorption, and the ability to retain a humid environment in the wound area and facilitate wound healing. Unfortunately, current wound dressings hamper the healing process, with poor antibacterial, anti-inflammatory, and antioxidant activity, frequent dressing changes, low biodegradability, and poor mechanical properties. Hydrogels are crosslinked polymer chains with three-dimensional (3D) networks that have been applicable as wound dressings. They could retain a humid environment on the wound site, provide a protective barrier against pathogenic infections, and provide pain relief. Hydrogel can be obtained from natural, synthetic, or hybrid polymers. Honey is a natural substance that has demonstrated several therapeutic efficacies, including anti-inflammatory, antibacterial, and antioxidant activity, which makes it beneficial for wound treatment. Honey-based hydrogel wound dressings demonstrated excellent characteristics, including good biodegradability and biocompatibility, stimulated cell proliferation and reepithelization, inhibited bacterial growth, and accelerated wound healing. This review aimed to demonstrate the potential of honey-based hydrogel in wound healing applications and complement the studies accessible regarding implementing honey-based hydrogel dressing for wound healing.

Aloe vera-Based Hydrogels for Wound Healing: Properties and Therapeutic Effects

Aloe vera-based hydrogels have emerged as promising platforms for the delivery of therapeutic agents in wound dressings due to their biocompatibility and unique wound-healing properties. The present study provides a comprehensive overview of recent advances in the application of Aloe vera-based hydrogels for wound healing. The synthesis methods, structural characteristics, and properties of Aloe vera-based hydrogels are discussed. Mechanisms of therapeutic agents released from Aloe vera-based hydrogels, including diffusion, swelling, and degradation, are also analyzed. In addition, the therapeutic effects of Aloe vera-based hydrogels on wound healing, as well as the reduction of inflammation, antimicrobial activity, and tissue regeneration, are highlighted. The incorporation of various therapeutic agents, such as antimicrobial and anti-inflammatory ones, into Aloe vera-based hydrogels is reviewed in detail. Furthermore, challenges and future prospects of Aloe vera-based hydrogels for wound dressing applications are considered. This review provides valuable information on the current status of Aloe vera-based hydrogels for the delivery of therapeutic agents in wound dressings and highlights their potential to improve wound healing outcomes.

Polymer-Based Hydrogels Applied in Drug Delivery: An Overview

Polymer-based hydrogels are hydrophilic polymer networks with crosslinks widely applied for drug delivery applications because of their ability to hold large amounts of water and biological fluids and control drug release based on their unique physicochemical properties and biocompatibility. Current trends in the development of hydrogel drug delivery systems involve the release of drugs in response to specific triggers such as pH, temperature, or enzymes for targeted drug delivery and to reduce the potential for systemic toxicity. In addition, developing injectable hydrogel formulations that are easily used and sustain drug release during this extended time is a growing interest. Another emerging trend in hydrogel drug delivery is the synthesis of nano hydrogels and other functional substances for improving targeted drug loading and release efficacy. Following these development trends, advanced hydrogels possessing mechanically improved properties, controlled release rates, and biocompatibility is developing as a focus of the field. More complex drug delivery systems such as multi-drug delivery and combination therapies will be developed based on these advancements. In addition, polymer-based hydrogels are gaining increasing attention in personalized medicine because of their ability to be tailored to a specific patient, for example, drug release rates, drug combinations, target-specific drug delivery, improvement of disease treatment effectiveness, and healthcare cost reduction. Overall, hydrogel application is advancing rapidly, towards more efficient and effective drug delivery systems in the future.

Exopolysaccharides Producing Bacteria: A Review

Bacterial exopolysaccharides (EPS) are essential natural biopolymers used in different areas including biomedicine, food, cosmetic, petroleum, and pharmaceuticals and also in environmental remediation. The interest in them is primarily due to their unique structure and properties such as biocompatibility, biodegradability, higher purity, hydrophilic nature, anti-inflammatory, antioxidant, anti-cancer, antibacterial, and immune-modulating and prebiotic activities. The present review summarizes the current research progress on bacterial EPSs including their properties, biological functions, and promising applications in the various fields of science, industry, medicine, and technology, as well as characteristics and the isolation sources of EPSs-producing bacterial strains. This review provides an overview of the latest advances in the study of such important industrial exopolysaccharides as xanthan, bacterial cellulose, and levan. Finally, current study limitations and future directions are discussed.

Zinc Oxide-Incorporated Chitosan-Poly(methacrylic Acid) Polyelectrolyte Complex as a Wound Healing Material

A novel type of porous films based on the ZnO-incorporated chitosan-poly(methacrylic acid) polyelectrolyte complex was developed as a wound healing material. The structure of porous films was established by Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and energy dispersive X-ray (EDX) analysis. Scanning electron microscope (SEM) and porosity studies revealed that the pore size and porosity of the developed films increased with the increase in zinc oxide (ZnO) concentration. The porous films with maximum ZnO content exhibited improved water swelling degree (1400%), controlled biodegradation (12%) for 28 days, a porosity of 64%, and a tensile strength of 0.47 MPa. Moreover, these films presented antibacterial activity toward Staphylococcus aureus and Micrococcus sp. due to the existence of ZnO particles. Cytotoxicity studies demonstrated that the developed films had no cytotoxicity against the mouse mesenchymal stem (C3H10T1/2) cell line. These results reveal that ZnO-incorporated chitosan-poly(methacrylic acid) films could be used as an ideal material for wound healing application.

An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of?

Acute skin failure is rarely the primary diagnosis that necessitates admission to an intensive care unit. Dermatological manifestations in critically ill patients, on the other hand, are relatively common and can be used to make a key diagnosis of an adverse drug reaction or an underlying systemic illness, or they may be caused by factors related to a prolonged stay or invasive procedures. In intensive care units, their classification is based on the aetiopathogenesis of the cutaneous lesion and, in the meantime, distinguishes critical patients. When evaluating dermatological manifestations, several factors must be considered: onset, morphology, distribution, and associated symptoms and signs. This review depicts dermatological signs in critical patients in order to lay out better recognition.