Wound dressings: selecting the most appropriate type

Human acellular amniotic membrane incorporating exosomes from adipose-derived mesenchymal stem cells promotes diabetic wound healing

Background

Diabetic wounds threaten the health and quality of life of patients and their treatment remains challenging. ADSC-derived exosomes have shown encouraging results in enhancing diabetic wound healing. However, how to use exosomes in wound treatment effectively is a problem that needs to be addressed at present.

Methods

A diabetic mouse skin wound model was established. ADSC-derived exosomes (ADSC-Exos) were isolated, and in vitro application of exosomes was evaluated using human umbilical vein endothelial cells (HUVECs) and human dermal fibroblasts (HDFs). After preparation and characterization of a scaffold of human acellular amniotic membrane (hAAM) loaded with ADSC-Exos in vitro, they were transplanted into wounds in vivo and wound healing phenomena were observed by histological and immunohistochemical analyses to identify the wound healing mechanism of the exosome-hAAM composites.

Results

The hAAM scaffold dressing was very suitable for the delivery of exosomes. ADSC-Exos enhanced the proliferation and migration of HDFs and promoted proliferation and tube formation of HUVECs in vitro. In vivo results from a diabetic skin wound model showed that the hAAM-Exos dressing accelerated wound healing by regulating inflammation, stimulating vascularization, and promoting the production of extracellular matrix.

Conclusion

Exosome-incorporated hAAM scaffolds showed great potential in promoting diabetic skin wound healing, while also providing strong evidence for the future clinical applications of ADSC-derived exosomes.

Ferrocene-functionalized hybrid hydrogel dressing with high-adhesion for combating biofilm

Bacterial infection is a common phenomenon in the process of postoperative wound healing. In severe cases, it may even lead to life-threatening, which brings a heavy burden to the clinical treatment and causes huge losses to the society and economy. As one of the most commonly applied medical materials for wound treatment, hydrogel dressings are mainly used to cover and protect wounds and provide a favorable environment to facilitate wound healing. In this work, we developed an antibacterial hydrogel dressing (Fc-PAAM) with high adhesion, which is consisted of polyacrylamide (PAM) hydrogel framework and polyacrylic acid-functionalized (PAA) with ferrocene (Fc). Morphology, adhesion and pressure resistance of PAAM hydrogel were confirmed by using scanning electron microscope (SEM) and universal testing machine, and Fc decoration in the hydrogel network was well demonstrated by using Fourier transform infrared spectroscopy (FT-IR). Ultraviolet-visible spectroscopy (UV-vis) displayed that the Fc-PAAM hydrogel had excellent peroxidase-like activity as well. It not only exhibited prominent antimicrobial activity against Gram (+/-) bacteria, but also performed high efficiency in preventing the formation of biofilms. In addition, in vivo experiments indicated that this adhesive dressing could significantly prevent bacterial infections. Compared with other clinical treatment methods, this kind of hydrogel is not easy to cause bacterial resistance, and the used raw materials are easy to obtain and low in price, which can amplify the antibacterial properties of H₂O₂ and provide a new opportunity for the treatment of clinical bacterial infections.

Preparation of nano-hydroxyapatite/chitosan/tilapia skin peptides hydrogels and its burn wound treatment

There is an urgent need for wound dressings to treat partial-thickness burns. Hydrogels are a promising material that can maintain hydration to promote necrotic tissue removal. Tilapia peptides (TP) and hydroxyapatite (HA) were incorporated into chitosan system to prepare new types of hydrogels. The hydrogels were cross-linking by tannin (TA), which were developed to promote rapid wound healing in a New Zealand rabbit partial-thickness burn model. Nanohydroxyapatite (NHA) was synthesized by coprecipitation method, which made hydrogels have a highly porous structure comprised of interconnected pores, excellent water absorption and low hemolysis. Besides, the hydrogels showed excellent antimicrobial activities against both Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), as well as the cytocompatibility on endothelial cells. Moreover, the hydrogels promoted epithelial and dermal regeneration, reduce the expression of TNF-α and IL-6 and promote the skin regeneration by enhancing expression of collagen, STAT3, and VEGF.

Antibacterial activity of antimicrobial peptide-conjugated nanofibrous membranes

Antimicrobial peptides (AMPs) are considered as novel potential alternatives to antibiotics against increasing number of multi drug resistant (MDR) pathogens. Although AMPs have shown strong antimicrobial activity against gram-negative or gram-positive microorganisms, AMP conjugated biomaterials that are effective against MDR microorganisms are yet to be developed. Herein, the potential use of (RWRWRWRW)-NH2 (AMP-1) and KRFRIRVRV-NH2 (AMP-2) peptide conjugated electrospun polylactic-co-glycolic-acid (PLGA) nanofibers (NFs) fabricated and their antimicrobial effect by themselves and in their dual combination (1:1) were evaluated on P. aeruginosa and methicillin-resistant S. aureus (MRSA). Those AMP conjugated NFs did not inhibit proliferation of keratinocytes. These results suggest that AMP conjugated NF, which has multiple biological activities, would be a promising candidate as a wound dressing material.

Aloe vera: A Medicinal Plant Used in Skin Wound Healing

Skin injury is a major problem threatening human physical and mental health, and how to promote wound healing has been the focus. Developing new wound dressings is an important strategy in skin regeneration. Aloe vera is a medicinal plant with a long history, complex constituents, and various pharmacological activities. Many studies have shown that A. vera plays an important role in promoting wound healing. Adding A. vera to wound dressing has become an ideal way. This review will describe the process of skin injury and wound healing and analyze the role of A. vera in wound healing. In addition, the types of wound dressing and the applications of A. vera in wound dressing will be discussed.

Effects of Carnosine, Ankaferd, and Silver Sulfadiazine on an Experimental Burn Model: Roles of Irisin and HSP70

In this study, the effects of carnosine, ankaferd, and 1% silver sulfadiazine applied topically on second-degree burns were investigated and the roles of irisin and Heat shock protein 70 (HSP70) in this healing process were evaluated. Ninety male albino rats were used and divided into five groups. The groups were classified as control, burn, burn + carnosine (CAR), burn + ankaferd (ABS), and burn + silver sulfadiazine (SS). It was found that level of irisin increased in the first week and decreased in the second week in the burn and CAR groups. In the ABS and SS groups, the level of irisin was determined that started to increase in the first week and continued to increase in the second week. The level of HSP70 was found to increased in the first week in burn and CAR groups and decreased in the second week, but started to increase in the second week in ABS and SS groups. Both levels of irisin and HSP70 were observed to decreased in all treatment groups in the third week. In this study, it was shown that ankaferd and silver sülfadiazine treatments cause an increase in the irisin levels in the early period and a gradually increase in HSP70 levels in the later period in burns. The inflammatory response was observed to be limited in the early period in the ankaferd and sulfadiazin groups. It was concluded that these findings were effective in early wound healing in burns.

Nitric Oxide-Releasing Thermoresponsive Pluronic F127/Alginate Hydrogel for Enhanced Antibacterial Activity and Accelerated Healing of Infected Wounds

Nitric oxide (NO), a highly reactive and lipophilic molecule, is one of the molecules present in the wound environment and implicated as an important regulator in all phases of wound healing. Here, we developed an NO-releasing thermoresponsive hydrogel (GSNO-PL/AL) composed of S-nitrosoglutathione (GSNO), pluronic F127 (PL), and alginate (AL) for the treatment of infected wounds. The GSNO was incorporated into the thermoresponsive PL/AL hydrogel, and differential scanning calorimetry techniques were used for the hydrogel characterization. The hydrogel was assessed by in vitro NO release, antibacterial activity, cytotoxicity, and wound-healing activity. The GSNO-PL/AL hydrogel demonstrated thermal responsiveness and biocompatibility, and it showed sustained NO release for 7 days. It also exhibited potent bactericidal activity against Gram-positive methicillin-resistant Staphylococcus aureus and Gram-negative multidrug-resistant Pseudomonas aeruginosa (MRPA). Moreover, the GSNO-PL/AL treatment of MRPA-infected wounds accelerated healing with a reduced bacterial burden in the wounds. The GSNO-PL/AL hydrogel would be a promising option for the treatment of infected wounds.

Sulfated Polysaccharides from Marine Algae as a Basis of Modern Biotechnologies for Creating Wound Dressings: Current Achievements and Future Prospects

Wound healing involves a complex cascade of cellular, molecular, and biochemical responses and signaling processes. It consists of successive interrelated phases, the duration of which depends on a multitude of factors. Wound treatment is a major healthcare issue that can be resolved by the development of effective and affordable wound dressings based on natural materials and biologically active substances. The proper use of modern wound dressings can significantly accelerate wound healing with minimum scar mark. Sulfated polysaccharides from seaweeds, with their unique structures and biological properties, as well as with a high potential to be used in various wound treatment methods, now undoubtedly play a major role in innovative biotechnologies of modern natural interactive dressings. These natural biopolymers are a novel and promising biologically active source for designing wound dressings based on alginates, fucoidans, carrageenans, and ulvans, which serve as active and effective therapeutic tools. The goal of this review is to summarize available information about the modern wound dressing technologies based on seaweed-derived polysaccharides, including those successfully implemented in commercial products, with a focus on promising and innovative designs. Future perspectives for the use of marine-derived biopolymers necessitate summarizing and analyzing results of numerous experiments and clinical trial data, developing a scientifically substantiated approach to wound treatment, and suggesting relevant practical recommendations.

Advanced Hydrogels as Wound Dressings

Skin is the largest organ of the human body, protecting it against the external environment. Despite high self-regeneration potential, severe skin defects will not heal spontaneously and need to be covered by skin substitutes. Tremendous progress has been made in the field of skin tissue engineering, in recent years, to develop new skin substitutes. Among them, hydrogels are one of the candidates with most potential to mimic the native skin microenvironment, due to their porous and hydrated molecular structure. They can be applied as a permanent or temporary dressing for different wounds to support the regeneration and healing of the injured epidermis, dermis, or both. Based on the material used for their fabrication, hydrogels can be subdivided into two main groups—natural and synthetic. Moreover, hydrogels can be reinforced by incorporating nanoparticles to obtain “in situ” hybrid hydrogels, showing superior properties and tailored functionality. In addition, different sensors can be embedded in hydrogel wound dressings to provide real-time information about the wound environment. This review focuses on the most recent developments in the field of hydrogel-based skin substitutes for skin replacement. In particular, we discuss the synthesis, fabrication, and biomedical application of novel “smart” hydrogels.

Alginate hydrogel dressings for advanced wound management

Wound healing is a complicated and continuous process affected by several factors, and it needs an appropriate surrounding to achieve accelerated healing. At present, various wound dressings are used for wound management, such as fiber, sponge, hydrogel, foam, hydrocolloid and so on. Hydrogels can provide mechanical support and moist environment for wounds, and are widely used in biomedical field. Alginate is a natural linear polysaccharide derived from brown algae or bacteria, consisting of repeating units of β-1,4-linked D-mannuronic acid (M) and L-guluronic acid (G) in different ratios. It is widely used in biomedical and engineering fields due to its good biocompatibility and liquid absorption capacity. Alginate-based hydrogels have been used in wound dressing, tissue engineering, and drug delivery applications for decades. In this review, we summarize the recent approaches in the chemical and physical preparation and the application of alginate hydrogels in wound dressings.

Biologic and Synthetic Cellular and/or Tissue-Based Products and Smart Wound Dressings/Coverings

Cellular and/or tissue-based products (CTPs) have advanced greatly in the past several decades and improve the ability to heal wounds more efficiently. Products can be characterized as nonviable cells, tissue based, animal; nonviable cells, tissue based, human; viable human cells, cultured in vitro, animal substrate; viable human cells, cultured in vitro, synthetic substrate; viable human cells, noncultured, intact tissue. There are approximately 77 different CTPs at the time of this writing, with many more being investigated. Cellular and/or tissue-based product selection, application, postapplication course, and patient selection depend on patient attributes, CTP specifications, and surgeon preference.

Investigating the effects of walnut ointment on non-healing burn wounds

Effective treatments for non-healing burn wounds are an unmet need for 95% of burn sufferers. Approaches currently available to treat non-healing burn wounds are not satisfactory due to undesirable side-effects or expense. The anti-oxidation and antibacterial activities of walnuts are recommended for treating chronic diseases. Walnut ointment has been developed and successfully applied to treat non-healing burn wounds in our hospital for decades. We report herein a detailed retrospective case review examining patients' response to the walnut ointment. The walnut ointment has shortened healing time of non-healing burn wounds and improved clinical outcomes. In order to investigate the mechanism of action, walnut ointment has been applied on wounds of porcine full-thickness burn wound models. Histological and immunohistochemical analysis indicated our walnut ointment supports wound healing through promoting keratinocyte proliferation and differentiation. Taken together, we recommend the walnut ointment offers an effective and economical treatment for patients presenting with non-healing burn wounds.

Chronic venous ulcers: a review on treatment with fibrin sealant and prognostic advances using proteomic strategies

Venous ulcers are the main causes of chronic lower-limb ulcers. The healing difficulties encourage the research and development of new products in order to achieve better therapeutic results. Fibrin sealant is one of these alternatives. Besides being a validated scaffold and drug delivery system, it possesses excellent healing properties. This review covered the last 25 years of the literature and showed that the fibrin sealant is used in various clinical situations to promote the healing of different types of ulcers, especially chronic ones. These are mostly venous in origin and usually does not respond to conventional treatment. Commercially, only the homologous fibrin sealants obtained from human blood are available, which are highly efficient but very expensive. The heterologous fibrin sealant is a non-commercial experimental low-cost product and easily produced due to the abundance of raw material. The phase I/II clinical trial is already completed and showed that the product is safe and promisingly efficacious for the treatment of chronic venous ulcers. In addition, clinical proteomic strategies to assess disease prognosis have been increasingly used. By analyzing liquid samples from the wounds through proteomic strategies, it is possible to predict before treatment which ulcers will evolve favorably and which ones will be difficult to heal. This prognosis is only possible by evaluating the expression of isolated proteins in exudates and analysis using label-free strategies for shotgun. Multicentric clinical trials will be required to evaluate the efficacy of fibrin sealant to treat chronic ulcers, as well as to validate the proteomic strategies to assess prognosis.

Nanomaterials for Wound Dressings: An Up-to-Date Overview

As wound healing continues to be a challenge for the medical field, wound management has become an essential factor for healthcare systems. Nanotechnology is a domain that could provide different new approaches concerning regenerative medicine. It is worth mentioning the importance of nanoparticles, which, when embedded in biomaterials, can induce specific properties that make them of interest in applications as materials for wound dressings. In the last years, nano research has taken steps to develop molecular engineering strategies for different self-assembling biocompatible nanoparticles. It is well-known that nanomaterials can improve burn treatment and also the delayed wound healing process. In this review, the first-line of bioactive nanomaterials-based dressing categories frequently applied in clinical practice, including semi-permeable films, semipermeable foam dressings, hydrogel dressings, hydrocolloid dressings, alginate dressings, non-adherent contact layer dressings, and multilayer dressings will be discussed. Additionally, this review will highlight the lack of high-quality evidence and the necessity for future advanced trials because current wound healing therapies generally fail to provide an excellent clinical outcome, either structurally or functionally. The use of nanomaterials in wound management represents a unique tool that can be specifically designed to closely reflect the underlying physiological processes in tissue repair.

Absorbable Thioether Grafted Hyaluronic Acid Nanofibrous Hydrogel for Synergistic Modulation of Inflammation Microenvironment to Accelerate Chronic Diabetic Wound Healing

Current standard of care dressings are unsatisfactorily inefficacious for the treatment of chronic wounds. Chronic inflammation is the primary cause of the long-term incurable nature of chronic wounds. Herein, an absorbable nanofibrous hydrogel is developed for synergistic modulation of the inflammation microenvironment to accelerate chronic diabetic wound healing. The electrospun thioether grafted hyaluronic acid nanofibers (FHHA-S/Fe) are able to form a nanofibrous hydrogel in situ on the wound bed. This hydrogel degrades and is absorbed gradually within 3 days. The grafted thioethers on HHA can scavenge the reactive oxygen species quickly in the early inflammation phase to relieve the inflammation reactions. Additionally, the HHA itself is able to promote the transformation of the gathered M1 macrophages to the M2 phenotype, thus synergistically accelerating the wound healing phase transition from inflammation to proliferation and remodeling. On the chronic diabetic wound model, the average remaining wound area after FHHA-S/Fe treatment is much smaller than both that of FHHA/Fe without grafted thioethers and the control group, especially in the early wound healing stage. Therefore, this facile dressing strategy with intrinsic dual modulation mechanisms of the wound inflammation microenvironment may act as an effective and safe treatment strategy for chronic wound management.

Electrospun cellulose acetate/gelatin nanofibrous wound dressing containing berberine for diabetic foot ulcer healing: in vitro and in vivo studies

Functional wound dressing with tailored physicochemical and biological properties is vital for diabetic foot ulcer (DFU) treatment. Our main objective in the current study was to fabricate Cellulose Acetate/Gelatin (CA/Gel) electrospun mat loaded with berberine (Beri) as the DFU-specific wound dressing. The wound healing efficacy of the fabricated dressings was evaluated in streptozotocin-induced diabetic rats. The results demonstrated an average nanofiber diameter of 502 ± 150 nm, and the tensile strength, contact angle, porosity, water vapor permeability and water uptake ratio of CA/Gel nanofibers were around 2.83 ± 0.08 MPa, 58.07 ± 2.35°, 78.17 ± 1.04%, 11.23 ± 1.05 mg/cm2/hr, and 12.78 ± 0.32%, respectively, while these values for CA/Gel/Beri nanofibers were 2.69 ± 0.05 MPa, 56.93 ± 1°, 76.17 ± 0.76%, 10.17 ± 0.21 mg/cm2/hr, and 14.37 ± 0.42%, respectively. The antibacterial evaluations demonstrated that the dressings exhibited potent antibacterial activity. The collagen density of 88.8 ± 6.7% and the angiogenesis score of 19.8 ± 3.8 obtained in the animal studies indicate a proper wound healing. These findings implied that the incorporation of berberine did not compromise the physical properties of dressing, while improving the biological activities. In conclusion, our results indicated that the prepared mat is a proper wound dressing for DFU management and treatment.

Flexible wound healing system for pro-regeneration, temperature monitoring and infection early warning

To break the "Black-Box" status of the wound healing process under traditional dressing, which cannot achieve satisfactory repair outcome of skin wounds, a wound healing system with the abilities of pro-regeneration and real-time monitoring of wound status has become a considerable necessity. Here, by integrating the emerging bioelectronics and software, we created a flexible wound healing system. The hardware system was designed as Band-Aid shaped with a double-layer structure; the upper is the flexible temperature-sensing layer comprising the temperature sensor STH21, power manager circuit and data processing circuit, and the lower is a collagen-chitosan dermal equivalent for skin regeneration. A customized software application (app) installed on a smartphone to receive data from the sensing layer by BLE4.0 can display and analyze real-time wound temperature. Our system had high monitoring sensitivity and stability, good stretchability, excellent reliability and biocompatibility. It was applied to a pig skin wound model to reveal temperature fluctuation during the entire wound regeneration process. As a credible reference and foundation for further early warning of an adverse event, three main phases of temperature fluctuation were found: the rising phase (below 39 °C), plateau phase (39-39.5 °C), and falling phase (below 39 °C), which were accompanied by significant wound biological events, including inflammatory cell infiltration, angiogenesis and wound healing. Furthermore, verified by wound infection models of different healing phases and wound Gram's staining, early warning ahead of serious infection was realized with the use of a customized app's alarm.

Alginate films augmented with chlorhexidine hexametaphosphate particles provide sustained antimicrobial properties for application in wound care

All chronic wounds are colonised by bacteria; for some, colonisation progresses to become infection. Alginate wound dressings are used for highly exuding chronic wounds as they are very absorbent, taking up large quantities of exudate while maintaining a moist wound bed to support healing. Some alginate dressings are doped with antimicrobials, most commonly silver, but evidence regarding the efficacy of these is largely inconclusive. This manuscript describes the development and in vitro assessment of alginate materials doped with chlorhexidine hexametaphosphate (CHX-HMP), a sparingly soluble salt which when exposed to aqueous environments provides sustained release of the common antiseptic chlorhexidine. Comparator materials were a commercial silver alginate dressing material and an alginate doped with chlorhexidine digluconate (CHXdg). CHX-HMP alginates provided a dose-dependent CHX release which was sustained for over 14 days, whereas CHXdg alginates released limited CHX and this ceased within 24 h. CHX-HMP and silver alginates were efficacious against 5 major wound pathogens (MRSA, E. coli, P. aeruginosa, K. pneumoniae, A. baumannii) in a total viable count (TVC) and an agar diffusion zone of inhibition (ZOI) model. At baseline the silver alginate was more effective than the CHX-HMP alginate in the TVC assay but the CHX-HMP alginate was the more effective in the ZOI assay. After 7 days' artificial aging the CHX-HMP alginate was more effective than the silver alginate for four of the five bacteria tested in both assays. These materials may ultimately find application in the development of wound dressings for chronic wounds that provide sustained antimicrobial protection.

Smart Flexible Electronics-Integrated Wound Dressing for Real-Time Monitoring and On-Demand Treatment of Infected Wounds

As the most frequent wound complication, infection has become a major clinical challenge in wound management. To overcome the "Black Box" status of the wound-healing process, next-generation wound dressings with the abilities of real-time monitoring, diagnosis during early stages, and on-demand therapy has attracted considerable attention. Here, by combining the emerging development of bioelectronics, a smart flexible electronics-integrated wound dressing with a double-layer structure, the upper layer of which is polydimethylsiloxane-encapsulated flexible electronics integrated with a temperature sensor and ultraviolet (UV) light-emitting diodes, and the lower layer of which is a UV-responsive antibacterial hydrogel, is designed. This dressing is expected to provide early infection diagnosis via real-time wound-temperature monitoring by the integrated sensor and on-demand infection treatment by the release of antibiotics from the hydrogel by in situ UV irradiation. The integrated system possesses good flexibility, excellent compatibility, and high monitoring sensitivity and durability. Animal experiment results demonstrate that the integrated system is capable of monitoring wound status in real time, detecting bacterial infection and providing effective treatment on the basis of need. This proof-of-concept research holds great promise in developing new strategies to significantly improve wound management and other pathological diagnoses and treatments.

The Ears of a Hippopotamus: Quality of Venous Leg Ulcer Care in Gauteng, South Africa

OBJECTIVE

To describe venous ulcer care and wound care practices in Gauteng, a province of South Africa, according to the Donabedian structure-process-outcome quality improvement model.

METHODS

Forty-eight facilities were selected randomly from public and private wound care practices in Gauteng. Structured interviews were conducted with care providers via questionnaire to assess the structural aspects of the Donabedian model. Within these facilities, investigators randomly selected 160 patient files and extracted data using a checklist to assess processes implemented and outcomes reached for patients who had previously presented with lower-leg venous ulcers.

RESULTS

Facilities lack the necessary equipment to perform vital assessments. Handheld Dopplers were available in 66% (n = 48) of the facilities. Sixty-one percent (n = 48) of the personnel at the facilities indicated that they had no formal wound care training. Although the majority of files (92%, n = 147) indicated that an assessment tool was used, many elements were not evaluated comprehensively according to the best available evidence. Aspects such as smoking, body mass index, and anemia were assessed in fewer than 30% of the patients. Distinguishing between superficial and deep infection and the accompanying overuse of antimicrobials and antibiotics were among the challenges identified. Further, 71% of patients received compression therapy, although the ankle-brachial pressure index of only 30% of patients was known. In 27 cases (17%), the outcome was amputation.

CONCLUSIONS

From this survey, it is evident that not all clinicians providing wound care in Gauteng are adequately trained or fully implementing best practice guidelines, and the consequences are detrimental to patients, particularly in terms of amputation. This article highlights the need for improved legislation and regulation for practitioners who deliver wound care services.

Smart wound dressing for infection monitoring and NIR-triggered antibacterial treatment

Hydrogel-based wound dressings can monitor infection via pH-responsive FRET changes and provide on-demand antibacterial treatment via NIR-triggered antibiotic release.

A Critical Update of the Assessment and Acute Management of Patients with Severe Burns

Significance: Burns are debilitating, life threatening, and difficult to assess and manage. Recent advances in assessment and management have occurred since a comprehensive review of the care of patients with severe burns was last published, which may influence research and clinical practice. Recent Advances: Recent advances have occurred in the understanding of burn pathophysiology, which has led to the identification of potential biomarkers of burn severity, such as protein C. There is new evidence about the potential superiority of natural colloids over crystalloids during fluid resuscitation, and new evidence about components of initial and perioperative management, including an improved understanding of pain following burns. Critical Issues: The limitations of the clinical examination highlight the need for imaging and biomarkers to assist in estimations of burn severity. Fluid resuscitation reduces mortality, although there is conjecture over the ideal method. The subsequent perioperative period is associated with significant morbidity and the evidence for preventing and treating pain, infection, and fluid overload while maximizing wound healing potential is described. Future Directions: Promising developments are ongoing in imaging technology, histopathology, biomarkers, and wound healing adjuncts such as hyperbaric oxygen therapy, topical negative pressure therapy, stem cell treatments, and skin substitutes. The greatest benefit from further research on management of patients with burns would most likely be derived from the elucidation of optimal fluid resuscitation protocols, pain management protocols, and surgical techniques from randomized controlled trials.

Silica-based nanosystems for therapeutic applications in the skin

Aging, exposure to oxidants, infectious pathogens, inflammogens, ultraviolet radiation and other environmental and genetic factors can result in the development of various skin disorders. Despite immense progress being made in dermatological treatments, many skin-associated problems still remain difficult to treat and various therapies have limitations. Progress in silica-based nanomaterials research provides an opportunity to overcome these drawbacks and improve therapies and is a promising tool for inclusion in clinical practice to treat skin diseases. This review focuses on the use of various types of silica nanoparticles with therapeutic applications in various skin disorders. These nanosystems improve treatment efficacy by maintaining or enhancing the effect of several drugs and are useful tools for nanomedicine, pharmaceutical sciences and future clinical applications.

Comparative efficacy of nine different dressings in healing diabetic foot ulcer: A Bayesian network analysis

BACKGROUND

There is a wide variety of dressings currently available for the treatment of diabetic foot ulcers (DFUs). Because of a lack of evidence from head-to-head randomized controlled trials (RCTs), the relative effects of these dressings in DFU patients remain unclear. This study compared the efficacy of nine dressings in healing DFU.

METHODS

A literature search was performed of the MEDLINE (PubMed), EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Reports published from 1993 to 2017 focusing on dressings for healing DFU were identified.

RESULTS

Twenty-one RCTs, with a total of 2159 patients, were included in the present study. Bayesian network analysis showed that amniotic membrane dressings were superior to alginate, basic wound contact, foam, honey-impregnated, hydrocolloid, and iodine-impregnated dressings. Hydrogel dressings were better than basic wound contact dressings. Other dressings showed no significant differences. According to the probability of ranking results, amniotic membrane and hydrogel dressings are preferred for healing DFUs.

CONCLUSIONS

The nine dressings evaluated in this study had different advantages in promoting the healing of DFU, but most differences among the dressings were not significant. According to the analysis of rank probability, amniotic membrane and hydrogel dressings are the most advantageous in terms of promoting DFU healing. It is recommended that the most suitable dressing should be selected taking into consideration exudate control, comfort, and cost.

Comparison of the efficacy and safety of povidone-iodine foam dressing (Betafoam), hydrocellular foam dressing (Allevyn), and petrolatum gauze for split-thickness skin graft donor site dressing

We evaluated the efficacy and safety of a povidone-iodine (PVP-I) foam dressing (Betafoam) for donor site dressing versus a hydrocellular foam dressing (Allevyn) and petrolatum gauze. This prospective Phase 4 study was conducted between March 2016 and April 2017 at eight sites in Korea. A total of 106 consenting patients (aged ≥ 19 years, scheduled for split-thickness skin graft) were randomised 1:1:1 to PVP-I foam, hydrocellular, or petrolatum gauze dressings for up to 28 days after donor site collection. We assessed time to complete epithelialisation, proportion with complete epithelialisation at Day 14, and wound infection. Epithelialisation time was the shortest with PVP-I foam dressing (12.74 ± 3.51 days) versus hydrocellular foam dressing (16.61 ± 4.45 days; P = 0.0003) and petrolatum gauze (15.06 ± 4.26 days, P = 0.0205). At Day 14, 83.87% of PVP-I foam dressing donor sites had complete epithelialisation, versus 36.36% of hydrocellular foam dressing donor sites (P = 0.0001) and 55.88% of petrolatum gauze donor sites (P = 0.0146). There were no wound infections. Incidence rates of adverse events were comparable across groups (P = 0.1940). PVP-I foam dressing required less time to complete epithelialisation and had a good safety profile.

Fibrin-Modified Cellulose as a Promising Dressing for Accelerated Wound Healing

Dermal injuries and chronic wounds usually regenerate with scar formation. Successful treatment without scarring might be achieved by pre-seeding a wound dressing with cells. We aimed to prepare a wound dressing fabricated from sodium carboxymethylcellulose (Hcel^® NaT), combined with fibrin and seeded with dermal fibroblasts in vitro. We fabricated the Hcel^® NaT in a porous and homogeneous form (P form and H form, respectively) differing in structural morphology and in the degree of substitution of hydroxyl groups. Each form of Hcel^® NaT was functionalized with two morphologically different fibrin structures to improve cell adhesion and proliferation, estimated by an MTS assay. Fibrin functionalization of the Hcel^® NaT strongly enhanced colonization of the material with human dermal fibroblasts. Moreover, the type of fibrin structures influenced the ability of the cells to adhere to the material and proliferate on it. The fibrin mesh filling the void spaces between cellulose fibers better supported cell attachment and subsequent proliferation than the fibrin coating, which only enwrapped individual cellulose fibers. On the fibrin mesh, the cell proliferation activity on day 3 was higher on the H form than on the P form of Hcel^® NaT, while on the fibrin coating, the cell proliferation on day 7 was higher on the P form. The Hcel^® NaT wound dressing functionalized with fibrin, especially when in the form of a mesh, can accelerate wound healing by supporting fibroblast adhesion and proliferation.

Development of a novel keratin dressing which accelerates full-thickness skin wound healing in diabetic mice: In vitro and in vivo studies

Impaired wound healing is a major medical problem in diabetes. The objective of this study was to determine the possible application of an insoluble fraction of fur-derived keratin biomaterial as a wound dressing in a full thickness surgical skin wound model in mice ( n = 20) with iatrogenically induced diabetes. The obtained keratin dressing was examined in vitro and in vivo. In vitro study showed the keratin dressing is tissue biocompatible and non-toxic for murine fibroblasts. Antimicrobial examination revealed the keratin dressing inhibited the growth of S. aureus and E. coli. In vivo studies showed the obtained dressing significantly ( p < 0.05) accelerated healing during the first week after surgery compared to control wounds. Keratin dressings were incorporated naturally into granulation and regenerating tissue without any visible signs of inflammatory response, which was confirmed by clinical and histopathological analysis. It is one of the first studies to show application of insoluble keratin proteins and its properties as a wound dressing. The obtained keratin dressing accelerated wound healing in mice with iatrogenically induced diabetes. Therefore, it can be considered as a safe and efficient wound dressing. Although future studies are needed to explain the molecular mechanism behind fur-derived keratin effect during the multilayer wound healing process, our findings may open the way for a new class of insoluble fur keratin dressings in chronic difficult to heal wounds treatment.

Effects of dynamic matrix remodelling on en masse migration of fibroblasts on collagen matrices

Fibroblast migration plays a key role during various physiological and pathological processes. Although migration of individual fibroblasts has been well studied, migration in vivo often involves simultaneous locomotion of fibroblasts sited in close proximity, so-called 'en masse migration', during which intensive cell-cell interactions occur. This study aims to understand the effects of matrix mechanical environments on the cell-matrix and cell-cell interactions during en masse migration of fibroblasts on collagen matrices. Specifically, we hypothesized that a group of migrating cells can significantly deform the matrix, whose mechanical microenvironment dramatically changes compared with the undeformed state, and the alteration of the matrix microenvironment reciprocally affects cell migration. This hypothesis was tested by time-resolved measurements of cell and extracellular matrix movement during en masse migration on collagen hydrogels with varying concentrations. The results illustrated that a group of cells generates significant spatio-temporal deformation of the matrix before and during the migration. Cells on soft collagen hydrogels migrate along tortuous paths, but, as the matrix stiffness increases, cell migration patterns become aligned with each other and show coordinated migration paths. As cells migrate, the matrix is locally compressed, resulting in a locally stiffened and dense matrix across the collagen concentration range studied.

Comparison of the Morphological and Physical Properties of Different Absorbent Wound Dressings

Good quality wound dressings should have exceptional properties for usage, such as being able to remove excess wound exudates, having rapid dehydration, and providing optimal water vapour permeability. This study evaluated and compared the morphological and physical properties of six different commercially absorbent wound dressings in Thailand: two hydrocolloids, two alginates, and two foams. These wound dressings are available in a variety of components and structures, some of which have a multilayer structure. The results showed that the calcium sodium alginate dressings had better absorption properties than the calcium alginate dressings, hydrocolloid dressings, hydrocolloid with foam layer dressings, foam with polyurethane film layer dressings, and foam with hydrogel and polyurethane film layer dressings. Furthermore, the calcium sodium alginate dressings had the highest rate of dehydration and provided an optimal water vapour transmission rate. However, the calcium sodium alginate dressings could not retain the original structure after being submerged with a wound exudate.

Product evaluation of an absorbent, antimicrobial, haemostatic dressing

This article reports on a product evaluation of KytoCel, an absorbent wound dressing used in the treatment of 30 wounds treated in community care and 10 split-thickness skin-graft donor sites treated in acute care. Within the community-treated cohort, unspecified leg wounds were the most common wound type (n=6) with the mean wound area of the 30 wounds being 17.6 cm² (standard deviation (SD) 31.7) and mean volume being 8.4 cm³ (SD 21.4). Most community treated wounds (27/30; 90%) were reported to have moderate to high levels of wound exudate with the majority (n=19) either healed or improved during treatment. All ten split-thickness skin graft donor sites healed during the evaluation. A semi-structured focus group consisting of 17 nurses provided their opinions on KytoCel, with positive comments offered on the dressing during the focus group and of the 17 participants, 10 commented that the KytoCel dressing was available on their local wound care formulary.

Probing community nurses' professional basis: a situational case study in diabetic foot ulcer treatment

Complicated and long-lasting wound care of diabetic foot ulcers are moving from specialists in wound care at hospitals towards community nurses without specialist diabetic foot ulcer wound care knowledge. The aim of the study is to elucidate community nurses' professional basis for treating diabetic foot ulcers. A situational case study design was adopted in an archetypical Danish community nursing setting. Experience is a crucial component in the community nurses' professional basis for treating diabetic foot ulcers. Peer-to-peer training is the prevailing way to learn about diabetic foot ulcer, however, this contributes to the risk of low evidence-based practice. Finally, a frequent behaviour among the community nurses is to consult colleagues before treating the diabetic foot ulcers.

Effects of Fibroin Microcarriers on Inflammation and Regeneration of Deep Skin Wounds in Mice

The process of tissue regeneration following damage takes place with direct participation of the immune system. The use of biomaterials as scaffolds to facilitate healing of skin wounds is a new and interesting area of regenerative medicine and biomedical research. In many ways, the regenerative potential of biological material is related to its ability to modulate the inflammatory response. At the same time, all foreign materials, once implanted into a living tissue, to varying degree cause an immune reaction. The modern approach to the development of bioengineered structures for applications in regenerative medicine should be directed toward using the properties of the inflammatory response that improve healing, but do not lead to negative chronic manifestations. In this work, we studied the effect of microcarriers comprised of either fibroin or fibroin supplemented with gelatin on the dynamics of the healing, as well as inflammation, during regeneration of deep skin wounds in mice. We found that subcutaneous administration of microcarriers to the wound area resulted in uniform contraction of the wounds in mice in our experimental model, and microcarrier particles induced the infiltration of immune cells. This was associated with increased expression of proinflammatory cytokines TNF, IL-6, IL-1β, and chemokines CXCL1 and CXCL2, which contributed to full functional recovery of the injured area and the absence of fibrosis as compared to the control group.

Electrospun mupirocin loaded polyurethane fiber mats for anti-infection burn wound dressing application

Wound care treatment is a serious issue faced by the medical staffs due to its variety and complexity. Wound dressings are typically used to manage the various types of wounds. In this study, polyurethane (PU) fibers containing mupirocin (Mu), a commonly used antibiotic in wound care, were fabricated via electrospinning technique. The aim of this study was to develop biomedical electrospun fiber scaffolds for preventing wound infections with good compatibility and to demonstrate their applications as anti-infective burn wound dressings. The surface morphology of fibers was obtained by scanning electron microscopy. FT-IR spectra, water vapor transmission rate, and drug release study in vitro were tested to demonstrate the fiber scaffold characteristic. The prepared PU/Mu composite scaffolds had satisfactory antibacterial activity especially against Staphylococcus aureus. The cell studies revealed that the scaffolds were biocompatible and safe for cell attachment. Histological and immunohistochemical examinations were performed in rats, and the results indicated the histological analysis of tissue stained with H&E showed no obvious inflammation reaction. The results indicated that the electrospun scaffolds were capable of loading and delivering drugs, and could be potentially used as novel antibacterial burn wound dressings.

Development of bioresorbable bilayered systems for application as affordable wound dressings

The objective of this work was the preparation and evaluation of a bioresorbable bilayered system for application in the treatment of dermal lesions. The system was based on a polyesterurethane as the external layer and a gelatin membrane as the internal layer. The polyesterurethane was synthesized from poly(ε-caprolactone), polyethylene glycol of 1 or 10 kDa as a hydrophilic component or Pluronic F127 as an amphiphilic component and l-lysine ethyl ester diisocyanate as an urethane precursor. Gelatin membrane was obtained by crosslinking with the naturally occurring crosslinker genipin. Three important points were addressed in this study: the physicochemical characterization of the system, the in vitro behaviour and the in vivo performance on a full-thickness wound defect of rat. The polyesterurethane containing polyethylene glycol of 10 kDa presented the optimum properties for the designed application as to be tested in animal experiments. The in vivo results showed good healing of the lesion with the formation of epidermis similar to normal rat skin. These promising results suggest the potential of this system to be used as an affordable wound dressing in the treatment of different dermal lesions.

Neuropathy and Diabetic Foot Syndrome

Diabetic foot ulceration is a serious complication of diabetes mellitus worldwide and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature; in the pathophysiology of diabetic foot ulceration polyneuropathy is important. Proper adherence to standard treatment strategies and interdisciplinary cooperation can reduce the still high rates of major amputations.