Factors affecting wound healing

Exploring the antibiotic potential of copper carbonate nanoparticles, wound healing, and glucose-lowering effects in diabetic albino mice

Bio-Nanoscience is an emerging field that integrates nanotechnology with biological systems to revolutionize medicine, agriculture, and environmental sustainability through innovative and targeted solutions. The aim of this study was to synthesize copper carbonate nanoparticles and to investigate their antibacterial, wound healing, and glucose-lowering properties. Nanoparticles (NPs) were Synthesized through chemical reduction method and confirmed by using SEM, XRD, and FTIR. Characterization revealed that the nanoparticles had an average size of 55 ± 16 nm, exhibited a crystalline structure, and were free of impurities. Antibacterial tests demonstrated enhanced inhibition zones for Pseudomonas spp., S. aureus, and other bacterial strains, with the largest zone of inhibition observed at 12 mg/ml, measuring 18.5 ± 1.05 mm for Pseudomonas spp. In wound healing activity in diabetic mice observations revealed a complete wound closure in NPs treated mice by day 14 as compared to the control group (96.10 % wound closure). Nanoparticle administration (oral) also significantly reduced glucose levels in diabetic mice after 15 days in the experimental period, whereas fasting glucose levels reduced from 398.00 ± 6.16 to 116.67 ± 12.47 mg/dl. The docking studies of copper carbonate nanoparticles (NPs) with proteins involved in wound healing, including Antileukoproteinase (-2.7 kcal/mol), Casein (-2.5 kcal/mol), Collagen (-2.9 kcal/mol), Lysozyme (-2.8 kcal/mol), and Phospholipase (-3.9 kcal/mol), revealed significant binding affinities, suggesting potential applications in enhancing wound healing processes. Therefore, the copper carbonate nanoparticles demonstrate strong antibacterial properties and show promising effects on wound healing, along with blood glucose-lowering activity. These findings suggest their potential in biomedical applications, particularly for treating diabetes and bacterial infections.

Antimicrobial Phenolic Materials: From Assembly to Function

Infectious diseases pose considerable challenges to public health, particularly with the rise of multidrug-resistant pathogens that globally cause high mortality rates. These pathogens can persist on surfaces and spread in public and healthcare settings. Advances have been made in developing antimicrobial materials to reduce the transmission of pathogens, including materials composed of naturally sourced polyphenols and their derivatives, which exhibit antimicrobial potency, broad-spectrum activity, and a lower likelihood of promoting resistance. This review provides an overview of recent advances in the fabrication of antimicrobial phenolic biomaterials, where natural phenolic compounds act as active antimicrobial agents or encapsulate other antimicrobial agents (e.g., metal ions, antimicrobial peptides, natural biopolymers). Various forms of phenolic biomaterials synthesized through these two strategies, including antimicrobial particles, capsules, hydrogels, and coatings, are summarized, with a focus on their application in wound healing, bone repair and regeneration, oral health, and antimicrobial coatings for medical devices. The potential of these advanced phenolic biomaterials provides a promising therapeutic approach for combating antimicrobial-resistant infections and reducing microbial transmission.

Single-cell RNA sequencing reveals a new mechanism of endothelial cell heterogeneity and healing in diabetic foot ulcers

Diabetic foot ulcers (DFU) are a common and severe complication among diabetic patients, posing a significant burden on patients' quality of life and healthcare systems due to their high incidence, amputation rates, and mortality. This study utilized single-cell RNA sequencing technology to deeply analyze the cellular heterogeneity of the skin on the feet ofDFU patients and the transcriptomic characteristics of endothelial cells, aiming to identify key cell populations and genes associated with the healing and progression of DFU. The study found that endothelial cells from DFU patients exhibited significant transcriptomic differences under various conditions, particularly in signaling pathways related to inflammatory responses and angiogenesis. Through trajectory analysis and cell communication research, we revealed the key role of endothelial cell subsets in the development of DFU and identified multiple important gene modules associated with the progression of DFU. Notably, the promoting effect of the SH3BGRL3 gene on endothelial cell proliferation, migration, and angiogenic capabilities under high glucose conditions was experimentally verified, providing a new potential target and theoretical basis for the treatment of DFU. This study not only enhances the understanding of the pathogenesis ofDFU but also provides a scientific basis for the development ofnew therapeutic strategies.

A Comprehensive Review: Advances in Mesenchymal Stem Cell Applications for Burn Wound Repair

Tissue repair following skin injury is a complex process that encompasses hemostasis, inflammation, tissue cell proliferation, and structural remodeling. Mesenchymal stem cells (MSCs) are derived from the mesodermal layer of tissues and possess multidirectional differentiation potential and self-renewal capabilities. MSCs from various sources, including the bone marrow, adipose tissue, dental pulp, umbilical cord, and amniotic membrane, have demonstrated effectiveness in promoting skin injury repair. They aid in this process by fostering the formation of new blood vessels in damaged tissues, self-renewal, or transdifferentiation into skin or sweat gland cells. Moreover, MSCs promote the proliferation and migration of skin cells, reduce wound inflammation, and restore the extracellular matrix through paracrine secretion. In this paper, we review recent findings regarding MSCs and their role in burn wound repair. Additionally, we explore the potential of combining MSCs with various biomaterials for treating burn wounds and analyze clinical cases wherein MSCs were administered to patients, offering insights into ongoing research on MSC-based therapies for skin injuries.

Functionalized extracellular vesicles of mesenchymal stem cells for regenerative medicine

Stem cell-derived extracellular vesicles (EVs) have emerged as a safe and potent alternative to regenerative medicine in recent decades. Furthermore, the adjustment of EV functions has been recently enabled by certain stem cell preconditioning methods, providing an exceptional opportunity to enhance the therapeutic potential or confer additional functions of stem cell-derived EVs. In this review, we discuss the recent progress of functionalized EVs, based on stem cell preconditioning, for treating various organ systems, such as the musculoskeletal system, nervous system, integumentary system, cardiovascular system, renal system, and respiratory system. Additionally, we summarize the expected outcomes of preconditioning methods for stem cells and their EVs. With recent progress, we suggest considerations and future directions for developing personalized medicine based on preconditioned stem cell-derived EVs.

Oxidation-Driven Assembly of Phenolic Compounds from Grape Seeds Waste into Nanoparticles as Potential Anti-Inflammatory and Wound Healing Therapies

Plant polyphenols have recently emerged as green nanoparticle (NP) precursors by oxidation-triggered assembly using oxidizing agents or in alkaline media. This study explored the potential of polyphenolic extracts derived from grape seed waste to serve as natural nanocarriers. Phenolic fractions were extracted from defatted grape seed waste, freeze-dried into powder, and characterized. Grape seed extracts (GSEs) of Obeidi and Asswad Karech, Lebanese autochthonous white and red grape varieties, respectively, had total phenolic contents (TPC) of 370 and 311 mg of gallic acid equivalents (GAE) per gram of dry matter, respectively, along with a high content of catechins, gallic acid, epicatechins, caffeic acid, syringic acid, and protocatechuic acid. GSE NPs were obtained by the oxidation-triggered self-assembly of Obeidi and Asswad Karech polyphenols in the presence of sodium metaperiodate as the oxidizing agent. The NPs exhibited a spherical morphology, hydrodynamic diameters of 109 and 142 nm, and zeta potential values of -20 and -19 mV for Obeidi and Asswad Karech, respectively. Both types of NPs showed high colloidal and chemical stability, even after storage for three months at 4 °C. They also demonstrated high antioxidant capacity, excellent biocompatibility in human dermal fibroblasts, and promising intracellular radical scavenging activity in stimulated RAW 264.7 macrophages. Furthermore, a gel formulation containing 2% Obeidi GSE NPs promoted wound healing with controlled infections and inflammation and faster tissue regeneration in a rat excision wound model. By day 19 of treatment, deep wounds treated with GSE NPs were fully healed with no visible scarring, while the untreated group showed deep scarring and discoloration. Our findings address the valorization of waste generated by wineries and present a promising natural nanocarrier with high stability, antioxidant properties, and anti-inflammatory activity.

N6-methyladenosine methyltransferase Wilms tumor 1-associated protein impedes diabetic wound healing through epigenetically activating DNA methyltransferase 1

BACKGROUND

Diabetic wound injury is a significant and common complication in individuals with diabetes. N6-methyladenosine (m6A)-related epigenetic regulation is widely involved in the pathogenesis of diabetes complications. However, the function of m6A methyltransferase Wilms tumor 1-associated protein (WTAP) in diabetic wound healing remains elusive.

AIM

To investigate the potential epigenetic regulatory mechanism of WTAP during diabetic wound healing.

METHODS

Human umbilical vein endothelial cells (HUVECs) were induced with high glucose (HG) to establish in vitro cell model. Male BALB/c mice were intraperitoneally injected with streptozotocin to mimic diabetes, and full-thickness excision was made to mimic diabetic wound healing. HG-induced HUVECs and mouse models were treated with WTAP siRNAs and DNA methyltransferase 1 (DNMT1) overexpression vectors. Cell viability and migration ability were detected by cell counting kit-8 and Transwell assays. In vitro angiogenesis was measured using a tube formation experiment. The images of wounds were captured, and re-epithelialization and collagen deposition of skin tissues were analyzed using hematoxylin and eosin staining and Masson's trichrome staining.

RESULTS

The expression of several m6A methyltransferases, including METTL3, METTL14, METTL16, KIAA1429, WTAP, and RBM15, were measured. WTAP exhibited the most significant elevation in HG-induced HUVECs compared with the normal control. WTAP depletion notably restored cell viability and enhanced tube formation ability and migration of HUVECs suppressed by HG. The unclosed wound area of mice was smaller in WTAP knockdown-treated mice than in control mice at nine days post-wounding, along with enhanced re-epithelialization rate and collagen deposition. The m6A levels on DNMT1 mRNA in HUVECs were repressed by WTAP knockdown in HUVECs. The mRNA levels and expression of DNMT1 were inhibited by WTAP depletion in HUVECs. Overexpression of DNMT1 in HUVECs notably reversed the effects of WTAP depletion on HG-induced HUVECs.

CONCLUSION

WTAP expression is elevated in HG-induced HUVECs and epigenetically regulates the m6A modification of DNMT1 to impair diabetic wound healing.

Effect of low- and high-dose methotrexate on wound healing in rats

PURPOSE

To investigate the effect of intraperitoneal treatment with low- and high-dose methotrexate (MTX) on wound healing in rats.

METHODS

The study sample consisted of 54 healthy rats. Under aseptic conditions, skin wounds were created with two circular full-thickness punch tools, 10 mm in diameter, one on the right and the other one on the left of the dorsal vertebral line. The rats were randomly assigned to one of three main treatment groups. On the 0th day (2 hours before wound creation), 7th day, and 14th day, the control group received 0.3-mL saline, the low-MTX group received 3 mg/kg MTX, and the high-MTX group received 30 mg/kg MTX, all administered intraperitoneally. The wounds were evaluated seven, 14, and 21 days after injury through morphometrical, biochemical, histopathological, and immunohistochemical analyses.

RESULTS

MTX dose-dependently decreased the degree of inflammation and angiogenesis, tissue hydroxyproline level, and HSP70 and tumor necrosis factor-α expression in the early phase of wound healing. It also suppressed epithelialization and collagen 1 expression throughout the wound-healing process.

CONCLUSION

The wounds treated with high-dose of MTX had statistically delayed wound closure on days 7, 14 and 21 compared to the saline group, while wounds treated with low-dose of MTX only had statistically delayed wound closure on day 14. In addition, weight loss was observed in rats treated with high-dose MTX, which was thought to reflect its toxicity. The dose-dependent adverse effect of MTX on wound healing may be due to its antiproliferative, antifibrotic, anti-inflammatory, and antiangiogenic effects.

Gingival thickness: effects on gingival wound healing

BACKGROUND

Although available evidence indicates that gingival thickness may affect periodontal surgical outcomes, there are no studies on the effect of gingival thickness on gingival excisional wound healing. This prospective study aimed to assess the effect of gingival thickness on the healing of standardized experimental gingival wounds.

METHODS

Healthy non-smokers with thick or thin gingiva were recruited. Standardized circular buccal gingival excisional wounds were created. Follow-up visits were conducted on postoperative day 3 (D3), 7 (D7), and 14 (D14). Healing Score Index (HSI) and H2O2 test were used to assess wound healing and epithelialization, respectively. Digital photographs were obtained to assess wound surface area. Patient-centered outcomes were assessed using custom and OHIP-14 questionnaires.

RESULTS

Twenty-six volunteers (24-36 years old) with thin/thick gingiva (n = 13 per group, age- and sex-matched) completed the study. HSI predictably increased from D3 to D14, without significant intergroup differences at any time point (p ≥ 0.99). Wound epithelialization was 0% on D3, 61-69% on D7, and 92-100% on D14, without significant intergroup differences at any time (p ≥ 0.99). Over 95% of the immediate postoperative wound area was closed by D14, without significant intergroup differences at any time (p ≥ 0.25). Although OHIP-14 scores did not differ significantly between groups (p ≥ 0.99), thin group reported more pain after the anesthesia wore off (day of the surgery; p = 0.0391).

CONCLUSIONS

Within the limitations of the present study, standardized buccal gingival wounds heal predictably within a short period of time, with no evidence that clinically determined gingival thickness has any effects on the wound healing.

Network Pharmacology, Molecular Docking and Experimental Validation on Potential Application of Diabetic Wound Healing of Cinnamomum zeylanicum Through Matrix Metalloproteinases-8 And 9 (MMP-8 And MMP-9)

Background

Diabetic wounds are a significant clinical challenge due to impaired healing processes often exacerbated by elevated matrix metalloproteinases (MMPs). Cinnamomum zeylanicum, known for its anti-inflammatory and antioxidant properties, has shown potential in promoting wound healing. This study investigates the molecular docking and experimental validation of Cinnamomum zeylanicum's effects on diabetic wound healing, focusing on its interaction with matrix metalloproteinases-8 (MMP-8) and 9 (MMP-9).

Methods

Molecular docking studies were performed to predict the binding affinity of Cinnamomum zeylanicum compounds to MMP-8 and MMP-9. Diabetic wound healing was evaluated using in vivo models where wounds were induced and treated with Cinnamomum zeylanicum extract. Various parameters were measured, including wound contraction, hydroxyproline content, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA) levels. Biochemical analyses included glucose levels, fasting blood glucose (FBG), oral glucose tolerance test (OGTT), and histomorphological examination of skin tissues.

Results

Molecular docking results indicated a high binding affinity of Cinnamomum zeylanicum's bioactive compounds with MMP-8 and MMP-9, suggesting potential inhibition. Experimental validation showed significant improvement in wound contraction and increased hydroxyproline content, indicating enhanced collagen synthesis. Antioxidant enzyme activities (SOD, GPx, CAT) were significantly elevated, while MDA levels were reduced, reflecting decreased oxidative stress. Biochemical analysis demonstrated improved glucose homeostasis with reduced FBG and enhanced OGTT responses. Histomorphological studies revealed improved tissue architecture and re-epithelialization in treated wounds.

Conclusion

Cinnamomum zeylanicum exhibits promising potential in diabetic wound healing by modulating MMP-8 and MMP-9 activities, enhancing antioxidant defenses, and improving glucose regulation. These findings support its therapeutic application for diabetic wounds, providing a foundation for further clinical investigations.

Metal-organic framework microneedles for precision transdermal drug delivery: design strategy and therapeutic potential

Metal-organic frameworks (MOFs) are porous materials renowned for their high porosity, large specific surface area, biocompatibility, and biodegradability. Hydrogel microneedles (MNs) is an emerging technology that minimally disrupts the skin or mucosal membranes, bypassing gastrointestinal absorption and the rapid metabolism typical of oral drug delivery. Over the past few decades, both MOFs and MNs have found applications across a range of fields. However, MOFs alone cannot penetrate the skin or mucosal barrier to deliver drugs effectively, and MNs have limited direct loading capacity. When combined, MOFs enhance the loading efficiency of therapeutic agents in hydrogel MNs and optimize their release kinetics. Additionally, the incorporation of MOFs improves the mechanical properties of hydrogel MNs, increasing their permeability to the skin. In turn, hydrogel MNs enable MOFs-whether therapeutically active or drug-loaded-to bypass the skin or mucosal barrier and deliver active compounds directly to the target site for localized treatment. This review discusses the structural features and preparation methods of MOFs and MOF-based MNs, explores their synergistic potential, and highlights strategies for integrating MOFs with MNs to enhance transdermal drug delivery in applications such as wound healing, scar management, acne treatment, and tumor suppression. Finally, we examine the challenges and future potential of MOF-based MNs and offer insights into their role in advancing transdermal therapies.

Electrospinning in promoting chronic wound healing: materials, process, and applications

In the field of wound treatment, chronic wounds pose a significant burden on the medical system, affecting millions of patients annually. Current treatment methods often fall short in promoting effective wound healing, highlighting the need for innovative approaches. Electrospinning, a technique that has garnered increasing attention in recent years, shows promise in wound care due to its unique characteristics and advantages. Recent studies have explored the use of electrospun nanofibers in wound healing, demonstrating their efficacy in promoting cell growth and tissue regeneration. Researchers have investigated various materials for electrospinning, including polymers, ceramics, carbon nanotubes (CNTs), and metals. Hydrogel, as a biomaterial that has been widely studied in recent years, has the characteristics of a cell matrix. When combined with electrospinning, it can be used to develop wound dressings with multiple functions. This article is a review of the application of electrospinning technology in the field of wound treatment. It introduces the current research status in the areas of wound pathophysiology, electrospinning preparation technology, and dressing development, hoping to provide references and directions for future research.

Multifunctional hydrogel targeting senescence to accelerate diabetic wound healing through promoting angiogenesis

Diabetic wound healing remains a significant clinical challenge because of hyperglycaemia-induced cellular senescence, impaired angiogenesis, and chronic inflammation. To address these issues, we developed a multifunctional hydrogel (GelMA/PNS/Alg@IGF-1) that integrates gelatine methacryloyl (GelMA), Panax notoginseng saponins (PNS), and sodium alginate microspheres encapsulating insulin-like growth factor-1 (IGF-1). This hydrogel was engineered to achieve gradient and sustained release of bioactive agents to target senescence and promote vascular repair. In vitro studies demonstrated that the hydrogel significantly reduced oxidative stress, suppressed senescence markers and senescence-associated secretory phenotypes, and restored endothelial cell function under high-glucose conditions by inhibiting NF-κB pathway activation. Transcriptomic analysis revealed the modulation of pathways linked to inflammation, apoptosis, and angiogenesis. This hydrogel accelerated diabetic wound closure in a rat model in vivo and enhanced collagen deposition, granulation tissue formation, and neovascularization. Furthermore, the hydrogel mitigated oxidative stress and cellular senescence and promoted tissue remodelling. The synergistic effects of PNS and IGF-1 within the hydrogel established a pro-regenerative microenvironment to address both pathological ageing and vascular dysfunction. These findings highlight GelMA/PNS/Alg@IGF-1 as a promising therapeutic platform for diabetic wound management, as this material offers dual anti-senescence and proangiogenic efficacy to overcome the complexities of chronic wound healing.

1α,25-Dihydroxyvitamin D3 accelerates skin wound re-epithelialization by promoting epidermal stem cell proliferation and differentiation through PI3K activation: an in vitro and in vivo study

1α,25-Dihydroxyvitamin D3 (VD3), the active form of vitamin D, plays a crucial role in wound healing. In this study, we aimed to investigate the effect of VD3 on the proliferation and differentiation of epidermal stem cells (EpSCs) and monitor its impact on re-epithelialization. We established a murine full-thickness skin defect model and applied four doses of VD3 (0, 5, 50, and 250 ng/mouse/day) to the wounds topically for three days. Immunostaining and flow cytometry confirmed the effect of VD3 on the proliferation and differentiation of EpSCs in wounds. This effect of VD3 (0, 1, 10, and 50 nM) on EpSCs and its possible mechanism were further confirmed in vitro by CCK8, westen blot, immunostaining, and flow cytometry. We found that on day five post-wounding, the means±SD length of the neo-epidermis was 195.88±11.57, 231.84±16.45, 385.80±17.50, and 268.00±8.22 μm in the control, 5, 50, and 250 ng groups, respectively, with a significant difference from the control (all P<0.05). Immunostaining and flow cytometry showed that VD3 improved the proliferation and differentiation of K15+ EpSC (vs control, all P<0.05), K14+ epidermal progenitor cells (vs control, all P<0.05), and K10+ epidermal terminal cells (vs control, all P<0.05) in vivo and in vitro. The PI3K signaling pathway appeared to underlie this response because significant inhibition of the response was found when inhibitors were used to inhibit PI3K. Our study demonstrated that VD3 is a potent promoter of cutaneous wound healing by stimulating EpSC proliferation and differentiation through PI3K activation.

The role of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers - A literature review

Diabetic Foot Ulcers (DFUs) are chronic foot wounds, in a person with diabetes, which are associated with peripheral arterial insufficiency and/or peripheral neuropathy of the lower limb. Recent UK audit figures report that approximately 50-60 % of DFUs remain unhealed after 12 weeks. Previous research has suggested that ischaemia plays a key role in the pathophysiology of many chronic wounds, including DFUs. For this reason, hyperbaric oxygen therapy (HOT) has been investigated. The study aimed to investigate 1) Current understanding of the physiology of normal wound healing and the pathological mechanisms that occur in DFUs to interrupt these processes; 2) Effectiveness of current DFU treatment approaches; 3) Effectiveness from clinical trials and meta-analyses for any demonstrated therapeutic benefits of HOT in the treatment of DFUs, 4) Patient selection criteria for HOT, and patients who stand to benefit most from treatment. The review found that wound healing is a complex process, involving many cells and signalling molecules, and it remains incompletely understood. However, current evidence suggests that hyperglycaemia, hypoxia, chronic inflammation (due to infection, immune-cell dysfunction or other causes), peripheral neuropathy, and macro- and micro-vascular dysfunction may all adversely affect DFU healing. The review found that current NICE guidelines do not approve HOT therapy in the UK for DFU's, despite encouraging clinical research findings. HOT shows theoretical promise and has been successfully used in the treatment of individual DFUs for several decades. Despite this, there remains a lack of strong clinical evidence of benefits to encourage HOT's wider use. The review found that there were four important patient selection criteria for HOT treatment, including glycaemic control, possible contraindications and complications associated with treatment, ulcer severity and resistance to first and second line treatments. The review concluded that further high-quality clinical research is needed to improve the evidence base.

Effect of sleep quality on wound healing among patients undergoing emergency laparotomy: an observational study

STUDY OBJECTIVES

We aimed to study the association between sleep quality, total sleep duration, and wound healing among adult patients who had good sleep quality at the time of admission to the hospital who underwent laparotomy for various reasons.

METHODS

In this observational study, consecutive adult patients undergoing emergency laparotomy were followed up until the eighth postoperative day. The primary outcome (wound healing) was assessed using the Southampton Wound Grading System. Sleep quality (assessed by the single-item sleep quality scale) was the primary predictor. Pain was assessed using a visual analog pain scale. We studied the effect of postoperative sleep quality on wound healing on postoperative day 8. Secondary analyses assessed the effect of total sleep time, severity of pain, and markers of systemic inflammation on wound healing.

RESULTS

In this study 110 participants were included. The average age of participants was 41.7 ± 16.2 years. On postoperative day 8, 34.5% rated their sleep quality as "poor to fair" and the rest as "good." Postoperative poor sleep quality was associated with impaired wound healing, starting from the third postoperative day (P < .001 for each subsequent day). Multiple logistic regression was overall significant (χ2 = 118.40; degrees of freedom = 9; P < .001), classified 92.7% cases correctly, and explained 88% variance to the outcome. This model showed that shorter total sleep time (P = .009), higher total leukocyte count (P = .005), presence of comorbidities (P = .01), and poor sleep quality during the postoperative week (odds ratio = 78.14; P = .005) increased the odds for impaired healing of wounds.

CONCLUSIONS

Poor sleep quality during the healing phase is associated with wound complications, a surrogate marker of impaired wound healing.

CITATION

Das A, Gupta R, Huda F, Kumar N, Krishnan V, Basu S. Effect of sleep quality on wound healing among patients undergoing emergency laparotomy: an observational study. J Clin Sleep Med. 2025;21(3):503-512.

The Prevalence, Aetiology and Healing Trajectories of Hard-To-Heal Wounds in South Africa

The incidence of hard-to-heal wounds is rising globally with adverse effects on quality of life. Yet, there is no reliable data available on hard-to-heal wound prevalence, aetiology, and outcomes in a low-to-middle income country without improper care being a confounding factor. In this retrospective study of 460 individuals (876 wounds) that received appropriate standard of care at a specialised wound care clinic in the Kwazulu-Natal province of South Africa, acute/traumatic wounds were most prevalent (230/460, 50%) followed by ulcers (173/460, 38%) (DFUs 13%, VLUs 12%, PIs 11%, MLUs < 1%, ALUs < 1%) and atypical wounds (55/460, 12%) (atypical wounds 8%, vectors 4%). Definitions for wound aetiologies are provided. Delayed referral for specialised wound care was evident for individuals with ulcers. 103/460 (22%) individuals did not respond to the standard of care and were classified as hard-to-heal (< 40% wound closure after 4 weeks and/or > 12 weeks of the standard of care). Diabetes mellitus (45/103, 44%) and wound infection (44/103, 43%) accounted for poor healing trajectories in the hard-to-heal cohort, whereas 14/103 (13%) individuals had other comorbidities. High prevalence rates of hard-to-heal wounds in the heterogenous South African population necessitate recognition of wound management as a specialty in South Africa.

Data Mining and in Silico Analysis of Ethiopian Traditional Medicine: Unveiling the Therapeutic Potential of Rumex abyssinicus Jacq

Multicomponent traditional medicine prescriptions are widely used in Ethiopia for disease treatment. However, inconsistencies across practitioners, cultures, and locations have hindered the development of reliable therapeutic medicines. Systematic analysis of traditional medicine data is crucial for identifying consistent and reliable medicinal materials. In this study, we compiled and analyzed a dataset of 505 prescriptions, encompassing 567 medicinal materials used for treating 106 diseases. Using association rule mining, we identified significant associations between diseases and medicinal materials. Notably, wound healing-the most frequently treated condition-was strongly associated with Rumex abyssinicus Jacq., showing a high support value. This association led to further in silico and network analysis of R. abyssinicus Jacq. compounds, revealing 756 therapeutic targets enriched in various KEGG pathways and biological processes. The Random-Walk with Restart (RWR) algorithm applied to the CODA PPI network identified these targets as linked to diseases such as cancer, inflammation, and metabolic, immune, respiratory, and neurological disorders. Many hub target genes from the PPI network were also directly associated with wound healing, supporting the traditional use of R. abyssinicus Jacq. for treating wounds. In conclusion, this study uncovers significant associations between diseases and medicinal materials in Ethiopian traditional medicine, emphasizing the therapeutic potential of R. abyssinicus Jacq. These findings provide a foundation for further research, including in vitro and in vivo studies, to explore and validate the efficacy of traditional and natural product-derived medicines.

FTY720P-treated macrophages in PEG-4MAL hydrogels promote oral wound healing

BACKGROUND AIMS

Oral wound healing involves hemostasis, inflammation, proliferation and tissue remodeling. The oral cavity is a complex wound healing environment because of the presence of saliva, a high bacterial burden and ongoing physical trauma from eating. The inflammatory component of wound healing balances the polarization of macrophages in healing tissues between M1 inflammatory macrophages and M2 anti-inflammatory macrophages. M2 macrophages secrete anti-inflammatory and pro-regenerative cytokines and chemokines, which aid wound healing. Fingolimod, or FTY720, a Food and Drug Administration-approved sphingosine-1-phosphate modulator, has been implicated in inducing the polarization of macrophages to the M2 phenotype. In this study, we investigated whether macrophage pre-treatment with phosphorylated FTY720 (FTY720P), the bioactive form of the drug, in a PEG-4MAL hydrogel promotes improved oral wound healing in a critically sized oral mucosal defect model.

METHODS AND RESULTS

Using cytokine dot blots and Luminex cytokine assays (MilliporeSigma, Burlington, MA, USA), FTY720P-treated murine RAW 264.7 and human THP1-differentiated macrophages in PEG-4MAL hydrogels secreted chemokines and cytokines known to regulate inflammation (e.g., interleukin [IL] 4, IL-13) and induce M2 macrophage polarization (e.g., CCL6, CCL22), leukocyte migration (e.g., CXCL2, CCL2, CCL12, CCL22), angiogenesis (e.g., vascular endothelial growth factor) and epithelialization (e.g., IL-1, IL-17, IL-22). In vitro, FTY720P-treated cells induced chemotaxis of macrophages and fibroblasts in Transwell assays (Corning, Corning, NY, USA) and oral epithelial scratch wound closure. In a murine oronasal fistula (ONF) model of oral wound healing, the local application of FTY720P-treated macrophages in PEG-4MAL hydrogels significantly increased wound closure (75% closure) relative to non-treated cells (40% closure) and blank hydrogel controls (25% closure) (P < 0.0001). Flow cytometry of mouse palatal tissue showed that application of FTY720P-treated macrophage hydrogels to ONFs significantly increased day 7 percentage of M1 and M2 macrophages, mesenchymal stromal cells and CD19+ B cells. Significantly fewer neutrophils, monocytes, CD4+/CD8+ T cells and endothelial cells were observed in the FTY720P-treated macrophage defects, suggesting that FTY720P-treated macrophages in hydrogels promote oral wound healing via suppression of granulation and resolution of inflammation and promotion of tissue maturation.

CONCLUSIONS

Our data provide new insights into the use of potential FTY720P-treated macrophage therapies for oral wound healing and have clinical implications for cleft palate and oral surgery.

A modified vertical pressure bandage to prevent pharyngocutaneous fistula after total laryngectomy

OBJECTIVE

Pharyngocutaneous Fistula (PCF) is one of the most common and challenging postoperative complications after Total Laryngectomy (TLE). This study aimed to evaluate the impact of the modified Vertical Pressure Bandage (VPB) on the occurrence of Pharyngocutaneous Fistula (PCF) after Total Laryngectomy (TLE) for Head and Neck (H&N) cancer.

METHODS

This retrospective study included patients with H&N cancer who underwent TLE at our hospital between January 2010 and January 2021. The patients were grouped according to whether modified VPB was used or not after surgery. The primary outcome was the occurrence of PCF. The secondary outcomes were the interval from operation to PCF, the healing time of PCF, and the length of hospital stay.

RESULTS

This study included 133 patients: 82 (aged 57.93 ± 10.18 years, 80 males) in the VPB group and 51 (aged 54.98 ± 9.22 years, 51 males) in the conventional group. Patients who received the modified VPB had a significantly lower occurrence of PCF compared with those did not (9.8% vs. 33.3%, p = 0.001). In addition, the patients in the VPB group had similar interval from the operation to the PCF (p = 0.374) and healing time of PCF (p = 0.256) but a significantly shorter length of hospital stay (p < 0.001) compared with those in conventional group. Moreover, multivariable logistic regression analysis showed that, after adjusting for age, preoperative radiotherapy, postoperative hematocrit < 35%, VPB (RR = 0.165, 95% CI 0.057‒0.474, p = 0.001) was an independent protective factor for PCF.

CONCLUSION

The modified VPB might reduce the occurrence of PCF after TLE for H&N cancers.

LEVEL OF EVIDENCE

Level 4.

Polyphenols in wound healing: unlocking prospects with clinical applications

Wound healing is a multifaceted, complex process that factors like aging, metabolic diseases, and infections may influence. The potentiality of polyphenols, natural compounds, has shown anti-inflammatory and antimicrobial properties in promoting wound healing and their potential applications in wound management. The studies reviewed indicate that polyphenols have multiple mechanisms that promote wound healing. This involves enhancing antioxidant defenses, reducing oxidative stress, modulating inflammatory responses, improving healing times, reducing infection rates, and enhancing tissue regeneration in clinical trials and in vivo and in vitro studies. Polyphenols have been proven to be effective in managing hard-to-heal wounds, especially in diabetic and elderly populations. Polyphenols have shown significant benefits in promoting angiogenesis and stimulating collagen synthesis. Polyphenol treatment has been demonstrated to have therapeutic effects in wound healing and chronic wound management. Their ability to regulate key healing processes makes them suitable for new wound care products and treatments. Future research should enhance formulations and delivery methods to optimize polyphenols' bioavailability and therapeutic efficacy in wound management approaches.

Effects of Thai Kaempferia Parviflora Extract on Human Gingival Fibroblasts: An in vitro Study of Wound Healing

Aim

Gingival fibroblasts are key players in oral wound healing as they migrate to the wound and produce extracellular matrix. Although contemporary methods can enhance healing, there is ongoing interest in alternative medicine due to its accessibility. Kaempferia parviflora, a traditional Thai herb, has been comprehensively studied for its pharmacological properties; however, its specific roles in wound healing remain to be explored. Thus, our study aimed to investigate the effects of K. parviflora extract (KPE) on the proliferation, migration, and collagen production of human gingival fibroblasts (HGFs).

Methods

HGFs were treated with 0.46-7.5 mg/mL KPE, followed by determination of cell viability using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay on days 1, 3, 5, and 7, and cell migration was assessed using scratch assay at 12, 24, and 48 h. Collagen production was analyzed by picrosirius red staining and real-time polymerase chain reaction (qRT-PCR) on days 7, 14, and 21.

Results

At 0.46 mg/mL, KPE induced cell proliferation in HGFs on days 3, 5, and 7, whereas higher concentrations were cytotoxic to HGFs. This concentration also enhanced cell migration at all time points, whereas higher doses hampered this process. KPE at 0.46 mg/mL stimulated collagen production and upregulated the expressions of COL3A1 and COL1A1 genes on day 14, although these levels were decreased by day 21.

Conclusions

KPE could promote proliferation, migration, and collagen production in HGFs, demonstrating its potential use as an adjunctive treatment for oral wounds. Nevertheless, establishing a safety margin is crucial before clinical application due to the possibility of cytotoxicity at higher concentrations.

Schwann Cell-Secreted S100B Promotes Wound Healing via Paracrine Modulation

As the supply source for gingival grafts, the palatal tissue possesses marked regenerative ability after repeated wounding over the buccal attached gingiva and skin. However, the intrinsic mechanisms are poorly understood. Schwann cells reportedly participate in wound repair of many tissues. Here, we investigate whether Schwann cells play an essential role in the wound healing of palatal mucosa. We performed multiomics analysis in nonhuman primates, integrating scRNA-seq and proteomics analysis, and built wound-healing models in the palatal mucosa and buccal attached gingiva and skin to compare the regeneration among different sites and explore the paracrine role of Schwann cells in the healing of palatal mucosa. With regard to in vivo validation, GelMA hydrogels loaded with conditional medium or exogenous protein were applied in rat and monkey skin. We revealed greater distributions and a lower differentiation state of Schwann cells in the palatal mucosa at baseline. Moreover, S100B levels were significantly greater in the wound healing of palatal mucosa than in the buccal attached gingiva, and Schwann cell-secreted S100B can promote the healing-related capabilities of fibroblasts via paracrine modulation with receptor of advanced glycation end products (RAGE), which activates the crosstalk between NF-κB and Notch signaling, leading to expedited wound closure in vivo. Our work shows that Schwann cells play a crucial role in the wound healing of the palatal mucosa through the S100B/RAGE/NF-κB/Notch paracrine axis. In addition, our data provide novel insights into the therapeutic effects of S100B protein on wound healing.

Targeted Cx43 therapeutics reduce NLRP3 inflammasome activation in rat burn injury

Burns are dynamic injuries characterized by an initial zone of necrosis that progresses to compromise surrounding tissue. Acute inflammation and cell death are two main factors contributing to burn progression. These processes are modulated by Connexin43 (Cx43) hemichannels and gap junctions in burns and chronic wounds. Particularly, Cx43-mediated ATP release may interact with the P2X7 receptor to activate the NLRP3 inflammasome pathway. This study used a deep partial thickness rat burn model to evaluate the effect of Cx43 antisense oligodeoxynucleotides (Cx43asODN) or the Cx43 hemichannel blocker Tonabersat for the inhibition of inflammasome activation and their use as potential treatments for burn injury. Using immunofluorescence analysis, our data showed that Cx43asODN or Tonabersat reduced Cx43 hemichannel and gap junction expression. Concomitantly, they marginally and transiently reduced P2X7 expression and inflammasome complex assembly and inflammation. Quantitative analysis using H&E, Masson's trichrome & Picrosirus Red revealed reduced epidermal thickness and improved collagen preservation in treated burn wounds. Collectively, our findings suggest a possible involvement of the Cx43-mediated NLRP3 inflammasome pathway via P2X7 activation in early burn wound healing. This indicates that targeting Cx43 may have a potential therapeutic effect to improve healing outcomes.

Exploring the ncRNA landscape in exosomes: Insights into wound healing mechanisms and therapeutic applications

Exosomal non-coding RNAs (ncRNAs), including miRNAs, lncRNAs, and circRNAs, have emerged as crucial modulators in cellular signaling, influencing wound healing processes. Stem cell-derived exosomes, which serve as vehicles for these ncRNAs, show remarkable therapeutic potential due to their ability to modulate wound healing stages, from initial inflammation to collagen formation. These ncRNAs act as molecular signals, regulating gene expression and protein synthesis necessary for cellular responses in healing. Wound healing is a complex, staged process involving inflammation, hemostasis, fibroblast proliferation, angiogenesis, and tissue remodeling. Stem cell-derived exosomal ncRNAs enhance these stages by reducing excessive inflammation, promoting anti-inflammatory responses, guiding fibroblast and keratinocyte maturation, enhancing vascularization, and ensuring organized collagen deposition. Their molecular cargo, particularly ncRNAs, specifically targets pathways to aid chronic wound repair and support scarless regeneration. This review delves into the unique composition and signaling roles of Stem cell-derived exosomes and ncRNAs, highlighting their impact across wound healing stages and their potential as innovative therapeutics. Understanding the interaction between exosomal ncRNAs and cellular signaling pathways opens new avenues in regenerative medicine, positioning Stem cell-derived exosomes and their ncRNAs as promising molecular-level interventions in wound healing.

Metal-Protein Hybrid Materials: Unlocking New Frontiers in Biomedical Applications

Metal-protein hybrid materials represent a novel class of functional materials that exhibit exceptional physicochemical properties and tunable structures, rendering them remarkable applications in diverse fields, including materials engineering, biocatalysis, biosensing, and biomedicine. The design and development of multifunctional and biocompatible metal-protein hybrid materials have been the subject of extensive research and a key aspiration for practical applications in clinical settings. This review provides a comprehensive analysis of the design strategies, intrinsic properties, and biomedical applications of these hybrid materials, with a specific emphasis on their potential in cancer therapy, drug and vaccine delivery, antibacterial treatments, and tissue regeneration. Through rational design, stable metal-protein hybrid materials can be synthesized using straightforward methods, enabling them with therapeutic, delivery, immunomodulatory, and other desired functionalities. Finally, the review outlines the existing limitations and challenges associated with metal-protein hybrid materials and evaluates their potential for clinical translation, providing insights into their practical implementation within biomedical applications.

Dual phage-incorporated electrospun polyvinyl alcohol-eudragit nanofiber matrix for rapid healing of diabetic wound infected by Pseudomonas aeruginosa and Staphylococcus aureus

Diabetic wound healing remains a healthcare challenge due to co-occurring multidrug-resistant (MDR) bacterial infections and the constraints associated with sustained drug delivery. Here, we integrate two new species of phages designated as PseuPha1 and RuSa1 respectively lysing multiple clinical MDR strains of P. aeruginosa and S. aureus into a novel polyvinyl alcohol-eudragit (PVA-EU†) nanofiber matrix through electrospinning for rapid diabetic wound healing. PVA-EU† evaluated for characteristic changes that occurred due to electrospinning and subjected to elution, stability and antibacterial assays. The biocompatibility and wound healing ability of PVA-EU† were assessed through mouse fibroblast cell line NIH3T3, followed by validation through diabetic mice excision wound co-infected with P. aeruginosa and S. aureus. The electrospinning resulted in the incorporation of ~ 75% active phages at PVA-EU†, which were stable at 25 °C for 30 days and at 4 °C for 90 days. PVA-EU† showed sustained release of phages for 18 h and confirmed to be detrimental to both mono- and mixed-cultures of target pathogens. The antibacterial activity of PVA-EU† remained unaltered in the presence of high amounts of glucose, whereas alkaline pH promoted the activity. The matrix exerted no cytotoxicity on NIH3T3, but showed significant (p < 0.0001) wound healing in vitro and the process was rapid as validated through a diabetic mice model. The sustained release, quick wound closure, declined abundance of target MDR bacteria in situ and histopathological signs of recovery corroborated the therapeutic efficacy of PVA-EU†. Taken together, our data signify the potential application of PVA-EU† in the rapid treatment of diabetic wounds without the aid of antibiotics.

Endoscopic vacuum therapy for gastrointestinal transmural defects: a literature review

Endoscopic vacuum therapy (EVT) has emerged as a transformative approach for managing gastrointestinal (GI) transmural defects, offering a less invasive and more promising alternative to surgery. Initially developed to address anastomotic leaks after rectal surgery, the application of EVT has expanded to include other locations within the GI tract. This review investigated the principles, indications, procedures, outcomes, challenges, and future perspectives of EVT for the management of GI transmural defects. In conclusion, EVT has demonstrated favorable outcomes in GI defect closure, with reduced complications, shortened hospital stay, and decreased morbidity rates as compared with conventional treatments. Although EVT faces challenges in some specific anatomical locations and in managing severe complications such as major bleeding, ongoing advancements in technology and standardization efforts offer promise for broader indications and better outcomes. Future perspectives include exploring novel EVT devices, refining patient selection criteria and pre-emptive applications, and standardizing procedural protocols.

A Compromised Maxillofacial Wound Healing Model for Characterization of Particulate Bone Grafting: An In Vivo Study in Rabbits

Preclinical testing of tissue engineering modalities are commonly performed in a healthy wound bed. These conditions do not represent clinically relevant compromised oral wound environments due to radiation treatments seen clinically. This study aimed to characterize the bone regeneration outcomes in critical-sized mandibular defects using particulate grafting in an irradiated preclinical model of compromised wound healing. Sixteen New Zealand white rabbits were divided into two groups (n = 8/group), namely (i) irradiated (experimental) and (ii) non-irradiated (control). The rabbits in the experimental group received a total of 36 Gy radiation, followed by surgical intervention to create critical-sized (10 mm), full-thickness mandibular defects. The control group was subjected to the same surgical intervention. All defects were filled with bovine bone grafting material (Bio-Oss, Geistlich, Princeton, NJ, USA) and allowed to heal for 8 weeks. At the study endpoint, rabbits were euthanized, and their mandibles were harvested for micro-computed tomographic, histological, and histomorphometric processing and analysis. Qualitative histological analysis revealed increased levels of bone formation and bridging in the control group relative to the experimental group. This was accompanied by increased levels of soft tissue presence in the experimental group. Volumetric reconstruction showed a significantly higher degree of bone in the control group (27.59% ± 2.71), relative to the experimental group (22.02% ± 2.71) (p = 0.001). The irradiated rabbit model exhibited decreased bone regeneration capacity relative to the healthy subjects, highlighting its suitability as a robust compromised wound healing environment for further preclinical testing involving growth factors or customized, high-fidelity 3D printed tissue engineering scaffolds.

The Impact of Body Mass Index on Breast Reduction Outcomes: A Multi-Institutional Data Analysis of 45,000 Cases over 15 Years

BACKGROUND

The caseload of breast reduction is on the rise. Despite this popularity, the association between body mass index (BMI) and postoperative outcomes remains unclear. We hypothesize that BMI is a significant determinant of postoperative morbidity after breast reduction and leverage a multi-institutional database to investigate this correlation.

METHODS

We queried the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) (2008-2022) to identify female adult patients who underwent breast reduction. We categorized all patients into six BMI subgroups, and compared their outcomes (i.e., 30-day surgical and medical complications, reoperation, readmission, and mortality) via multivariate logistic regression analyses.

RESULTS

45,373 patients (mean age: 40 ± 14 years; mean BMI: 31 ± 6.1 kg/m2) were identified, of whom 0.1% (n = 61) were underweight, 12% (n = 5635) healthy weight, 34% (n = 15,346) overweight, 30% (n = 13,795) had obesity I, 15% (n = 6843) obesity II, and 8.1% (n = 3693) obesity III. Overall, 2881 (6.4%) patients experienced complications, with 1936 (4.3%) cases of surgical complications and 317 (0.7%) cases of medical complications. The risk for complications increased stepwise above the healthy BMI range. Compared to women with healthy weight, patients with obesity I, II, and III had a significantly higher risk of any complication (OR 1.5, p < 0.001; OR 1.87, p < 0.001; and OR 2.6, p < 0.001, respectively), medical complications (OR 2.4, p = 0.005; OR 2.99, p = 0.001; and OR 5.2, p < 0.001, respectively), and surgical complications (OR 2.2, p < 0.001; OR 2.81, p < 0.001; and OR 4.2, p < 0.001, respectively). Overweight patients were also at higher risk for any complication (OR 1.2, p = 0.09), medical complications (OR 2.1, p = 0.02), and surgical complications (OR 1.4, p = 0.004). The odds for reoperation did not increase with higher BMI classes.

CONCLUSION

Our multi-institutional data analysis revealed a significant correlation between elevated BMI and the occurrence of both surgical and medical complications after breast reduction surgery. The postoperative risk increased progressively with BMI above the healthy range. These findings are essential for informing preoperative counseling, refining risk assessment, and developing tailored protocols.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .

Efficiency of medical leech on experimentally induced incisional wound healing in rats

OBJECTIVES

This study was conducted in response to the increasing interest in understanding the effects of both modern and traditional complementary medicine on incisional wound healing. Herein, it was aimed to investigate the wound healing effects of medicinal leech therapy and leech saliva in an experimentally created incisional skin wound model.

METHODS

Fifteen rats underwent full-thickness incisions on their dorsal regions and were randomly assigned to five equal groups, as the Leech Saliva (LS) group, where wounds were treated topically with leech saliva once daily; Leech Therapy-1 (LT-1) group, where leech therapy was administered once at the beginning of the experiment; Leech Therapy-2 (LT-2) group, where leech therapy was applied twice, on days 0 and 3; Positive Control (PC) group, where wounds were treated daily with Phyto cream containing Triticum vulgare; and Negative Control (NC) group, where no treatment was given.

RESULTS

Wound healing was assessed daily, and the experiment continued until complete healing was observed. At the conclusion, the wound size, appearance, and histological features were analyzed to compare healing progress across the groups.

CONCLUSIONS

Medicinal leech therapy was observed to have a positive wound healing effect in the rat model.

Challenges in Radial Forearm Free Flap Surgery: A Comprehensive Case Analysis of Septic Complications at the Donor Site

ABSTRACT

The radial forearm free flap (RFFF) has emerged as a leading option for microvascular reconstruction of head and neck soft-tissue defects. Despite the favorable outcomes conferred by RFFFs, complications such as skin graft loss and tendon exposure can occur. We present the case of a 77-year-old man who underwent RFFF reconstruction after excision of squamous cell carcinoma from the head and neck. The patient subsequently developed flexor tenosynovitis, septic arthritis of the wrist, and osteomyelitis of several carpal bones as a direct result of partial skin graft loss and prolonged tendon exposure at the donor site. To the best of our knowledge, this is the first reported case of this specific complication. Review of the literature reveals the need for continued research into RFFF donor site complications to mitigate the incidence of significant morbidity.

Copper-Based Nanozymes: Potential Therapies for Infectious Wounds

Bacterial infections are a significant obstacle to the healing of acute and chronic wounds, such as diabetic ulcers and burn injuries. Traditional antibiotics are the primary treatment for bacterial infections, but they present issues such as antibiotic resistance, limited efficacy, and potential side effects. This challenge leads to the exploration of nanozymes as alternative therapeutic agents. Nanozymes are nanomaterials with enzyme-like activities. Owing to their low production costs, high stability, scalability, and multifunctionality, nanozymes have emerged as a prominent focus in antimicrobial research. Among various types of nanozymes, metal-based nanozymes offer several benefits, including broad-spectrum antimicrobial activity and robust catalytic properties. Specifically, copper-based nanozymes (CuNZs) have shown considerable potential in promoting wound healing. They exhibit strong antimicrobial effects, reduce inflammation, and enhance tissue regeneration, making them highly advantageous for use in wound care. This review describes the dual functions of CuNZs in combating infection and facilitating wound repair. Recent advancements in the design and synthesis of CuNZs, evaluating their antimicrobial efficacy, healing promotion, and biosafety both in vitro and in vivo on the basis of their core components, are critically important.

Psychological, behavioural and relevant factors affecting wound healing, and the buffering role of interventions

Wound healing is a complex process accompanying numerous health conditions, and millions of people across the world experience deleterious impacts caused by wounds. There are many non-biological factors that can directly or indirectly affect the health outcomes of patients with wounds. The purpose of this review was to investigate the effects of psychological, behavioural and other relevant factors on wound healing. In addition, as the possible associations among these factors have, in the authors' view, not been addressed appropriately, we also aimed to examine if there were specific relationships among these factors and between these factors and health outcomes. Finally, we reviewed the role of various interventions in buffering negative impacts during health procedures.

GC-MS Profiling, Pharmacological Predictions, Molecular Docking, and ADME Studies of Different Parts of Thymus Linearis against Multiple Target Proteins in Wound Healing

Thymus linearis from the Himalayan woodlands of Gilgit Baltistan, Pakistan, is a phytomedicine that has not been well-studied. Traditionally, it is recognized for its potential in treating conditions such as dermatitis, psoriasis, weight loss, and discomfort. The study investigates the wound-healing properties of methanolic extracts from the plant's stems, leaves, and roots. GC-MS disclosed cadaverine, dihydroxy-3,3-dimethyl-3-hydroxy-N-isopropylbutyramide, phthalic acid-di(2-propylpentyl)ester, and benzo[h]quinolone-2,4-dimethyl in stem along with betamethasone valerate, 17-pentatriacontene, 1,1-cyclobutanedicarboxmide, heptadecane-9-hexyl, cyclohexanol-2-methylene-3(1-methylethenyl) and pentacyclo[12.3.0.0(1,13).0(2,10).0(5,9)]hepatodecane-6-ol-15-one in leaf extracts and 2-myristynonyl pantetheine, 7,8-epoxylanostan-11-ol-3-acetoxy, heneicosane (1-(1-ethyl propyl)), 2-piperidinone-N-[4-bromobutyl] and 1-monolinoleoylglycerol trimethyl silyl ether in the root extract. The antioxidant activity was assessed using several assays including DPPH, bound iron %, ABTS, total flavonoid content, and total phenolic content. The methanolic stem extract (MSE) showed the highest antioxidant capacity compared to the leaf and root extracts. The stem extract demonstrated the highest wound-healing potential, followed by leaves and roots in albino mice. The findings were supported by computational analysis, which revealed that the binding interactions of phytochemicals from stem have more affinity than leaf and root with specific receptor sites. The in-silico analysis ascertains that dihydroxy-3,3-dimethyl-3-hydroxy-N-isopropylbutyramide from MSE is the most effective wound-healing agent. Moreover, ADME predictions demonstrated the drug-like properties of the hit compounds.

Combined Stromal Vascular Fraction and Fractional CO2 Laser Therapy for Hypertrophic Scar Treatment: A Systematic Review and Meta-Analysis

BACKGROUND

Hypertrophic scars (HTSs) result from aberrant wound healing processes, leading to raised, thickened tissue with functional discomfort and cosmetic concerns. Current treatments, including corticosteroid injections and laser therapy, have limitations. Stromal vascular fraction (SVF) therapy and CO2 laser treatment offer promising avenues, with SVF therapy showing regenerative potential and CO2 laser therapy promoting precise tissue removal and wound healing. This study aims to investigate the combined application of SVF therapy and CO2 laser treatment for HTS, aiming to enhance treatment efficacy, tissue remodeling, and aesthetic outcomes, ultimately improving patient satisfaction in HTS management.

METHOD

PubMed, Scopus, Embase, and Web of Science databases have been searched for relevant studies. The "R" software (version 4.3.1) along with the "tidyverse" and "meta" statistical packages utilized to analyze data related to the efficiency of this combined method. A random-effects model was fitted to the data. For each study, continuous outcomes were pooled by calculating the standardized mean difference, along with their 95% confidence intervals. The assessment of heterogeneity utilized the I2 and chi-squared tests, applying the random effect model.

RESULTS

Six articles fulfilled our inclusion criteria and were included in our review. Results from the pooled analysis of Vancouver Scar Scale (VSS) scores across three included studies indicated a significant impact of the SVF+CO2 method on VSS scores post-treatment (SMD=-3.0144; 95% CI:-4.3706 to -1.6583, p<0.0001). However, analysis of transepidermal water loss levels before and after treatment showed no significant difference (SMD=-2.7603; 95% CI: -6.8729 to 1.3522; p=0.1883). Comparatively, in a pooled analysis of two studies, the combined SVF+CO2 method demonstrated superior efficacy in VSS scores compared to other methods (SMD= -1.3573; 95% CI: -2.2475 to -0.4672, p = 0.0028), with moderate heterogeneity across studies (I^2=23.0%, p = 0.2545).

CONCLUSION

The combined application of SVF and CO2 laser treatment shows significant promise in improving hypertrophic scars' appearance and texture. The SVF+CO2 method demonstrates superior efficacy compared to other modalities, suggesting its potential as a valuable therapeutic approach for hypertrophic scar management.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Use of Cyanoacrylate Tissue Adhesives in Various Wound Suturing Techniques to Enhance the Healing Process of Surgical Wounds: An Animal Study

OBJECTIVES

This study aimed to investigate the effect of cyanoacrylate tissue adhesive and suture techniques on closing surgical wounds in rabbits.

MATERIALS AND METHODS

This study randomly divided 32 male New Zealand white rabbits into four groups. In the first group, interrupted sutures were applied. In the second group, interrupted sutures were placed, and using a pipette, the surface of the wound was covered by tissue adhesive. In the third group, the wound was closed with a continuous suture, and in the fourth group, in addition to the continuous suture, tissue adhesive was also used. On the fifth day of surgery, rabbits were killed and tissue samples were collected and examined for epithelial tissue thickness, rate of inflammatory tissue, and area of granulation tissue.

RESULTS

In general, among the four groups, the highest thickness of the formed epithelial tissue was in the continuous suture without tissue adhesive group, and the lowest of epithelial tissue was seen in the interrupted suture with tissue adhesive group. There was a tendency to reduce the intensity of inflammation in the groups that used tissue adhesive, but except in one case, no significant difference was seen in the rest of the groups. Among the studied groups, the rate of granulation tissue was less in the continuous suture with an adhesive group compared with the other groups.

CONCLUSIONS

The use of tissue adhesive on any type of suture technique can reduce the rate of inflammation and cause less granulation tissue. In the short term, the use of tissue adhesive could be an obstacle in the formation of epithelial tissue.

Incidence, risk factors, outcomes, and prediction model of surgical site infection after hepatectomy for hepatocellular carcinoma: A multicenter cohort study

BACKGROUND & AIMS

Surgical site infection (SSI) is a common complication after hepatectomy for hepatocellular carcinoma (HCC), but its risk factors and impact on outcomes remain poorly characterized. We aimed to investigate the incidence, risk factors, and outcomes of SSI after hepatectomy for HCC and develop a prediction model.

METHODS

This multicenter retrospective study included patients who underwent curative-intent hepatectomy for HCC across 15 Chinese hepatobiliary centers from 2010 to 2021. SSI was defined according to Centers for Disease Control and Prevention criteria. Logistic regression identified independent risk factors for SSI. A nomogram was developed and internally validated.

RESULTS

Among 4124 patients, 393 (9.5 %) developed SSI; 76 (19.3 %) were diagnosed after discharge. SSI was associated with prolonged hospital stay (mean: 21 vs. 11 days), higher 30-day readmission (13.7 % vs. 3.2 %), and 90-day mortality (5.1 % vs. 2.9 %) (all P < 0.001). Independent risk factors for SSI were obesity (odds ratio [OR] 2.12), diabetes (OR 3.31), portal hypertension (OR 1.96), blood loss ≥400 mL (OR 1.75), open approach (OR 4.99), diaphragmatic incision (OR 2.27), major hepatectomy (OR 1.88), and operative time ≥180 min (OR 1.55). The nomogram model and online calculator (http://asapcalculate.top/Cal14_en.html) demonstrated good discrimination (C-index 0.733) and calibration.

CONCLUSIONS

SSI was common after hepatectomy for HCC and associated with worse short-term postoperative outcomes. The novel easy-to-use prediction calculator may facilitate individualized risk assessment and guide targeted preventive strategies. Future studies should focus on external validation and evaluating interventions in high-risk patients.

Relationship of opioid tolerance to patient and wound factors, and wound micro-environment in patients with open wounds

OBJECTIVE

Opioid tolerance is a criterion for opioid use disorder, which is currently an epidemic in the US. Individuals with open wounds are frequently administered opioids; however, the phenomenon of opioid tolerance has not been examined in the context of wounds. The purpose of this exploratory study was to compare patient/wound factors, wound microbiome and inflammatory mediators between individuals who were opioid-tolerant versus those who were not opioid-tolerant.

METHOD

Patients with acute open wounds were enrolled in this cross-sectional study. All study data were collected before and during a one-time study dressing change.

RESULTS

The study included a total of 385 participants. Opioid-tolerant participants were significantly younger (p<0.0001); had higher levels of depression (p=0.0055) and anxiety (p=0.0118); had higher pain catastrophising scores (p=0.0035); reported higher resting wound pain (p<0.0001); had a higher number of wounds of <30 days' duration (p=0.0486); and had wounds with lower bacterial richness (p=0.0152) than participants who were not opioid-tolerant. A backward elimination logistic regression model showed that four predictors-resting wound pain, age, bacterial richness and depression-were the most important variables in predicting opioid-tolerance status.

CONCLUSION

These findings provide the first insights into the phenomenon of opioid tolerance in the context of open wounds. This study provides findings from which to guide hypothesis-driven research in the future.

Biosynthesis of trimetallic nanoparticles and their biological applications: a recent review

Trimetallic nanoparticles (TMNPs) have emerged as a pivotal area of research due to their unique properties and diverse applications across medicine, agriculture, and environmental sciences. This review provides several novel contributions that distinguish it from existing literature on trimetallic nanoparticles (TMNPs). Firstly, it offers a focused exploration of TMNPs, specifically addressing their unique properties and applications, which have been less examined compared to other multimetallic nanoparticles. This targeted analysis fills a significant gap in current research. Secondly, the review emphasizes innovative biosynthesis methods utilizing microorganisms and plant extracts, positioning these green synthesis approaches as environmentally friendly alternatives to traditional chemical methods. This focus aligns with the increasing demand for sustainable practices in nanotechnology. Furthermore, the review integrates discussions on both medical and agricultural applications of TMNPs, highlighting their multifunctional potential across diverse fields. This comprehensive perspective enhances our understanding of how TMNPs can address various challenges. Additionally, the review explores the synergistic effects among the different metals in TMNPs, providing insights into how these interactions can be harnessed to optimize their properties for specific applications. Such discussions are often overlooked in existing studies. Moreover, this review identifies critical research gaps and challenges within the field, outlining future directions that encourage further investigation and innovation in TMNP development. By doing so, it proactively contributes to advancing the field. Finally, the review advocates for interdisciplinary collaboration among material scientists, biologists, and environmental scientists, emphasizing the importance of diverse expertise in enhancing the research and application of TMNPs.

The Role of Umbilical Cord Mesenchymal Stem Cell-Derived Extracellular Vesicles in Modulating Dermal Fibroblast Activity: A Pathway to Enhanced Tissue Regeneration

Extracellular vesicles (EVs) secreted by umbilical cord-derived mesenchymal stem cells (UC-MSCs) hold significant promise as therapeutic agents in regenerative medicine. This study investigates the effects of UC-MSC-derived EVs on dermal fibroblast function, and their potential in wound healing applications. EVs were characterized by nanoparticle tracking analysis and transmission electron microscopy, revealing a mean size of 118.6 nm, consistent with exosomal properties. Dermal fibroblasts were treated with varying concentrations of EVs (25-100 µg/mL), and their impacts on cellular metabolism, mitochondrial activity, reactive oxygen species (ROS) production, wound closure, inflammatory cytokine secretion, growth factor production, and extracellular matrix (ECM) gene expression were evaluated. At lower concentrations (25-50 µg/mL), EVs significantly enhanced fibroblast metabolic and mitochondrial activity. However, higher concentrations (≥75 µg/mL) increased ROS levels, suggesting potential hormetic effects. EVs also modulated inflammation by reducing pro-inflammatory cytokines (IL-6, TNF-α) while promoting pro-regenerative cytokines (IL-33, TGF-β). Treatment with 50 µg/mL of EVs optimally stimulated wound closure and growth factor secretion (VEGF, BDNF, KGF, IGF), and upregulated ECM-related gene expression (type I and III collagen, fibronectin). These findings demonstrate that UC-MSC-derived EVs exert multifaceted effects on dermal fibroblast function, including enhanced cellular energetics, stimulation of cell migration, regulation of inflammation, promotion of growth factor production, and increased ECM synthesis. This study highlights the potential of EVs as a novel therapeutic strategy for wound healing and tissue regeneration, emphasizing the importance of optimizing EV concentration for maximal therapeutic efficacy.

Electrospun Collagen-Coated Nanofiber Membranes Functionalized with Silver Nanoparticles for Advanced Wound Healing Applications

Complex wounds pose a significant healthcare challenge due to their susceptibility to infections and delayed healing. This study focuses on developing electrospun polycaprolactone (PCL) nanofiber membranes coated with Type I collagen derived from bovine skin and functionalized with silver nanoparticles (AgNPs) to address these issues. The collagen coating enhances biocompatibility, while AgNPs synthesized through chemical reduction with sodium citrate provide broad-spectrum antimicrobial properties. The physical properties of the membranes were characterized using scanning electron microscopy (SEM) and atomic force microscopy (AFM). Results showed the formation of nanofibers without defects and the uniform distribution of AgNPs. A swelling test and contact angle measurements confirmed that the membranes provided an optimal environment for wound healing. In vitro biological assays with murine 3T3 fibroblasts revealed statistically significant (p ≤ 0.05) differences in cell viability among the membranes at 24 h (p = 0.0002) and 72 h (p = 0.022), demonstrating the biocompatibility of collagen-coated membranes and the minimal cytotoxicity of AgNPs. Antibacterial efficacy was evaluated against Staphylococcus aureus (SA), Pseudomonas aeruginosa (PA), and Vancomycin-resistant Enterococcus (VRE), with the significant inhibition of biofilm formation observed for VRE (p = 0.006). Overall, this novel combination of collagen-coated electrospun PCL nanofibers with AgNPs offers a promising strategy for advanced wound dressings, providing antimicrobial benefits. Future in vivo studies are warranted to further validate its clinical and regenerative potential.

Topical delivery of gel-in-oil emulsion cocktail with growth factors for the treatment of diabetic pressure ulcers

Healing diabetic foot ulcers (DFUs) poses a serious challenge for many individuals with diabetes. The use of biomaterials applied locally for treating DFUs has recently garnered significant attention. Here, we present a gel-in-oil nanogel dispersion (G/O-NGD) capable of local delivery of six different growth factors (GFs) via the topical route, followed by an in-vivo evaluation in mice. Both macroscopic and microscopic changes in skin structure were evidented after topical application of GF-cocktail G/O-NGD, and changes in CD68 and CD31 levels and collagen content were measured. Expression and synthesis of Interleukin-6 (IL-6), transforming GF beta 1 (TGF-β1), and basic fibroblast GF (bFGF) were also analyzed. The results showed that a significant reduction in ulcer area, restoration of skin structure, increase in collagen content, angiogenesis, and suppression of inflammation were possible with GF-cocktail G/O-NGD, indicating that G/O-NGD is a prospective carrier for local delivery of GF, improving wound healing processes.

Potential matrix metalloproteinase 2 and 9 inhibitors identified from Ehretia species for the treatment of chronic wounds - Computational drug discovery approaches

Matrix metalloproteinases (MMPs) serve as prognostic factors in several pathophysiological conditions, including chronic wounds. Therefore, they are considered important therapeutic targets in the intervention and treatment of these conditions. In this study, computational tools such as molecular docking and molecular dynamics simulations were used to gain insight into protein‒ligand interactions and determine the free binding energy between Ehretia species phytoconstituents and gelatinases (MMP2 and MMP9). A total of 74 phytoconstituents from Ehretia species were compiled from the literature, and 46 of these compounds were identified as potential inhibitors of at least one type of MMP. Molecular docking revealed that lithospermic acid B, rosmarinic acid, and danshensu had stronger binding affinities against the two enzymes than the reference ligands. Furthermore, (9S, 10E, 12Z, 15Z)-9-hydroxy-10,12,15-octadecatrienoic (∗-octadecatrienoic) had a higher binding energy for MMP2, whereas caffeic anhydride and caffeic acid established stronger binding energy with MMP9 than the reference ligand. These complexes also demonstrated relatively stable, favourable, and comparable conformational changes with those of unbound proteins at 500 ns. The free energy decomposition results further provide detailed insights into the contributions of active site residues and different types of interactions to the overall binding free energy. Finally, most of the hit phytoconstituents (rosmarinic acid, caffeic anhydride, caffeic acid, and danshensu) had good physicochemical, drug-likeness, and pharmacokinetic properties. Collectively, our findings showed that phytoconstituents from Ehretia species could be beneficial in the search for novel MMP inhibitors as therapeutic agents for the treatment of chronic wounds.

Delayed Immune Response Upon Injury in Diabetic Wounds Impedes Healing

BACKGROUND

Chronic wounds are a severe complication of diabetes. Dysregulated inflammatory signalling is thought to underly the poor healing outcomes. Yet, there is little information available on the acute response following injury and its impact on healing.

METHODS

Using a murine full thickness excisional wound model, the current study therefore assessed the expression of pro-inflammatory and pro-resolving lipid mediators during the early stages post injury in acute and diabetic wounds and compared the timeframe for transitioning through the phases of healing. Tissue eicosanoid (LTB4, PGE2, TxA2, MaR1, RvE1, RvD1, PD) and MMP-9 levels were assessed at 6 h post wounding using ELISAs. Wound closure, healing dynamics (histology), cellular infiltration and MPO, TNF-α expression (IHC) were assessed at 6 h, day2, day7 post wounding.

RESULTS

Eicosanoid expression did not differ between groups (LTB4 24-125 pg/mL, PGE2 63-177 pg/mL, TxA2 529-1184 pg/mL, MaR1 365-2052 pg/mL, RvE1 43-1157 pg/mL, RvD1 1.5-69 pg/mL, PD1 11.5-4.9 ng/mL). An inverse relationship (p < 0.05) between MMP-9 and eicosanoids were however only evident in acute and not in diabetic wounds. Diminished cellular infiltration (x5 fold) (p < 0.05) in diabetic wounds coincided with a significant delay in the expression of TNF-α (pro-inflammatory cytokine) and MPO (neutrophil marker). A significant difference in the expression of TNF-α (C 1.8 ± 0.6; DM 0.7 ± 0.1 MFI) and MPO (C 4.9 ± 1.9; DM 0.9 ± 0.4 MFI) (p < 0.05) was observed as early as 6 h post wounding, with histology parameters supporting the notion that the onset of the acute inflammatory response is delayed in diabetic wounds.

CONCLUSION

These observations imply that the immune cells are unresponsive to the initial eicosanoid expression in the diabetic wound tissue.

Wound management in end-stage dermatomyositis: a case report

Little has been written about the challenges in wound healing presented by rare cases of dermatomyositis (DM) complicated by glucocorticoid use. The authors explore the clinical presentation of a 60-year-old female patient with end-stage DM, chronic steroid use and delayed wound healing, requiring surgical debridement of wounds and extensive calcification removal. Her atypical presentation-lacking some of the characteristic dermal and antibody findings-is described, while also highlighting calcification and wound trials that complicated management. The underlying pathophysiology of effects on capillary networks is discussed, as well as the effectiveness of various treatment modalities, including steroids, antimetabolites and biologics, some of which were used. The report concludes with opportunities for future study on the disease's complex mechanisms.

Solution Blow Spinning: An Emerging Nanomaterials-Based Wound-Care Technology

Application of one-dimensional nanofibers have witnessed exponential growth over the past few decades and are still emerging with their excellent physicochemical and electrical properties. The driving force behind this intriguing transition lies in their unique high surface-to-volume ratio, ubiquitous nanodomains, improved tensile strength, and flexibility to incorporate deliberate functionalities required for specific and advanced applications. Besides numerous benefits, nanomaterials may adversely interact with biological tissues and potentially be cytotoxic and carcinogenic. However, precisely engineered design can outperform the risk with myriad benefits. Wound care technologies are evolving, and products involved in wound care management have a yearly market value of $15-22 billion. Solution blow spinning (SBS) is a facile technique to synthesize biocompatible nanofibers with scalable processing variables for multidirectional biomedical applications. SBS is feasible for a wide range of thermoplastic polymers and nanomaterials to fabricate nanocomposites. This review will focus on the relevance of SBS technology for wound care, including dressings, drug delivery, tissue engineering scaffolds, and sensors.

Differences between first- and second-generation autologous platelet concentrates

Autologous platelet concentrates (APCs) applied alone or combined with other biomaterials are popular bioactive factors employed in regenerative medicine. The main biological rationale of using such products is to concentrate blood-derived growth factors and cells into the wound microenvironment to enhance the body's natural healing capacity. First-generation APC is represented by platelet-rich plasma (PRP). While different protocols have been documented for PRP preparation, they overall consist of two cycles of centrifugation and have important limitations related to the use of an anticoagulant first and an activator afterward, which may interfere with the natural healing process and the release of bioactive molecules. The second generation of platelet concentrates is represented by leukocyte and platelet-rich fibrin (L-PRF). L-PRF protocols involve a single centrifugation cycle and do not require the use of anticoagulants and activators, which makes the preparation more straight forward, less expensive, and eliminates potential risks associated with the use of activators. However, since no anticoagulant is employed, blood undergoes rapid clotting within the blood collection tube; hence, a timely management of L-PRF is crucial. This review provides an overview on the most documented protocols for APC preparations and critically discusses the main differences between first- and second-generation APCs in terms of cell content, protein release, and the formation of a 3D fibrin network. It appears evident that the inconsistency in reporting protocol parameters by most studies has contributed to conflicting conclusions regarding the efficacy of different APC formulations and has significantly limited the ability to interpret the results of individual clinical studies. In the future, the use of a standardized classification system, together with a detailed reporting on APC protocol parameters is warranted to make study outcomes comparable. This will also allow to clarify important aspects on the mechanism of action of APCs (like the role of leukocytes and centrifugation parameters) and to optimize the use of APCs in regenerative medicine.

Plasma-Activated Water Improve Wound Healing in Diabetic Rats by Influencing the Inflammatory and Remodelling Phase

Diabetic foot ulcers have an enormous impact on patients' quality of life and represent a major economic burden. The cause is delayed and incomplete wound healing due to hyperglycemia, reduced blood flow, infections, oxidative stress and chronic inflammation. Plasma-activated water (PAW) is emerging as a new therapeutic approach in wound treatment, as it has many of the advantages of cold atmospheric plasma but is easier to apply, thus allowing for widespread use. The aim of this study was to investigate the potential of PAW to improve wound healing in diabetic rats, with a focus on uncovering the underlying mechanisms. Two full-thickness wounds in control and diabetic animals were treated with PAW, and healing was monitored for 15 days at five time points. PAW improved wound healing in diabetic rats and mainly affected the inflammatory phase of wound healing. Application of PAW decreased the number of inflammatory cells, myeloperoxidase (MPO) and N-acetyl-b-D-glycosaminidase (NAG) activity, as well as the mRNA expression of proinflammatory genes in diabetic rats. Ten days after injury, PAW treatment increased collagen deposition in the diabetic animals by almost 10% without affecting collagen mRNA expression, and this is in correlation with a decrease in the Mmp-9/Timp-1 ratio. In conclusion, PAW treatment affects wound healing by reducing the inflammatory response and influencing extracellular matrix turnover, suggesting that it has great potential to accelerate the healing of diabetic wounds.

Molecular Modification of Queen Bee Acid and 10-Hydroxydecanoic Acid with Specific Tripeptides: Rational Design, Organic Synthesis, and Assessment for Prohealing and Antimicrobial Hydrogel Properties

Royal jelly and medical grade honey are traditionally used in treating wounds and infections, although their effectiveness is often variable and insufficient. To overcome their limitations, we created novel amphiphiles by modifying the main reparative and antimicrobial components, queen bee acid (hda) and 10-hydroxyl-decanoic acid (hdaa), through peptide bonding with specific tripeptides. Our molecular design incorporated amphiphile targets as being biocompatible in wound healing, biodegradable, non-toxic, hydrogelable, prohealing, and antimicrobial. The amphiphilic molecules were designed in a hda(hdaa)-aa1-aa2-aa3 structural model with rational selection criteria for each moiety, prepared via Rink/Fmoc-tBu-based solid-phase peptide synthesis, and structurally verified by NMR and LC-MS/MS. We tested several amphiphiles among those containing moieties of hda or hdaa and isoleucine-leucine-aspartate (ILD-amidated) or IL-lysine (ILK-NH2). These tests were conducted to evaluate their prohealing and antimicrobial hydrogel properties. Our observation of their hydrogelation and hydrogel-rheology showed that they can form hydrogels with stable elastic moduli and injectable shear-thinning properties, which are suitable for cell and tissue repair and regeneration. Our disc-diffusion assay demonstrated that hdaa-ILK-NH2 markedly inhibited Staphylococcus aureus. Future research is needed to comprehensively evaluate the prohealing and antimicrobial properties of these novel molecules modified from hda and hdaa with tripeptides.