Advanced Therapeutic Dressings for Effective Wound Healing--A Review

Growth characteristics of human juvenile, adult and murine fibroblasts: a comparison of polymer wound dressings

OBJECTIVE

Fibroblasts are important for the successful healing of deep wounds. However, the influence exerted by Cuticell, a natural polymer on fibroblasts and by the synthetic polymer, Suprathel, made of poly-L-lactic acid, is not sufficiently characterised. This study compared the survival and growth characteristics of human juvenile and adult dermal fibroblasts as well as murine fibroblast cell line L929, on a natural polymer with those of a synthetic polymer using different culture models.

METHOD

Murine, juvenile and adult human fibroblasts were seeded on both the natural and synthetic polymers using statical slide culture or the medium air interface and dynamical rotatory culture. Cell adherence, viability, morphology and actin cytoskeleton architecture were monitored for 1-7 days. Biomaterial permeability was checked with a previously established diffusion chamber.

RESULTS

The majority of the murine and adult human fibroblasts survived in slide and rotatory cultures on both wound dressings. The fibroblasts seeded on the synthetic polymer exhibited phenotypically a typical spread shape with multiple cell adhesion sites earlier than those on the natural polymer. The highest survival rates in all tested fibroblast species over the entire observation time were detected in rotatory culture (mean: >70%). Nevertheless, it led to cell-cluster formation on both materials. In the medium air interface culture, few adult fibroblasts adhered and survived until the seventh day of culture on both the natural and synthetic polymers, and no viable juvenile and L929 fibroblasts could be found by day seven. Apart from a significant higher survival rate of L929 in slide culture on the natural polymer compared with the synthetic polymer at the end of the culturing period (p<0.0001), and a higher cell survival of L929 on the natural polymer in medium air interface culture, only minor differences between both materials were evident. This suggested a comparable cytocompatibility of both materials. Permeability testing revealed slightly higher permeance of the natural polymer compared with the synthetic polymer.

CONCLUSION

Cell survival rates depended on the culture system and the fibroblast source. Nevertheless, the juvenile skin fibroblasts were the most sensitive. This observation suggests that wound dressings used in treating children should be tested beforehand with juvenile fibroblasts to ensure the dressing does not compromise wound healing. Future experiments should also include the response of compromised fibroblasts, for example, from burn patients.

Biomass-derived nanocarbon materials for biological applications: challenges and prospects

Biomass-derived nanocarbons (BNCs) have attracted significant research interests due to their promising economic and environmental benefits. Following their extensive uses in physical and chemical research domains, BNCs are now growing in biological applications. However, their practical biological applications are still in their infancy, requiring critical evaluations and strategic directions, which are provided in this review. The carbonization of biomass sources and major types of BNCs are introduced, encompassing carbon nanodots, nanofibres, nanotubes, and graphenes. Next, essential biological uses of BNCs, antibacterial/antibiofilm materials (nanofibres and nanodots) and bioimaging agents (predominantly nanodots), are summarized. Furthermore, the future potential of BNCs, for designing wound dressing/healing materials, water and air disinfection platforms, and microbial electrochemical systems, is discussed. We reach the conclusion that a crucial challenge is the structural control of BNCs. Furthermore, a key knowledge gap for realizing practical biological applications is the lack of systematic comparisons of BNCs with nanocarbons of synthetic origin in the current literature. Although we did not attempt to perform an exhaustive literature survey, the evaluation of the existing results indicates that BNCs are promising as easily accessible materials for various biomedically and environmentally relevant applications.

Plant- vs. Bacterial-Derived Cellulose for Wound Healing: A Review

Cellulose is a naturally existing element in the plant's cell wall and in several bacteria. The unique characteristics of bacterial cellulose (BC), such as non-toxicity, biodegradability, hydrophilicity, and biocompatibility, together with the modifiable form of nanocellulose, or the integration with nanoparticles, such as nanosilver (AgNP), all for antibacterial effects, contributes to the extensive usage of BC in wound healing applications. Due to this, BC has gained much demand and attention for therapeutical usage over time, especially in the pharmaceutical industry when compared to plant cellulose (PC). This paper reviews the progress of related research based on in vitro, in vivo, and clinical trials, including the overall information concerning BC and PC production and its mechanisms in wound healing. The physicochemical differences between BC and PC have been clearly summarized in a comparison table. Meanwhile, the latest Food and Drug Administration (FDA) approved BC products in the biomedical field are thoroughly discussed with their applications. The paper concludes on the need for further investigations of BC in the future, in an attempt to make BC an essential wound dressing that has the ability to be marketable in the global marketplace.

Preparation of smooth and macroporous hydrogel via hand-held blender for wound healing applications: in vitro and in vivo evaluations

Wound dressings play an indispensable role in wound healing. However, traditional wound dressings have several disadvantages, such as poor mechanical properties and small pore diameters, which do not allow sufficient gas exchange. To overcome these shortcomings, this paper reports a polyvinyl alcohol (PVA)-based hydrogel physically crosslinked at -20 °C and containing polyethylene glycol (PEG) and nanohydroxyapatite (HAP). The physical and chemical properties of the hydrogels formed by different stirring methods (stirring with a glass rod or a hand-held homogenizer) were compared. The average roughness of Gel 1 (prepared using a hand-held homogenizer) is 112.6 nm, which is much lower than the average surface roughness of Gel 2 (1222 nm, prepared using a glass rod). Moreover, the hydrogel made by the unconventional mixing method (with a homogenizer) showed better performance, including a more interconnected open-pore microstructure and better mechanical properties. Finally, a full-thickness skin defect test was performed. The experimental results demonstrated that the hydrogel has considerable potential for applications in wound dressings.

New Antivirals and Antibacterials Based on Silver Nanoparticles

The rediscovery of the medical uses of silver provides another noticeable example, this time at the interface of chemistry and medicine, of the real (and nonlinear) progress of scientific research. Several new silver-based antimicrobial products have thus been commercialized in the last two decades. Next-generation antibacterials and antivirals of broad scope, low toxicity and affordable cost, we argue in this study, will be based on microencapsulated Ag nanoparticles.

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.

Electrospun Bioactive Wound Dressing Containing Colloidal Dispersions of Birch Bark Dry Extract

Novel birch bark dry extract (TE)-loaded polyvinyl alcohol (PVA) fiber mats intended for wound therapy were developed through an electrospinning process. Colloidal dispersions containing TE as the active substance were prepared by the high-pressure homogenization (HPH) technique using hydrogenated phospholipids as stabilizer. Subsequently, the colloidal dispersions were blended with aqueous PVA solutions in the ratio of 60:40 (wt.%) and electrospun to form the nanofiber mats. Fiber morphology examined using scanning electron microscopy (SEM) indicated that fibers were uniform and achieved diameters in the size range of 300–1586 nm. Confocal Raman spectral imaging gave good evidence that triterpenes were encapsulated within the electrospun mats. In vitro drug release and ex vivo permeation studies indicated that the electrospun nanofibers showed a sustained release of betulin, the main component of birch bark dry extract, making the examined dressings highly applicable for several wound care applications. Ex vivo wound healing studies proved that electrospun fiber mats containing TE accelerated wound healing significantly more than TE oleogel, which was comparable to an authorized product that consists of TE and sunflower oil and has proved to enhance wound healing. Therefore, our results conclude that the developed TE-PVA-based dressings show promising potential for wound therapy, an area where effective remedy is needed.

Catechol modified quaternized chitosan enhanced wet adhesive and antibacterial properties of injectable thermo-sensitive hydrogel for wound healing

Wound dressings based on injectable thermo-sensitive hydrogel possess several advantages over preformed conventional dressings such as rapid reversible sol-gel transition behavior and the capacity of filling the irregular wound defect. Nevertheless, its clinical application is hindered by the weak tissue adhesiveness. Therefore, in this study, the catechol modified quaternized chitosan (QCS-C) was fabricated and incorporated into poly(d,l-lactide)-poly(ethylene glycol)-poly(d,l-lactide) (PLEL) hydrogel to develop an injectable hydrogel with the properties of thermo-sensitive, antibacterial and tissue adhesive. QCS-C could lower the LCST of hydrogel for easy gelation at physiological temperature, and significantly enhanced the tissue adhesion. For wound generation, nano-scaled bioactive glass (nBG：80 SiO₂, 16 CaO and 4 P₂O₅; mol%) was loaded into hydrogel to promote angiogenesis. The mice partial laceration experiment showed that PLEL-nBG-QCS-C hydrogel could effectively seal the ruptured skin and significantly accelerate wound healing. Thus, our findings established a new type of clinical treatment technology for complicated wounds.

PDA/Cu Bioactive Hydrogel with "Hot Ions Effect" for Inhibition of Drug-Resistant Bacteria and Enhancement of Infectious Skin Wound Healing

Quick and effective sterilization of drug-resistant bacteria inevitably became an ever-growing global challenge. In this study, a multifunctional composite (PDA/Cu-CS) hydrogel mainly composed of polydopamine (PDA) and copper-doped calcium silicate ceramic (Cu-CS) was prepared. It was confirmed that PDA/copper (PDA/Cu) complexing in the composite hydrogel played a key role in enhancing the photothermal performance and antibacterial activity. Through a unique "hot ions effect", created by the heating of Cu ions through the photothermal effect of the composite hydrogel, the hydrogel showed high-efficiency, quick, and long-term inhibition of methicillin-resistant Staphylococcus aureus and Escherichia coli. In addition, the hydrogel possessed remarkable bioactivity to stimulate angiogenesis. The in vivo results confirmed that the "hot ions effect" of the composite hydrogel removed existing infection in the wound area efficiently and significantly promoted angiogenesis and collagen deposition during infectious skin wound healing. Our results suggested that the design of multifunctional hydrogels with "hot ions effect" may be an effective therapeutic approach for the treatment of infectious wounds.

The impact of COVID-19 pandemics on dermatologic surgery: real-life data from the Italian Red-Zone

BACKGROUND

The COVID-19 pandemic is challenging healthcare systems worldwide. Dermatology had to re-prioritize visits, guarantee urgent care, and ensure continuity for chronic patients.

OBJECTIVES

To evaluate the COVID-19 impact on dermatologic surgery outpatient management.

MATERIAL AND METHODS

In this real-life retrospective observational study, we evaluated both major and minor outpatient surgeries (MaOS and MiOS) performance in 2020, before and during the first month of lockdown declaration, in a primary referral center in Northern Italy. During the lockdown, all lifesaving and cancer surgery, (approximately 80% of our usual activities), were continued. Data from 2020 were compared with the 2019 corresponding periods to assess the real-life impact of COVID-19 in dermatologic surgical activities.

RESULTS

From January 1st to April 3rd, 2020 we performed 769 interventions, compared to 908 over the corresponding 2019 period. After the lockdown, scheduled surgeries were reduced by 14.8%; overall performed ones displayed a reduction of 46.5% (51.6% MaOS, 44.2% MiOS). 52.9% and 12.5% procedures were canceled due to patients' renunciation and due to confirmed/suspected COVID-19, respectively.

CONCLUSIONS

While reduced in number, dermatologic surgeries, similarly to other surgical specialties, remained operative to provide oncological and/or life-saving procedures.

Electrospun nanofibers: A nanotechnological approach for drug delivery and dissolution optimization in poorly water-soluble drugs

Electrospinning is a novel and sophisticated technique for the production of nanofibers with high surface area, extreme porous structure, small pore size, and surface morphologies that make them suitable for biomedical and bioengineering applications, which can provide solutions to current drug delivery issues of poorly water-soluble drugs. Electrospun nanofibers can be obtained through different methods asides from the conventional one, such as coaxial, multi-jet, side by side, emulsion, and melt electrospinning. In general, the application of an electric potential to a polymer solution causes a charged liquid jet that moves downfield to an oppositely charged collector, where the nanofibers are deposited. Plenty of polymers that differ in their origin, degradation character and water affinity are used during the process. Physicochemical properties of the drug, polymer(s), and solvent systems need to be addressed to guarantee successful manufacturing. Therefore, this review summarizes the recent progress in electrospun nanofibers for their use as a nanotechnological tool for dissolution optimization and drug delivery systems for poorly water-soluble drugs.

Marine Algae Polysaccharides as Basis for Wound Dressings, Drug Delivery, and Tissue Engineering: A Review

The present review considers the physicochemical and biological properties of polysaccharides (PS) from brown, red, and green algae (alginates, fucoidans, carrageenans, and ulvans) used in the latest technologies of regenerative medicine (tissue engineering, modulation of the drug delivery system, and the design of wound dressing materials). Information on various types of modern biodegradable and biocompatible PS-based wound dressings (membranes, foams, hydrogels, nanofibers, and sponges) is provided; the results of experimental and clinical trials of some dressing materials in the treatment of wounds of various origins are analyzed. Special attention is paid to the ability of PS to form hydrogels, as hydrogel dressings meet the basic requirements set out for a perfect wound dressing. The current trends in the development of new-generation PS-based materials for designing drug delivery systems and various tissue-engineering scaffolds, which makes it possible to create human-specific tissues and develop target-oriented and personalized regenerative medicine products, are also discussed.

Bioactive compounds of Copaifera sp. impregnated into three-dimensional gelatin dressings

This study investigates the immersion impregnation process of the copaiba oleoresin and leaf extract into Spongostan^TM gelatin dressings to be used in wound healing treatment. Copaiba oleoresin and leaf extract were characterized by spectroscopic analyses in order to confirm the identity of bioactive compounds and their compatibility with dressing material. Their antibacterial properties were evaluated and oleoresin activity against Escherichia coli and Staphylococcus aureus bacteria was confirmed while the leaf extract showed activity against S. aureus. Solubility assays in organic solvents revealed that copaiba oleoresin is miscible into dichloromethane, while leaf extract showed a 20 g/ml solubility coefficient at 35 °C in the same solvent. These miscibility and solubility conditions were selected for the impregnation process. Using the organic solvent immersion method, 11 mg of copaiba oleoresin and 19 mg of leaf extract were impregnated into 1 cm³ of 3D matrix. The main bioactives from copaiba products, such as β-caryophyllene and lupeol, were tracked in the gelatin dressing. DSC and TGA assays showed no thermal changes in the samples after impregnation. Furthermore, the spatial organization of foam structure of the dressings was preserved after superficial distribution of oleoresin, as well as amorphous-like particulate deposition of leaf extract. The main compound of copaiba oleoresin, β-caryophyllene, which exhibits well-known anti-inflammatory activities, and the main compound of copaiba leaf extract, lupeol, also an anti-inflammatory agent, were successfully impregnated using organic solvent in wound dressings and are promising for further application on tissue wound healing. Graphical Abstract.

Improvement in mechanical properties and biodegradability of PLA using poly(ethylene glycol) and triacetin for antibacterial wound dressing applications

Wound is among the most common injuries. A suitable wound dressing has a significant effect on the healing process. In this study, a porous wound dressing was prepared using poly (lactic acid) (PLA) and two plasticizers, polyethylene glycol (PEG) and triacetin (TA), through solvent casting method. For antibacterial activities, metronidazole was incorporated in the structure. The morphology was investigated by scanning electron microscopy (SEM). In addition, the effect of plasticizers ratio on porosity growth was evaluated. It was also observed that each had a unique effect on the structure's porosity. The mechanical properties confirmed the effect of both plasticizers on increasing polymer softness and flexibility, and the most similar formulations to human skin in terms of mechanical properties were introduced. According to the results, TA had stronger effect on mechanical properties. The differential scanning calorimetry (DSC) showed the effect of increasing plasticizer concentration on crystalline structure and Tm reduction of PLA. The water contact angle measurement showed that both plasticizers enhanced hydrophilic characteristics of PLA, and this effect was weaker in PEG-containing formulations. The in vitro degradation study showed biodegradability, as a desirable property in wound dressing. Results suggested that higher degradation can be obtained by both plasticizers at the same time. The results also showed that PEG was more effective in enhancing water absorbency. In vitro drug release study indicated an explosive release and the highest amount was 85% over 186 h. The antibacterial activity test confirmed the effectiveness of the drug in preventing bacterial growth in the drug-containing formulations, while it showed the antibacterial property of TA. MTT assay was performed and the cellular toxicity of the formulations was checked and those that revealed the least toxicity were introduced.

Chitosan and phospholipid assisted topical fusidic acid drug delivery in burn wound: Strategies to conquer pharmaceutical and clinical challenges, opportunities and future panorama

Burn is the immense public health issue globally. Low and middle income countries face extensive deaths owing to burn injuries. Availability of conventional therapies for burns has always been painful for patients as well as expensive for our health system. Pharmaceutical experts are still searching reliable, cheap, safe and effective treatment options for burn injuries. Fusidic acid is an antibiotic of choice for the management of burns. However, fusidic acid is encountering several pharmaceutical and clinical challenges like poor skin permeability and growing drug resistance against burn wound microbes like Methicillin resistant Staphylococcus aureus (MRSA). Therefore, an effort has been made to present a concise review about molecular pathway followed by fusidic acid in the treatment of burn wound infection in addition to associated pros and cons. Furthermore, we have also summarized chitosan and phospholipid based topical dermal delivery systems customized by our team for the delivery of fusidic acid in burn wound infections on case-to-case basis. However, every coin has two sides. We recommend the integration of in-silico docking techniques with natural biomacromolecules while designing stable, patient friendly and cost effective topical drug delivery systems of fusidic acid for the management of burn wound infection as future opportunities.

Fabrication of sliver nanoparticles/polyvinyl alcohol/gelatin ternary nanofiber mats for wound healing application

PURPOSE

In this study, we aimed to determine the regenerative and antimicrobial impact of the electrospun nanofiber mats, with/without silver nanoparticles (AgNPs), on full-thickness skin wounds in rabbits.

METHODS

Polyvinyl alcohol was combined with gelatin to provide biocompatible electrospun binary nanofiber mats. AgNPs were added to the polyvinyl alcohol/gelatin mixture to obtain ternary nanofiber-AgNPs mats. Binary and ternary nanofiber mats were characterized by scanning electron microscopy before being applied as wound dressings in vivo. Subsequently, wound healing was evaluated.

RESULTS

Both nanofiber/nanofiber-AgNPs mats improved the microscopic quality of the healed skin, albeit without obvious acceleration of the healing rate. As well, both types of nanofiber mats were able to combat microbial invasion into the wound bed.

CONCLUSIONS

Both binary polyvinyl alcohol/gelatin and ternary polyvinyl alcohol/gelatin/AgNPs nanofiber mats developed in the present study depicted similar regenerative and antimicrobial potential when applied as full-thickness wound dressing. However, in comparison to the binary nanofiber mats, no obvious synergistic effect was observed after loading nanofibers with AgNPs.

Bioactive antibacterial bilayer PCL/gelatin nanofibrous scaffold promotes full-thickness wound healing

Treatment of diabetic, chronic, and full-thickness wounds is a challenge as these injuries usually lead to infections that cause delayed and inappropriate healing. Therefore, fabrication of skin scaffolds with prolonged antibacterial properties are of great interest. Due to this demand, bilayered nanofibrous scaffolds were fabricated based on polycaprolactone and gelatin. The top layer of these scaffolds contained amoxicillin as a model drug and the bottom layer was loaded with zinc oxide nanoparticles to accelerate wound healing. Several characterization techniques including FTIR, SEM, swelling, tensile test, in vitro degradation, drug release, antibacterial activity, and MTT assay were used to assess physical, mechanical, and biological properties of produced nanofibers. SEM results demonstrated that bilayered scaffolds have smooth bead-free microstructures while in vitro release test showed that samples have a sustained release for amoxicillin up to 144 h (tested time). Disk diffusion assessment confirmed the potency of scaffolds for hindering bacterial growth while results of cytotoxicity evaluation revealed that scaffolds could effectively accelerate cell proliferation. Finally, in vivo tests on full-thickness rat models revealed that fabricated nanofibers accelerate wound contraction, increase collagen deposition and angiogenesis, and prevent scar formation. Altogether, results showed that fabricated scaffolds are promising candidates for treatment of full-thickness wounds.

The effect of natural matrix biopolymer membrane on hard-to-heal venous leg ulcers: a pilot randomised clinical trial

OBJECTIVE

The aim of this study was to evaluate the therapeutic effects of natural matrix biopolymer membrane (NMBM) in the treatment of venous leg ulcers (VLUs).

METHOD

Patients exhibiting one or more VLU were assigned to a test group receiving NMBM or to a control group receiving conventional treatment. Patients exhibiting venous insufficiency-related ulcers within 0.1-170cm² were included. Efficacy was assessed based on ulcer size and visual analogue scale (VAS) pain scores at baseline and at weeks one, two and four. Ulcer size and pain were compared between groups using a two-way ANOVA.

RESULTS

In this study, 25 patients with 32 VLUs (NMBM group: 14 patients with 17 ulcers; control group: 11 patients with 15 ulcers) were included in the final analysis. At four weeks after baseline measurements, the mean percentage change in VLU area of patients in the NMBM group was 61.6% (95% CI: 40.3-82.9) compared with 84.1% (95% CI: 56.5-111.7) for control group patients. Additionally, the mean percentage change in VLU volume of NMBM group patients was 51.2% (95% CI: 31.8-70.6) compared with 84.0% (95% CI: 57.0-121.0) for control group patients. The NMBM group patients exhibited a mean decrease of 0.38 (95% CI: -0.85-1.61) in VAS pain score over four weeks, compared with a mean decrease of 0.13 (95% CI: -1.32-1.58) for control group patients. No significant differences in VLU area (p=0.210), volume (p=0.122) or VAS pain score (p=0.460) were shown between groups.

CONCLUSION

NMBM was found to be as effective and safe as the control group treatments. This pilot study suggests NMBM can be used safely to promote ulcer healing.

Development of a polyvinyl alcohol/sodium alginate hydrogel-based scaffold incorporating bFGF-encapsulated microspheres for accelerated wound healing

In the present study, a hybrid microsphere/hydrogel system, consisting of polyvinyl alcohol (PVA)/sodium alginate (SA) hydrogel incorporating PCL microspheres is introduced as a skin scaffold to accelerate wound healing. The hydrogel substrate was developed using the freeze-thawing method, and the proportion of the involved polymers in its structure was optimized based on the in-vitro assessments. The bFGF-encapsulated PCL microspheres were also fabricated utilizing the double-emulsion solvent evaporation technique. The achieved freeze-dried hybrid system was then characterized by in-vitro and in-vivo experiments. The results obtained from the optimization of the hydrogel showed that increasing the concentration of SA resulted in a more porous structure, and higher swelling ability, elasticity and degradation rate, but decreased the maximum strength and elongation at break. The embedding of PCL microspheres into the optimized hydrogel structure provided sustained and burst-free release kinetics of bFGF. Besides, the addition of drug-loaded microspheres led to no significant change in the degradation mechanism of the hydrogel substrate; however, it reduced its mechanical strength. Furthermore, the MTT assay represented no cytotoxic effect for the hybrid system. The in-vivo studies on a burn-wound rat model, including the evaluation of the wound closure mechanism, and histological analyses indicated that the fabricated scaffold efficiently contributed to promoting cell-induced tissue regeneration and burn-wound healing.

Chitosan hydrogel encapsulated with LL-37 peptide promotes deep tissue injury healing in a mouse model

BACKGROUND

LL-37 peptide is a member of the human cathelicidin family, and has been shown to promote the healing of pressure ulcers. However, the low stability of this peptide within the wound environment limits its clinical use. Chitosan (CS) hydrogel is commonly used as a base material for wound dressing material.

METHODS

CS hydrogel (2.5% w/v) was encapsulated with LL-37. Cytotoxicity of the product was examined in cultured NIH3T3 fibroblasts. Effects on immune response was examined by measuring tumor necrosis factor-α (TNF-α) release from RAW 264.7 macrophages upon exposure to lipopolysaccharides. Antibacterial activity was assessed using Staphylococcus aureus. Potential effect on pressure ulcers was examined using a mouse model. Briefly, adult male C57BL/6 mice were subjected to skin pressure using magnets under a 12/12 h schedule for 21 days. Mice were randomized to receive naked LL-37 (20 μg), chitosan gel containing 20-μg LL-37 (LL-37/CS hydrogel) or hydrogel alone under the ulcer bed (n = 6). A group of mice receiving no intervention was also included as a control.

RESULTS

LL-37/CS hydrogel did not affect NIH3T3 cell viability. At a concentration of 1-5 μg/ml, LL-37/CS inhibited TNF-α release from macrophage. At 5 μg/ml, LL-37/CS inhibited the growth of Staphylococcus aureus. The area of the pressure ulcers was significantly lower in mice receiving LL-37/CS hydrogel in comparison to all other 3 groups on days 11 (84.24% ± 0.25%), 13 (56.22% ± 3.91%) and 15 (48.12% ± 0.28%). Histological examination on days 15 and 21 showed increased epithelial thickness and density of newly-formed capillary with naked LL-37 and more so with LL-37/CS. The expression of key macromolecules in the process of angiogenesis (i.e., hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor-A (VEGF-A)) in wound tissue was increased at both the mRNA and protein levels.

CONCLUSION

Chitosan hydrogel encapsulated with LL-37 is biocompatible and could promote the healing of pressure ulcers.

Evaluation of ROCEN on Burn Wound Healing and Thermal Pain: Transforming Growth Factor-β1 Activation

The present study aimed to evaluate the effect of liposomal arthrocen 2% (ROCEN) on the healing of burn wound and pain alleviation of thermal stimuli in a rat model of the second-degree burn. The results showed that ROCEN formulation significantly improved the main parameters of burn wound healing in a short period of time (7 days). The percentage of wound surface was also reduced significantly compared with the control group following once daily application of ROCEN for 14 days. The level of TGF (transforming growth factor)-β1 cytokine was also elevated significantly in the burn tissue treated with ROCEN almost the same as zinc oxide cream. Also, ROCEN showed a significant analgesic effect evaluated by 2 models of acute thermal pain, tail-flick and hotplate tests, which suggested that the formulation may act as a pain reliever in burn injuries. In conclusion, the application of the topical formulation of ROCEN may have benefits in the acceleration of the wound healing process and alleviation of the pain due to burn injuries.

Supercritical carbon dioxide techniques for processing microbial exopolysaccharides used in biomedical applications

Microbial exopolysaccharides are polymers that show a great potential for biomedical applications, such as tissue engineering applications and drug delivery, due to their biocompatibility, biodegradability and their gelling properties. These polysaccharides are obtained from a microorganism culture with a relatively straightforward downstream process thanks to their extracellular character, and can be processed to obtain aerogels, fibers and micro- or nano-particles with conventional techniques. However, these techniques present several disadvantages in that they involve time-consuming processes and the use of toxic solvents. Supercritical carbon dioxide techniques can overcome these drawbacks, but their use for processing microbial exopolysaccharides is not extended in the scientific community. This review describes the most frequently used exopolysaccharides in biomedical applications and how they can be obtained, as well as the different supercritical carbon dioxide techniques that can be used for processing them and their challenges. Specifically, high pressure shows a great potential to process and sterilize exopolysaccharide biomaterials for biomedical applications (e.g. tissue engineering or drug delivery systems) in spite of the disadvantage concerning the hydrophilicity of this type of polymers.

A Wirelessly Controlled Smart Bandage with 3D-Printed Miniaturized Needle Arrays

Chronic wounds are one of the most devastating complications of diabetes and are the leading cause of nontraumatic limb amputation. Despite the progress in identifying factors and promising in vitro results for the treatment of chronic wounds, their clinical translation is limited. Given the range of disruptive processes necessary for wound healing, different pharmacological agents are needed at different stages of tissue regeneration. This requires the development of wearable devices that can deliver agents to critical layers of the wound bed in a minimally invasive fashion. Here, for the first time, a programmable platform is engineered that is capable of actively delivering a variety of drugs with independent temporal profiles through miniaturized needles into deeper layers of the wound bed. The delivery of vascular endothelial growth factor (VEGF) through the miniaturized needle arrays demonstrates that, in addition to the selection of suitable therapeutics, the delivery method and their spatial distribution within the wound bed is equally important. Administration of VEGF to chronic dermal wounds of diabetic mice using the programmable platform shows a significant increase in wound closure, re-epithelialization, angiogenesis, and hair growth when compared to standard topical delivery of therapeutics.

Advances and Impact of Antioxidant Hydrogel in Chronic Wound Healing

The accelerating and thorough treatment of chronic wounds still represents a major unmet medical need owing to the complex symptoms resulting from metabolic disorder of the wound microenvironment. Although numerous strategies and bioactive hydrogels are developed, an effective and widely used method of chronic wound treatment remains a bottleneck. With the aim to accelerate chronic wound healing, many hydrogel dressings with antioxidant functions have emerged and are proven to accelerate wound healing, especially for chronic wound repair. The new strategy in chronic wound treatment brought by antioxidant hydrogels is of great significance to human health. Here, the application of antioxidant hydrogels in the repair of chronic wounds is discussed systematically, aiming to provide an important theoretical reference for the further breakthrough of chronic wound healing.

Soft and Ion-Conducting Materials in Bioelectronics: From Conducting Polymers to Hydrogels

Bioelectronics devices that directly interface with cells and tissue have applications in neural and cardiac stimulation and recording, electroceuticals, and brain machine interfaces for prostheses. The interface between bioelectronic devices and biological tissue is inherently challenging due to the mismatch in both mechanical properties (hard vs soft) and charge carriers (electrons vs ions). In addition to conventional metals and silicon, new materials have bridged this interface, including conducting polymers, carbon-based nanomaterials, as well as ion-conducting polymers and hydrogels. This review provides an update on advances in soft bioelectronic materials for current and future therapeutic applications. Specifically, this review focuses on soft materials that can conduct both electrons and ions, and also deliver drugs and small molecules. The future opportunities and emerging challenges in the field are also highlighted.

An Injectable and Instant Self-Healing Medical Adhesive for Wound Sealing

Designing versatile functional medical adhesives with injectability, self-healing, and strong adhesion is of great significance to achieve desirable therapeutic effects for promoting wound sealing in healthcare. Herein, a self-healing injectable adhesive is fabricated by physical interaction of polyphenol compound tannic acid (TA) and eight-arm poly(ethylene glycol) end-capped with succinimide glutarate active ester (PEG-SG). The hydrogen bonding induced from the structural unit (-CH₂-CH₂-O-) of PEG and catechol hydroxyl (-OH) of TA, accompanied by ester exchange between N-hydroxysuccinimide (-NHS) and amino (-NH₂) of proteins, contributes to self-healing ability and rapid strong adhesion. Notably, the PEG/TA adhesive can repeatedly adhere to rigid porcine tissues, close the coronary artery under a large incision tension, and bear a heavy load of 2 kg. By exhibiting shear-thinning and anti-swelling properties, the PEG/TA adhesive can be easily applied through single-syringe extrusion onto various wounds. The single-channel toothpaste-like feature of the adhesive ensures its storage hermetically for portable usage. Moreover, in vivo operation and histological H&E staining results indicate that the PEG/TA adhesive greatly accelerates wound healing and tissue regeneration in a rat model. With the specialty of injectability, instant self-healing, and long-lasting strong adhesion to facilitate excellent therapeutic effects, the multifunctional PEG/TA adhesive may provide a new alternative for self-rescue and surgical situations.

Antibiotic Delivery Strategies to Treat Skin Infections When Innate Antimicrobial Defense Fails

The epidermal skin barrier protects the body from a host of daily challenges, providing protection against mechanical insults and the absorption of chemicals and xenobiotics. In addition to the physical barrier, the epidermis also presents an innate defense against microbial overgrowth. This is achieved through the presence of a diverse collection of microorganisms on the skin (the "microbiota") that maintain a delicate balance with the host and play a significant role in overall human health. When the skin is wounded, the local tissue with a compromised barrier can become colonized and ultimately infected if bacterial growth overcomes the host response. Wound infections present an immense burden in healthcare costs and decreased quality of life for patients, and treatment becomes increasingly important because of the negative impact that infection has on slowing the rate of wound healing. In this review, we discuss specific challenges of treating wound infections and the advances in drug delivery platforms and formulations that are under development to improve topical delivery of antimicrobial treatments.

Evaluation of Different Methods for Cultivating Gluconacetobacter hansenii for Bacterial Cellulose and Montmorillonite Biocomposite Production: Wound-Dressing Applications

Bacterial cellulose (BC) has received considerable attention due to its unique properties, including an ultrafine network structure with high purity, mechanical strength, inherent biodegradability, biocompatibility, high water-holding capacity and high crystallinity. These properties allow BC to be used in biomedical and industrial applications, such as medical product. This research investigated the production of BC by Gluconacetobacter hansenii ATCC 23769 using different carbon sources (glucose, mannitol, sucrose and xylose) at two different concentrations (25 and 50 g∙L⁻¹). The BC produced was used to develop a biocomposite with montmorillonite (MMT), a clay mineral that possesses interesting characteristics for enhancing BC physical-chemical properties, at 0.5, 1, 2 and 3% concentrations. The resulting biocomposites were characterized in terms of their physical and barrier properties, morphologies, water-uptake capacities, and thermal stabilities. Our results show that bacteria presented higher BC yields in media with higher glucose concentrations (50 g∙L⁻¹) after a 14-day incubation period. Additionally, the incorporation of MMT significantly improved the mechanical and thermal properties of the BC membranes. The degradation temperature of the composites was extended, and a decrease in the water holding capacity (WHC) and an improvement in the water release rate (WRR) were noted. Determining a cost-effective medium for the production of BC and the characterization of the produced composites are extremely important for the biomedical applications of BC, such as in wound dressing materials.

Wound healing and antimicrobial effect of active secondary metabolites in chitosan-based wound dressings: A review

Wound healing can lead to complex clinical problems, hence finding an efficient approach to enhance the healing process is necessary. An ideal wound dressing should treat wounds at reasonable costs, with minimal inconveniences for the patient. Chitosan is one of the most investigated biopolymers for wound healing applications due to its biocompatibility, biodegradability, non-toxicity, and antimicrobial activity. Moreover, chitosan and its derivative have attracted numerous attentions because of the accelerating wound healing, and easy processability into different forms (gels, foams, membranes, and beads). All these properties make chitosan-based materials particularly versatile and promising for wound dressings. Besides, secondary natural metabolites could potentially act like the antimicrobial and anti-inflammatory agents and accelerate the healing process. This review collected almost all studies regarding natural compounds applications in wound healing by focusing on the chitosan-based bioactive wound dressing systems. An accurate analysis of different chitosan formulations and the influence of bioactive compounds on their wound healing properties are reported.

Polymeric films containing pomegranate peel extract based on PVA/starch/PAA blends for use as wound dressing: In vitro analysis and physicochemical evaluation

Chronic wounds constitute a serious public health problem, and developing pharmaceutical dosage forms to ensure patient comfort and safety, as well as optimizing treatment effectiveness, are of great interest in the pharmaceutical, medical and biomaterial fields. In this work, the preparation of films based on blends of poly(vinyl alcohol), starch and poly(acrylic acid), polymers widely used as pharmaceutical excipients, and pomegranate peel extract (PPE), a bioactive compound with antimicrobial and healing activities relevant to the use as a bioactive wound dressing, was proposed. Initially, the minimum inhibitory concentration (MIC) of the PPE was investigated by an in vitro method. Then, the best concentration of the PPE to be used to prepare the films was researched using an antimicrobial susceptibility test with the disc diffusion method. The microbiological assay was performed in films prepared by the solvent casting method in the presence of two concentrations of PPE: 1.25% w/v and 2.5% w/v. Films containing the lower PPE concentration showed antimicrobial activity against Staphylococcus aureus and Staphylococcus epidermidis, with a difference that was not considered statistically significant when compared to the higher concentration of the extract. Therefore, the films prepared with the lower proportion of PPE (1.25% w/v) were considered for the other studies. The miscibility and stability of the extract in the films were investigated by thermal analysis. Parameters that determine the barrier properties of the films were also investigated by complementary techniques. Finally, in vitro biological tests were performed for safety evaluation and activity research. Analysis of the results showed that the incorporation of the higher proportion of starch in the blend (15% v/v) (PVA:S:PAA:PPE4) yielded smooth, transparent, and domain-free films without phase separation. Additionally, the PVA:S:PAA:PPE4 film presented barrier properties suitable for use as a cover. These films, when subjected to the in vitro hemolytic activity assay, were nonhemolytic and biocompatible. No toxicity from the extract was observed at the concentrations studied. The results of the wound healing in vitro test showed that films containing 1.25% PPE are efficient in reducing the scratch open area, provoking almost total closure of the scratches within 48 h without cytotoxicity.

Keratinous materials: Structures and functions in biomedical applications

Keratins are a family of fibrous proteins anticipated to possess wide-ranging biomedical applications due to their abundance, physicochemical properties and intrinsic biological activity. This review mainly focuses on the biomaterials derived from three major sources of keratins; namely human hair, wool and feather, that have effective applications in tissue engineering, wound healing and drug delivery. This article offers five viewpoints regarding keratin i) an introduction to keratin protein extraction and keratin-based scaffold fabrication methods ii) applications in nerve and bone tissue engineering iii) a review on the keratin dressings applied to different types of wounds to facilitate wound healing and thereby repair the skin iv) the utilization of keratinous materials as a carrier system for therapeutics with a controlled manner v) a discussion regarding the main challenges for using keratin in biomedical applications as well as its future prospects.

Graphene oxide coated shell-core structured chitosan/PLLA nanofibrous scaffolds for wound dressing

Graphite oxide (GO) and chitosan (CS) nanofibers have aroused intense interest as wound dressing due to their physicochemical, antimicrobial properties and nanotopography. In this study, GO nanosheets were coated on shell (chitosan, CS)-core (L-polylactic acid, PLLA) structured nanofibrous scaffolds to create a synergistic microenvironment for wound healing. Through scanning electron microscopy (SEM) and atomic force microscopy (AFM) tests, results showed that the surface of GO-coated CS/PLLA nanofibers presented corrugated wrinkles and rougher than that of CS/PLLA nanofibers, and the GO nanosheets did not destroy the structure of nanofibers. X-ray photoelectron spectroscopy (XPS) and thermogravimetric analysis (TGA) demonstrated that GO nanosheets were successfully coated on CS/PLLA nanofibrous scaffolds. Furthermore, the coatings of GO nanosheets significantly improved the hydrophilicity of CS/PLLA nanofibrous scaffolds. GO-coated CS/PLLA nanofibrous scaffolds revealed more excellent antimicrobial activity to Gram-negative Escherichia coli (E. coli) and Gram-positive Staphylococcus aureus (S. aureus) than that of CS/PLLA nanofibrous scaffolds, meanwhile, they promoted the proliferation of pig iliac endothelial cells (PIECs). Rats wounds covered by GO-coated CS/PLLA nanofibrous scaffolds were healed better than other groups on pathological section. This type of nanofibrous scaffolds with GO nanosheets would possess an excellent potential in wound healing process.

Salmonella enterica serovar Paratyphi A isolated from a hard-to-heal diabetic ulcer: a case report

Chronically infected diabetic wounds have a polymicrobial aetiology. However, Salmonella Paratyphi A is a very rare cause of wound infection. A 76-year-old female patient with type II diabetes presented with a wound on the left leg of two months' duration. The wound was painful, erythematous and a thick, foul-smelling discharge was present. There was a history of delayed wound healing. Salmonella Paratyphi A and Pseudomonas aeruginosa were isolated from the wound tissue. The patient was treated with cefuroxime and cloxacillin empirically and following the antibiotic susceptibility testing (ABST) report, ciprofloxacin was given for 10 days. The wound was treated with multiple debridements and topical antiseptic. On follow-up, the patient remained afebrile with subsiding discharge from the ulcer. This is the first reported case of Salmonella Paratyphi A from an infected diabetic ulcer in Sri Lanka and it serves to further define the spectrum of illnesses caused by this uncommon pathogen.

Porous ZnO modified silk sutures with dual light defined antibacterial, healing promotion and controlled self-degradation capabilities

Current sutures have disadvantages such as poor antibacterial activities, low healing effects, and a lack of self-degradation ability.

Prospects for the application of growth factors in wound healing

As the largest organ of the body, human skin is multifunctional and enjoys two layers, the epidermis and the dermis, the separation of which is performed by a basement membrane zone. Skin protects the body against mechanical forces and infections. Skin wounds represent large and growing challenges to the healthcare systems globally. Skin wound healing, as a protective shield for the body against the external environment, includes interactions among cell types, the neurovascular system, cytokines, and matrix remodeling. Growth factors (GFs) affect the microenvironment of the wound, and cause rises in cell differentiation, proliferation, and migration. Administrating exogenous GFs has revealed potential in enhancing wound healing outcomes. The use of human GFs in the field of wound healing is becoming gradually more interesting, because of the low-invasive techniques required for their use. Reviewed here are the literatures on the healing of skin wounds with emphasize on the role of GFs and their future prospects, containing profits, and probable long-standing side effects accompanied with their use.

Curcumin-In-Deformable Liposomes-In-Chitosan-Hydrogel as a Novel Wound Dressing

A liposomes-in-hydrogel system as an advanced wound dressing for dermal delivery of curcumin was proposed for improved chronic wound therapy. Curcumin, a multitargeting poorly soluble active substance with known beneficial properties for improved wound healing, was incorporated in deformable liposomes to overcome its poor solubility. Chitosan hydrogel served as a vehicle providing superior wound healing properties. The novel system should assure sustained skin delivery of curcumin, and increase its retention at the skin site, utilizing both curcumin and chitosan to improve the therapy outcome. To optimize the properties of the formulation and determine the effect of the liposomal charge on the hydrogel properties, curcumin-containing deformable liposomes (DLs) with neutral (NDLs), cationic (CDLs), and anionic (ADLs) surface properties were incorporated in chitosan hydrogel. The charged DLs affected the hydrogel’s hardness, cohesiveness, and adhesiveness. Importantly, the incorporation of DLs, regardless of their surface charge, in chitosan hydrogel did not decrease the system’s bioadhesion to human skin. Stability testing revealed that the incorporation of CDLs in hydrogel preserved hydrogel´s bioadhesiveness to a higher degree than both NDLs and ADLs. In addition, CDLs-in-hydrogel enabled the most sustained skin penetration of curcumin. The proposed formulation should be further evaluated in a chronic wound model.

Atypical Ulcers: Diagnosis and Management

Atypical ulcers show atypical clinical features, histology, localization, and resistance to standard therapies. The persistence of a chronic ulcer despite treatment with standard therapies requires a more specific diagnostic investigation. Diagnosis involves obtaining the history and performing clinical examination and additional tests. A skin biopsy is frequently used to confirm unclear diagnosis. In difficult cases, microbiological and immunohistochemical examinations, laboratory blood tests, or instrumental tests should be evaluated. The treatment of atypical wounds is characterized by local systemic therapy and pain control. Our results highlight the need for early diagnosis, and standardized and targeted management by a multidisciplinary wound healing center.