Advanced Therapeutic Dressings for Effective Wound Healing--A Review

Three Dimensional Printing Bilayer Membrane Scaffold Promotes Wound Healing

Full-thickness skin wounds are common and could be a heavy physical and economic burden. With the development of three dimensional (3D) printing technology, skin-like constructs have been fabricated for skin wound healing and regeneration. Although the 3D printed skin has great potential and enormous advantages before vascular networks can be well-constructed, living cells are not recommended for 3D skin printing for in vivo applications. Herein, we designed and printed a bilayer membrane (BLM) scaffold consisting of an outer poly (lactic-co-glycolic acid) (PLGA) membrane and a lower alginate hydrogel layer, which respectively mimicked the skin epidermis and dermis. The multi-porous alginate hydrogel of the BLM scaffolds promoted cell adhesion and proliferation in vitro, while the PLGA membrane prevented bacterial invasion and maintained the moisture content of the hydrogel. Skin regeneration using the bilayer scaffold was compared with that of PLGA, alginate hydrogel and the untreated defect in vivo. Tissue samples were analyzed using histopathological and immunohistochemical staining of CD31. In addition, mRNA expression levels of collagen markers [collagen type 1 alpha 1 (COL1a1) and collagen type 3 alpha 1 (COL3a1)] and inflammatory markers [interleukin-1β (IL-1β), as well as tumor necrosis factor (TNF-α)] were measured. Conclusively, the application of BLM scaffold resulted in highest levels of best skin regeneration by increasing neovascularization and boosting collagen I/III deposition. Taken together, the 3D-printed BLM scaffolds can promote wound healing, and are highly suitable for a wide range of applications as wound dressings or skin substitutes.

Chitosan-bacterial cellulose patch of ciprofloxacin for wound dressing: Preparation and characterization studies

Biopolymeric blends based on bacterial cellulose (BC) films modified with low molecular weight chitosan (Chi) were developed for controlled release of ciprofloxacin (Cip). Biophysical studies revealed a compatible and cooperative network between BC and Chi including deep structural changes in the BC matrix shown by spectroscopic and thermal analyses (SEM, roughness analysis, FTIR, XRD, TGA, mechanical properties and water vapor transmission rate). Incorporation of chitosan to BC matrix generated a thickening scaffold with high permeability to water vapor from 0.7 to 3.2 g mm/m² h. Cip loaded onto the BC-Chi film showed a hyperbolic release profile with a 30% decrease in antibiotic release mediated by the presence of Chi. BC-Chi blend films containing Cip tested against Pseudomonas aeruginosa and Staphylococcus aureus showed a synergic effect of chitosan on Cip antimicrobial activity. Besides, in vitro studies revealed the lack of cytotoxicity of BC-Chi-Cip films in human fibroblasts.

Preparation and characterization of chemically TEMPO-oxidized and mechanically disintegrated sacchachitin nanofibers (SCNF) for enhanced diabetic wound healing

TEMPO-oxidization and mechanical disintegration were utilized to develop sacchachitin nanofibers (SCNF) with a 3D gel structure for being an ideal scaffold. Mechanically disintegrated SCNF (MDSCNF) with NanoLyzer® at 20,000 psi for 5 cycles and TEMPO-oxidized SCNF (TOSCNF) produced with 5.0 and 10.0 mmole NaClO/g SC was designated as SCN5, T050SC, and T100SC, respectively. All 2% MDSCNF suspensions were demonstrated to be in gel form, while all except T100SC of 2% TOSCNF suspensions showed to be wet fiber-like hydrogel. In diabetic wound healing study, both SCN5 and T050SC incorporated in AMPS (2-acrylamide-2-methyl-propane sulfonate)-based wound dressing were showed to accelerate diabetic wound healing forming nearly the same as normal tissues. T050SC/H further provided the healed wound with growth of sweat glands and hair follicles indicating the wound had healed as functional tissue. Conclusively, TEMPO-oxidized SCNF-based hydrogel scaffolds showed greater potentials in tissue regeneration due to its unique physical and chemical properties.

Delivery of antiseptic solutions by a bacterial cellulose wound dressing: Uptake, release and antibacterial efficacy of octenidine and povidone-iodine

BACKGROUND

Bacterial nanocellulose (BNC) is considered a promising carrier for various substances and novel approaches using BNC in combination with antiseptics are well documented. However, the difference in the molecular weight of these molecules influences their uptake by and release from BNC. Analysing the diffusion of standard molecules with different weight, e.g. dextrans, offers the possibility to investigate the mobility of various molecules. We aimed to test the use of BNC regarding uptake and release of different standard molecules as well as two commercially available antiseptics for possible applications in future wound dressings.

MATERIAL AND METHODS

Diffusion profiles, uptake and release of three FITC-dextran molecules differing in weight as well as octenidine (Octenisept®) and povidone-iodine (Betaisodona®)-based antiseptics were tested with BNC-based wound dressings. Furthermore, the antiseptic efficacy of BNC in combination with antiseptics against Staphylococcus aureus was tested.

RESULTS

Uptake and release capacity for FITC-dextran molecules showed a molecular weight-dependent mobility from BNC into an agarose gel. The loading capacity of BNC was also inversely proportional to the molecular weight of the antiseptics. The release test for octenidine showed a sustained and prolonged delivery into a solid matrix, whereas povidone-iodine was released faster. Both antiseptic solutions combined with BNC showed a good dose-dependent efficacy against S. aureus.

CONCLUSION

Results obtained from the mobility of FITC-dextran molecules in the BNC matrix could open possible applications for the combination of BNC with other molecules for medical applications. Combination of both tested antiseptics with BNC showed to be an efficient approach to control bacterial infections.

Development and Evaluation of a Prototype Scratch Apparatus for Wound Assays Adjustable to Different Forces and Substrates

Scratch assays enable the study of the migration process of an injured adherent cell layer in vitro. An apparatus for the reproducible performance of scratch assays and cell harvesting has been developed that meets the requirements for reproducibility in tests as well as easy handling. The entirely autoclavable setup is divided into a sample translation and a scratching system. The translational system is compatible with standard culture dishes and can be modified to adapt to different cell culture systems, while the scratching system can be adjusted according to angle, normal force, shape, and material to adapt to specific questions and demanding substrates. As a result, a fully functional prototype can be presented. This system enables the creation of reproducible and clear scratch edges with a low scratch border roughness within a monolayer of cells. Moreover, the apparatus allows the collection of the migrated cells after scratching for further molecular biological investigations without the need for a second processing step. For comparison, the mechanical properties of manually performed scratch assays are evaluated.

Fibrous Materials Made of Poly(ε-caprolactone)/Poly(ethylene oxide)-b-Poly(ε-caprolactone) Blends Support Neural Stem Cells Differentiation

In this work, we design and produce micron-sized fiber mats by blending poly(ε-caprolactone) (PCL) with small amounts of block copolymers poly(ethylene oxide)_m-block-poly(ε-caprolactone)_n (PEO_m-b-PCL_n) using electrospinning. Three different PEO_m-b-PCL_n block copolymers, with different molecular weights of PEO and PCL, were synthesized by ring opening polymerization of ε-caprolactone using PEO as initiator and stannous octoate as catalyst. The polymer blends were prepared by homogenous solvent mixing using dichloromethane for further electrospinning procedures. After electrospinning, it was found that the addition to PCL of the different block copolymers produced micron-fibers with smaller width, equal or higher hydrophilicity, lower Young modulus, and rougher surfaces, as compared with micron-fibers obtained only with PCL. Neural stem progenitor cells (NSPC), isolated from rat brains and grown as neurospheres, were cultured on the fibrous materials. Immunofluorescence assays showed that the NSPC are able to survive and even differentiate into astrocytes and neurons on the synthetic fibrous materials without any growth factor and using the fibers as guidance. Disassembling of the cells from the NSPC and acquisition of cell specific molecular markers and morphology progressed faster in the presence of the block copolymers, which suggests the role of the hydrophilic character and porous topology of the fiber mats.

Antimicrobial and wound healing properties of a bacterial cellulose based material containing B. subtilis cells

A biocomposite composed of bacterial cellulose (BC) gel-film and Bacillus subtilis (BS) cells was obtained and characterized with a view to future biomedical applications. The inclusion of functional ingredient (1010/g viable BS cells) in the composite was carried out by their joint aggregation with the BC gel-film. Immobilized BS cells displayed high antagonistic activity towards causative agents of wound infections such as Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa. Application of the BC/BS-biocomposite for the treatment of excision wounds, performed on laboratory animals, stimulated reparative processes and shortened the healing time. Possible mechanisms of the wound-healing effect of BC/BS gel films are discussed. In this work we claim that the developed BC/BS-material can be positioned as a universal wound coating and sanitary-hygienic product.

Tazarotene Released from Aligned Electrospun Membrane Facilitates Cutaneous Wound Healing by Promoting Angiogenesis

Wound treatment is a long-lasting clinical issue. Poor angiogenesis leading to delayed wound closure causes huge challenges for healing. Functional electrospun membranes have been established as an efficient strategy to promote wound recovery by protecting and improving vascular regeneration. Here, we aimed to investigate the effect of tazarotene, an active drug for angiogenesis, loaded in aligned electrospun nanofibrous barrier on a soft tissue wound. This aligned membrane was arranged in a single direction, and tazarotene could be released from its nanofibers sustainably. The in vitro study demonstrated that compared with the random drug-loaded or other control groups, the aligned tazarotene-loaded membranes [poly-caprolactone (PCL)/AT] could stimulate proliferation, migration, angiogenesis, and vascular endothelial growth factor secretion and its gene expression of human umbilical vein endothelial cells. Furthermore, the in vivo model showed that the prepared tazarotene-loaded aligned membrane significantly accelerated the speed of healing, improved the neovascularization and re-epithelialization, and inhibited the inflammatory reaction in the wound area. All these results above indicated that the PCL/AT nanofibrous dressing, which could promote angiogenesis because of both stimulation of structure and chemical signals, is a promising wound-caring material.

A novel self-nanoemulsifying drug delivery system for curcumin used in the treatment of wound healing and inflammation

The main objective of this study was to develop and evaluate self-nanoemulsifying drug delivery system (SNEDDS) of curcumin (Cur) to enhance their solubility as well as improve skin permeation; and evaluate wound healing potential of Cur via SNEDDS in comparison with standards pure eucalyptus oil-SNEDDS (Euc-SNEDDS), pure curcumin suspension (Cur-S), and standard fusidic acid followed by their anti-inflammatory action. Curcumin-loaded different SNEDDS formulations were formulated through aqueous phase titration method and the zones of SNEDDS were recognized by the construction of phase diagrams. Eucalyptus oil, Tween 80 (surfactant), and Transcutol HP (co-surfactant) were selected on the basis of their solubility and highest nanoemulsion region. Characterization of thermodynamic stability for Cur-loaded SNEDDS was evaluated by its globule size, zeta potential, polydispersity index, viscosity, % transmittance, refractive index, and surface morphology. Cur-SNEDDS (Cur-SN4) was optimized and selected on the basis of their excellent physicochemical parameters for in vivo activity. The particle size (59.56 ± 0.94 nm), % transmittance (99.08 ± 0.07%), and PDI (0.207 ± 0.011 were observed for optimized Cur-SNEDDS. TEM and SEM showed their smooth and spherical shape of the morphological characterization with zeta potential (- 21.41 ± 0.89), refractive index (1.341 ± 0.06), and viscosity (11.64 ± 1.26 cp) for optimized Cur-SNEDDS. Finally, optimized Cur-SNEDDS was used to enhance skin permeation with improvement in the solubility of Cur. However, optimized Cur-SNEDDS showed significant wound healing activity as compared with pure eucalyptus oil and Cur-S on topical application. Optimized Cur-SNEDDS showed healing of wound as compared to standard fusidic acid. Optimized Cur-SNEDDS exhibited no signs of inflammatory cells on the histopathological studies of treated rats which were recommended the safety and non-toxicity of Cur-SNEDDS. Newly developed Cur-SNEDDS could be successfully used to enhance Cur-solubility and skin permeation, as well as suggested a potential role of Cur-SNEDDS for better improvement of wound healing activity followed by anti-inflammatory action of Cur via topical application.

Spongy wound dressing of pectin/carboxymethyl tamarind seed polysaccharide loaded with moxifloxacin beads for effective wound heal

An attempt was made to formulate moxifloxacin loaded alginate beads incorporated into spongy wound dressing to heal chronic wounds as well as to reduce frequency of painful dressing change. Moxifloxacin loaded beads (sodium alginate:pectin, 1:1) were prepared by ionic gelation method, with entrapment efficiency 94.52%, crushing strength 25.30 N and drug release 90.52%. Beads were further incorporated into wound dressing, made of pectin and carboxymethyl tamarind seed polysaccharide (CMTSP). Spongy wound dressing was obtained by freeze drying technology, which showed good folding endurance, high wound fluid absorption and good crushing strength. Drug release was found to be 85.09%. Dressing made of CMTSP:pectin (1.5:2) showed good water vapour transmission and antibacterial activity. Porous nature of dressing absorbed exudates of wound. Excision wound model in rats revealed wound healing within 17 days: groups I (control), II (moxifloxacin beads loaded wound dressing), III (moxifloxacin beads), IV (pectin film) and V (sodium alginate film) showed 65.28, 99.09, 86.90, 66.84 and 64.30% wound closure, respectively. To conclude, moxifloxacin beads loaded spongy wound dressing has good healing and wound closing potential compared to pectin film and moxifloxacin beads. Thus, the formulation is novel for biomedical application which reduced the frequency of painful dressing change.

Fast Approach to the Hydrophobization of Bacterial Cellulose via the Direct Polymerization of Ethyl 2-Cyanoacrylate

Bacterial cellulose (BC) has a broad range of applications in biomedical fields and cosmetics. Applied as wound dressing, BC tends to stick to the sore especially upon drying, and hydrophobization improves its performance in this regard. This article reports a facile and rapid yet a highly efficient approach for BC hydrophobization through direct polymerization of ethyl 2-cyanoacrylate on the BC fibers. The modified material preserves the favorable porous structure of the matrix material while displaying significantly higher hydrophobicity and significantly decreased stickiness to the wound. The BC surface can be modified in 15 min. Overall, this can be considered a ready-to-apply approach for the fabrication of BC wound dressings with enhanced performance. The modification was demonstrated to improve the material's biocompatibility and to introduce antimicrobial activity (immortalized human fibroblast assay).

A Critical Review and Perspective of Honey in Tissue Engineering and Clinical Wound Healing

Significance: Historically, honey has been regarded as a potent agent in bacterial inhibition and wound healing. An increased prevalence of antibiotic resistant pathogens spurred an initial resurgence in honey's clinical popularity, with it quickly finding a place in wound care and regenerative medicine. However, this renewed usage demanded a need for improved delivery and overall research of its bioactive properties. This review provides an overview of the antibacterial properties and clinical use of honey. Recent Advances: The past and present clinical use of honey is noted, focusing specifically on burns and ulcers, as these are the most common applications of the natural agent. While honey is often used without modification clinically, there are also commercially available products ranging from dressings to gels, which are discussed. Critical Issues: Despite these products growing in popularity, the need for improved delivery and a structure to support wound healing could improve the treatment method. Future Directions: Tissue engineering scaffolds can provide an alternative method of honey delivery with research focusing primarily on electrospun scaffolds, hydrogels, and cryogels. Current studies on these scaffolds are discussed with respect to their advantages and potential for future clinical work. Overall, this review provides a comprehensive overview of the properties of honey, its current use in wound healing, and the potential for future incorporation into tissue-engineered scaffolds to provide an innovative wound healing agent.

Design, synthesis and evaluation of wound healing activity for β-sitosterols derivatives as potent Na+/K+-ATPase inhibitors

β-Sitosterols, is a common steroid that can be identified in a variety of plants and their efficacy in promoting wound healing has been demonstrated. Na⁺/K⁺-ATPase, more than a pump, its signal transduction function for involvement in cell growth regulation attracts widespread concern. The Na⁺/K⁺-ATPase/Src receptor complex can serve as a receptor involved in multiple signaling pathways including promoting wound healing pathways. To finding potent accelerating wound healing small molecular, we choose the high inhibitory activity of Na⁺/K⁺-ATPase and non-cardiotoxic natural compound, β-sitosterol as the substrate. A series of β-sitosterol derivatives were designed, synthesized and evaluated as potential Na⁺/K⁺-ATPase inhibitors. Among them, compounds 31, 47, 49, showed improved inhibitory activity on Na⁺/K⁺-ATPase, with IC₅₀ value of 3.0 μM, 3.4 μM, 2.2 μM, which are more potent than β-sitosterol with IC₅₀ 7.6 μM. Especially, compound 49 can induce cell proliferation, migration and soluble collagen production in L929 fibroblasts. Compared to model, compound 49 can accelerate wound healing in SD rats. Further studies indicated that 49 can activate the sarcoma (Src), uptake the protein kinase B (Akt), extracellular signal-regulated kinase (ERK) proteins expression in a concentration dependent manner. Finally, binding mode of compound 49 with Na⁺/K⁺-ATPase was studied, which provides insights into the determinants of potency and selectivity. These results proved β-stitosterol derivative 49 can serve as an effective inhibitor of Na⁺/K⁺-ATPase and potential candidate for accelerating wound healing agents.

Therapeutic compression materials and wound dressings for chronic venous insufficiency: A comprehensive review

Chronic venous insufficiency (CVI) is a common disorder worldwide. Related pathophysiological mechanisms reportedly involve venous pooling and reduced venous return, leading to heaviness, aching, itchiness, tiredness, varicosities, pigmentation, and even lower limb ulceration. Approaches adopted to manage CVI at various stages of clinical-etiology-anatomy-pathophysiology include compression therapy, pharmacological treatment, ultrasound treatment, surgery, electrical or wireless microcurrent stimulation, and pulsed electromagnetic treatment. Among these, polymer-based therapeutic compression materials and wound dressings play increasingly key roles in treating all stages of CVI because of their unique physical, mechanical, chemical, and biological functions. However, the characteristics, working mechanisms, and effectiveness of these CVI treatment materials are not comprehensively understood. The present systematic review examines the structures, properties, types, and applications of various polymer-based compression materials and wound dressings used in prophylaxis and treatment of CVI. Existing problems, limitations, and future trends of CVI treatment materials are also discussed. This review could contribute to the design and application of new functional polymer materials and dressings to enhance the efficiency of CVI treatments, thereby facilitating patients' self-care ability and long-term health improvement.

Emerging progress on the mechanism and technology in wound repair

Normal wound repair is a dynamic and complex process involving multiple coordinated interactions between growth factors, cytokines, chemokines, and various cells. Any failure during the repair process may cause chronic wounds or scar formation, which increase the financial burden of patients due to repetitive treatments and considerable medical expenditures, and affect their quality of life. Nowadays, extensive efforts have been made to develop novel therapeutics for wound repair. Genetic engineering technology, tissue engineering technology, stem cell-based therapy, physical and biochemical technology, and vacuum-assisted closure technique have been proposed to be beneficial for wound repair, and shown considerable potential for improving the rate and quality of wound healing and skin regeneration. However, challenges remain as applying these techniques. As the development of cell biology and molecular biology, the understanding of the mechanism under wound repair has gradually deepened. As the growth of interdisciplinary research on physics, chemistry, biology, tissue engineering, and materials, the concept and technique relating wound repair for clinical application have rapidly developed. This article reviews the latest progress on the mechanism and technique in wound repair.

Towards a modern approach to traditional use: in vitro and in vivo evaluation of Alchemilla vulgaris L. gel wound healing potential

ETHNOPHARMACOLOGICAL RELEVANCE

Alchemilla vulgaris is an important remedy in European folk medicine, known for its astringent and anti-inflammatory properties; it is traditionally used to heal gynecological and gastrointestinal diseases. Despite its folkloric use in wound healing, there is a lack of scientific data to support this therapeutic application.

AIM OF THE STUDY

To analyze the wound healing potential of different solvent A. vulgaris extracts per se and after incorporation into hydrogels as topical vehicles, using two complementary methods - in vitro wound healing assay with L929 fibroblasts and in vivo assessment of skin barrier repair potential. Besides scientific justification of the traditional usage, we aimed to ephasize the importance of a proper vehicle for herbal extracts. The wound healing activity has been connected to the chemical profile of the investigated extracts, their antioxidative properties, but also to pH of the investigated gels and their mechanical characteristics.

MATERIALS AND METHODS

Antioxidant activity of investigated extracts was estimated using both 2,2-diphenyl-1-picrylhydrazyl and β-carotene/linoleic acid models. Chemical profile was achieved applying spectrophotometric and HPLC methods. In vitro scratch assay with L929 fibroblasts, and in vivo study of skin barrier repair potential of hydrogels with A. vulgaris extracts on human skin employing biophysical measurements, were performed in order to confirm the wound healing potential of A. vulgaris. Texture analysis of the gels was performed alongside the pH measurements.

RESULTS

All tested extracts and gels accelerated the wound healing process while the effect of ethanolic extract on migration of fibroblasts was the most pronounced. The highest extent of wound closure was also observed for the ethanolic extract. The most favorable effect on in vitro wound healing was observed for gel with propyleneglycolic extract. Results of in vivo study were in line with in vitro findings. Healing potential may be attributed to phenolic compounds found in A. vulgaris extracts, low pH of the gels, and the satisfying antioxidant activity of the extracts. Parameters obtained by textural analysis indicated satisfying mechanical properties of the gels, relevant to topical application.

CONCLUSION

Our study offers pharmacological evidence on the folkloric use of A. vulgaris in wound treatment, particularly after incorporation into hydrogel, and underlines an importance of a proper vehicle for incorporation of herbal extracts intended for topical treatment.

Hyaluronic acid and chitosan-based nanosystems: a new dressing generation for wound care

INTRODUCTION

The main goal in the management of chronic wounds is the development of multifunctional dressings able to promote a rapid recovery of skin structure and function, improving patient compliance.

AREAS COVERED

This review discusses the use of nanosystems, based on hyaluronic acid and chitosan or their derivatives for the local treatment of chronic wounds. The bioactive properties of both polysaccharides will be described, as well as the results obtained in the last decade by the in vitro and in vivo evaluation of the wound healing properties of nanosystems based on such polymers.

EXPERT OPINION

In the last decades, there has been a progressive change in the local treatments of chronic wounds: traditional inert dressings have been replaced by more effective bioactive ones, based on biopolymers taking part in wound healing and able to release the loaded active agents in a controlled way. With the advance of nanotechnologies, the scenario has further changed: nanosystems, characterized by a large area-to-volume ratio, show an improved interaction with the biological substrates, amplifying the activity of the constituent biopolymers. In the coming years, a deeper insight into wound healing mechanisms and the development of new techniques for nanosystem manufacturing will results in the design of new scaffolds with improved performance.

A pH-regulated drug delivery dermal patch for targeting infected regions in chronic wounds

This work presents a low-cost, passive, flexible, polymeric pump for topical drug delivery which uses wound pH as a trigger for localized drug release. Its operation relies on a pH-responsive hydrogel actuator which swells when exposed to the alkaline pH of an infected wound. The pump enables slow release (<0.1 μL min-1) of aqueous anti-bacterial solution for up to 4 hours and sustains against up to 8 kPa of backpressure. Featuring a scalable layer-by-layer fabrication technique to expand the pump into a 2 × 2 array, the device can dispense 50 μl onto a 160 mm2 dermal coverage within 4 hours. Robustness tests show that when integrated within a medical adhesive, the device can be worn around the forearm and can withstand various daily activities (non-intensive) for up to 12 hours. In vitro experiments demonstrate a 58 times decrease of live P. aeruginosa after 24 hours of the pump assisted antibiotics treatment.

Development of a Novel Polymer-Based mRNA Coating for Surgical Suture to Enhance Wound Healing

A therapeutic strategy to improve wound healing has become an increasingly important medical task due to the rising incidence of adiposity and type II diabetes as well as the proceeding population aging. In order to cope with the resulting burdens, new strategies to achieve rapid and complete wound healing must now be developed. Accordingly, the development of a bioactive wound dressing in the form of a messengerRNA (mRNA)-bearing poly(lactide-co-glycolide acid) (PLGA) coating on surgical suture is being pushed further with this study. Furthermore, the evaluation of the polymer-based transfection reagent Viromer RED has shown that it can be used for the transfection of eukaryotic cells: The mRNA gets properly complexed and translated into a functional protein. In addition, the mRNA-PLGA coating triggered the expression of the keratinocyte growth factor (KGF) in HaCat cells although KGF is not expressed under physiological conditions. Moreover, transfection via surgical sutures coated with mRNA does not affect the cell viability and a proinflammatory reaction in the transfected cells is not induced. These properties make the mRNA-PLGA coating very attractive for the in vivo application. For the future, this could mean that through the use of mRNA-coated sutures in surgical wound closure, cells in the wound area can be transfected directly, thus accelerating and improving wound healing.

ZnO-NPs embedded biodegradable thiolated bandage for postoperative surgical site infection: In vitro and in vivo evaluation

Post-operative surgical site infections (SSI) present a serious threat and may lead to complications. Currently available dressings for SSI lack mucoadhesion, safety, efficacy and most importantly patient compliance. We aimed to address these concerns by developing a bioactive thiolated chitosan-alginate bandage embedded with zinc oxide nanoparticles (ZnO-NPs) for localized topical treatment of SSI. The FTIR, XRD, DSC and TGA of bandage confirmed the compatibility of ingredients and modifications made. The porosity, swelling index and lysozyme degradation showed good properties for wound healing and biodegradation. Moreover, in-vitro antibacterial activity showed higher bactericidal effect as compared to ZnO-NPs free bandage. In-vivo wound healing in murine model showed significant improved tissue generation and speedy wound healing as compared to positive and negative controls. Over all, thiolated bandage showed potential as an advanced therapeutic agent for treating surgical site infections, meeting the required features of an ideal surgical dressing.

Acellular and cellular approaches to improve diabetic wound healing

Chronic diabetic wounds represent a huge socioeconomic burden for both affected individuals and the entire healthcare system. Although the number of available treatment options as well as our understanding of wound healing mechanisms associated with diabetes has vastly improved over the past decades, there still remains a great need for additional therapeutic options. Tissue engineering and regenerative medicine approaches provide great advantages over conventional treatment options, which are mainly aimed at wound closure rather than addressing the underlying pathophysiology of diabetic wounds. Recent advances in biomaterials and stem cell research presented in this review provide novel ways to tackle different molecular and cellular culprits responsible for chronic and nonhealing wounds by delivering therapeutic agents in direct or indirect ways. Careful integration of different approaches presented in the current article could lead to the development of new therapeutic platforms that can address multiple pathophysiologic abnormalities and facilitate wound healing in patients with diabetes.

Re-epithelialization of adult skin wounds: Cellular mechanisms and therapeutic strategies

Cutaneous wound healing in adult mammals is a complex multi-step process involving overlapping stages of blood clot formation, inflammation, re-epithelialization, granulation tissue formation, neovascularization, and remodelling. Re-epithelialization describes the resurfacing of a wound with new epithelium. The cellular and molecular processes involved in the initiation, maintenance, and completion of epithelialization are essential for successful wound closure. A variety of modulators are involved, including growth factors, cytokines, matrix metalloproteinases, cellular receptors, and extracellular matrix components. Here, we focus on cellular mechanisms underlying keratinocyte migration and proliferation during epidermal closure. Inability to re-epithelialize is a clear indicator of chronic non-healing wounds, which fail to proceed through the normal phases of wound healing in an orderly and timely manner. This review summarizes the current knowledge regarding the management and treatment of acute and chronic wounds, with a focus on re-epithelialization, offering some insights into novel future therapies.

Naturally-derived electrospun wound dressings for target delivery of bio-active agents

Electrospun nanofibers are known as the advanced means for wound dressing. They have represented remarkable potency to encapsulate and deliver biomolecules promoting the wound healing process. Compared to synthetic polymers, naturally derived polymers (NDP) are more qualified candidates for fabrication of biomedical electrospun scaffolds. Not only nanofibers of NDP illustrate higher biocompatibility and biodegradability rates, but also they mimic the native extracellular matrix more closely, which leads to the wound closure acceleration by enhancing tissue regeneration. Aside, incorporation of bioactive molecules and therapeutic agents into the nanofibers can generate innovative bioactive wound dressings with significantly improved healing potentials. This paper starts with a brief discussion on the steps and factors influencing the wound healing process. Then, the recent applications of electrospun nanofibers as wound dressing with healing accelerating properties are reviewed. Further, the various healing agents and alternative strategies for modification and functionalization of bioactive naturally-derived electrospun nanofibers are discussed.

Effect of grape seed extract ointment on cesarean section wound healing: A double-blind, randomized, controlled clinical trial

BACKGROUND

and purpose: Complications of the delayed recovery of cesarean section (CS) wound can include stress, discomfort, and dissatisfaction of the mother in the postpartum period. This study tried to determine the effect of grape seed extract ointment on CS wound healing.

MATERIALS AND METHODS

This is a double-blind, randomized, controlled clinical trial incorporating 129 women eligible for CS in eastern Iran. Participants were selected through convenience sampling method and were subsequently randomly assigned into three groups: 2.5% grape seed extract ointment, 5% grape seed extract ointment, and petrolatum. CS wound healing indices were assessed before the intervention, and 6 and 14 days after the intervention using the REEDA scale (redness, edema, ecchymosis, discharge, and approximation).

RESULTS

The mean scores on days 6 and 14 after intervention were respectively 2.02 ± 0.52 and 0.98 ± 0.61 in the 5% ointment group, 2.83 ± 0.54 and 1.58 ± 0.67 in the 2.5% ointment group, and 2.91 ± 0.51 and 1.55 ± 0.74 in the petrolatum group. While the mean score in the 5% ointment group was significantly different from those of 2.5% ointment and petrolatum groups (P < 0.001), the mean score in the 2.5% ointment group was not significantly different from that of the petrolatum group on days 6 and 14 after intervention (P = 0.38 and P = 0.79, respectively).

CONCLUSION

The current results suggest that 5% grape seed extract may have beneficial therapeutic effects in promoting CS wound healing.

Skin tissue regeneration for burn injury

The skin is the largest organ of the body, which meets the environment most directly. Thus, the skin is vulnerable to various damages, particularly burn injury. Skin wound healing is a serious interaction between cell types, cytokines, mediators, the neurovascular system, and matrix remodeling. Tissue regeneration technology remarkably enhances skin repair via re-epidermalization, epidermal-stromal cell interactions, angiogenesis, and inhabitation of hypertrophic scars and keloids. The success rates of skin healing for burn injuries have significantly increased with the use of various skin substitutes. In this review, we discuss skin replacement with cells, growth factors, scaffolds, or cell-seeded scaffolds for skin tissue reconstruction and also compare the high efficacy and cost-effectiveness of each therapy. We describe the essentials, achievements, and challenges of cell-based therapy in reducing scar formation and improving burn injury treatment.

Mussel-Inspired Electroactive and Antioxidative Scaffolds with Incorporation of Polydopamine-Reduced Graphene Oxide for Enhancing Skin Wound Healing

Wound repair and tissue regeneration are complex processes that involve many physiological signals. Thus, employing novel wound dressings with potent biological activity and physiological signal response ability to accelerate wound healing is a possible solution. Herein, inspired by mussel chemistry, we developed a polydopamine (PDA)-reduced graphene oxide (pGO)-incorporated chitosan (CS) and silk fibroin (SF) (pGO-CS/SF) scaffold with good mechanical, electroactive, and antioxidative properties as an efficient wound dressing. First, pGO with good dispersibility and cell affinity was obtained upon reduction by PDA under alkali conditions. Second, pGO was dispersed into a CS/SF mixture, and then CS and SF chains were dual-cross-linked by poly(ethylene glycol) diglycidyl ether and glutaraldehyde to obtain a pGO-incorporated gel. Finally, the gel underwent a freeze-dry process to obtain the pGO-CS/SF scaffold. Owing to PDA reduction and functionalization, pGO in the scaffold plays important roles for the performances of the scaffolds. First, the pGO acts as nanoreinforcement to enhance the mechanical properties of the scaffold by combining the dual-cross-linked CS/SF network. Second, the uniformly distributed pGO in the scaffolds comprises a well-connected electric pathway, which can provide a channel for the transmission of electrical signals in the scaffold. Moreover, pGO in the scaffolds serves as an antioxidant agent to scavenge reactive oxygen species (ROS) and therefore terminates excessive ROS oxidation. In vitro studies show that electroactive pGO-CS/SF scaffolds can respond to electrical signals and promote cytological behavior. In addition, the pGO-CS/SF scaffolds can reduce cellular oxidation by removing excessive ROS. The in vivo full-thickness skin defect model demonstrates that the electroactive and antioxidative pGO-CS/SF scaffold can efficiently enhance wound healing. In summary, the pGO-CS/SF scaffold is a promising wound dressing because of its ability to promote physiological electrical signal transmission for cell growth and reduce ROS oxidation, resulting in an improved wound regeneration effect.

Improved Morphine-Loaded Hydrogels for Wound-Related Pain Relief

The use of morphine applied topically to painful wounds has potential advantages, such as dose reduction, fewer side effects and compound formulations, have been proposed for this purpose. Given the potential high impact of drug product quality on a patient’s health, the aim of the present study was to develop two stable sterile hydrogels containing morphine hydrochloride, intended for topical application on painful wounds. Two carboxymethylcellulose sodium-based hydrogels were prepared containing 0.125% w/w (F1-MH semi-solid formulation) and 1.0% w/w (F2-MH fluid formulation) morphine hydrochloride (MH), respectively. Studies included a risk assessment approach for definition of the quality target product profile (QTPP) and assessment of critical quality attributes (CQA) of the hydrogels to support product quality and safety. Safe, odourless, yellowish, translucent and homogeneous gels were obtained, with suitable microbiological and pharmaceutical characteristics. The active substance concentration was adapted according to the characteristics of the dose-metering device. Release profiles were investigated using Franz diffusion cells, and characterised by different kinetic models. Increasing gel viscosity prolonged drug release, with rates of 17.9 ± 2.2 μg·cm⁻²·h⁻¹ (F1-MH) and 258.0 ± 30.4 μg·cm⁻²·h⁻¹ (F2-MH), allowing for the reduction of the number of applications and improving patient compliance. The gels proved to be stable for up to 60 days at room temperature. The semi-solid and fluid MH-containing hydrogel formulations are safe, stable and suitable for use in hospital settings, which is rather important for wound-related pain management in cancer palliative care or burn patients.

Efficacy of Prophylactic Negative Pressure Wound Therapy After Pediatric Liver Transplant

OBJECTIVES

Wound dehiscence is a common surgical complication, especially among pediatric liver transplant recipients in our center. In 2013, we introduced negative pressure wound therapy as a preventive treatment. We herein report the clinical outcomes of this intervention.

MATERIALS AND METHODS

We conducted a retrospective review of the 26 pediatric liver transplant recipients in our center since 2011. We excluded 1 girl whose wound could not be closed due to bowel edema. The first 13 of the 25 remaining patients were treated with conventional wound management (conventional group). The latter 12 were treated with prophylactic negative pressure wound therapy (prophylactic group). Incidences of surgical complications and patient characteristics were compared between groups.

RESULTS

Wound dehiscence occurred in 7 of the 13 patients in the conventional group and 3 of the 12 patients in the prophylactic group. When restricted to dehiscence that required surgical debridement, there were 6 cases in the conventional group and no cases in the prophylactic group. Although background data showed that liver insufficiency in the prophylactic group was more severe, this group had a lower incidence of wound dehiscence (P = .015).

CONCLUSIONS

Prophylactic negative pressure wound therapy is thought to be effective for preventing wound dehiscence among pediatric liver transplant recipients.

Surface engineering of spongy bacterial cellulose via constructing crossed groove/column micropattern by low-energy CO2 laser photolithography toward scar-free wound healing

Bacterial cellulose (BC) is a bio-derived polymer, and it has been considered as an excellent candidate material for tissue engineering. In this study, a crossed groove/column micropattern was constructed on spongy, porous BC using low-energy CO₂ laser photolithography. Applying the targeted immobilization of a tetrapeptide consisting of Arginine-Glycine-Aspartic acid-Serine (H-Arg-Gly-Asp-Ser-OH, RGDS) as a fibronectin onto the column platform surface, the resulting micropatterned BC (RGDS-MPBC) exhibited dual affinities to fibroblasts and collagen. Material characterization of RGDS-MPBC revealed that the micropattern was built by the column part with size of ~100 × 100 μm wide and ~100 μm deep, and the groove part with size of ~150 μm wide. Hydrating the MPBC did not result in the collapse of the integrity of the micropattern, suggesting its potential application in a highly hydrated wound environment. Cell culture assays revealed that the RGDS-MPBC exhibited an improved cytotoxicity to mouse fibroblasts L929, as compared to the pristine BC. Meanwhile, it was observed that the RGDS-MPBC was able to guide the ordered aggregation of human skin fibroblast (HSF) cells on the column platform surface, and no HSF cells were found in the groove channels. Over time, it was found that a dense network of collagen was gradually established across the groove channels. Furthermore, the in-vivo animal study preliminarily demonstrated the scar-free healing potential of the micropatterned BC materials. Therefore, this RGDS-MPBC material exhibited its advantages in guiding cell migration and collagen distribution, which could present a prospect in the establishment of "basket-woven" organization of collagen in normal skin tissue against the formation of dense, parallel aggregation of collagen fibers in scar tissue toward scar-free wound healing outcome.

Treatment of Infected Wounds in the Age of Antimicrobial Resistance: Contemporary Alternative Therapeutic Options

As antibiotic resistance increases and antimicrobial options diminish, there is a pressing need to identify and develop new and/or alternative (non-antimicrobial-based) wound therapies. The authors describe the implications of antibiotic resistance on their current wound treatment paradigms and review the most promising non-antibiotic-based antimicrobial agents currently in research and development, with a focus on preclinical and human studies of therapeutic bacteriophages, antimicrobial peptides, cold plasma treatment, photodynamic therapy, honey, silver, and bioelectric dressings.