Emerging Innovative Wound Dressings

Computational Designed and Optimized Liposomal Curcumin-Embedded Bifunctional Cross-Linked Hydrogels for Wound Healing

Curcumin (CUR) bifunctional cross-linked nanocomposite hydrogels are presented as an efficient method for CUR delivery in wound healing. CUR-loaded liposomes (CUR-Ls) were optimized using the Box-Behnken design to augment particle size, size distribution, zeta potential, and CUR concentration. The antioxidant activity and cytotoxicity of CUR-Ls were assessed. Hyaluronic acid (HA)/poly(vinyl alcohol) (PVA) hydrogels were optimized with a central composite design; then, poly(N-vinylpyrrolidone-co-itaconic acid) (PNVP-ITA) was synthesized to enrich the properties of the hydrogels. The drug release kinetics of the CUR-L@HA/PVA/PNVP-ITA hydrogels were studied. Skin recovery was investigated in vivo on rat dorsal skin. The optimized CUR-Ls were constructed from 2.7% Tween® 20, 0.04% oleic acid, and 8.1% CUR, yielding nano-CUR-L with a narrow size distribution, negative surface charge, and CUR content of 19.92 ± 0.54 µg/mg. CUR-Ls improved the antioxidant effects of CUR. The optimized hydrogel contained 5% HA and 10% PVA. PNVP-ITA improved the properties of the hydrogels via enhanced cross-linking. CUR-Ls exhibited a more rapid release than CUR, whereas the hydrogels enhanced CUR release via a diffusion-controlled mechanism. CUR-L@HA/PVA/PNVP-ITA hydrogels improved the skin recovery rate compared to the commercial patch after 5 days. Therefore, the optimized CUR-L@HA/PVA/PNVP-ITA hydrogels facilitated skin recovery and could be a promising nanocomposite for wound dressings.

Applications of mesenchymal stem cell-exosome components in wound infection healing: new insights

The healing process at a wound is made up of many types of cells, growth factors, the extracellular matrix, nerves and blood vessels all interacting with each other in complex and changing ways. Microbial colonization and proliferation are possible at the place of injury, which makes infection more likely. Because of this, any cut has a chance of getting an infection. Researchers have found that wound infections make patients more upset and cost the healthcare system a lot of money. Surgical site infections happen a lot to people who have recently had surgery. This study shows that such surgical infection is linked to a high rate of illness and death. This is shown by the fact that 25% of patients get serious sepsis and need to be transferred to an intensive care unit. In both animal models and people, mesenchymal stem cells (MSCs) play an active role in all stages of wound healing and have positive effects. Exosomes are one of the main things MSCs release. They have effects that are similar to those of the parent MSCs. Various effector proteins, messenger RNA and microRNAs can be transported by extracellular vesicles to control the activity of target cells. This has a big impact on the healing process. These results suggest that using MSC-exosomes as a new type of cell-free therapy could be a better and safer option than whole cell therapy. This review is mostly about how to use parts of MSC-exosomes to help wound infections heal.

An antifouling electrochemical biosensor based on oxidized bacterial cellulose and quaternized chitosan for reliable detection of involucrin in wound exudate

The monitoring of biomarkers in wound exudate is of great importance for wound care and treatment, and electrochemical biosensors with high sensitivity are potentially useful for this purpose. However, conventional electrochemical biosensors always suffer from severe biofouling when performed in the complex wound exudate. Herein, an antifouling electrochemical biosensor for the detection of involucrin in wound exudate was developed based on a wound dressing, oxidized bacterial cellulose (OxBC) and quaternized chitosan (QCS) composite hydrogel. The OxBC/QCS hydrogel was prepared using an in-situ chemical oxidation and physical blending method, and the proportion of OxBC and QCS was optimized to achieve electrical neutrality and enhanced hydrophilicity, therefore endowing the hydrogel with exceptional antifouling and antimicrobial properties. The involucrin antibody SY5 was covalently bound to the OxBC/QCS hydrogel to construct the biosensor, and it demonstrated a low limit of detection down to 0.45 pg mL-1 and a linear detection range from 1.0 pg mL-1 to 1.0 μg mL-1, and it was capable of detecting targets in wound exudate. Crucially, the unique antifouling and antimicrobial capability of the OxBC/QCS hydrogel not only extends its effective lifespan but also guarantees the sensing performance of the biosensor. The successful application of this wound dressing, OxBC/QCS hydrogel for involucrin detection in wound exudate demonstrates its promising potential in wound healing monitoring.

Development and characterization of curcumin nanosuspension-embedded genipin-crosslinked chitosan/polyvinylpyrrolidone hydrogel patch for effective wound healing

This study investigated the development of a genipin-crosslinked chitosan (CS)-based polyvinylpyrrolidone (PVP) hydrogel containing curcumin nanosuspensions (Cur-NSs) to promote wound healing in an excisional wound model. Cur-NSs were prepared, and a simplex centroid mixture design was employed to optimize hydrogel properties for high water absorption, degree of crosslinking, and sufficient toughness. The in vivo wound healing effect was tested in Wistar rats. The optimized hydrogel consisted of a 70:30 ratio of CS:PVP, crosslinked with a 2 % w/w genipin solution. It exhibited high swelling capability (486 %) while maintaining solidity, robustness, and durability. Incorporating 5 % w/w Cur-NSs resulted in a more compact structure, although with a reduction in swelling properties. The release kinetics of Cur from the hydrogel followed the Korsmeyer-Peppas Fickian diffusion model. In vitro biocompatibility studies demonstrated that the hydrogel was non-toxic to skin fibroblast cells. The in vivo experiment revealed a desirable wound healing rate with over 80 % recovery by day 7. Cur-NSs likely aided wound healing by reducing the inflammatory response and stimulating fibroblast proliferation. Additionally, the CS-based hydrogel provided a moist wound environment with hydration and gas transfer, further accelerating wound closure. These findings suggest that the Cur-NS-embedded hydrogel shows promise as a wound dressing material.

Lipid-based nanosystems for wound healing

INTRODUCTION

Wounds, resulting from traumas, surgery, burns or diabetes, are important medical problems due to the complexity of wound healing process regarding healing times and healthcare costs. Nanosystems have emerged as promising candidates in this field thank to their properties and versatile applications in drugs delivery.

AREAS COVERED

Lipid-based nanosystems (LBN) are described for wound treatment, highlighting their different behaviors when interacting with the cutaneous tissue. The role of nanosystems in delivering mostly natural compounds on skin as well as the technological and engineering strategies to increase their efficiency in wound healing effect are reviewed. Finally, in vitro, ex-vivo and in vivo studies are reported.

EXPERT OPINION

LBN have shown promise in addressing the challenges of wound healing as they can improve the stability of drugs used in wound therapy, leading to higher efficacy and fewer adverse effects as compared to traditional formulations. LBNs being involved in the inflammatory and proliferation stages of the wound healing process, enable the modification of wound healing through multiple ways. In addition, the use of new technologies, including 3D bioprinting and photobiomodulation, may lead to potential breakthroughs in wound healing. This would provide clinicians with more potent forms of therapy for wound healing.

The essential oil of Melaleuca alternifolia incorporated into hydrogel induces antimicrobial and anti-inflammatory effects on infected wounds by Staphylococcus aureus

Staphylococcus aureus is one of the most common bacterial isolates found in wounds. Thus, innovative dressings, such as hydrogels, are interesting vehicles for incorporating bioactive compounds like those from Melaleuca alternifolia essential oil (MaEO). In this study, we evaluated the antimicrobial and anti-inflammatory potential of MaEO incorporated into an alginate and chitosan hydrogel for treating wounds infected by S. aureus. The hydrogel incorporated with MaEO 1% (HMa 1%) was homogeneous with a bright pale-yellow color and the characteristic smell of Melaleuca. The incorporation of MaEO 1% does not affect the stability of the hydrogel, which was stable up to 90 days of storage. The Scanning electron microscopy analysis revealed that hydrogels showed irregular surfaces and interconnected porous structures with accumulations of oil crystals distributed throughout the formulation. HMa 1% has a high moisture content (95.1%) and can absorb simulated wound fluid. Regarding the antimicrobial effects, HMa 1% reduced the growth of S. aureus ATCC 6538 in both in vitro conditions and in an ex vivo model of wounds using porcine skin. In addition, the dairy topical treatment of murine skin lesions with HMa 1% induced a significant reduction of the wound area, inflammation score, and bacterial load, as well as tissue re-epithelialization and modulation of inflammatory mediators. Therefore, hydrogel incorporated with MaEO 1% has excellent potential to be used in the pharmacotherapy of infected wounds.

Fibronectin Connecting Cell Sheet Based on Click Chemistry for Wound Repair

As a living repair material, cell sheet exhibits significant potential in wound repair. Nonetheless, wound healing is a complicated and protracted process that necessitates specific repair functions at each stage, including hemostasis and antibacterial activity. In this work, on the basis of harvesting the cell sheet via a photothermal response strategy, a fibronectin attached cell sheet (FACS) is prepared to enhance its wound repair capability. For this purpose, the azide group (N3 ) is initially tagged onto the cell surface through metabolic glycoengineering of unnatural sugars, and then the conjugate (DBCO-fibronectin) comprises of the dibenzocyclooctyne (DBCO) and fibronectin with multiple wound repair functions is linked to N3 using click chemistry. Biological evaluations following this demonstrates that the FACS preparation exhibits excellent biocompatibility, and the fibronectin modification enhances the capacity for cell proliferation and migration. Moreover, in vivo wound healing experiment confirms the reparative efficacy of FACS. It not only has a wound closure rate 1.46 times that of a conventional cell sheet but also reduces inflammatory cell infiltration, promotes hair follicle and blood vessel regeneration, and encourages collagen deposition. This strategy holds enormous clinical potential and paves the way for advanced functional modifications of cell sheets.

Silver nanoparticle reinforced polylactic acid and gelatin composite films for advanced wound dressing

Multifunctional and biodegradable dressings with high mechanical strength and good antibacterial activity are crucial in fundamental health services. This study was initiated to prepare a novel curative wound dressing film consisting of natural biodegradable gelatin (G) and polylactic acid (PLA) with silver nanoparticles (AgNPs) where glutaraldehyde (GA) was used as compatibilizer. The prepared composite films addressed the poor thermal and biological stability of G and the limited fluid retention capacity of PLA. Silver nanoparticles were prepared by basic chemical reduction and reinforced on polymer films using simple solvent casting, which obviated common clinical infections and accelerated wound closure rate (p < .05). Fourier transform infrared (FTIR) studies confirmed composite formation through H-bonding and X-ray diffraction (XRD) revealed increased crystallinity due to incorporating AgNPs. Films with G, PLA & GA (50:50:5 by volume) introduced the best elasticity & strength with excellent fluid retention properties (p < .05). Scanning electron microscopy (SEM) images unfolded surface morphology and presence of agglomerated AgNPs on film surfaces. Prepared films exhibited significant antimicrobial efficacy against Staphylococcus aureus and Pseudomonas sp. and showed excellent cell viability (>97 %) in Vero cell line. Finally, an in vivo mouse model study showed 99.7 % contraction (p < .05) within 12 days, which was most effectual and 12 % faster than conventional gauge bandages. These results demonstrated the promising and cost-effective potential of the prepared film for wound healing.

Hesperidin-loaded cubogel as a novel therapeutic armamentarium for full-thickness wound healing

Wounds are a physical manifestation of injury to the skin causing it to rupture or tear. The process of wound healing naturally restores skin integrity while minimizing the extent of the damage. Hesperidin (HPN) is a natural polyphenolic flavonoid and is effective in treating wounds due to its ability to reduce inflammation and stimulate angiogenesis. However, its use is limited by its poor physicochemical attributes such as poor solubility in water. Recently, nanoparticles, particularly Cubosomes, are found to be promising candidates for advancing wound-healing therapies, owing to their unique properties. The present study was conducted to develop a hydrogel system based on Cubosomes encapsulating HPN (HPN-Cubogel), with the potential to mitigate full-thickness wounds. The therapeutic efficacy of the formulation assessed in the animal model showed that the HPN-Cubogel formulation group exhibited a wound closure rate of 98.96 ± 1.50% after 14 days post-wounding compared to 89.12 ± 2.6% in the control group suggesting superior wound contraction activity. Collagen synthesis was superior in the formulation compared to the control group, as determined through MT staining. In summary, the HPN-Cubogel formulation was found to be the most effective in enhancing full-thickness wound healing.

Preparation and characterization of tannin-maltodextrin-polyvinyl alcohol hydrogel based on hydrogen bonding for wound healing

The development of multifunctional and low-cost hydrogel dressings with good mechanical properties, antibacterial activity, and nontoxicity is of great relevance in healthcare. This study aimed to prepare a series of hydrogels consisting of maltodextrin (MD), polyvinyl alcohol (PVA), and tannic acid (TA) through a freeze-thaw cycling technique. Micro-acid hydrogels with different mass ratios (0, 0.25, 0.5, and 1 wt%) were obtained by adjusting the TA content. Among all hydrogels, TA-MP2 hydrogels (with a TA content of 0.5 wt%) showed good physicochemical and mechanical properties. In addition, the biocompatibility of TA-MP2 hydrogels was confirmed by the high cell survival rate of NIH3T3 cells, which was over 90% after 24 h and 48 h of incubation. Additionally, TA-MP2 hydrogels showed multifunctional properties, including antibacterial and antioxidative effects. In vivo experiments showed that TA-MP2 hydrogel dressings significantly accelerated wound healing in a full-layer skin wound model. These findings indicated the potential of TA-MP2 hydrogel dressings in promoting wound healing.

Animal tissue-derived biomaterials for promoting wound healing

The skin serves as the primary barrier between the human body and external environment, and is therefore susceptible to damage from various factors. In response to this challenge, animal tissue-derived biomaterials have emerged as promising candidates for wound healing due to their abundant sources, low side-effect profiles, exceptional bioactivity, biocompatibility, and unique extracellular matrix (ECM) mimicry. The evolution of modern engineering technology and therapies has allowed these animal tissue-derived biomaterials to be transformed into various forms and modified to possess the necessary properties for wound repair. This review provides an overview of the wound healing process and the factors that influence it. We then describe the extraction methods, important properties, and recent practical applications of various animal tissue-derived biomaterials. Our focus then shifts to the critical properties of these biomaterials in skin wound healing and their latest research developments. Finally, we critically examine the limitations and future prospects of biomaterials generated from animal tissues in this field.

Chitosan-Collagen Electrospun Nanofibers Loaded with Curcumin as Wound-Healing Patches

Composite chitosan-collagen nanofibrous mats embedded with curcumin were prepared via a single-step electrospinning procedure and explored as wound-healing patches with superior biological activity. A mild crosslinking protocol consisting of a short exposure to ammonia vapor and UV radiation was developed to ensure proper stability in physiological-like conditions without affecting the intrinsic biocompatibility of chitosan and collagen. The fabricated composite patches displayed a highly porous, homogeneous nanostructure consisting of fibers with an average diameter of 200 nm, thermal stability up to 200 °C, mechanical features able to ensure protection and support to the new tissues, and water-related properties in the ideal range to allow exudate removal and gas exchange. The release kinetic studies carried out in a simulated physiological environment demonstrated that curcumin release was sustained for 72 h when the mats are crosslinked hence providing prolonged bioactivity reflected by the displayed antioxidant properties. Remarkably, combining chitosan and collagen not only ensures prolonged stability and optimal physical-chemical properties but also allows for better-promoting cell adhesion and proliferation and enhanced anti-bacteriostatic capabilities with the addition of curcumin, owing to its beneficial anti-inflammatory effect, ameliorating the attachment and survival/proliferation rates of keratinocytes and fibroblasts to the fabricated patches.

Diabetic wound healing potential of silk sericin protein based hydrogels enriched with plant extracts

The complications associated with diabetic wounds make their healing process prolonged. Hydrogels could be ideal wound dressings therefore present research was conducted to prepare silk sericin (an adhesive protein polymer) based hydrogels in combination with plant extracts and to evaluate its effectiveness against wound healing process in mice with alloxan induced diabetes. Excision wounds were formed via a biopsy puncture (6 mm). Experimental hydrogels were prepared and applied topically on the diabetic wounds. All the hydrogel treatment groups showed significantly higher (P < 0.001) percent wound contraction from day 3 to day 11 as compared to the negative diabetic control group. The serum level of anti-inflammatory cytokine (Interleukin-10) and tissue inhibitor metalloproteinase (TIMP) was significantly higher (P < 0.001), while the level of pro-inflammatory cytokines (tumor necrosis factor-α, Interleukin-6) and matrix metalloproteinases (MMP-2, MMP-9) was significantly lower (P < 0.001) in hydrogels treatment groups as compared to diabetic control group. Although all the hydrogels showed effective results, however the best results were shown by 4 % sericin+4 % banyan+4 % onion based hydrogel. It can be concluded that Sericin based hydrogel enriched with banyan and onion extracts can be used as an effective remedy for the treatment of diabetic wounds due to their high healing and regenerative properties.

Self-assembled short peptides: Recent advances and strategies for potential pharmaceutical applications

Self-assembled short peptides have intrigued scientists due to the convenience of synthesis, good biocompatibility, low toxicity, inherent biodegradability and fast response to change in the physiological environment. Therefore, it is necessary to present a comprehensive summary of the recent advances in the last decade regarding the construction, route of administration and application of self-assembled short peptides based on the knowledge on their unique and specific ability of self-assembly. Herein, we firstly explored the molecular mechanisms of self-assembly of short peptides, such as non-modified amino acids, as well as Fmoc-modified, N-functionalized, and C-functionalized peptides. Next, cell penetration, fusion, and peptide targeting in peptide-based drug delivery were characterized. Then, the common administration routes and the potential pharmaceutical applications (drug delivery, antibacterial activity, stabilizers, imaging agents, and applications in bioengineering) of peptide drugs were respectively summarized. Last but not least, some general conclusions and future perspectives in the relevant fields were briefly listed. Although with certain challenges, great opportunities are offered by self-assembled short peptides to the fascinating area of drug development.

Wound Dressing Modifications for Accelerated Healing of Infected Wounds

Infections that occur during wound healing involve the most frequent complications in the field of wound care which not only inhibit the whole process but also lead to non-healing wound formation. The diversity of the skin microbiota and the wound microenvironment can favor the occurrence of skin infections, contributing to an increased level of morbidity and even mortality. As a consequence, immediate effective treatment is required to prevent such pathological conditions. Antimicrobial agents loaded into wound dressings have turned out to be a great option to reduce wound colonization and improve the healing process. In this review paper, the influence of bacterial infections on the wound-healing phases and promising modifications of dressing materials for accelerated healing of infected wounds are discussed. The review paper mainly focuses on the novel findings on the use of antibiotics, nanoparticles, cationic organic agents, and plant-derived natural compounds (essential oils and their components, polyphenols, and curcumin) to develop antimicrobial wound dressings. The review article was prepared on the basis of scientific contributions retrieved from the PubMed database (supported with Google Scholar searching) over the last 5 years.

Thermoresponsive nanofibers loaded with antimicrobial α-aminophosphonate-o/w emulsion supported by cellulose nanocrystals for smart wound care patches

Long-term topical application of antibiotics on wounds has led to the emergence of drug-resistant bacterial infections. Antibiotic incorporation into the wound dressing requires enormous advancement of the field to ensure that the needed dose is released when the infection arises. This study synthesized a series of antimicrobial α-aminophosphonate derivatives, and the most effective compound was incorporated into thermoresponsive wound dressing patches. Wound dressing mats were fabricated by needleless electrospinning, and the resultant nanofiber mats were coated with a thermoresponsive eicosane/cellulose nanocrystals o/w system loaded with active α-aminophosphonate derivatives. Chemical, physical, thermal, and antimicrobial properties of the wound dressings were characterized wound dressings. Using SEM analysis, Nanofibers spun with 20 % w/v solutions were selected for drug-emulsion loading since they showed lower diameters with higher surface area. Furthermore, the drug-emulsion coating on the electrospun dressings improved the hydrophilicity of the wound dressings, and the thermoresponsive behavior of the mats was proved using differential scanning calorimetry data. Finally, the drug-loaded electrospun meshes were found active against tested microorganisms, and clear inhibition zones were observed. In conclusion, this novel approach of synthesizing a new family of antimicrobial molecules and their incorporation into nanofibers from renewable sources exhibits great potential for smart and innovative dressings.

Recent advances in decellularized biomaterials for wound healing

The skin is one of the most essential organs in the human body, interacting with the external environment and shielding the body from diseases and excessive water loss. Thus, the loss of the integrity of large portions of the skin due to injury and illness may lead to significant disabilities and even death. Decellularized biomaterials derived from the extracellular matrix of tissues and organs are natural biomaterials with large quantities of bioactive macromolecules and peptides, which possess excellent physical structures and sophisticated biomolecules, and thus, promote wound healing and skin regeneration. Here, we highlighted the applications of decellularized materials in wound repair. First, the wound-healing process was reviewed. Second, we elucidated the mechanisms of several extracellular matrix constitutes in facilitating wound healing. Third, the major categories of decellularized materials in the treatment of cutaneous wounds in numerous preclinical models and over decades of clinical practice were elaborated. Finally, we discussed the current hurdles in the field and anticipated the future challenges and novel avenues for research on decellularized biomaterials-based wound treatment.

Effect of Matrix Metalloproteinase 23 Accelerating Wound Healing Induced by Hydroxybutyl Chitosan

Skin wounds may cause severe financial and social burden due to the difficulties in wound healing. Original inert dressings cannot meet multiple needs in the process of wound healing. Therefore, the development of materials to accelerate healing progress is essential and urgent. In the previous study, we found that the homogeneously synthesized hydroxybutyl chitosan (HBCS) had an effective performance in promoting wound healing. Proteomic analysis of the same specimen suggested that matrix metalloproteinase 23 (MMP23) may play a key role in HBCS expediting the progress of wound healing. In this work, we aim to reveal the underlying mechanism of MMP23 in the dynamic process of cutaneous proliferation and repair period. In order to regulate the expression level of MMP23 in the local wound area, we leaded in adeno-associated virus (AAV) to specifically decreased expression quantity of MMP23 in rat skin. In contrast to the negative control groups, we found that the wound closed faster and the collagen fibers and neovascularization were significantly increased in AAV groups. These findings highlighted that MMP23 was involved in wound healing after traumatic injury, and managing the expression of MMP23 could be a potential intervention target to accelerate wound healing.

Applications of MXene and its modified materials in skin wound repair

The rapid healing and repair of skin wounds has been receiving much clinical attention. Covering the wound with wound dressing to promote wound healing is currently the main treatment for skin wound repair. However, the performance of wound dressing prepared by a single material is limited and cannot meet the requirements of complex conditions for wound healing. MXene is a new two-dimensional material with electrical conductivity, antibacterial and photothermal properties and other physical and biological properties, which has a wide range of applications in the field of biomedicine. Based on the pathophysiological process of wound healing and the properties of ideal wound dressing, this review will introduce the preparation and modification methods of MXene, systematically summarize and review the application status and mechanism of MXene in skin wound healing, and provide guidance for subsequent researchers to further apply MXene in the design of skin wound dressing.

Hybrid gelatin-sulfated alginate scaffolds as dermal substitutes can dramatically accelerate healing of full-thickness diabetic wounds

Diabetic foot ulcers (DFUs) are defined as chronic and non-healing wounds that cause skin disorders. Here, we introduce a novel biodegradable gelatin/sulfated alginate hybrid scaffold as a dermal substitute to accelerate the healing of full-thickness diabetic ulcers in a diabetic mouse model. The hybrid scaffold possessing different weight ratios of sulfated alginate, from 10 % up to 50 %, were prepared through chemical crosslinking by carbodiimide chemistry and further freeze-drying. Based on the in vitro cytotoxicity experiments, the hybrid scaffolds not only showed no cytotoxicity, but the cell growth also dramatically increased by increasing the sulfated alginate content. Finally, the pathology of hybrid scaffolds as the dermal substitutes for healing of full-thickness diabetic wounds showed the more appropriate formation of epidermal layer, more homogeneous distribution of collagenous tissue and lower penetration of immune cells for the hybrid scaffolds-treated wounds.

[Treatment of 52 patients with a self-adhesive siliconised superabsorbent dressing: a multicentre observational study]

OBJECTIVE

To provide 'in use' clinical data to support exudate management in patients with moderately to highly exuding wounds with bordered superabsorbent wound dressing with a silicone adhesive interface Zetuvit Plus Silicone Border (Paul Hartmann Ltd., Germany).

MATERIALS AND METHODS

This study was an open-labelled non-comparative study. Patients included in the study were selected by the clinical investigator(s) according to whether the patient required a dressing for the management of moderately to highly exuding wounds such as pressure ulcers, diabetic foot ulcers, venous leg ulcer and arterial ulcers The patients were treated with A superabsorbent sterile wound dressing with bordered superabsorbent wound dressing with a silicone adhesive interface Zetuvit Plus Silicone Border (Paul Hartmann Ltd., Germany).

RESULTS

The Zetuvit Plus Silicone Border dressing had met the clinical objectives relating to exudate management, affirmed by the health professionals with a yes response in 94% of cases. Additionally, the health professionals rated the handling of exudate as excellent/good (78%) and most (80%) reported that they would use the superabsorbent wound dressing with a silicone adhesive interface again. Allied to this was the fact that the dressing improved the wound edge and periwound skin conditions (29% and 36% of patients, respectively). The dressing retained its position in 72% of patients. For wear time, the largest proportion of dressing changes, both pre-study and during the evaluation period, was every third day (45% and 44%, respectively). But there was a shift to extended wear time with use of the superabsorbent wound dressing with a silicone adhesive interface with 72% of patients' dressing changes being every third day or longer.

CONCLUSION

The superabsorbent silicone border dressing was successful in managing wound exudate in moderately to highly exuding wounds and consequently this had a beneficial impact on the wound edge and periwound skin. Overall, there was a positive effect on wound bed preparation and in turn the healing response was progressive.

Antiseptic-Loaded Casein Hydrogels for Wound Dressings

Chronic wound treatment accounts for a substantial percentage of the medical expenses worldwide. Improving and developing novel wound care systems can potentially help to handle this problem. Wound dressings loaded with antiseptics may be an important tool for wound care, as they inhibit bacterial growth at the wound site. The goal of the present work was to investigate the potential of using casein hydrogel dressings loaded with two antiseptic drugs, Octiset^® or polyhexanide, to treat chronic wounds. Casein-based hydrogels are inexpensive and have several properties that make them suitable for biomedical applications. Two types of casein were used: casein sodium salt and acid casein, with the formulations being labelled CS and C, respectively. The hydrogels were characterised with respect to their physical properties (swelling capacity, water content, morphology, mechanical resistance, and stability), before and after sterilisation, and they showed adequate values for the intended application. The hydrogels of both formulations were able to sustain controlled drug-release for, at least, 48 h. They were demonstrated to be non-irritant, highly haemocompatible, and non-cytotoxic, and revealed good antimicrobial properties against Staphylococcus aureus and Pseudomonas aeruginosa. Steam-heat sterilisation did not compromise the material's properties. The in vivo performance of C hydrogel loaded with Octiset^® was evaluated in a case study with a dog. The efficient recovery of the wounds confirms its potential as an alternative for wound treatment. To our knowledge, this is the first time that wound dressings loaded with Octiset^®, one of the most efficient drugs for wound treatment, were prepared and tested.

Therapeutic and pro-healing potential of advanced wound dressings loaded with bioactive agents

Chronic skin wound infections are inextricably linked with high mortality rates. With the rise in the aging population and the threat of diabetes, obesity and lifestyle-based diseases, the risk incurred from invasive wound pathogens has been ever escalating. Thus, more efficacious wound care management is necessary to cope with such morbid illnesses. A plethora of bioactive agents, such as antibiotics, phytochemicals, essential oils, phages among others, has been exploited to develop wound dressings, raising tremendous interest in their prospective use as wound care products. The present review critically focuses on the therapeutic implications of advanced wound dressings that have assisted in the expansion of regenerative medicine and also discusses the practical concerns that have limited their bench-to-market entry.

Fabrication of chitosan-gelatin films incorporated with thymol-loaded alginate microparticles for controlled drug delivery, antibacterial activity and wound healing: In-vitro and in-vivo studies

Previously, studies have demonstrated the unique characteristics of chitosan-gelatin films as wound dressings applications. However, their application has been limited due to their inadequacy of antimicrobial and anti-inflammatory characteristics. To improve the intended multifunctional characteristics of chitosan-gelatin film, in this study, we designed a novel composite film with the capability of controlled and prolonged release of thymol as a natural antioxidant and antimicrobial drug. Here, thymol-loaded ALG MPs (Thymol-ALG MPs) were prepared by electrospraying method and incorporated into the chitosan-gelatin film. The composite wound dressings of Thymol-ALG MPs incorporated in chitosan-gelatin film (CS-GEL/Thymol-ALG MPs) were characterized by in vitro and in vivo evaluations. The Thymol-ALG MPs demonstrated spherical and uniform morphology, with high encapsulation efficiency (88.9 ± 1.1 %). The CS-GEL/Thymol-ALG MPs exhibited high antibacterial activity against both Gram-positive and Gram-negative bacteria and no cytotoxicity for the L929 fibroblast cells. The release trend of thymol from CS-GEL/Thymol-ALG MPs and Thymol-ALG MPs followed a pseudo-Fickian diffusion mechanism. This wound dressing effectively accelerates the wound healing process at rats' full-thickness skin excisions. Also, the histological analysis demonstrated that the CS-GEL/Thymol-ALG MPs could significantly enhance epithelialization, collagen deposition, and induce skin regeneration. The present antibacterial composite film has promising characteristics for wound dressings applications.

Growth Factor Binding Peptides in Poly (Ethylene Glycol) Diacrylate (PEGDA)-Based Hydrogels for an Improved Healing Response of Human Dermal Fibroblasts

Growth factors (GF) are critical cytokines in wound healing. However, the direct delivery of these biochemical cues into a wound site significantly increases the cost of wound dressings and can lead to a strong immunological response due to the introduction of a foreign source of GFs. To overcome this challenge, we designed a poly(ethylene glycol) diacrylate (PEGDA) hydrogel with the potential capacity to sequester autologous GFs directly from the wound site. We demonstrated that synthetic peptide sequences covalently tethered to PEGDA hydrogels physically retained human transforming growth factor beta 1 (hTGFβ1) and human vascular endothelial growth factor (hVEGF) at 3.2 and 0.6 ng/mm², respectively. In addition, we demonstrated that retained hTGFβ1 and hVEGF enhanced human dermal fibroblasts (HDFa) average cell surface area and proliferation, respectively, and that exposure to both GFs resulted in up to 1.9-fold higher fraction of area covered relative to the control. After five days in culture, relative to the control surface, non-covalently bound hTGFβ1 significantly increased the expression of collagen type I and hTGFβ1 and downregulated vimentin and matrix metalloproteinase 1 expression. Cumulatively, the response of HDFa to hTGFβ1 aligns well with the expected response of fibroblasts during the early stages of wound healing.

In Vitro and In Vivo Characterization Methods for Evaluation of Modern Wound Dressings

Chronic wound management represents a major challenge in the healthcare sector owing to its delayed wound-healing process progression and huge financial burden. In this regard, wound dressings provide an appropriate platform for facilitating wound healing for several decades. However, adherent traditional wound dressings do not provide effective wound healing for highly exudating chronic wounds and need the development of newer and innovative wound dressings to facilitate accelerated wound healing. In addition, these dressings need frequent changing, resulting in more pain and discomfort. In order to overcome these issues, a wide range of affordable and innovative modern wound dressings have been developed and explored recently to accelerate and improve the wound healing process. However, a comprehensive understanding of various in vitro and in vivo characterization methods being utilized for the evaluation of different modern wound dressings is lacking. In this context, an overview of modern dressings and their complete in vitro and in vivo characterization methods for wound healing assessment is provided in this review. Herein, various emerging modern wound dressings with advantages and challenges have also been reviewed. Furthermore, different in vitro wound healing assays and in vivo wound models being utilized for the evaluation of wound healing progression and wound healing rate using wound dressings are discussed in detail. Finally, a summary of modern wound dressings with challenges and the future outlook is highlighted.

Innovation for infection prevention and control-revisiting Pasteur's vision

Louis Pasteur has long been heralded as one of the fathers of microbiology and immunology. Less known is Pasteur's vision on infection prevention and control (IPC) that drove current infection control, public health, and much of modern medicine and surgery. In this Review, we revisited Pasteur's pioneering works to assess progress and challenges in the process and technological innovation of IPC. We focused on Pasteur's far-sighted conceptualisation of the hospital as a reservoir of microorganisms and amplifier of transmission, aseptic technique in surgery, public health education, interdisciplinary working, and the protection of health services and patients. Examples from across the globe help inform future thinking for IPC innovation, adoption, scale up and sustained use.

3D-printed scaffold composites for the stimuli-induced local delivery of bioactive adjuncts

Polysaccharide scaffolds have been successfully employed to reconstruct environments that sustain skin tissue regeneration after injuries. Three-dimensional (3D) advanced additive manufacturing technologies allow creating scaffolds with controlled and reproducible macro- and micro-structure that improve the quality of the restored tissue to favor spontaneous repair. However, when persistent inflammation occurs, the physiological tissue healing capacity is reduced, like in the presence of pathologies like diabetes, vascular diseases, chronic infection, and others. In these circumstances, the bioavailability of therapeutic adjuncts like the growth factors in addition to the standard treatments represents undoubtedly a promising strategy to accelerate the healing of skin lesions. Precisely designed polysaccharide scaffolds obtained by 3D printing represent a robust platform that can be further implemented with the controlled delivery of bioactive adjuncts. Human elastin-like polypeptides (HELPs) are stimuli-responsive biopolymers. Their structure allows the integration of domains endowed with biological functionality, making them attractive compounds to prepare composites with smart properties. In the present study, 3D-printed alginate and chitosan scaffolds were combined with the HELP components. The HELP biopolymer was fused to the epidermal growth factor (EGF) as the bioactive domain. Different constructs were prepared and the stimuli-responsive behavior as well as the biological activity were evaluated, suggesting that these smart bioactive composites are suitable to realize multifunctional dressings that sustain the local release of therapeutic adjuncts.

Gellan Gum in Wound Dressing Scaffolds

Several factors, such as bacterial infections, underlying conditions, malnutrition, obesity, ageing, and smoking are the most common issues that cause a delayed process of wound healing. Developing wound dressings that promote an accelerated wound healing process and skin regeneration is crucial. The properties of wound dressings that make them suitable for the acceleration of the wound healing process include good antibacterial efficacy, excellent biocompatibility, and non-toxicity, the ability to provide a moist environment, stimulating cell migration and adhesion, and providing gaseous permeation. Biopolymers have demonstrated features appropriate for the development of effective wound dressing scaffolds. Gellan gum is one of the biopolymers that has attracted great attention in biomedical applications. The wound dressing materials fabricated from gellan gum possess outstanding properties when compared to traditional dressings, such as good biocompatibility, biodegradability, non-toxicity, renewability, and stable nature. This biopolymer has been broadly employed for the development of wound dressing scaffolds in different forms. This review discusses the physicochemical and biological properties of gellan gum-based scaffolds in the management of wounds.

Polymer-Based Hydrogels Enriched with Essential Oils: A Promising Approach for the Treatment of Infected Wounds

Among the factors that delay the wound healing process in chronic wounds, bacterial infections are a common cause of acute wounds becoming chronic. Various therapeutic agents, such as antibiotics, metallic nanoparticles, and essential oils have been employed to treat infected wounds and also prevent the wounds from bacterial invasion. Essential oils are promising therapeutic agents with excellent wound healing, anti-inflammatory and antimicrobial activities, and good soothing effects. Some essential oils become chemically unstable when exposed to light, heat, oxygen, and moisture. The stability and biological activity of essential oil can be preserved via loading into hydrogels. The polymer-based hydrogels loaded with bioactive agents are regarded as ideal wound dressings with unique features, such as controlled and sustained drug release mechanisms, good antibacterial activity, non-toxicity, excellent cytocompatibility, good porosity, moderate water vapour transmission rate, etc. This review addresses the pre-clinical outcomes of hydrogels loaded with essential oils in the treatment of infected wounds.

Evaluation of the Antibacterial Properties of Iron Oxide, Polyethylene Glycol, and Gentamicin Conjugated Nanoparticles against Some Multidrug-Resistant Bacteria

Antibacterial resistance is observed as a public health issue around the world. Every day, new resistance mechanisms appear and spread over the world. For that reason, it is imperative to improve the treatment schemes that have been developed to treat infections caused by wound infections, for instance, Staphylococcus epidermidis (S. epidermidis), Proteus mirabilis (P. mirabilis), and Acinetobacter baumannii (A. baumannii). In this case, we proposed a method that involves mixing the Gentamicin (Gen) with iron oxide nanoparticles (Fe3O4 NPs) and a polymer (polyethylene glycol (PEG)) with Fe3O4 NPs. X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), energy dispersive X-ray (EDX), scanning electron microscope (SEM), and transmission electron microscope (TEM) were used to characterize Fe3O4 NPs. Zeta potential and dynamic light scattering (DLS) were also assessed. The antibacterial activity of Fe3O4 NPs, Fe3O4 NPs+PEG, Fe3O4 NPs+Gen, and Fe3O4 NPs+PEG+Gen composites was investigated. The results showed a significant improvement in the antibacterial activity of nanoparticles against bacterial isolates, especially for the Fe3O4 NPs+PEG+Gen as the diameter of the inhibition zone reached 26.33 ± 0.57 mm for A. baumannii, 25.66 ± 0.57 mm for P. mirabilis, and 23.66 ± 0.57 mm for S. epidermidis. The Fe3O4 NPs, Fe3O4 NPs+PEG, Fe3O4+Gen, and Fe3O4+PEG+Gen also showed effectiveness against the biofilm produced by these isolated bacteria. The minimum inhibitory concentration (MIC) of Fe3O4 NPs for S. epidermidis was 25 µg mL−1 and for P. mirabilis and A. baumannii was 50 µg mL−1. The findings suggest that the prepared nanoparticles could be potential therapeutic options for treating wound infections caused by S. epidermidis, P. mirabilis, and A. baumannii.

A Randomized Controlled Trial of Three Advanced Wound Dressings in Split-Thickness Skin Grafting Donor Sites-A Personalized Approach?

Background: Split-thickness skin grafting (STSG) is a frequently used reconstructive technique, and its donor site represents a standardized clinical model to evaluate wound dressings. We compared hydroactive nanocellulose-based, silver-impregnated and ibuprofen-containing foam wound dressings. Methods: A total of 46 patients scheduled for elective surgery were evaluated on the STSG donor site for wound healing (time-to-healing, Hollander Wound Evaluation Scale), pain level (Visual Analogue Scale), and handling (ease of use), as well as scar quality (Patient Scar Assessment Scale, Vancouver Scar Scale) after 3, 6 and 12 months. Results: Almost all dressings compared equally well. We observed statistically relevant differences for pain level favoring the ibuprofen-containing dressing (p = 0.002, ΔAIC = 8.1), and user friendliness in favor of nanocellulose (dressing removal: p = 0.037, ΔAIC = 2.59; application on patient: p = 0.042, ΔAIC = 2.33; wound adhesion: p = 0.017, ΔAIC = 4.16; sensation on skin: p = 0.027, ΔAIC = 3.21). We did not observe any differences for wound healing across all groups. Treatment with hydroactive nanocellulose and the ibuprofen-containing foam revealed statistically relevant better scar appearances as compared to the silver wound dressing (p < 0.001, ΔAIC = 14.77). Conclusion: All wound dressings performed equally well, with the detected statistical differences hinting future directions of clinical relevance. These include the reserved use of silver containing dressings for contaminated or close to contaminated wounds, and the facilitated clinical application of the nanocellulose dressing, which was the only suitable candidate in this series to be impregnated with a range of additional therapeutic agents (e.g., disinfectants and pain-modulating drugs). Personalized donor site management with the tested dressings can meet individual clinical requirements after STSG and improve management strategies and ultimately patient outcomes.

Deciphering the focuses and trends in skin regeneration research through bibliometric analyses

Increasing attention to skin regeneration has rapidly broadened research on the topic. However, no bibliometric analysis of the field’s research trends has yet been conducted. In response to this research gap, this study analyzed the publication patterns and progress of skin regeneration research worldwide using a bibliometric analysis of 1,471 papers comprising 1,227 (83.4%) original articles and 244 (16.6%) reviews sourced from a Web of Science search. Publication distribution was analyzed by country/region, institution, journal, and author. The frequency of keywords was assessed to prepare a bibliometric map of the development trends in skin regeneration research. China and the United States were the most productive countries in the field: China had the greatest number of publications at 433 (29.4%) and the United States had the highest H-index ranking (59 with 15,373 citations or 31.9%). Author keywords were classified into four clusters: stem cell, biomaterial, tissue engineering, and wound dressing. “Stem cells,” “chitosan,” “tissue engineering,” and “wound dressings” were the most frequent keywords in each cluster; therefore, they reflected the field’s current focus areas. “Immunomodulation,” “aloe vera,” “extracellular vesicles,” “injectable hydrogel,” and “three-dimensional (3D) bioprinting” were relatively new keywords, indicating that biomaterials for skin regeneration and 3D bioprinting are promising research hotspots in the field. Moreover, clinical studies on new dressings and techniques to accelerate skin regeneration deserve more attention. By uncovering current and future research hotspots, this analysis offers insights that may be useful for both new and experienced scholars striving to expand research and innovation in the field of skin regeneration.

Active Potential of Bacterial Cellulose-Based Wound Dressing: Analysis of Its Potential for Dermal Lesion Treatment

The use of innate products for the fast and efficient promotion of healing process has been one of the biomedical sector's main bets for lesion treatment modernization process. The aim of this study was to develop and characterize bacterial cellulose-based (BC) wound dressings incorporated with green and red propolis extract (2 to 4%) and the active compounds p-coumaric acid and biochanin A (8 to 16 mg). The characterization of the nine developed samples (one control and eight active wound dressings) evidenced that the mechanics, physics, morphological, and barrier properties depended not only on the type of active principle incorporated onto the cellulosic matrix, but also on its concentration. Of note were the results found for transparency (28.59-110.62T₆₀₀ mm^-1), thickness (0.023-0.046 mm), swelling index (48.93-405.55%), water vapor permeability rate (7.86-38.11 g m² day^-1), elongation (99.13-262.39%), and antioxidant capacity (21.23-86.76 μg mL^-1). The wound dressing based on BC and red propolis was the only one that presented antimicrobial activity. The permeation and retention test revealed that the wound dressing containing propolis extract presented the most corneal stratum when compared with viable skin. Overall, the developed wound dressing showed potential to be used for treatment against different types of dermal lesions, according to its determined proprieties.

Progress in hydrogels for skin wound repair

As the first defensive line between the human body and the outside world, the skin is vulnerable to damage from the external environment. Skin wounds can be divided into acute wounds (mechanical injuries, chemical injuries and surgical wounds, etc.) and chronic wounds (burns, infections, diabetes, etc.). In order to manage skin wound, a variety of wound dressings have been developed, including gauze, films, foams, nanofibers, hydrocolloids and hydrogels. Recently, hydrogels have received much attention because of their natural extracellular matrix (ECM)-mimik structure, tunable mechanical properties, and facile bioactive substance delivery capability. They show great potential application in skin wound repair. This paper first introduces the anatomy and function of the skin, the process of wound healing and conventional wound dressings, and then introduces the composition and construction methods of hydrogels. Next, this paper introduces the necessary properties of hydrogels in skin wound repair and the latest research progress of hydrogel dressings for skin wound repair. Finally, the future development goals of hydrogel materials in the field of wound healing are proposed. This article is protected by copyright. All rights reserved.

Hydro-responsive wound dressings for treating hard-to-heal wounds: a narrative review of the clinical evidence

A break in skin integrity must be repaired as quickly as possible to avoid excess blood and fluid loss, and to minimise the onset of infection. Hard-to-heal wounds, in which the progression of the wound healing response is compromised, present several challenges to healing (for example, the presence of devitalised tissue acting as a physical barrier to healing and as a focus for bacterial contamination with the potential for subsequent infection). The objective of this article is to present, as a narrative review, the clinical evidence supporting the use of a unique hydro-responsive wound dressing (HydroClean, HRWD1, PAUL HARTMANN AG, Germany). The dressing provides a simple treatment option to address a number of clinical challenges clinicians must overcome in order to facilitate wound healing progression. These studies demonstrated that this product supported successful debridement/cleansing of a wide variety of wounds, including hard-to-heal wounds, enabled wound bed preparation, and lead to positive healing outcomes, including in wounds that previously had failed to heal. The simplicity of using HRWD1 as a single dressing can help clinicians overcome a variety of challenges when treating both acute and hard-to-heal wounds, which, with the benefit of proven patient outcomes, could make it an ideal choice for a first-line treatment.

Preparation of sodium hyaluronate/dopamine/AgNPs hydrogel based on the natural eutetic solvent as an antibaterial wound dressing

Baesd on previous researches, the natural deep eutectic solvent (DES) has enormous potential to be used in the fabrication of hydrogel wound dressing due to its outstanding properties including cytocompatibility, degradability and solubility. In order to further improve the antibaterial capacity of hydrogel, in the present study sodium hyaluronate (SH) and the natural DES were utilized to develop a novel hydrogel wound dressing by dopamine (DA) coated SH with in situ reduction of silver nanoparticles (DES-DASH@Ag). Furthermore, during the preparation process, we discovered for the first time that the DES can be used to fill the freeze-dried DASH to prepare a hydrogel (DES-DASH), which was promising to utilized in the fabrication of other hydrogels. Besides, the chemical and physical properties as well as wound healing capacity of the DES-DASH@Ag hydrogel were characterized. As a result, the DES-DASH@Ag hydrogel presented good cytocompatibility tested using NIH-3 T3 fibroblast cells, and prominent antibacterial effect against two types of bacteria infecting exposed wound. Furthermore, the hydrogel facilitated regeneration of mouse skin tissue in the wound area. The overall performance of DES-DASH@Ag hydrogel suggested that it could be a promising wound dressing in modern medicine.

An Overview of Cellulose Derivatives-Based Dressings for Wound-Healing Management

Presently, notwithstanding the progress regarding wound-healing management, the treatment of the majority of skin lesions still represents a serious challenge for biomedical and pharmaceutical industries. Thus, the attention of the researchers has turned to the development of novel materials based on cellulose derivatives. Cellulose derivatives are semi-synthetic biopolymers, which exhibit high solubility in water and represent an advantageous alternative to water-insoluble cellulose. These biopolymers possess excellent properties, such as biocompatibility, biodegradability, sustainability, non-toxicity, non-immunogenicity, thermo-gelling behavior, mechanical strength, abundance, low costs, antibacterial effect, and high hydrophilicity. They have an efficient ability to absorb and retain a large quantity of wound exudates in the interstitial sites of their networks and can maintain optimal local moisture. Cellulose derivatives also represent a proper scaffold to incorporate various bioactive agents with beneficial therapeutic effects on skin tissue restoration. Due to these suitable and versatile characteristics, cellulose derivatives are attractive and captivating materials for wound-healing applications. This review presents an extensive overview of recent research regarding promising cellulose derivatives-based materials for the development of multiple biomedical and pharmaceutical applications, such as wound dressings, drug delivery devices, and tissue engineering.

3D-Printed Products for Topical Skin Applications: From Personalized Dressings to Drug Delivery

3D printing has been widely used for the personalization of therapies and on-demand production of complex pharmaceutical forms. Recently, 3D printing has been explored as a tool for the development of topical dosage forms and wound dressings. Thus, this review aims to present advances related to the use of 3D printing for the development of pharmaceutical and biomedical products for topical skin applications, covering plain dressing and products for the delivery of active ingredients to the skin. Based on the data acquired, the important growth in the number of publications over the last years confirms its interest. The semisolid extrusion technique has been the most reported one, probably because it allows the use of a broad range of polymers, creating the most diverse therapeutic approaches. 3D printing has been an excellent field for customizing dressings, according to individual needs. Studies discussed here imply the use of metals, nanoparticles, drugs, natural compounds and proteins and peptides for the treatment of wound healing, acne, pain relief, and anti-wrinkle, among others. The confluence of 3D printing and topical applications has undeniable advantages, and we would like to encourage the research groups to explore this field to improve the patient's life quality, adherence and treatment efficacy.

Marine Polysaccharides for Wound Dressings Application: An Overview

Wound dressings have become a crucial treatment for wound healing due to their convenience, low cost, and prolonged wound management. As cutting-edge biomaterials, marine polysaccharides are divided from most marine organisms. It possesses various bioactivities, which allowing them to be processed into various forms of wound dressings. Therefore, a comprehensive understanding of the application of marine polysaccharides in wound dressings is particularly important for the studies of wound therapy. In this review, we first introduce the wound healing process and describe the characteristics of modern commonly used dressings. Then, the properties of various marine polysaccharides and their application in wound dressing development are outlined. Finally, strategies for developing and enhancing marine polysaccharide wound dressings are described, and an outlook of these dressings is given. The diverse bioactivities of marine polysaccharides including antibacterial, anti-inflammatory, haemostatic properties, etc., providing excellent wound management and accelerate wound healing. Meanwhile, these biomaterials have higher biocompatibility and biodegradability compared to synthetic ones. On the other hand, marine polysaccharides can be combined with copolymers and active substances to prepare various forms of dressings. Among them, emerging types of dressings such as nanofibers, smart hydrogels and injectable hydrogels are at the research frontier of their development. Therefore, marine polysaccharides are essential materials in wound dressings fabrication and have a promising future.

The modified TIME-H scoring system, a versatile tool in wound management practice: a preliminary report

Background and Aims:

The concept of WBP (wound bed preparation) has revolutionized the way to diagnose and correctly identify the best therapeutic path about the widespread clinical problem of difficult wounds. Starting from the modified TIME-H, authors conducted a preliminary study with the aim of assessing the impact of skin lesions and soft tissues for the surgical patient.

Materials and Methods:

38 patients were preliminarily evaluated. The patients were classified according to the lesion examined, in particular among those who had an infectious or vascular etiology (SSTIs), and patients with surgical site lesions (SSI) and assigned to one of three categories prognosis: favorable (with healing expected within 12 weeks) (0-3A, 0-1B), intermediate (with healing expected over 12 weeks) (4-6A, 2-4B) and uncertain healing (7-8A, 5-8B).

Results:

At the end of the one-year observation period, authors established the healing prediction rate among the studied lesions: the surgical site lesions presented the highest percentage of predictivity (88%), followed by the mixed etiology (72%) and the infectious/vascular injuries (63%).

Conclusion:

This modified-TIME-H can be considered as a versatile and useful scoring tool that should be used in daily clinical practice for the study and treatment of chronic wound diseases.

Functional hydrogels for diabetic wound management

Diabetic wounds often have a slow healing process and become easily infected owing to hyperglycemia in wound beds. Once planktonic bacterial cells develop into biofilms, the diabetic wound becomes more resistant to treatment. Although it remains challenging to accelerate healing in a diabetic wound due to complex pathology, including bacterial infection, high reactive oxygen species, chronic inflammation, and impaired angiogenesis, the development of multifunctional hydrogels is a promising strategy. Multiple functions, including antibacterial, pro-angiogenesis, and overall pro-healing, are high priorities. Here, design strategies, mechanisms of action, performance, and application of functional hydrogels are systematically discussed. The unique properties of hydrogels, including bactericidal and wound healing promotive effects, are reviewed. Considering the clinical need, stimuli-responsive and multifunctional hydrogels that can accelerate diabetic wound healing are likely to form an important part of future diabetic wound management.

Combining Biocompatible and Biodegradable Scaffolds and Cold Atmospheric Plasma for Chronic Wound Regeneration

Skin regeneration is a quite complex process. Epidermal differentiation alone takes about 30 days and is highly regulated. Wounds, especially chronic wounds, affect 2% to 3% of the elderly population and comprise a heterogeneous group of diseases. The prevailing reasons to develop skin wounds include venous and/or arterial circulatory disorders, diabetes, or constant pressure to the skin (decubitus). The hallmarks of modern wound treatment include debridement of dead tissue, disinfection, wound dressings that keep the wound moist but still allow air exchange, and compression bandages. Despite all these efforts there is still a huge treatment resistance and wounds will not heal. This calls for new and more efficient treatment options in combination with novel biocompatible skin scaffolds. Cold atmospheric pressure plasma (CAP) is such an innovative addition to the treatment armamentarium. In one CAP application, antimicrobial effects, wound acidification, enhanced microcirculations and cell stimulation can be achieved. It is evident that CAP treatment, in combination with novel bioengineered, biocompatible and biodegradable electrospun scaffolds, has the potential of fostering wound healing by promoting remodeling and epithelialization along such temporarily applied skin replacement scaffolds.

Recent Advances in Cellulose-Based Structures as the Wound-Healing Biomaterials: A Clinically Oriented Review

Application of wound-healing/dressing biomaterials is amongst the most promising approaches for wound repair through protection from pathogen invasion/contamination, maintaining moisture, absorbing exudates, modulating inflammation, and facilitating the healing process. A wide range of materials are used to fabricate wound-healing/dressing biomaterials. Active wound-healing/dressings are next-generation alternatives for passive biomaterials, which provide a physical barrier and induce different biological activities, such as antibacterial, antioxidant, and proliferative effects. Cellulose-based biomaterials are particularly promising due to their tunable physical, chemical, mechanical, and biological properties, accessibility, low cost, and biocompatibility. A thorough description and analysis of wound-healing/dressing structures fabricated from cellulose-based biomaterials is discussed in this review. We emphasize and highlight the fabrication methods, applied bioactive molecules, and discuss the obtained results from in vitro and in vivo models of cellulose-based wound-healing biomaterials. This review paper revealed that cellulose-based biomaterials have promising potential as the wound-dressing/healing materials and can be integrated with various bioactive agents. Overall, cellulose-based biomaterials are shown to be effective and sophisticated structures for delivery applications, safe and multi-customizable dressings, or grafts for wound-healing applications.

Development of Spanish Broom and Flax Dressings with Glycyrrhetinic Acid-Loaded Films for Wound Healing: Characterization and Evaluation of Biological Properties

The selection of an appropriate dressing for each type of wound is a very important procedure for a faster and more accurate healing process. So, the aim of this study was to develop innovative Spanish Broom and flax wound dressings, as alternatives to cotton used as control, with polymeric films containing glycyrrhetinic acid (GA) to promote wound-exudate absorption and the healing process. The different wound dressings were prepared by a solvent casting method, and characterized in terms of drug loading, water uptake, and in vitro release. Moreover, biological studies were performed to evaluate their biocompatibility and wound-healing efficacy. Comparing the developed wound dressings, Spanish Broom dressings with GA-loaded sodium hyaluronate film had the best functional properties, in terms of hydration ability and GA release. Moreover, they showed a good biocompatibility, determining a moderate induction of cell proliferation and no cytotoxicity. In addition, the wound-healing test revealed that the Spanish Broom dressings promoted cell migration, further facilitating the closure of the wound.

Wound Healing: From Passive to Smart Dressings

The universal increase in the number of patients with nonhealing skin wounds imposes a huge social and economic burden on the patients and healthcare systems. Although, the application of traditional wound dressings contributes to an effective wound healing outcome, yet, the complexity of the healing process remains a major health challenge. Recent advances in materials and fabrication technologies have led to the fabrication of dressings that provide proper conditions for effective wound healing. The 3D-printed wound dressings, biomolecule-loaded dressings, as well as smart and flexible bandages are among the recent alternatives that have been developed to accelerate wound healing. Additionally, the new generation of wound dressings contains a variety of microelectronic sensors for real-time monitoring of the wound environment and is able to apply required actions to support the healing progress. Moreover, advances in manufacturing flexible microelectronic sensors enable the development of the next generation of wound dressing substrates, known as electronic skin, for real-time monitoring of the whole physiochemical markers in the wound environment in a single platform. The current study reviews the importance of smart wound dressings as an emerging strategy for wound care management and highlights different types of smart dressings for promoting the wound healing process.

Antioxidant and multi-sensitive PNIPAAm/keratin double network gels for self-stripping wound dressing application

Hydrogel is a potential wound dressing material due to its ability to maintain a humid environment, the strong absorptive capacity of exuded tissue fluid, and gas exchange function. Herein, poly(N-isopropyl acrylamide)/keratin double network (PNIPAAm/keratin DN) gels were fabricated through covalent and ionic double cross-linking strategy. The effects of PNIPAAm/keratin ratios on the morphology and swelling rate of gels were characterized. The DN gels could swell up from 2600% to 4600% in proportion to the keratin content, demonstrating their great ability to absorb tissue fluid. The gels possessed thermo-sensitiveness, imparting self-stripping property. Moreover, the antibacterial chlorhexidine acetate (CHX) was loaded into gels with a post-fabrication drug-loading strategy. The release behavior showed that CHX-loaded DN gels exhibited multiple responsive characteristics (temperature, pH, and ROS). Furthermore, the drug-loaded gels showed greater antibacterial activity than free CHX due to the sustained drug release effect. Meanwhile, the antioxidant efficiency of PNIPAAm/keratin DN gels was ca. 33.1%, while the PNIPAAm gel was just ca. 18.2%, indicating the strong oxidation resistance of DN gels. In the Sprague Dawley (SD) rat skin defect model, the hydrogel had better tissue regeneration ability than the commercial film. Taken together, the multifunctional PNIPAAm/keratin DN gels are potential candidates for clinical wound treatment.

WITHDRAWN: Epicatechin gallate-loaded calcium alginate sponges promote diabetic wound healing through protecting against oxidative stress and modulation of immune response via PI3K/AKT/NFκB signaling pathway

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