Wound Dressings: A Comprehensive Review

Recent advances in mesoporous silica nanoparticles formulations and drug delivery for wound healing

Wound healing is a natural process that can be disrupted by disease. Nanotechnology is a promising platform for the development of new therapeutic agents to accelerate acute and chronic wound healing. Drug delivery by means of nanoparticles as well as wound dressings have emerged as suitable options to improving the healing process. The characteristics of mesoporous silica nanoparticles (MSNs) make them efficient carriers of pharmaceutical agents alone or in combination with dressings. In order to maximize the effect of a drug and minimize its adverse consequences, it may be possible to include targeted and intelligent release of the drug into the design of MSNs. Its use to facilitate closure of adjacent sides of a cut as a tissue adhesive, local wound healing, controlled drug release and induction of blood coagulation are possible applications of MSNs. This review summarizes research on MSN applications for wound healing. It includes a general overview, wound healing phases, MSN formulation, therapeutic possibilities of MSNs and MSN-based drug delivery systems for wound healing.

Developmental prospects of carrageenan-based wound dressing films: Unveiling techno-functional properties and freeze-drying technology for the development of absorbent films - A review

This review explores the intricate wound healing process, emphasizing the critical role of dressing material selection, particularly for chronic wounds with high exudate levels. The aim is to tailor biodegradable dressings for comprehensive healing, focusing on maximizing moisture retention, a vital element for adequate recovery. Researchers are designing advanced wound dressings that enhance techno-functional and bioactive properties, minimizing healing time and ensuring cost-effective care. The study delves into wound dressing materials, highlighting carrageenan biocomposites superior attributes and potential in advancing wound care. Carrageenan's versatility in various biomedical applications demonstrates its potential for tissue repair, bone regeneration, and drug delivery. Ongoing research explores synergistic effects by combining carrageenan with other novel materials, aiming for complete biocompatibility. As innovative solutions emerge, carrageenan-based wound-healing medical devices are poised for global accessibility, addressing challenges associated with the complex wound-healing process. The exceptional physico-mechanical properties of carrageenan make it well-suited for highly exudating wounds, offering a promising avenue to revolutionize wound care through freeze-drying techniques. This thorough approach to evaluating the wound healing effectiveness of carrageenan-based films, particularly emphasizing the development potential of lyophilized films, has the potential to significantly improve the quality of life for patients receiving wound healing treatments.

Development of Thyme-Infused Polydimethylsiloxane Composites for Enhanced Antibacterial Wound Dressings

Polydimethylsiloxane (PDMS) is widely used in biomedical applications due to its biocompatibility and flexibility but faces challenges due to its hydrophobicity and limited mechanical strength. This study explores the incorporation of thyme (Thymus vulgaris L.) into PDMS to enhance its properties for wound dressing applications. PDMS composites containing 2.5 wt.% and 5 wt.% of thyme were prepared and evaluated for physical, chemical, mechanical, and biological properties. Scanning electron microscopy, contact angle measurements, absorption tests, Fourier-transform infrared spectroscopy, differential scanning calorimetry, hardness, tensile testing, antibacterial activity, and cell viability assays were conducted. Thyme integration improved mechanical properties with increased absorption and preserved hydrophobicity. FTIR and DSC analyses indicated minimally altered crystallinity and chemical interactions. Hardness decreased with higher thyme content due to terpene-induced polymerization inhibition. Tensile testing showed reduced stress at break but increased elongation, suitable for wound dressings. Enhanced antibacterial activity was observed, with composites meeting bacteriostatic standards. Cell viability exceeded 70%, with optimal results at 2.5 wt.% thyme, attributed to cytokine-inducing compounds. Thyme-incorporated PDMS composites exhibit improved antibacterial and mechanical properties, demonstrating the potential for advanced wound dressings.

An Overview of Wound Dressing Materials

Wounds are an increasing global concern, mainly due to a sedentary lifestyle, frequently associated with the occidental way of life. The current prevalence of obesity in Western societies, leading to an increase in type II diabetes, and an elderly population, is also a key factor associated with the problem of wound healing. Therefore, it stands essential to find wound dressing systems that allow for reestablishing the skin integrity in the shortest possible time and with the lowest cost, avoiding further damage and promoting patients' well-being. Wounds can be classified into acute or chronic, depending essentially on the duration of the healing process, which is associated withextent and depth of the wound, localization, the level of infection, and the patient's health status. For each kind of wound and respective healing stage, there is a more suitable dressing. The aim of this review was to focus on the possible wound dressing management, aiming for a more adequate healing approach for each kind of wound.

Development and Evaluation of Fucoidan-Loaded Electrospun Polyvinyl Alcohol/Levan Nanofibers for Wound Dressing Applications

Wound dressing is an ancient technique for promoting healing, and modern technology has led to the development of advanced dressings that enhance patient care. Nanofiber-based wound dressings are a medical innovation with enhanced properties, including improved adhesion, reduced infection rates, and increased tissue regeneration. This article focuses on electrospun nanofibrous wound dressing materials produced using the widely adopted method of electrospinning. This article explores several parameters that influence fiber size, including electrical conductivity, electric potential, collector distance, viscosity, flow rate, and surface tension. With Fucoidan (FUC) loading, an increase in the fiber diameter of the control group from 310 nm to 395 nm was observed. This research also examines the use of Halomonas Levan (HL), a polysaccharide, and polyvinyl alcohol (PVA) polymer as wound dressing materials to enhance the mechanical properties of the latter. The incorporation of various concentrations of FUC into PVA-HL electrospun nanofibers yielded diverse effects on tensile strength: an enhancement was observed in the PVA-HL-10FUC formulation, while reductions were noted in the PVA-HL-13FUC and PVA-HL-15FUC formulations. The WST1 assay demonstrated that none of the samples exhibited cytotoxicity up to 72 h, as cell viability increased over time. In conclusion, nanofibrous PVA-HL structures loaded with FUC, which promote tissue regeneration and prevent infection, could be considered a novel wound dressing material.

How the combination of alginate and chitosan can fabricate a hydrogel with favorable properties for wound healing

Wound management has always been a significant concern, particularly for men, and the search for effective wound dressings has led to the emergence of hydrogels as a promising solution. In recent years, hydrogels, with their unique properties, have gained considerable importance in wound management. Among the various types of hydrogels, those incorporating chitosan and alginate, two distinct chemical materials, have shown potential in accelerating wound healing. This review aims to discuss the desirable characteristics of an effective wound dressing, explore the alginate/chitosan-based hydrogels developed by different researchers, and analyze their effects on wound healing through in vitro and in vivo assessments. In vitro tests encompass a wide range of evaluations, including swelling capacity, degradation rate, porosity, Fourier Transform Infrared Spectroscopy, X-ray diffraction analysis, moisture vapor transmission rate, release studies, mechanical properties, microscopic observation, antibacterial properties, compatibility assessment, cell adhesion investigation, blood clotting capability, cell migration analysis, water contact angle determination, and structural stability. Furthermore, in vivo assessments encompass the examination of wound closure rate, modulation of gene expression, as well as histopathological and immunohistochemical studies.

Bringing innovative wound care polymer materials to the market: Challenges, developments, and new trends

The development of innovative products for treating acute and chronic wounds has become a significant topic in healthcare, resulting in numerous products and innovations over time. The growing number of patients with comorbidities and chronic diseases, which may significantly alter, delay, or inhibit normal wound healing, has introduced considerable new challenges into the wound management scenario. Researchers in academia have quickly identified promising solutions, and many advanced wound healing materials have recently been designed; however, their successful translation to the market remains highly complex and unlikely without the contribution of industry experts. This review article condenses the main aspects of wound healing applications that will serve as a practical guide for researchers working in academia and industry devoted to designing, evaluating, validating, and translating polymer wound care materials to the market. The article highlights the current challenges in wound management, describes the state-of-the-art products already on the market and trending polymer materials, describes the regulation pathways for approval, discusses current wound healing models, and offers a perspective on new technologies that could soon reach consumers. We envision that this comprehensive review will significantly contribute to highlighting the importance of networking and exchanges between academia and healthcare companies. Only through the joint of these two actors, where innovation, manufacturing, regulatory insights, and financial resources act in harmony, can wound care products be developed efficiently to reach patients quickly and affordably.

Multifunctional Nanoclay-Based Hemostatic Materials for Wound Healing: A Review

Bleeding to death accounts for around 30-40% of all trauma-related fatalities. Current hemostatic materials are mainly mono-functional or have insufficient hemostatic capacity. Nanoclay has been recently shown to accelerate hemostasis, improve wound healing, and provide the resulting multifunctional hemostatic materials antibacterial, anti-inflammatory, and healing-promoting due to its distinctive morphological structure and physicochemical properties. Herein, the chemical design and action mechanism of nanoclay-based hemostatic, antibacterial, and pro-wound healing materials in the context of wound healing are discussed. The physiological processes of hemostasis and wound healing to elucidate the significance of nanoclay for functional wound hemostatic dressing design are outlined. A summary of the features of various nanoclay and product types used in wound hemostatic dressings is provided. Nanoclay can be antimicrobial due to the slow release of metal ions and has an abundant surface charge allowing for high affinity for proteins and cells, which can activate the coagulation reaction or facilitate tissue repair. Nanoclay with a microporous structure can be used as drug carriers to create composites critical for inhibiting bacterial growth on wounds or promoting the regeneration of vascular, muscle, and skin tissues. Directions for further research and innovation of nanoclay-based multifunctional materials for hemostasis and tissue regeneration are explored.

Exploring polysaccharide-based bio-adhesive topical film as a potential platform for wound dressing application: A review

Wound dressings act as a physical barrier between the wound site and the external environment, preventing additional harm; choosing suitable wound dressings is essential for the healing process. Polysaccharide biopolymers have demonstrated encouraging findings and therapeutic prospects in recent decades about wound therapy. Additionally, polysaccharides have bioactive qualities like anti-inflammatory, antibacterial, and antioxidant capabilities that can help the process of healing. Due to their excellent tissue adhesion, swelling, water absorption, bactericidal, and immune-regulating properties, polysaccharide-based bio-adhesive films have recently been investigated as intriguing alternatives in wound management. These films also mimic the structure of the skin and stimulate the regeneration of the skin. This review presented several design standards and functions of suitable bio-adhesive films for the healing of wounds. Additionally, the most recent developments in the use of bio-adhesive films as wound dressings based on polysaccharides, including hyaluronic acid, chondroitin sulfate, dextran, alginate, chitosan, cellulose, konjac glucomannan, gellan gum, xanthan gum, pectin, guar gum, heparin, arabinogalactans, carrageen, and tragacanth gum, are thoroughly discussed. Lastly, to create a road map for the function of polysaccharide-based bio-adhesive films in advanced wound care, their clinical performances and future challenges in making bio-adhesive films by three-dimensional bioprinting are summarized.

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.

Functional hydrogel-based wound dressings: A review on biocompatibility and therapeutic efficacy

Chronic wounds, burns, and surgical incisions represent critical healthcare challenges that significantly impact patient quality of life and strain healthcare resources. In response to these pressing needs, the field of wound healing has witnessed a radical advancement with the emergence of functional hydrogel-based dressings. This review article underscores the severity and importance of this transformative study in the domain of wound healing. The hydrogel matrix offers a moist and supportive environment that facilitates cellular migration, proliferation, and tissue regeneration, vital for efficient wound closure. Their conformable nature ensures patient comfort, reducing pain and uneasiness during dressing changes, particularly in chronic wounds where frequent interventions are required. Beyond their structural merits, functional hydrogel dressings possess the capability of incorporating bioactive molecules such as growth factors and antimicrobial agents. This facilitates targeted and sustained delivery of therapeutics directly to the wound site, addressing the multifactorial nature of chronic wounds and enhancing the healing trajectory. The integration of advanced nanotechnology has propelled the design of hydrogel dressings with enhanced mechanical strength and controlled drug release profiles, amplifying their therapeutic potential. In conclusion, the significance of this study lies in its ability to revolutionize wound healing practices and positively impact the lives of countless individuals suffering from chronic wounds and burns. As this transformative technology gains momentum, it holds the promise of addressing a major healthcare burden worldwide, thus heralding a new era in wound care management.

The Preparation and Clinical Efficacy of Amnion-Derived Membranes: A Review

Biological tissues from various anatomical sources have been utilized for tissue transplantation and have developed into an important source of extracellular scaffolding material for regenerative medicine applications. Tissue scaffolds ideally integrate with host tissue and provide a homeostatic environment for cellular infiltration, growth, differentiation, and tissue resolution. The human amniotic membrane is considered an important source of scaffolding material due to its 3D structural architecture and function and as a source of growth factors and cytokines. This tissue source has been widely studied and used in various areas of tissue repair including intraoral reconstruction, corneal repair, tendon repair, microvascular reconstruction, nerve procedures, burns, and chronic wound treatment. The production of amniotic membrane allografts has not been standardized, resulting in a wide array of amniotic membrane products, including single, dual, and tri-layered products, such as amnion, chorion, amnion-chorion, amnion-amnion, and amnion-chorion-amnion allografts. Since these allografts are not processed using the same methods, they do not necessarily produce the same clinical responses. The aim of this review is to highlight the properties of different human allograft membranes, present the different processing and preservation methods, and discuss their use in tissue engineering and regenerative applications.

Bandage modified with antibacterial films of quaternized chitosan & sodium carboxymethyl cellulose microgels/baicalein nanoparticles for accelerating infected wound healing

Wound dressings capable of sterilizing pathogenic bacteria and scavenging free radicals are important to inhibit bacterial invasion and accelerate wound healing. The target of this work is to develop an antibacterial dressing by modifying bandages with films composed of biological macromolecule microgels and baicalein@tannic acid (Bai@TA) nanoparticles (NPs). Firstly, hydrophobic Bai was made into water soluble Bai@TA NPs using a solvent exchange method with TA as stabilizer. Polymeric microgels of sodium carboxymethyl cellulose (CMC)&hydroxypropyltrimethyl ammonium chloride chitosan (HACC) were then prepared by a simple blending method. Further, CMC&HACC/Bai@TA multilayer films were deposited on medical bandages by using a layer-by-layer assembly technique to obtain an antibacterial dressing. The as-prepared dressings showed great antibacterial ability against E. coli, S. aureus and methicillin resistant Staphylococcus aureus (MRSA), excellent antioxidant activity and good biological safety. In addition, compared to conventional medical bandages, the dressings could efficaciously diminish inflammation in the wound, accelerate skin regeneration and functional restoration, and promote the in vivo healing speed of full-thickness skin wounds infected by MRSA. We believe that as a low-cost but effective wound dressing, the antibacterial bandage modified with CMC&HACC/Bai@TA films has potentials to replace traditional dressings in the clinical management of infected wounds.

Polymer-Based Wound Dressings Loaded with Ginsenoside Rg3

The skin, the largest organ in the human body, mainly plays a protective role. Once damaged, it can lead to acute or chronic wounds. Wound healing involves a series of complex physiological processes that require ideal wound dressings to promote it. The current wound dressings have characteristics such as high porosity and moderate water vapor permeability, but they are limited in antibacterial properties and cannot protect wounds from microbial infections, which can delay wound healing. In addition, several dressings contain antibiotics, which may have bad impacts on patients. Natural active substances have good biocompatibility; for example, ginsenoside Rg3 has anti-inflammatory, antibacterial, antioxidant, and other biological activities, which can effectively promote wound healing. Some researchers have developed various polymer wound dressings loaded with ginsenoside Rg3 that have good biocompatibility and can effectively promote wound healing and reduce scar formation. This article will focus on the application and mechanism of ginsenoside Rg3-loaded dressings in wounds.

Reusable antimicrobial antibiotic-free dressings obtained by photopolymerization

In recent years significant efforts have been made to develop new materials for wound dressing with improved healing properties. However, the synthesis methods usually employed to this end are often complex or require several steps. We describe here the synthesis and characterization of antimicrobial reusable dermatological wound dressings based on N-isopropylacrylamide co-polymerized with [2-(Methacryloyloxy) ethyl] trimethylammonium chloride hydrogels (NIPAM-co-METAC). The dressings were obtained with a very efficient single-step synthesis procedure based on visible light (455 nm) by photopolymerization. To this end, F8BT nanoparticles of the conjugated polymer (poly(9,9-dioctylfluorene-alt-benzothiadiazole) - F8BT) were used as macro-photoinitiators, and a modified silsesquioxane was employed as crosslinker. Dressings obtained by this simple and gentle method show antimicrobial and wound healing properties, without the incorporation of antibiotics or any other additives. The physical and mechanical properties of these hydrogel-based dressings were evaluated, as well as their microbiological properties, through in vitro experiments. Results show that dressings with a molar ratio of METAC of 0.5 or higher exhibit high swelling capacity, appropriate water vapor transmission rate values, stability and thermal response, high ductility and adhesiveness. In addition, biological tests showed that the dressings have significant antimicrobial capacity. The best inactivation performance was found for hydrogels synthesized with the highest METAC content. The dressings were tested several times with fresh bacterial cultures, showing a bacterial kill efficiency of 99.99 % even after three repetitions in a row, employing the same dressing, demonstrating the intrinsic bactericidal property of the materials and their reusability. In addition, the gels show low hemolytic effect, high dermal biocompatibility and noticeable wound healing effects. Overall results demonstrate that some specific hydrogel formulations have potential application as dermatological dressings for wound healing and disinfection.

Biomedical materials for wound dressing: recent advances and applications

Wound healing is vital to maintain the physiological functions of the skin. The most common treatment is the use of a dressing to cover the wound and reduce infection risk and the rate of secondary injuries. Modern wound dressings have been the top priority choice for healing various types of wounds owing to their outstanding biocompatibility and biodegradability. In addition, they also maintain temperature and a moist environment, aid in pain relief, and improve hypoxic environments to stimulate wound healing. Due to the different types of wounds, as well as the variety of advanced wound dressing products, this review will provide information on the clinical characteristics of the wound, the properties of common modern dressings, and the in vitro, in vivo as well as the clinical trials on their effectiveness. The most popular types commonly used in producing modern dressings are hydrogels, hydrocolloids, alginates, foams, and films. In addition, the review also presents the polymer materials for dressing applications as well as the trend of developing these current modern dressings to maximize their function and create ideal dressings. The last is the discussion about dressing selection in wound treatment and an estimate of the current development tendency of new materials for wound healing dressings.

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.

Research Progress on Emerging Polysaccharide Materials Applied in Tissue Engineering

The development and application of polysaccharide materials are popular areas of research. Emerging polysaccharide materials have been widely used in tissue engineering fields such as in skin trauma, bone defects, cartilage repair and arthritis due to their stability, good biocompatibility and reproducibility. This paper reviewed the recent progress of the application of polysaccharide materials in tissue engineering. Firstly, we introduced polysaccharide materials and their derivatives and summarized the physicochemical properties of polysaccharide materials and their application in tissue engineering after modification. Secondly, we introduced the processing methods of polysaccharide materials, including the processing of polysaccharides into amorphous hydrogels, microspheres and membranes. Then, we summarized the application of polysaccharide materials in tissue engineering. Finally, some views on the research and application of polysaccharide materials are presented. The purpose of this review was to summarize the current research progress on polysaccharide materials with special attention paid to the application of polysaccharide materials in tissue engineering.

Insights into the Design of Polyurethane Dressings Suitable for the Stages of Skin Wound-Healing: A Systematic Review

Dressings made with polyurethanes have been found to exhibit good and varied biological properties that make them good candidates for this application. However, as has been seen, the wound-healing process is complex, which includes four different stages. So far, the design and evaluation of polyurethane for wound dressing has focused on achieving good properties (mechanical, physicochemical, and biological), but each of them separates from the others or even directed at only one of the stages of skin wound-healing. Therefore, the aim of this systematic review is to explore the applications of polyurethanes in wound dressings and to determine whether could be designed to cover more than one stage of skin wound-healing. The PRISMA guidelines were followed. The current research in this field does not consider each stage separately, and the design of polyurethane dressings is focused on covering all the stages of wound healing with a single material but is necessary to replace polyurethanes in short periods of time. Additionally, little emphasis is placed on the hemostasis stage and further characterization of polyurethanes is still needed to correlate mechanical and physicochemical properties with biological properties at each stage of the wound-healing. Current research demonstrates an effort to characterize the materials physiochemically and mechanically, but in terms of their biological properties, most of the literature is based on the performance of histological tests of explants morphologically probing the compromised tissues, which give an indication of the potential use of polyurethanes in the generation of wound-healing dressings.

Polyurethane based hybrid ciprofloxacin-releasing wound dressings designed for skin engineering purpose

PURPOSE

Even in the 21st century, chronic wounds still pose a major challenge due to potentially inappropriate treatment options, so the latest wound dressings are hybrid systems that enable clinical management, such as a hybrid of hydrogels, antibiotics and polymers. These wound dressings are mainly used for chronic and complex wounds, which can easily be infected by bacteria.

MATERIALS AND METHODS

Six Composite Porous Matrices (CPMs) based on polyurethane (PUR) in alliance with polylactide (PLAs) and poly(vinyl alcohol) (PVA) were prepared and analyzed using optical microscopy. Three different types of hydrogels and their Ciprofloxacin (Cipro) modified variants' ratios were prepared and analyzed using FTIR, SEM and EDX techniques. Six Hybrid Cipro-Releasing Hydrogel Wound Dressings (H-CRWDs) were also prepared and underwent short-term degradation, Cipro release, microbiology and cell viability measurements.

RESULTS

Average porosity of CPMs was in the range of 69-81%. The pore size of the obtained CPMs was optimal for skin regeneration. Short-term degradation studies revealed degradability in physiological conditions regardless of sample type. A meaningful release was also observed even in short time (21.76 ​± ​0.64 ​μg/mL after 15 ​min). Microbiological tests showed visible inhibition zones. Cell viability tests proved that the obtained H-CRWDs were biocompatible (over 85% of cells).

CONCLUSIONS

A promising hybrid wound dressing was labeled. Simple and cost-effective methods were used to obtain microbiologically active and biocompatible dressings. The results were of importance for the design and development of acceptable solutions in the management of chronic wounds of high potential for infection.

Recent Progress in Development of Dressings Used for Diabetic Wounds with Special Emphasis on Scaffolds

Diabetic wound (DW) is a secondary application of uncontrolled diabetes and affects about 42.2% of diabetics. If the disease is left untreated/uncontrolled, then it may further lead to amputation of organs. In recent years, huge research has been done in the area of wound dressing to have a better maintenance of DW. These include gauze, films, foams or, hydrocolloid-based dressings as well as polysaccharide- and polymer-based dressings. In recent years, scaffolds have played major role as biomaterial for wound dressing due to its tissue regeneration properties as well as fluid absorption capacity. These are three-dimensional polymeric structures formed from polymers that help in tissue rejuvenation. These offer a large surface area to volume ratio to allow cell adhesion and exudate absorbing capacity and antibacterial properties. They also offer a better retention as well as sustained release of drugs that are directly impregnated to the scaffolds or the ones that are loaded in nanocarriers that are impregnated onto scaffolds. The present review comprehensively describes the pathogenesis of DW, various dressings that are used so far for DW, the limitation of currently used wound dressings, role of scaffolds in topical delivery of drugs, materials used for scaffold fabrication, and application of various polymer-based scaffolds for treating DW.

How Effective are Nano-Based Dressings in Diabetic Wound Healing? A Comprehensive Review of Literature

Chronic wound caused by diabetes is an important cause of disability and seriously affects the quality of life of patients. Therefore, it is of great clinical significance to develop a wound dressing that can accelerate the healing of diabetic wounds. Nanoparticles have great advantages in promoting diabetic wound healing due to their antibacterial properties, low cytotoxicity, good biocompatibility and drug delivery ability. Adding nanoparticles to the dressing matrix and using nanoparticles to deliver drugs and cytokines to promote wound healing has proven to be effective. This review will focus on the effects of diabetes on wound healing, introduce the properties, preparation methods and action mechanism of nanoparticles in wound healing, and describe the effects and application status of various nanoparticle-loaded dressings in diabetes-related chronic wound healing.

ELECTROSPUN SODIUM ALGINATE/POLY(ETHYLENE OXIDE) NANOFIBERS FOR WOUND HEALING APPLICATIONS: CHALLENGES AND FUTURE DIRECTIONS

Alginate is an interesting natural biopolymer to be considered for biomedical applications due to its advantages and good biological properties. These biological properties make electrospun alginate nanofibers suitable for various uses in the biomedical field, such as wound healing dressings, drug delivery systems, or both. Unfortunately, the fabrication of alginate nanofibers by electrospinning is very challenging because of the high viscosity of the solution, high surface tension and rigidity in water due to hydrogen bonding, and also their diaxial linkages. This review presents an overview of the factors affecting the electrospinning process of sodium alginate/poly(ethylene oxide) (SA/PEO), the application of SA/PEO in drug delivery systems for wound healing applications, and the degradation and swelling properties of SA/PEO. The challenges and future directions of SA/PEO in the medical field are also discussed.

Evaluation of a Multifunctional Polyvinylpyrrolidone/Hyaluronic Acid-Based Bilayer Film Patch with Anti-Inflammatory Properties as an Enhancer of the Wound Healing Process

The management of acute and chronic wounds is still a socioeconomic burden for society due to the lack of suitable tools capable of supporting all the healing phases. The exponential spread of diabetes worldwide and the consequent increase of complicated diabetic ulcers require further efforts to develop scalable, low-cost, and easy-to-use treatments for tackling this emergency. Recently, we explored the fabrication of a polyvinylpyrrolidone/hyaluronic acid-based bilayer wound dressing, characterizing its physicochemical features and detailing its excellent antimicrobial activity. Here, we further demonstrate its biocompatibility on fibroblasts, keratinocytes, and red blood cells. The bilayer shows anti-inflammatory properties, statistically reducing the level of IL-6, IL-1β, and TNF-α, and a capacity to accelerate wound healing in vitro and in healthy and diabetic mice models compared to untreated mice. The outcomes suggest that this bilayer material can be an effective tool for managing different skin injuries.

ANTIPSEUDOMONAL ACTIVITY OF METABOLIC COMPLEXES OF L. RHAMNOSUS GG AND S. BOULARDII AGAINST THE POLYRESISTENT PATHOGEN IN IN VITRO AND IN VIVO TESTS

OBJECTIVE

The aim: Explore the antimicrobial properties of lactobacilli's metabolites and combination of lactobacilli's and saccharomycetes' metabolites with different concentrations (in vitro) and to test the effectiveness of samples with minimum inhibitory concentration on infected polyresistant strain P. aeruginosa skin wounds (in vivo) for the possibility of creating prophylactic antimicrobial agents.

PATIENTS AND METHODS

Materials and methods: Metabolic complexes (L. rhamnosus GG and S. boulardi) were obtained by culturing lactobacilli or lactobacilli and saccharomycetes in lactobacilli disintegrates. The sensitivity of Pseudomonas aeruginosa PR (in vitro) to them was determined by the microtechnique of serial dilutions in a liquid nutrient medium. In vivo, 0.9 % sodium chloride solution (control) or lactobacillus metabolic complex (experiment, treatment group) was applied to infected skin wounds or, in addition, immediately before the infection, to the wound and then to infected wounds (experiment, prophylactic-treatment group).

RESULTS

Results: There was observed the decrease of the infectious process of skin wounds in the prophylactic-treatment group (3.25-3.4 times; p=0.01 related to control samples) compared with the treatment group (2.05-2.25 times; p=0.02) by the wound healing rate (day 5). The healing rate of control wounds (day 11) coincided with the rates of experimental wounds in the prophylactic-treatment group (day 8), indicating that the use of lactobacilli metabolites promotes the acceleration of healing by almost three days.

CONCLUSION

Conclusions: Metabolic complexes of probiotic microorganisms are promising for construction on their new class of antimicrobials for the effective pharmacoprophylaxis and pharmacotherapy.

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.

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.

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.

Polymer-Based Scaffolds Loaded with Aloe vera Extract for the Treatment of Wounds

The treatment of wounds is one challenging biomedical field due to delayed wound healing common in chronic wounds. Several factors delay wound healing, including microbial infections, malnutrition, underlying physiological conditions, etc. Most of the currently used wound dressing materials suffer from poor antimicrobial properties, poor biodegradability and biocompatibility, and weak mechanical performance. Plant extracts, such as Aloe vera, have attracted significant attention in wound management because of their interesting biological properties. Aloe vera is composed of essential constituents beneficial for the wound healing process, such as amino acids, vitamins C and E, and zinc. Aloe vera influences numerous factors that are involved in wound healing and stimulates accelerated healing. This review reports the therapeutic outcomes of aloe vera extract-loaded polymer-based scaffolds in wound management.

Bioaerogels: Promising Nanostructured Materials in Fluid Management, Healing and Regeneration of Wounds

Wounds affect one's quality of life and should be managed on a patient-specific approach, based on the particular healing phase and wound condition. During wound healing, exudate is produced as a natural response towards healing. However, excessive production can be detrimental, representing a challenge for wound management. The design and development of new healing devices and therapeutics with improved performance is a constant demand from the healthcare services. Aerogels can combine high porosity and low density with the adequate fluid interaction and drug loading capacity, to establish hemostasis and promote the healing and regeneration of exudative and chronic wounds. Bio-based aerogels, i.e., those produced from natural polymers, are particularly attractive since they encompass their intrinsic chemical properties and the physical features of their nanostructure. In this work, the emerging research on aerogels for wound treatment is reviewed for the first time. The current scenario and the opportunities provided by aerogels in the form of films, membranes and particles are identified to face current unmet demands in fluid managing and wound healing and regeneration.

Modifications of Wound Dressings with Bioactive Agents to Achieve Improved Pro-Healing Properties

The great variety of wounds and the lack of an effective universal treatment method has resulted in high demand for modern treatment strategies. Traditional approaches are often ineffective on a variety of chronic wounds, such as venous ulcers or the diabetic foot ulcer. There is strong evidence that naturally derived bioactive compounds have pro-healing properties, raising a great interest in their potential use for wound healing. Plant-derived compounds, such as curcumin and essential oils, are widely used to modify materials applied as wound dressings. Moreover, dressing materials are more often enriched with vitamins (e.g., L-ascorbic acid, tocopherol) and drugs (e.g., antibiotics, inhibitors of proteases) to improve the skin healing rate. Biomaterials loaded with the above-mentioned molecules show better biocompatibility and are basically characterized by better biological properties, ensuring faster tissue repair process. The main emphasis of the presented review is put on the novel findings concerning modern pro-healing wound dressings that have contributed to the development of regenerative medicine. The article briefly describes the synthesis and modifications of biomaterials with bioactive compounds (including curcumin, essential oils, vitamins) to improve their pro-healing properties. The paper also summarizes biological effects of the novel wound dressings on the enhancement of skin regeneration. The current review was prepared based on the scientific contributions in the PubMed database (supported with Google Scholar searching) over the past 5 years using relevant keywords. Scientific reports on the modification of biomaterials using curcumin, vitamins, and essential oils were mainly considered.

Effect of Crosslinking Type on the Physical-Chemical Properties and Biocompatibility of Chitosan-Based Electrospun Membranes

Chitosan nanofibrous membranes are prepared via an electrospinning technique and explored as potential wound healing patches. In particular, the effect of a physical or chemical crosslinking treatment on the mat morphological, mechanical, water-related, and biological properties is deeply evaluated. The use of phosphate ions (i.e., physical crosslinking) allows us to obtain smooth and highly homogenous nanofibers with an average size of 190 nm, whereas the use of ethylene glycol diglycidyl ether (i.e., chemical crosslinking) leads to rougher, partially coalesced, and bigger nanofibers with an average dimension of 270 nm. Additionally, the physically crosslinked mats show enhanced mechanical performances, as well as greater water vapour permeability and hydrophilicity, with respect to the chemically crosslinked ones. Above all, cell adhesion and cytotoxicity experiments demonstrate that the use of phosphate ions as crosslinkers significantly improves the capability of chitosan mats to promote cell viability owing to their higher biocompatibility. Moreover, tuneable drug delivery properties are achieved for the physically crosslinked mats by a simple post-processing impregnation methodology, thereby indicating the possibility to enrich the prepared membranes with unique features. The results prove that the proposed approach may lead to the preparation of cheap, biocompatible, and efficient chitosan-based nanofibers for biomedical and pharmaceutical applications.

From Grafts to Human Bioengineered Vascularized Skin Substitutes

The skin plays an important role in the maintenance of the human's body physiological homeostasis. It acts as a coverage that protects against infective microorganism or biomechanical impacts. Skin is also implied in thermal regulation and fluid balance. However, skin can suffer several damages that impede normal wound-healing responses and lead to chronic wounds. Since the use of autografts, allografts, and xenografts present source limitations and intense rejection associated problems, bioengineered artificial skin substitutes (BASS) have emerged as a promising solution to address these problems. Despite this, currently available skin substitutes have many drawbacks, and an ideal skin substitute has not been developed yet. The advances that have been produced on tissue engineering techniques have enabled improving and developing new arising skin substitutes. The aim of this review is to outline these advances, including commercially available skin substitutes, to finally focus on future tissue engineering perspectives leading to the creation of autologous prevascularized skin equivalents with a hypodermal-like layer to achieve an exemplary skin substitute that fulfills all the biological characteristics of native skin and contributes to wound healing.

Skin wound healing assisted by angiogenic targeted tissue engineering: A comprehensive review of bioengineered approaches

Skin injuries and in particular, chronic wounds, are one of the major prevalent medical problems, worldwide. Due to the pivotal role of angiogenesis in tissue regeneration, impaired angiogenesis can cause several complications during the wound healing process and skin regeneration. Therefore, induction or promotion of angiogenesis can be considered as a promising approach to accelerate wound healing. This article presents a comprehensive overview of current and emerging angiogenesis induction methods applied in several studies for skin regeneration, which are classified into the cell, growth factor, scaffold, and biological/chemical compound-based strategies. In addition, the advantages and disadvantages of these angiogenic strategies along with related research examples are discussed in order to demonstrate their potential in the treatment of wounds.

Bioactive Glasses: A Promising Therapeutic Ion Release Strategy for Enhancing Wound Healing

The morbidity, mortality, and burden of burn victims and patients with severe diabetic wounds are still high, which leads to an extensively growing demand for novel treatments with high clinical efficacy. Biomaterial-based wound treatment approaches have progressed over time from simple cotton wool dressings to advanced skin substitutes containing cells and growth factors; however, no wound care approach is yet completely satisfying. Bioactive glasses are materials with potential in many areas that exhibit unique features in biomedical applications. Today, bioactive glasses are not only amorphous solid structures that can be used as a substitute in hard tissue but also are promising materials for soft tissue regeneration and wound healing applications. Biologically active elements such as Ag, B, Ca, Ce, Co, Cu, Ga, Mg, Se, Sr, and Zn can be incorporated in glass networks; hence, the superiority of these multifunctional materials over current materials results from their ability to release multiple therapeutic ions in the wound environment, which target different stages of the wound healing process. Bioactive glasses and their dissolution products have high potency for inducing angiogenesis and exerting several biological impacts on cell functions, which are involved in wound healing and some other features that are valuable in wound healing applications, namely hemostatic and antibacterial properties. In this review, we focus on skin structure, the dynamic process of wound healing in injured skin, and existing wound care approaches. The basic concepts of bioactive glasses are reviewed to better understand the relationship between glass structure and its properties. We illustrate the active role of bioactive glasses in wound repair and regeneration. Finally, research studies that have used bioactive glasses in wound healing applications are summarized and the future trends in this field are elaborated.

A carrageenan/agarose composite sponge and its immunomodulatory activities toward RAW264.7

A kind of commercial hybrid carrageenan (HC)/agarose composite sponge containing κ-, μ-, ι-, and ν-carrageenan, which could turn into hydrogel and release carrageenan at human body temperature was fabricated for immune stimulation and modulation. Release behavior demonstrated that the hybrid carrageenan contained sponge was mechanically stable and could release carrageenan constantly. RT-PCR and ELISA experiments showed that the leaching liquor of the sponge could stimulate RAW264.7 from M0 state to a polarized state by secreting more anti-inflammatory factor IL-10 than pro-inflammatory ones, such as, IL-6 and TNF-α. Transwell experiments also indicated that the leaching liquor could promote the proliferation of NIH-3T3 by stimulating RAW264.7 of M0 state after 7 days. Results of particle size and intracellular concentration analyses suggested that the released carrageenan might enter into the cellular interior of RAW264.7 in the form of microgels or protein complexes. The sponge would be a promising candidate for skin wound dressing.

Bringing Safe and Standardized Cell Therapies to Industrialized Processing for Burns and Wounds

Cultured primary progenitor cell types are worthy therapeutic candidates for regenerative medicine. Clinical translation, industrial transposition, and commercial implementation of products based on such cell sources are mainly hindered by economic or technical barriers and stringent regulatory requirements. Applied research in allogenic cellular therapies in the Lausanne University Hospital focuses on cell source selection technique optimization. Use of fetal progenitor cell sources in Switzerland is regulated through Federal Transplantation Programs and associated Fetal Biobanks. Clinical applications of cultured primary progenitor dermal fibroblasts have been optimized since the 1990s as “Progenitor Biological Bandages” for pediatric burn patients and adults presenting chronic wounds. A single organ donation procured in 2009 enabled the establishment of a standardized cell source for clinical and industrial developments to date. Non-enzymatically isolated primary dermal progenitor fibroblasts (FE002-SK2 cell type) served for the establishment of a clinical-grade Parental Cell Bank, based on a patented method. Optimized bioprocessing methodology for the FE002-SK2 cell type has demonstrated that extensive and consistent progenitor cell banks can be established. In vitro mechanistic characterization and in vivo preclinical studies have confirmed potency, preliminary safety and efficacy of therapeutic progenitor cells. Most importantly, highly successful industrial transposition and up-scaling of biobanking enabled the establishment of tiered Master and Working Cell Banks using Good Manufacturing Practices. Successive and successful transfers of technology, know-how and materials to different countries around the world have been performed. Extensive developments based on the FE002-SK2 cell source have led to clinical trials for burns and wound dressing. Said trials were approved in Japan, Taiwan, USA and are continuing in Switzerland. The Swiss Fetal Transplantation Program and pioneer clinical experience in the Lausanne Burn Center over three decades constitute concrete indicators that primary progenitor dermal fibroblasts should be considered as therapeutic flagships in the domain of wound healing and for regenerative medicine in general. Indeed, one single organ donation potentially enables millions of patients to benefit from high-quality, safe and effective regenerative therapies. This work presents a technical and translational overview of the described progenitor cell technology harnessed in Switzerland as cellular therapies for treatment of burns and wounds around the globe.

Synthesis, characterization, and their some chemical and biological properties of PVA/PAA/nPS hydrogel nanocomposites: Hydrogel and wound dressing

The nanocomposite hydrogels were prepared by dispersing of the nanopomegranate seed particles into poly(vinyl alcohol)/poly(acrylic acid) blend matrix in an aqueous medium by the solvent casting method. These hydrogels were characterized using scanning electron microscopy, Fourier transform infrared spectra, differential scanning calorimetry, and optical contact angle instruments. The nanopomegranate seed, blend, and hydrogel nanocomposites were tested for microbial activity. In addition, cytocompatibilities of these blend and hydrogel nanocomposites/composites were tested on human lymphocyte with in vitro MTS cell viability assays. Fourier transform infrared spectra revealed that esterification reaction took place among functional groups in the structure of poly(vinyl alcohol) and poly(acrylic acid). The hydrophilic properties of all hydrogels decreased with increasing nanopomegranate seed content. The mean diameters of the nanopomegranate seed particles were about 88 nm. Nanopomegranate seed particles demonstrated antibacterial properties against gram-positive bacteria, Staphylococcus aureus, and gram-negative bacteria, Escherichia coli. The lymphocyte viabilities increased after addition of nanopomegranate seeds into the polymer blend. The swelling behavior of blend and hydrogels was dependent on the cross-linking density created by the reaction between poly(vinyl alcohol)/poly(acrylic acid) blend and nanopomegranate seed. Scanning electron microscopy images were highly consistent with Fourier transform infrared spectra, differential scanning calorimetry, and antibacterial activity results.

Selection of Appropriate Wound Dressing for Various Wounds

There are many factors involved in wound healing, and the healing process is not static. The therapeutic effect of modern wound dressings in the clinical management of wounds is documented. However, there are few reports regarding the reasonable selection of dressings for certain types of wounds in the clinic. In this article, we retrospect the history of wound dressing development and the classification of modern wound dressings. In addition, the pros and cons of mainstream modern wound dressings for the healing of different wounds, such as diabetic foot ulcers, pressure ulcers, burns and scalds, and chronic leg ulcers, as well as the physiological mechanisms involved in wound healing are summarized. This article provides a clinical guideline for selecting suitable wound dressings according to the types of wounds.

Treatment of Coral Wounds by Combining an Antiseptic Bilayer Film and an Injectable Antioxidant Biopolymer

Coral reefs are vital for the marine ecosystem and their potential disappearance can have unequivocal consequences on our environment. Aside from pollution-related threats (changes in water temperature, plastics, and acidity), corals can be injured by diseases, predators, humans and other invasive species. Diseases play an important role in this decline, but so far very few mitigation strategies have been proposed and developed to control this threat. In this work, we demonstrate that recently developed bi-layer human skin wound treatment patches containing antiseptics and natural antioxidants with controlled-release capacity can be adapted to treat scleractinian coral wounds effectively. A hydrophilic bilayer film based on polyvinylpyrrolidone (PVP) and hyaluronic acid was used to cover the open wounds while delivering the antiseptics for rapid action. Afterwards, the hydrophilic bi-layer covered wound was sealed with an antioxidant and hydrophobic ε-caprolactone-p-coumaric acid copolymer by melt injection at low temperatures. Treated coral injuries were monitored both in aquaria system and in natural environment in Maldives for over 4 months to reduce the number of entry points for organisms that could lead to diseases. The corals well-tolerated both biomaterials as well as the antiseptics incorporated in these materials. The treatments displayed self-adhering properties, tuneable dissolution time, and biocompatibility and stimulated regeneration properties within the coral wound. As such, this work demonstrates that certain human skin wound treatment materials can be successfully adapted to the curing of coral wounds and delivery of specific drugs to slow down, reduce or even stop the spread of diseases in scleractinian corals as well as in all other benthic organisms affected by uncontrolled pathologies.

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

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

Evolution of Biological Bandages as First Cover for Burn Patients

Significance: Cutaneous wound regeneration is vital to keep skin functions and for large wounds, to maintain human survival. In a deep burn, the ability of the skin to heal is compromised due to the damage of vasculature and resident cells, hindering a coordinated response in the regeneration process. Temporal skin substitutes used as first cover can play a major role in skin regeneration as they allow a rapid wound covering that, in turn, can significantly reduce infection risk, rate of secondary corrective surgeries, and indirectly hospitalization time and costs. Recent Advances: Skin was one of the first tissues to be bioengineered providing thus a skin equivalent; however, what is the current status subsequent to 40 years of tissue engineering? We review the classic paradigms of biological skin substitutes used as first cover and evaluate recent discoveries and clinical approaches adapted for burn injuries cover, with an emphasis on innovative cell-based approaches. Critical Issues: Cell-based first covers offer promising perspectives as they can have an active function in wound healing, such as faster healing minimizing scar formation and prepared wound bed for subsequent grafting. However, cell-based therapies encounter some limitations due to regulatory hurdles, as they are considered as "Advanced Therapy Medicinal Products," which imposes the same industry-destined good manufacturing practices as for pharmaceutical products and biological drug development. Future Directions: Further improvements in clinical outcome can be expected principally with the use of cell-based therapies; however, hospital exemptions are necessary to assure accessibility to the patient and safety without hindering advances in therapies.

Cryostructuring of Polymeric Systems. 52. Properties, Microstructure and an Example of a Potential Biomedical Use of the Wide-Pore Alginate Cryostructurates

Wide-pore cryostructurates were prepared via freezing sodium alginate aqueous solutions with subsequent ice sublimation from the frozen samples, followed by their incubation in the ethanol solutions of calcium chloride or sulfuric acid, rinsing, and final drying. Such sequence of operations resulted in the calcium alginate or alginic acid sponges, respectively. The swelling degree of the walls of macropores in such matrices decreased with increasing polymer concentration in the initial solution. The dependence of the degree of swelling on the cryogenic processing temperature had a bell-like character with a maximum for the samples formed at -20 °C. According to 1H NMR spectroscopy, the content of mobile (non-frozen) water in the frozen water-sodium alginate systems also depended on the initial polymer concentration and freezing temperature. The cryostructurates obtained did not lose their integrity in water, saline, in an acidic medium at pH 2 for at least three weeks. Under alkaline conditions at pH 12 the first signs of dissolution of the Ca-alginate sponge arose only after a week of incubation. Microbiological testing of the model depot form of the antibiotics entrapped in the Ca-alginate cryostructurate demonstrated the efficiency of this system as the antibacterial material.