Topical hydrogen peroxide treatment of ischemic ulcers in the guinea pig: blood recruitment in multiple skin sites

CAPE derivatives: Multifaceted agents for chronic wound healing

Chronic wounds significantly impact the patients' quality of life, creating an urgent interdisciplinary clinical challenge. The development of novel agents capable of accelerating the healing process is essential. Caffeic acid phenethyl ester (CAPE) has demonstrated positive effects on skin regeneration. However, its susceptibility to degradation limits its pharmaceutical application. Chemical modification of the structure improves the pharmacokinetics of this bioactive phenol. Hence, two novel series of CAPE hybrids were designed, synthesized, and investigated as potential skin regenerative agents. To enhance the stability and therapeutic efficacy, a caffeic acid frame was combined with quinolines or isoquinolines by an ester (1a-f) or an amide linkage (2a-f). The effects on cell viability of human gingival fibroblasts (HGFs) and HaCaT cells were evaluated at different concentrations; they are not cytotoxic, and some proved to stimulate cell proliferation. The most promising compounds underwent a wound-healing assay in HGFs and HaCaT at the lowest concentrations. Antimicrobial antioxidant properties were also explored. The chemical and thermal stabilities of the best compounds were assessed. In silico predictions were employed to anticipate skin penetration capabilities. Our findings highlight the therapeutic potential of caffeic acid phenethyl ester (CAPE) derivatives 1a and 1d as skin regenerative agents, being able to stimulate cell proliferation, control bacterial growth, regulate ROS levels, and being thermally and chemically stable. An interesting structure-activity relationship was discussed to suggest a promising multitargeted approach for enhanced wound healing.

Oxidative stress responses in biofilms

Oxidizing agents are low-molecular-weight molecules that oxidize other substances by accepting electrons from them. They include reactive oxygen species (ROS), such as superoxide anions (O2-), hydrogen peroxide (H2O2), and hydroxyl radicals (HO-), and reactive chlorine species (RCS) including sodium hypochlorite (NaOCl) and its active ingredient hypochlorous acid (HOCl), and chloramines. Bacteria encounter oxidizing agents in many different environments and from diverse sources. Among them, they can be produced endogenously by aerobic respiration or exogenously by the use of disinfectants and cleaning agents, as well as by the mammalian immune system. Furthermore, human activities like industrial effluent pollution, agricultural runoff, and environmental activities like volcanic eruptions and photosynthesis are also sources of oxidants. Despite their antimicrobial effects, bacteria have developed many mechanisms to resist the damage caused by these toxic molecules. Previous research has demonstrated that growing as a biofilm particularly enhances bacterial survival against oxidizing agents. This review aims to summarize the current knowledge on the resistance mechanisms employed by bacterial biofilms against ROS and RCS, focussing on the most important mechanisms, including the formation of biofilms in response to oxidative stressors, the biofilm matrix as a protective barrier, the importance of detoxifying enzymes, and increased protection within multi-species biofilm communities. Understanding the complexity of bacterial responses against oxidative stress will provide valuable insights for potential therapeutic interventions and biofilm control strategies in diverse bacterial species.

Shengjihuayu formula ameliorates the oxidative injury in human keratinocytes via blocking JNK/c-Jun/MMPs signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

The reactive oxygen species (ROS) surge in the chronic wound tissue of diabetic ulcers (DUs) aggravates the inflammatory response. The oxidative stress state during inflammation will exacerbate inflammation and cause tissue damage, resulting in prolonged wound healing. Shengjihuayu Formula (SJHYF) is a renowned Chinese medicine prescription for treating chronic wounds in diabetic ulcers. Growing clinical evidence has demonstrated that SJHYF exhibits superior therapeutic efficacy and has a favorable safety profile. However, the underlying mechanisms by which SJHYF ameliorates oxidative damage under pathological conditions of DUs remain unclear.

OBJECTIVE

To investigate the cytoprotective properties of SJHYF on hydrogen peroxide (H2O2)-induced cell damage in human HaCaT keratinocytes and to explore its potential targets and molecular pathways in treating DUs using RNA-seq.

METHODS

HaCaT cells were incubated with H2O2 for 24 h to construct an oxidative stress cell model. Cell viability and proliferation were measured using the MTT and EdU assays, respectively. Cell migration was assessed using the scratch assay, and the fluorescence intensity of ROS was measured using the DCFH-DA probe. The chemical components of SJHYF were analyzed by UPLC-Q-TOF/MS, while the therapeutic effects of SJHYF on H2O2-induced HaCaT cells were analyzed using RNA-Seq. The potential target genes were validated using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). At the same time, the pathway phenotype expression of SJHYF on the protection of H2O2-induced HaCaT cells was explored using Western Blot.

RESULTS

The application of SJHY at a concentration of 0.25 mg/mL promoted cell proliferation, cell migration, and reduced ROS production. In addition, SJHYF was detected to have a total of 93 active compounds, including key components such as Galloyl-beta-D-glucose, Danshensu, Procyanidin B2, Catechin, and Alkannin. The RNA-seq analysis identified several core targets namely KRT17, TGM1, JUNB, PRDX5, TXNIP, PRDX1, HSP90AA1, HSP90AB1, HSPA8, and TNF-α. Western blot revealed the presence of the JNK/c-Jun/MMPs pathway and its related transcription factors.

CONCLUSION

SJHYF displays significant protective effects on H2O2-induced oxidative cell damage in HaCaT cells via blocking the JNK/c-Jun/MMPs pathway.

Gas Plasma Exposure Alters Microcirculation and Inflammation during Wound Healing in a Diabetic Mouse Model

Diabetes can disrupt physiological wound healing, caused by decreased levels or impaired activity of angiogenic factors. This can contribute to chronic inflammation, poor formation of new blood vessels, and delayed re-epithelialization. The present study describes the preclinical application of medical gas plasma to treat a dermal, full-thickness ear wound in streptozotocin (STZ)-induced diabetic mice. Gas plasma-mediated effects occurred in both sexes but with gender-specific differences. Hyperspectral imaging demonstrated gas plasma therapy changing microcirculatory parameters, particularly oxygen saturation levels during wound healing, presumably due to the gas plasma's tissue delivery of reactive species and other bioactive components. In addition, gas plasma treatment significantly affected cell adhesion by regulating focal adhesion kinase and vinculin, which is important in maintaining skin barrier function by regulating syndecan expression and increasing re-epithelialization. An anticipated stimulation of blood vessel formation was detected via transcriptional and translational increase of angiogenic factors in gas plasma-exposed wound tissue. Moreover, gas plasma treatment significantly affected inflammation by modulating systemic growth factors and cytokine levels. The presented findings may help explain the mode of action of successful clinical plasma therapy of wounds of diabetic patients.

The initiation of oxidative stress and therapeutic strategies in wound healing

When the production of reactive oxygen species (ROS) is overloaded surpassing the capacity of the reductive rheostat, mammalian cells undergo a series of oxidative damage termed oxidative stress (OS). This phenomenon is ubiquitously detected in many human pathological conditions. Wound healing program implicates continuous neovascularization, cell proliferation, and wound remodeling. Increasing evidence indicates that reactive oxygen species (ROS) have profound impacts on the wound healing process through regulating a series of the physiological and pathological program including inflammatory response, cell proliferation, angiogenesis, granulation as well as extracellular matrix formation. In most pathological wound healing processes, excessive ROS exerts a negative role on the wound healing process. Interestingly, the moderate increase of ROS levels is beneficial in killing bacteria at the wound site, which creates a sterile niche for revascularization. In this review, we discussed the physiological rhythms of wound healing and the role of ROS in this progress, aim to explore the potential manipulation of OS as a promising therapeutic avenue.

Accelerating skin regeneration and wound healing by controlled ROS from photodynamic treatment

Cellular metabolisms produce reactive oxygen species (ROS) which are essential for cellular signaling pathways and physiological functions. Nevertheless, ROS act as “double-edged swords” that have an unstable redox balance between ROS production and removal. A little raise of ROS results in cell proliferation enhancement, survival, and soft immune responses, while a high level of ROS could lead to cellular damage consequently protein, nucleic acid, and lipid damages and finally cell death. ROS play an important role in various pathological circumstances. On the contrary, ROS can show selective toxicity which is used against cancer cells and pathogens. Photodynamic therapy (PDT) is based on three important components including a photosensitizer (PS), oxygen, and light. Upon excitation of the PS at a specific wavelength, the PDT process begins which leads to ROS generation. ROS produced during PDT could induce two different pathways. If PDT produces control and low ROS, it can lead to cell proliferation and differentiation. However, excess production of ROS by PDT causes cellular photo damage which is the main mechanism used in cancer treatment. This review summarizes the functions of ROS in living systems and describes role of PDT in production of controllable ROS and finally a special focus on current ROS-generating therapeutic protocols for regeneration and wound healing.

Animal experimental models of ischemic wounds - A review of literature

Critical limb ischemia is a serious form of peripheral arterial disease (PAD). The consequences of lower limb ischemia are pain, claudication and chronic non-healing wounds. Patients with diabetes are especially at a high risk for developing non-healing ulcers. The most serious complication is major amputation. For this reason, there is a significant medical requirement to develop new therapies in order to prevent the progression of PAD. For research purposes, it is crucial to find an appropriate model of chronic ischemia to explore the processes of wound healing. According to recently acquired information, rodents are currently the most commonly used animals in these types of studies. The main advantage of using small animals is the low financial cost due to the relatively small demand for food, water and living space. The disadvantage is their anatomy, which is different from that of humans. Larger animals have a more human-like anatomy and physiology, but they require more expense and space for housing. A bipedicle skin flap and its modifications are popular models for ischemic wounds. In order to secure healing through re-epithelisation, as opposed to contraction in rodents, there is a need to remove the panniculus carnosus muscle. Wounds in other experimental animals heal primarily through re-epithelisation. The application of a silicone mesh underneath the flap prevents vascular regrowth in ischemic tissue. There is an ongoing effort to create in vivo diabetic models for chronic ulcer research. This work presents an overview of existing animal models of ischemic wounds.

The innate immune system and fever under redox control: A Narrative Review

ABSTRACT:

In living cells, redox potential is vitally important for normal physiological processes that are closely regulated by antioxidants, free amino acids and proteins that either have reactive oxygen and nitrogen species capture capability or can be compartmentalized. Although hundreds of experiments support the regulatory role of free radicals and their derivatives, several authors continue to claim that these perform only harmful and non-regulatory functions. In this paper we show that countless intracellular and extracellular signal pathways are directly or indirectly linked to regulated redox processes. We also briefly discuss how artificial oxidative stress can have important therapeutic potential and the possible negative effects of popular antioxidant supplements.

Dissolved oxygen technologies as a novel strategy for non-healing wounds: A critical review

Non-healing wounds are steadily becoming a global-health issue. Prolonged hypoxia propagates wound chronicity; yet, oxygenating treatments are considered inadequate to date. Dissolved oxygen (DO) in aqueous solutions introduces a novel approach to enhanced wound oxygenation, and is robustly evaluated for clinical applications. A systematic literature search was conducted, whereby experimental and clinical studies of DO technologies were categorized per engineering approach. Technical principles, methodology, endpoints and outcomes were analysed for both oxygenating and healing effects. Forty articles meeting our inclusion criteria were grouped as follows: DO solutions (17), oxygen (O₂ ) dressings (9), O₂ hydrogels (11) and O₂ emulsions (3). All technologies improved wound oxygenation, each to a variable degree. They also achieved at least one statistically significant outcome related to wound healing, mainly in epithelialization, angiogenesis and collagen synthesis. Scarcity in clinical data and methodological variability precluded quantitative comparisons among the biotechnologies studied. DO technologies warrantee further evaluation for wound oxygenation in the clinical setting. Standardised methodologies and targeted research questions are pivotal to facilitate global integration in healthcare.

Reactive oxygen species (ROS): utilizing injectable antioxidative hydrogels and ROS-producing therapies to manage the double-edged sword

Reactive oxygen species (ROS) are generated in cellular metabolism and are essential for cellular signalling networks and physiological functions. However, the functions of ROS are 'double-edged swords' to living systems that have a fragile redox balance between ROS generation and elimination. A modest increase of ROS leads to enhanced cell proliferation, survival and benign immune responses, whereas ROS stress that overwhelms the cellular antioxidant capacity can damage nucleic acids, proteins and lipids, resulting in oncogenic mutations and cell death. ROS are therefore involved in many pathological conditions. On the other hand, ROS present selective toxicity and have been utilised against cancer and pathogens, thus also acting as a double-edged sword in the healthcare field. Injectable antioxidative hydrogels are gel precursors that form hydrogel constructs in situ upon delivery in vivo to maintain an antioxidative capacity. These hydrogels have been developed to counter ROS-induced pathological conditions, with significant advantages of biocompatibility, excellent moldability, and minimally invasive delivery. The intrinsic, readily controllable ROS-scavenging ability of the functionalised hydrogels overcomes many drawbacks of small molecule antioxidants. This review summarises the roles of ROS under pathological conditions and describes the state-of-the-art of injectable antioxidative hydrogels. A particular emphasis is also given to current ROS-producing therapeutic interventions, enabling potential application of injectable antioxidant hydrogels to prevent the adverse effects of many cancer and infection treatments.

Raising the 'Good' Oxidants for Immune Protection

Redox medicine is a new therapeutic concept targeting reactive oxygen species (ROS) and secondary reaction products for health benefit. The concomitant function of ROS as intracellular second messengers and extracellular mediators governing physiological redox signaling, and as damaging radicals instigating or perpetuating various pathophysiological conditions will require selective strategies for therapeutic intervention. In addition, the reactivity and quantity of the oxidant species generated, its source and cellular location in a defined disease context need to be considered to achieve the desired outcome. In inflammatory diseases associated with oxidative damage and tissue injury, ROS source specific inhibitors may provide more benefit than generalized removal of ROS. Contemporary approaches in immunity will also include the preservation or even elevation of certain oxygen metabolites to restore or improve ROS driven physiological functions including more effective redox signaling and cell-microenvironment communication, and to induce mucosal barrier integrity, eubiosis and repair processes. Increasing oxidants by host-directed immunomodulation or by exogenous supplementation seems especially promising for improving host defense. Here, we summarize examples of beneficial ROS in immune homeostasis, infection, and acute inflammatory disease, and address emerging therapeutic strategies for ROS augmentation to induce and strengthen protective host immunity.

Low-budget, single-session elimination of CIED pocket infection

BACKGROUND

The dramatic increase in the use of cardiovascular implantable electronic devices (CIED) was associated with an increased rate of CIED infection, which has a high management cost.

AIM OF THE STUDY

To test the safety and efficacy of a single-session protocol, aiming to reuse the infected pocket side and the same device and leads in patients with CIED pocket infection.

PATIENTS AND METHODS

We included patients with isolated pocket infection between January 2015 and November 2019. The Patient was prepared by taking a swab for culture and sensitivity before the procedure. The pocket was debrided and the capsule was removed, the pocket was rinsed with povidone-iodine and hydrogen peroxide mixture, then packed with gauze sponge soaked with povidone-iodine. The device was debrided using ultrasonic irrigation and sterilized using gas plasma. The device was reimplanted and the wound was closed in layers.

RESULTS

During the period of the study, we had 12 patients with isolated pocket infection. Nine presented with erosion, two with impending erosion, and one with a chronic sinus. Patient's age was 61.5 ± 7.64 years. The infection was diagnosed 14.2 ± 8.22 weeks post device implantation. They were admitted for 7.6 ± 1.54 days postprocedure. The follow-up duration was 26.5 ± 15 (1.7-52) months. Only one patient (8%) had a recurrence of the infection after 50 days of the procedure.

CONCLUSION

Our protocol was successful in treating 92% of device-related pocket infection without the need to replace the device or the pocket side.

Reactive Oxygen Species in Venous Thrombosis

Reactive oxygen species (ROS) have physiological roles as second messengers, but can also exert detrimental modifications on DNA, proteins and lipids if resulting from enhanced generation or reduced antioxidant defense (oxidative stress). Venous thrombus (DVT) formation and resolution are influenced by ROS through modulation of the coagulation, fibrinolysis, proteolysis and the complement system, as well as the regulation of effector cells such as platelets, endothelial cells, erythrocytes, neutrophils, mast cells, monocytes and fibroblasts. Many conditions that carry an elevated risk of venous thrombosis, such as the Antiphospholipid Syndrome, have alterations in their redox homeostasis. Dietary and pharmacological antioxidants can modulate several important processes involved in DVT formation, but their overall effect is unknown and there are no recommendations regarding their use. The development of novel antioxidant treatments that aim to abrogate the formation of DVT or promote its resolution will depend on the identification of targets that enable ROS modulation confined to their site of interest in order to prevent off-target effects on physiological redox mechanisms. Subgroups of patients with increased systemic oxidative stress might benefit from unspecific antioxidant treatment, but more clinical studies are needed to bring clarity to this issue.

Redox dysregulation in the pathogenesis of chronic venous ulceration

In chronic venous ulcers (CVUs), which account for up to 75% of leg ulcers, the inflammatory stage of wound healing fails to down-regulate, preventing progression to proliferation, remodeling and eventual epithelialisation. The roles of reactive oxygen species (ROS) in the oxidative burst and pathogen killing are well known, but ROS also have important functions in extra-cellular and intra-cellular signalling. Iron deposition, resulting from venous reflux, primes macrophages towards a persistent inflammatory response, with ongoing stimulation by bacteria potentially playing a role. Generation of excessive ROS by activated inflammatory cells causes tissue destruction and disintegration of the dermis, and then at later stages, a failure to heal. Here, we review the evidence for ROS in CVU formation and in normal and delayed healing. We also discuss how ROS modulation might be used to influence the healing of these complex wounds, which cause long-term morbidity and are associated with a significant financial burden to healthcare systems.

Hydrogen peroxide and cutaneous biology: Translational applications, benefits, and risks

Hydrogen peroxide (H₂O₂) is an endogenous reactive oxygen species that contributes to oxidative stress directly as a molecular oxidant and indirectly through free radical generation. Topically applied 1% to 45% H₂O₂ can be used for a range of clinical purposes, which will be reviewed here in addition to its safety. In concentrations from 1% to 6%, H₂O₂ has antimicrobial properties and can act as a debriding agent through its effervescence, making low-concentration H₂O₂ useful for wound care. H₂O₂ has also been shown to promote venous insufficiency ulcer healing, but studies in other wound types are needed. In 1% formulations, H₂O₂ is used outside the United States to treat acne and has shown efficacy similar to or greater than benzoyl peroxide, with reduced side effects. In a concentration of 40%, H₂O₂ is US Food and Drug Administration-approved to treat seborrheic keratoses and may cause fewer pigmentary changes than cryotherapy, although elimination often requires 2 to 4 treatments. However, H₂O₂ should be used with caution, as exposure can cause adverse effects through its oxidant capabilities. Low H₂O₂ concentrations cause only transient symptoms (blanching and blistering), but exposure to 9% to 45% H₂O₂ can cause more severe skin damage, including epidermal necrosis leading to erythema and bullae. Overall, H₂O₂ has numerous therapeutic uses, and novel indications, such as treating actinic keratoses and skin cancers, continue to be explored.

Hydrogen peroxide (H2O2): a review of its use in surgery

Hydrogen peroxide has been used in medicine for more than 100 years. It is known in surgery as a highly useful irrigation solution by virtue of both its hemostatic and its antimicrobial effects. Due to its possible negative effect on wound healing and its cytotoxic effect in higher concentrations, there are concerns about the safety of its use. The objective of this paper is to review the safety and beneficial effects of hydrogen peroxide.

Oxygen therapies and their effects on wound healing

Oxygen is an important factor for wound healing. Although several different therapies investigated the use of oxygen to aid wound healing, the results of these studies are not unequivocal. This systematic review summarizes the clinical and experimental studies regarding different oxygen therapies for promoting wound healing, and evaluates the outcomes according the methodological details. A systematic literature search was conducted using Embase, Medline, Web of Science, Cochrane, PubMed publisher, and Google Scholar libraries. Clinical and experimental studies investigating oxygen for wound healing were selected. Included articles were categorized according to the kind of therapy, study design, and wound type. The methodological details were extracted and analyzed. Sixty-five articles were identified and divided in three different oxygen therapies: Local oxygen therapy, hyperbaric oxygen therapy, and supplemental inspired oxygen therapy. More than half of the included local oxygen and hyperbaric oxygen studies had one or more significant positive outcomes, 77 and 63%, respectively. Supplemental inspired oxygen therapy during gastrointestinal and vascular surgery was more likely to have a positive result than during other surgical interventions reducing surgical site infections. These many positive outcomes promote the use of oxygen treatment in the stimulation of wound healing. However, the lack of clinical studies and vast methodological diversity made it impossible to perform a proper comparison within and between the different therapies. Further randomized clinical studies are warranted to examine the value of these therapies, especially studies that investigate the more patient-friendly oxygen dressings and topical wound oxygen therapies. Also, to achieve more solid and consistent data, studies should use more standardized methods and subjects.

Reactive oxygen species (ROS) and wound healing: the functional role of ROS and emerging ROS-modulating technologies for augmentation of the healing process

Reactive oxygen species (ROS) play a pivotal role in the orchestration of the normal wound-healing response. They act as secondary messengers to many immunocytes and non-lymphoid cells, which are involved in the repair process, and appear to be important in coordinating the recruitment of lymphoid cells to the wound site and effective tissue repair. ROS also possess the ability to regulate the formation of blood vessels (angiogenesis) at the wound site and the optimal perfusion of blood into the wound-healing area. ROS act in the host's defence through phagocytes that induce an ROS burst onto the pathogens present in wounds, leading to their destruction, and during this period, excess ROS leakage into the surrounding environment has further bacteriostatic effects. In light of these important roles of ROS in wound healing and the continued quest for therapeutic strategies to treat wounds in general and chronic wounds, such as diabetic foot ulcers, venous and arterial leg ulcers and pressure ulcers in particular, the manipulation of ROS represents a promising avenue for improving wound-healing responses when they are stalled. This article presents a review of the evidence supporting the critical role of ROS in wound healing and infection control at the wound site, and some of the new emerging concepts associated with ROS modulation and its potential in improving wound healing are discussed.

Hydrogen Peroxide Wound Irrigation in Orthopaedic Surgery

As the burden of deep hardware infections continues to rise in orthopaedics, there is increasing interest in strategies for more effective debridement of colonized tissues and biofilm. Hydrogen peroxide has been used medically for almost a century, but its applications in orthopaedic surgery have yet to be fully determined. The basic science and clinical research on the antiseptic efficacy of hydrogen peroxide have demonstrated its efficacy against bacteria, and it has demonstrated potential synergy with other irrigation solutions such as chlorhexidine and povidone-iodine. While hydrogen peroxide is effective in infection reduction, there are concerns with wound healing, cytotoxicity, and embolic phenomena, and we recommend against hydrogen peroxide usage in the treatment of partial knee replacements, hemiarthroplasties, or native joints. Additionally, due to the potential for oxygen gas formation, hydrogen peroxide should not be used in cases of dural compromise, when pressurizing medullary canals, or when irrigating smaller closed spaces to avoid the possibility of air embolism. Finally, we present our protocol for irrigation and debridement and exchange of modular components in total joint arthroplasty, incorporating hydrogen peroxide in combination with povidone-iodine and chlorhexidine.

Improvement of Microcirculation and Healing of Venous Hypertension and Ulcers With Crystacide ®: Evaluation With a Microcirculatory Model, Including Free Radicals, Laser Doppler Flux, and PO2/PCO2 Measurements

In 32 patients with chronic venous insufficiency and venous hypertension associated with ulcerations, the effects of the local application of a hydrogen peroxide cream (Crystacide) applied onto the skin was evaluated using a complex, proportional, microcirculatory model to assess and quantify venous microangiopathy after local treatment. A comparative group treated without Crystacide was included. Laser Doppler flowmetry was used to assess skin perfusion (flux and venoarteriolar response) in association with transcutaneous PO2 and PCO2 measurements. Local plasma free radicals were evaluated in the area surrounding the venous ulcer using the D-Roms test. Crystacide was applied around and on the ulcer for 10 days. Crystacide was more effective than the control treatments. PO2 was increased (improved, P < .05), and plasma free radicals, PCO2, and laser Doppler flowmetry were decreased (improving toward normal values, P < .05). Also, the ulcerated area was significantly smaller at 10 days in the Crystacide group in comparison with controls (P < .05). In the proportional microcirculatory model, all parameters indicated an important level of improvement significantly larger than in controls. In conclusion, in chronic venous insufficiency and venous ulcerations, local treatment with Crystacide (10 days) improves the microcirculation and decreases skin free radicals, thus improving healing.

Effect of povidone iodine and hydrogen peroxide on fracture healing: a histomorphometric study on rats

PURPOSE

To evaluate the effect of povidone iodine and hydrogen peroxide on fracture healing in a rat model.

METHODS

The middle section of the right femur of 36 male Sprague Dawley rats was osteotomised with a saw. In the control group (n=9), the wound was irrigated with 100 ml 0.9% saline. In the 10% povidone iodine (n=9), 1% povidone iodine (n=9), and 3% hydrogen peroxide (n=9) groups, the wound was completely soaked with the respective solution for 2 minutes, and then irrigated with 100 ml saline. The osteotomy was fixed with an intramedullary Kirschner wire. Rats were euthanised at week 1, 2, and 5. In each femur, the percentage area of osseous, cartilaginous, and fibrous tissue in the callus was evaluated in 3 slides (one median and 2 paramedian).

RESULTS

The control group differed significantly to the other 3 groups (p=0.023 to p<0.001) in weeks 1, 2, and 5, except for the 1% povidone iodine group in terms of percentage of osseous (p=0.349) and fibrous (p=0.999) tissue. The healing process was similar in the 1% povidone iodine group and the control group, whereas healing was impaired in the 10% povidone iodine group and 3% hydrogen peroxide group, as indicated by the lower percentage of osseous tissue, higher percentage of fibrous tissue, and increased percentage of cartilaginous tissue between weeks 2 and 5 (delayed bone healing).

CONCLUSION

The 1% povidone iodine solution is recommended as the irrigation adjuvant in fracture surgery.

The Role of Hydrogen Peroxide and Other Reactive Oxygen Species in Wound Healing

Wound healing is a complex physiological process important for tissue homeostasis. An acute injury initiates massive cell migration, proliferation and differentiation, synthesis of extracellular matrix components, scar formation and remodelling. Blood flow and tissue oxygenation are parts of the complex regulation of healing. Higher organisms utilize molecular oxygen as a terminal oxidant. This way of gaining energy for vital processes such as healing leads to the production of a number of oxygen compounds that may have a defensive or informatory role. They may be harmful when present in high concentrations. Both the lack and the excess of reactive oxygen species may influence healing negatively.

A new technique in management of pilonidal sinus, a university teaching hospital experience

This paper evaluates a new technique that can lead to excision of pilonidal sinus with less healing time and low recurrence rate. A prospective randomized double-blind controlled study on 142 patients with pilonidal sinus conducted during the period from September 2008 to March 2012. The patients were prospectively randomized to be operated with one of four surgical techniques, excision and primary closure, or excision after using hydrogen peroxide (H202) and primary closure, or excision without closure, or excision after injection of H202 without closure. The main outcome measures were the healing time and the recurrence rate. Out of 142 patients, 118 patients were males (83%), and 24 were females (17%). The mean age was 24.5 years. The recurrence rate in patients treated with excision after injection of H202 without closure was the lowest (1.8%) with P-value < 0.005, and the mean duration of healing was 30.7 days with P-value < 0.005. We recommend using excision after injection of H202 without closure in management of PNS. Injection of H202 into the pilonidal tracts can give a precise delineation of the affected tracts, which can be excised with minimal amount of surrounding normal tissues and hence lead to a quicker recovery and low recurrence rate.

Honey: a potential therapeutic agent for managing diabetic wounds

Diabetic wounds are unlike typical wounds in that they are slower to heal, making treatment with conventional topical medications an uphill process. Among several different alternative therapies, honey is an effective choice because it provides comparatively rapid wound healing. Although honey has been used as an alternative medicine for wound healing since ancient times, the application of honey to diabetic wounds has only recently been revived. Because honey has some unique natural features as a wound healer, it works even more effectively on diabetic wounds than on normal wounds. In addition, honey is known as an "all in one" remedy for diabetic wound healing because it can combat many microorganisms that are involved in the wound process and because it possesses antioxidant activity and controls inflammation. In this review, the potential role of honey's antibacterial activity on diabetic wound-related microorganisms and honey's clinical effectiveness in treating diabetic wounds based on the most recent studies is described. Additionally, ways in which honey can be used as a safer, faster, and effective healing agent for diabetic wounds in comparison with other synthetic medications in terms of microbial resistance and treatment costs are also described to support its traditional claims.

Efficacy of debridement and wound cleansing with 2% hydrogen peroxide on graft take in the chronic-colonized burn wounds; a randomized controlled clinical trial

BACKGROUND

Severe burns are associated with dramatic outcomes which are potentially detrimental. Nowadays the standard treatment for deep partial thickness and full-thickness burn is early excision and grafting, which is not always feasible this leads to chronicity and microbial colonization of burn wounds. Interesting properties of hydrogen peroxide 2% soaked gauze convinced us to use it in management of chronic burn wounds.

METHODS

From January 2009 to September 2011, in a prospective clinical trial, 49 patients (98 limbs) with chronic-colonized burn wounds in both limbs were included in this study. Tissue cultures were taken from all the wounds. For the right, after debridement of granulation tissue and washing with hydrogen peroxide 2% soaked gauze for 5min followed by normal saline irrigation, grafting was done; debridement and skin grafting was performed in the conventional method in left limb wounds. The success rate of graft take was compared between two groups, after 21 days by the surgeon using the formula: Graft take surface area (cm2) x 100%/Total grafted area (cm2).

RESULTS

The study group was composed of 98 limbs in 49 patients with mean age of 26.44±5.66 and burn in 28.3±7.23% TBSA. The most common causes of the burn wounds chronicity was delayed admission associated with poor compliance. (44.8%) Staphylococcus was the most frequent isolate bacterial wounds colonization in our patients. (59.2%) Mean graft take was 82.85% in right limbs, and 65.61% in left limbs; which was significantly different (P<0.05).

CONCLUSIONS

Our study showed that, administration of hydrogen peroxide intraoperatively appears to be safe and significantly increases the mean success rate graft take in chronic-colonized wounds. Therefore, it can be recommended in management of chronic burn wounds management.

Floral markers of cornflower (Centaurea cyanus) honey and its peroxide antibacterial activity for an alternative treatment of digital dermatitis

Cornflower (Centaurea cyanus) honey can be characterized by a greenish yellow color and an intense flavor with a bitter aftertaste. Because cornflower honey contains only a limited amount of pollen for the verification of its floral origin, one objective was the characterization of its polyphenol and norisoprenoid contents to assign floral markers. Here, lumichrome (18.8-43.5 mg/kg), 7-carboxylumichrome, (Z/E)-3-oxo-retro-α-ionol, and 3-oxo-α-ionol appeared to be quite suitable for distinguishing cornflower honey from other unifloral honeys. Additionally, due to its comparably high hydrogen peroxide content (0.5-0.9 mM/h) and the associated antibacterial activity, cornflower honey was used as an alternative treatment of digital dermatitis on an organic dairy farm. Cows affected by this hoof disease often show severe lameness and a subsequent decline in milk yield and loss of body condition. The cows' hooves treated with cornflower honey showed significantly faster healing than the control group without any treatment.

Honey and microbial infections: a review supporting the use of honey for microbial control

Honey has been used as a medicine throughout the ages and has recently been reintroduced to modern medical practice. Much of the research to date has addressed honey's antibacterial properties and its effects on wound healing. Laboratory studies and clinical trials have shown that honey is an effective broad-spectrum antibacterial agent. Honey antimicrobial action explains the external and internal uses of honey. Honey has been used to treat adult and neonatal postoperative infection, burns, necrotizing fasciitis, infected and nonhealing wounds and ulcers, boils, pilonidal sinus, venous ulcers, and diabetic foot ulcers. These effects are ascribed to honey's antibacterial action, which is due to acidity, hydrogen peroxide content, osmotic effect, nutritional and antioxidants content, stimulation of immunity, and to unidentified compounds. When ingested, honey also promotes healing and shows antibacterial action by decreasing prostaglandin levels, elevating nitric oxide levels, and exerting prebiotic effects. These factors play a major role in controlling inflammation and promoting microbial control and healing processes. This article reviews data supporting the effectiveness of natural honey in eradicating human pathogens and discusses the mechanism of actions.

Evaluation of LHP® (1% hydrogen peroxide) cream versus petrolatum and untreated controls in open wounds in healthy horses: a randomized, blinded control study

Background

Treatment and protection of wounds in horses can be challenging; protecting bandages may be difficult to apply on the proximal extremities and the body. Unprotected wounds carry an increased risk of bacterial contamination and subsequent infection which can lead to delayed wound healing. Topical treatment with antimicrobials is one possibility to prevent bacterial colonization or infection, but the frequent use of antimicrobials ultimately leads to development of bacterial resistance which is an increasing concern in both human and veterinary medicine.

Methods

Standardized wounds were created in 10 Standardbred mares. Three wounds were made in each horse. Two wounds were randomly treated with LHP^® or petrolatum and the third wound served as untreated control. All wounds were assessed daily until complete epithelization. Protocol data were recorded on day 2, 6, 11, 16, 21 and 28. Data included clinical scores for inflammation and healing, photoplanimetry for calculating wound areas and swab cytology to assess bacterial colonization and inflammation. Bacterial cultures were obtained on day 2, 6 and 16.

Results

Mean time to complete healing for LHP^® treated wounds was 32 days (95%CI = 26.9-37.7). Mean time to complete healing for petrolatum and untreated control wounds were 41.6 days (95%CI = 36.2-47.0) and 44.0 days (95%CI = 38.6-49.4) respectively. Wound healing occurred significantly faster in LHP^® wounds compared to both petrolatum (p = 0.0004) and untreated controls (p < 0.0001). There was no significant difference in time for healing between petrolatum and untreated controls. Total scores for bacteria and neutrophils were significantly (p < 0.0001) lower for LHP^® treated wounds compared to petrolatum from day 16 and onwards. Staphylococcus aureus and Streptococcus zooepidemicus were only found in cultures from petrolatum treated wounds and untreated controls.

Conclusions

Treatment with LHP^® reduced bacterial colonization and was associated with earlier complete wound healing. LHP^® cream appears to be safe and effective for topical wound treatment or wound protection.

An update on pharmacological interventions for diabetic foot ulcers

Diabetic foot ulcers are the most common lower extremity complications of diabetes. Peripheral neuropathy and peripheral vascular disease are the underlying risk factors for diabetic foot ulcers, subsequently leading to infections and requiring antimicrobial therapy for the management of the disease. Each risk factor is a target for clinical intervention, with the intent to delay or prevent disease progression to amputation. The effective therapy includes interdisciplinary care, which involves optimized pharmacological interventions in concert with other treatments such as debridement strategies and specialized wound dressings. The pharmacological therapy alone cannot lead to successful therapy, and therefore, these supplementary techniques/modalities should not be overlooked. It is therefore the aim of this report to review various pharmacological interventions, specific to the diabetic foot and wound healing, along with incorporation of advanced therapies required to achieve a multifaceted treatment of diabetic foot ulcers and provide basis for superior drugs as well as drug delivery systems.

The rheological and thermal characteristics of freeze-thawed hydrogels containing hydrogen peroxide for potential wound healing applications

The current study involves the development of a hydrogel carrier for a H(2)O(2) delivery system. In this work poly (vinyl alcohol) (PVA) and poly (acrylic acid) (PAA) based hydrogels were prepared, and their mechanical and physical properties examined. The novel aspect of this research is the differing functionality created by varying the concentration of H(2)O(2). The mechanical and thermal properties were determined by parallel plate rheometry and modulated differential scanning calorimetry (MDSC) respectively. The results indicated that the hydrogels containing H(2)O(2) are significantly weaker than those synthesised using water alone at test temperatures of 30 and 45 degrees C. MDSC analysis suggested that thermal transitions occur at temperatures that may make these hydrogels useful as temperature sensitive drug delivery systems. The chemical structure of the hydrogels was confirmed by means of attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR), while swelling experiments in distilled water indicate that the swelling of the gels is temperature dependent.

Hydrogen peroxide and wound healing: a theoretical and practical review for hair transplant surgeons

BACKGROUND

In most hair restoration practices, hydrogen peroxide has been routinely used to remove blood during and after hair transplant surgery. In other specialties, hydrogen peroxide is also used in these ways: wound cleaning, prevention of infection, hemostasis, and removal of debris. Despite its widespread use, there are still concerns and controversy about the potential toxic effect of hydrogen peroxide.

OBJECTIVE

The objective was to review all available literature including in vivo and in vitro effects of hydrogen peroxide, as well as general wound healing research.

MATERIAL AND METHODS

Literature up to and including the past three decades was investigated.

RESULTS

Two pilot studies were found, and there are not enough data examining the real impact of using hydrogen peroxide in hair transplant surgery. In other specialties, H(2)O(2) appears to have positive effects, such as stimulation of vascular endothelial growth factor, induction of fibroblast proliferation, and collagen, or negative effects, such as cytotoxicity, inhibition of keratinocyte migration, disruption of scarless fetal wound repair, and apoptosis.

CONCLUSIONS

There are not enough data in hair restoration surgery about the use of hydrogen peroxide, and it is unknown and unclear what the optimum dilution should be. Positive and negative effects were found in other specialties. Further studies are recommended. The authors have indicated no significant interest with commercial supporters.

Postcare Recommendations for Emergency Department Wounds

Diligent posttreatment wound care management undoubtedly will improve wound outcome and patient satisfaction. There are limited recommendations in the literature to guide management plans. Nevertheless patients must receive specific instructions to complete wound care. These instructions should include whether a dressing is indicated, which dressing should be used, the duration of use, and the method of application. The plan must explain clearly the reasons for returning for further medical attention, for follow-up, for routine removal of sutures/staples, and an earlier return for possible concerns of infection or dehiscence. Preprinted discharge instruction sheets are useful, and illustrations can be helpful.

The effect of hyperbaric oxygen therapy on the adverse effects of octreotide on wound healing

OBJECTIVE

Octreotide, a long-acting somatostatin analogue, has been used in the treatment of various disorders. Octreotide has significant detrimental impacts upon wound healing. We tested the hypothesis that hyperbaric oxygen therapy may overcome octreotide-mediated suppression of wound healing.

DESIGN

Prospective, randomised, parallel-group animal study.

METHODS

Operated rats were divided into four groups: (1) controls, (2) octreotide therapy, (3) hyperbaric oxygen therapy and (4) combination of octreotide and hyperbaric oxygen therapy. Wound healing was assessed by breaking-strength measurements, hydroxyproline levels and fibrosis scores.

RESULTS

Octreotide decreased the breaking-strength measurements, hydroxyproline levels and fibrosis scores to 72%, 88% and 55%, respectively, of the control group. In the combination group, hyperbaric oxygen therapy increased breaking-strength measurements and hydroxyproline levels to 137% and 126%, respectively, of the control group. In the combination group, hyperbaric oxygen therapy tended to increase the fibrosis scores to 111% of the control group, but without statistical significance.

CONCLUSION

Hyperbaric oxygen therapy tends to reverse the octreotide-induced impairment of wound healing.

Improvement of microcirculation and healing of venous hypertension and ulcers with Crystacide. Evaluation of free radicals, laser Doppler flux and PO2. A prospective-randomized-controlled study

In 20 patients with chronic venous insufficiency and venous hypertension associated with ulcerations, the effects of a new compound, applied onto the skin (Crystacide) were assessed in a randomized, controlled study. Duplex scanning was used to assess the presence of venous obstruction and incompetence, and microcirculatory methods were used to assess and quantify venous microangiopathy and to follow up subjects after local treatment with Crystacide. Laser Doppler flowmetry (LDF) was used to assess skin perfusion in association with transcutaneous (tc) partial pressure of oxygen (PO2) measurements. Local plasma free radicals (PFR) were evaluated in the area surrounding the venous ulcer, with the D-Rom test. Crystacide was applied around and on the ulcer for 10 days. Crystacide was more effective than the control treatment: PO2 was increased, PFR and LDF were decreased (flux increase is associated with venous hypertension), and the ulcer area was significantly smaller at 10 days in the Crystacide group in comparison with the placebo group (p<0.05). In conclusion, in venous ulcerations, local treatment with Crystacide (10 days) improves the microcirculation and decreases skin free radicals improving healing.

Where have all the bubbles gone? An ode to Hydrogen peroxide, the champagne of all wound cleaners

Hydrogen peroxide solution can be very effective for cleaning grit filled wounds and grazes. Its use in Accident and Emergency (A&E) departments has gone out of vogue due to concerns about air emboli formation. This article discusses the truth behind these concerns and whether it is in fact safe to use hydrogen peroxide solution for wound cleaning in specific situations.

The effect of dilution on the rate of hydrogen peroxide production in honey and its implications for wound healing

OBJECTIVE

Honey is an effective antiseptic wound dressing, mainly the result of the antibacterial activity of hydrogen peroxide that is produced in honey by the enzyme glucose oxidase. Because the rate of production of hydrogen peroxide is known to vary disproportionately when honey is diluted, and dilution of honey dressings will vary according to the amount of wound exudate, it is important to know more about the production of hydrogen peroxide at different concentrations of honey.

DESIGN

The rates of hydrogen peroxide production by honey with respect to honey dilution were measured in eight different samples of honey from six different floral sources.

SETTINGS

Honey Research Unit, Waikato University, Hamilton, New Zealand.

MAIN RESULTS

The maximum levels of accumulated hydrogen peroxide occurred in honey solutions diluted to concentrations between 30% and 50% (v/v) with at least 50% of the maximum levels occurring at 15-67% (v/v). This is equivalent to a 10 cm x 10 cm dressing containing 20 mL of honey becoming diluted with 10 to 113 mL of wound exudate. Maximum levels of hydrogen peroxide reached in the diluted honeys were in the range of 1-2 mmol/L.

CONCLUSION

Significant antibacterial activity can be maintained easily when using honey as a wound dressing, even on a heavily exuding wound. Concentrations of hydrogen peroxide generated are very low in comparison to those typically applied to a wound, thus, cytotoxic damage by hydrogen peroxide is very low.

Oxygen, oxidants, and antioxidants in wound healing: an emerging paradigm

Disrupted vasculature and high energy-demand by regenerating tissue results in wound hypoxia. Wound repair may be facilitated by oxygen therapy. Evidence supporting the mode of action of hyperbaric oxygen in promoting wound healing is sketchy, however. Topical oxygen therapy involves local administration of pure oxygen. The advantages of topical oxygen therapy include low cost, the lack of systemic oxygen toxicity, and possibility of home treatment. While this modality of wound care is of outstanding interest, it clearly lacks the support of mechanism-oriented studies. The search for mechanisms by which oxygen supports wound healing has now taken another step. Respiratory burst-derived oxidants support healing. Oxidants serve as cellular messengers to promote healing. Although this information is of outstanding significance to the practice of oxygen therapy, it remains largely unexplored. The search for "natural remedies" has drawn attention to herbals. Proanthocyanidins or condensed tannins are a group of biologically active polyphenolic bioflavonoids that are synthesized by many plants. Proanthocyanidins and other tannins facilitate wound healing. A combination of grape seed proanthocyanidin extract and resveratrol facilitates inducible VEGF expression, a key element supporting wound angiogenesis. Strategies to manipulate the redox environment in the wound are likely to be of outstanding significance in wound healing.

Healing of an MRSA-colonized, hydroxyurea-induced leg ulcer with honey

BACKGROUND

With the everincreasing emergence of antibiotic-resistant pathogens, in particular methicillin-resistant Staphylococcus aureus (MRSA) in leg ulcers, a means of reducing the bacterial bioburden of such ulcers, other than by the use of either topical or systemic antibiotics, is urgently required.

METHODS

We report the case of an immunosuppressed patient who developed a hydroxyurea-induced leg ulcer with subclinical MRSA infection which was subsequently treated with topical application of manuka honey, without cessation of hydroxyurea or cyclosporin.

RESULTS

MRSA was eradicated from the ulcer and rapid healing was successfully achieved.

CONCLUSION

Honey is recognized to have antibacterial properties, and can also promote effective wound healing. A traditional therapy, therefore, appears to have enormous potential in solving new problems.

Neonatal skin care

The relative importance of neonatal health and neonatal skin care has been highlighted in recent years as infant mortality rates have decreased while death rates during the neonatal period remain unacceptably high in many areas of the world. During the neonatal period, many newborns develop preventable, clinically apparent skin problems, and many more, especially preterm neonates, experience morbidity caused by compromised skin barrier integrity. Several strategies are available for protecting the integrity and promoting the hygiene of the skin and augmenting its function as a barrier to TEWL and heat loss and the entrance of infectious or toxic agents. Research defining optimal applications of many of these strategies, however, and the development of new approaches in skin care is one of the greatest challenges in pediatric dermatology and holds promise for improving neonatal outcome in the future. The ability to modulate epidermal barrier function and integrity relies largely on the topical use of protective materials and substances and manipulation of the external environment. As understanding of epidermal barrier development advances, perhaps pharmacologic manipulation of barrier development, as now practiced for augmentation of neonatal lung maturity, will become a reality. In the meantime, greater awareness among neonatal health care practitioners of state-of-the-art strategies for optimizing skin integrity in neonates is an important step toward improving neonatal health.