Imparting commercial antimicrobial dressings with low-adherence to burn wounds

Development of κ-carrageenan-PEG/lecithin bioactive hydrogel membranes for antibacterial adhesion and painless detachment

The issue of wound dressing adherence poses a substantial challenge in the field of wound care, with implications both clinically and economically. Overcoming this challenge requires the development of a hydrogel dressing that enables painless removal without causing any secondary damage. However, addressing this issue still remains a significant challenge that requires attention and further exploration. The present study is focused on the synthesis of hydrogel membranes based on κ-carrageenan (CG), polyethylene glycol (PEG), and soy lecithin (LC), which can provide superior antioxidant and antibacterial attachment properties with a tissue anti adhesion activity for allowing an easy removability without causing secondary damage. The (CG-PEG)/LC mass ratio was varied to fabricate hydrogel membranes via a facile approach of physical blending and solution casting. The physicochemical properties of (CG-PEG)/LC hydrogel membranes were studied by scanning electron microscopy (SEM), Fourier transforms infrared spectroscopy (FTIR), X-ray diffraction (XRD), differential scanning calorimetry (DSC), and mechanical analyses. The membranes showed significantly enhanced mechanical properties with excellent flexibility and had high swelling capacity (˃1000 %), which would provide a moist condition for wound healing. The membranes also exhibited excellent free radical scavenging ability (>60 %). In addition, the (CG-PEG)/LC hydrogel membranes showed reduced peel strength 26.5 N/m as a result of weakening the hydrogel-gelatin interface during an in vitro gelatin peeling test. Moreover, the membrane showed superior antibacterial adhesion activity (>90 %) against both S. aureus and E. coli due to the presence of both PEG and LC. The results also suggested that the hydrogel membranes exhibit NIH3T3 cell antiadhesion property, making them promising material for easy detachment from the healed tissue without causing secondary damage. Thus, this novel combination of (CG-PEG)/LC hydrogel membranes have immense application potential as a biomaterial in the healthcare sector.

A wound-friendly antibacterial hyaluronic acid dressing with on-demand removability for infected wound healing

BACKGROUND

Antibacterial activity and on-demand removability are key characteristics governing the effectiveness of clinic wound dressing. However, the excellent tissue adhesion of new dressings is often overemphasized without a detailed discussion of dressing replacement. Besides, the inherent antibacterial ability of dressings is beneficial for promoting the healing of infected wound. Therefore, we rationally design an injectable antibacterial wound dressing with on-demand removability to accelerate infected wound healing.

METHOD

We design this wound dressing with a simple and feasible method based on the electrostatic self-assembly of hyaluronic acid and ε-polylysine. We investigated the efficacy of this dressing in terms of its microtopography, rheology, self-healing performance, adhesive ability, antimicrobial, hemostatic, on-demand removal properties, and wound healing promotion through various tests.

RESULTS

The prepared dressing possesses injectability, self-healing ability and antibacterial activity, showing NaCl-triggered on-demand dissolution due to the disruption of electrostatic interactions. When used as dressings for healing full-thickness wounds, it could effectively accelerate wound healing by killing bacteria, downregulating inflammation, promoting collagen deposition, enhancing keratinocyte migration and angiogenesis due to its excellent adhesion ability, favorable hemostatic property, and potent antibacterial performance.

CONCLUSION

All results indicate that this is a simple and practical dressing for clinical application. This strategy provides a novel idea for developing on-demand removal dressings with antibacterial and injectable properties.

Chitosan/carboxymethyl cellulose wound dressings supplemented with biologically synthesized silver nanoparticles from the ligninolytic fungus Anamorphous Bjerkandera sp. R1

Chitosan (CHI) and carboxymethyl cellulose (CMC) are naturally sourced materials with excellent physical, chemical, and biological properties, which make them a promising tool for the development of different medical devices. In this research, CHI-CMC wound dressings were manufactured, by using different colloidal suspensions of silver nanoparticles (AgNPs) synthesized from the ligninolytic fungus Anamorphous Bjerkandera sp. R1, called CS and SN. Transmission electron microscopy (TEM), UV-Vis spectroscopy, and dynamic light scattering (DLS) analysis were used to characterize AgNPs. The wound dressings were characterized, by scanning electron microscopy (SEM), optical microscopy and their mechanical, antimicrobial, and biological properties were evaluated. The results of the different characterizations revealed the formation of spherical AgNPs with a mean size between 10 and 70 nm for the different mixtures worked. The mechanical properties of CHI-CMS-AgNPs doped with CS and SN suspensions showed superior mechanical properties with respect to CHI-CMC wound dressings. Compared to the latter, CHI-CMC-AgNPs wound dressings yielded better antibacterial activity against the pathogen Escherichia coli. In biological assays, it was observed that manufactured CHI-CMC-AgNPs wound dressings were not toxic when in contact with human skin fibroblasts (Detroit). This study, then, suggests that this type of wound dressings with a chitosan matrix and carboxymethyl cellulose doped with biologically synthesized nanoparticles from the fungus Bjerkandera sp., may be an ideal alternative for the manufacture of new wound dressings.

Wound dressing adherence: a review

Wound dressing adherence is an important problem that is frequently encountered in wound care, and is associated with both clinical and economic burdens. However, only a few review articles have focused on this issue. The objective of this review was to present a comprehensive discussion of wound dressing adherence, including the mechanism of dressing adherence, adverse consequences (clinical burdens and economic burdens), factors affecting adherence (dressing-, patient- and wound-related factors, and factors related to the wound care procedure), tests to assess dressing adherence (in vitro assay, in vivo assay and clinical trials), and reduction of wound adherence (modification of dressing adherence and special care in particular patients). Accordingly, this review article emphasises an awareness of dressing adherence, and is intended to be an informative source for the development of new dressings and for wound management.

Effect of a DACC-coated dressing on keratinocytes and fibroblasts in wound healing using an in vitro scratch model

Wound dressings that exert an antimicrobial effect in order to prevent and treat wound infections can be harmful to the wound healing process. Dressings with hydrophobic coatings, however, have been suggested to both reduce the microbial load and promote the healing process. Therefore, the potential effects of a dialkylcarbamoyl chloride (DACC)-coated dressing on fibroblasts and keratinocytes in wound healing were studied using mechanical scratch wounding of confluent cell layers as an in vitro model. Additionally, gene expression analysis by qRT-PCR was used to elucidate the longitudinal effects of the DACC-coated dressing on cell responses, specifically inflammation, growth factor induction and collagen synthesis. DACC promoted cell viability, did not stick to the cell layers, and supported normal wound healing progression in vitro. In contrast, cells became attached to the uncoated reference material, which inhibited scratch closure. Moreover, DACC slightly induced KGF, VEGF, and GM-CSF expression in HaCaT cells and NHDF. Physiological COL1A1 and COL3A1 gene expression by NHDF was observed under DACC treatment with no observable effect on S100A7 and RNASE7 levels in HaCaT cells. Overall, the DACC coating was found to be safe and may positively influence the wound healing outcome. Graphical abstract.

Nanomaterials for Wound Dressings: An Up-to-Date Overview

As wound healing continues to be a challenge for the medical field, wound management has become an essential factor for healthcare systems. Nanotechnology is a domain that could provide different new approaches concerning regenerative medicine. It is worth mentioning the importance of nanoparticles, which, when embedded in biomaterials, can induce specific properties that make them of interest in applications as materials for wound dressings. In the last years, nano research has taken steps to develop molecular engineering strategies for different self-assembling biocompatible nanoparticles. It is well-known that nanomaterials can improve burn treatment and also the delayed wound healing process. In this review, the first-line of bioactive nanomaterials-based dressing categories frequently applied in clinical practice, including semi-permeable films, semipermeable foam dressings, hydrogel dressings, hydrocolloid dressings, alginate dressings, non-adherent contact layer dressings, and multilayer dressings will be discussed. Additionally, this review will highlight the lack of high-quality evidence and the necessity for future advanced trials because current wound healing therapies generally fail to provide an excellent clinical outcome, either structurally or functionally. The use of nanomaterials in wound management represents a unique tool that can be specifically designed to closely reflect the underlying physiological processes in tissue repair.

Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation

Background and Objectives: The tie-over bolster technique has been conventionally used for skin graft fixation; however, long operative times and postoperative pain are the main disadvantages of this method. In this study, we introduce a new method using vacuum-assisted closure (VAC) with a silicon-based dressing as an alternative for skin graft fixation. This retrospective study aimed to evaluate the clinical effect of the VAC plus silicon-based dressing method and the conventional tie-over bolster technique for skin graft fixation in terms of pain, operative time, and skin graft take rate. Materials and Methods: Sixty patients who underwent skin graft surgery performed by a single surgeon from January 2017 to October 2018 were included in this clinical study. They were divided into two groups based on the type of treatment: tie-over bolster technique and vacuum-assisted closure (VAC), or silicon-based dressing groups. The operative times were recorded twice (during suturing or stapling of the graft and during removal of the dressing) in the two groups; similarly, pain was assessed using a numeric rating scale (NRS) after surgery and during dressing removal. Skin graft take rate was evaluated two weeks after dressing removal. Results: Twenty-six patients who met the eligibility criteria were enrolled into the study and assigned to one of the two groups (n = 13 each). No significant differences in age, gender, and graft area were noted between the two groups of patients. The VAC plus silicon-based dressing group demonstrated higher skin graft take rates (p < 0.05), shorter operation times (p < 0.05), and lower levels of pain (postoperative pain and pain during dressing removal) compared with the tie-over bolster technique group (p < 0.05). Conclusions: These findings indicate that VAC with silicon-based dressing can be used for skin graft fixation due to its superior properties when compared with the conventional method, and can improve the quality of life of patients undergoing skin graft fixation.

Effect of non-adhering dressings on promotion of fibroblast proliferation and wound healing in vitro

Non-adhering dressings are commonly used during granulation, tissue formation, and re-epithelialization. Elucidating cytotoxic effects and influence on proliferation/migration capacity of cells like fibroblasts is of interest. Dressings’ effects were investigated by comprehensive in vitro approach: (1) MTT assay measuring cell viability after direct contact, (2) ATP assay determining effects on cell proliferation, and (3) scratch wound assay featuring an in vitro wound healing model. One cotton-based dressing with vaseline (vas) was included in the study and four polyester dressings containing vas and technology-lipido-colloid matrix (TLC), carboxymethylcellulose (CMC), hydrocolloid (HC), or glycerin (gly) as additives. A polyamide dressing with vas + CMC and three silicone-based dressings (AT, CC, M) were tested. Polyester + vas + CMC did not negatively affect cell viability or proliferation but it was found that fibroblast layers appeared more irregular with decreased F-actin network structure and tubulin density possibly leading to hampered scratch closure. Silicone AT, polyester + gly and polyamide + vas + CMC caused distinct cell damage. The latter two further reduced cell viability, proliferation and scratch healing. From the overall results, it can be concluded that cotton + vas, polyester + TLC, polyester + vas + HC and the silicone dressings CC and M have the potential to prevent damage of newly formed tissue during dressing changes and positively influence wound healing.

Bacteria-Responsive Single and Core-Shell Nanofibrous Membranes Based on Polycaprolactone/Poly(ethylene succinate) for On-Demand Release of Biocides

Traditional antibacterial dressings continuously elute biocides, even if there are no bacteria. This unneeded release can cause cytotoxicity, increase costs, and delay healing. We designed a bacteria-responsive nanofibrous wound dressing, which can be degraded in the presence of bacteria to release antimicrobial agents. A model biocide, benzyl dimethyl tetradecyl ammonium chloride (BTAC), was incorporated into bacteria-degradable polymers [polycaprolactone and poly(ethylene succinate)] in two ways: evenly distributed inside the polymers as single nanofibers and encapsulated in a core surrounded by the same polymers as core-shell nanofibers. Because of bacterial activity (both lipase secretion and acidic pH), degradation of the fibers was facilitated and caused the release of incorporated BTAC. BTAC-loaded single and core-shell nanofibers presented >1 log reduction of both Staphylococcus aureus and Escherichia coli within 2 h. Additionally, the core-shell structure provided a more controlled release of BTAC with prolonged antibacterial properties than single nanofibers. The core-shell nanofibers also exhibited minimal cytotoxicity against human fibroblast cells (>80% viable cells after 24 h contact). These nanofibrous mats have the potential to selectively release antibacterial agents to prevent wound infections without delaying wound healing.

Physically Cross-Linked Gels of PVA with Natural Polymers as Matrices for Manuka Honey Release in Wound-Care Applications

Manuka honey is a well-known natural material from New Zealand, considered to have properties beneficial for burn treatment. Gels created from polyvinyl alcohol (PVA) blended with natural polymers are potential burn-care dressings, combining biocompatibility with high fluid uptake. Controlled release of manuka honey from such materials is a possible strategy for improving burn healing. This work aimed to produce polyvinyl alcohol (PVA), PVA⁻sodium carboxymethylcellulose (PVA-CMC), PVA⁻gelatin (PVA-G), and PVA⁻starch (PVA-S) cryogels infused with honey and to characterize these materials physicochemically, morphologically, and thermally, followed by in vitro analysis of swelling capacity, degradation/weight loss, honey delivery kinetics, and possible activity against Staphylococcus aureus. The addition of honey to PVA led to many PVA crystals with defects, while PVA⁻starch⁻honey and PVA⁻sodium carboxymethylcellulose⁻honey (PVA-CMC-H) formed amorphous gels. PVA-CMC presented the highest swelling degree of all. PVA-CMC-H and PVA⁻gelatin⁻honey presented the highest swelling capacities of the honey-laden samples. Weight loss/degradation was significantly higher for samples containing honey. Layers submitted to more freeze⁻thawing cycles were less porous in SEM images. With the honey concentration used, samples did not inhibit S. aureus, but pure manuka honey was bactericidal and dilutions superior to 25% honey were bacteriostatic, indicating the need for higher concentrations to be more effective.

Fluorescence-tunable Ag-DNA biosensor with tailored cytotoxicity for live-cell applications

DNA-stabilized silver clusters (Ag-DNA) show excellent promise as a multi-functional nanoagent for molecular investigations in living cells. The unique properties of these fluorescent nanomaterials allow for intracellular optical sensors with tunable cytotoxicity based on simple modifications of the DNA sequences. Three Ag-DNA nanoagent designs are investigated, exhibiting optical responses to the intracellular environments and sensing-capability of ions, functional inside living cells. Their sequence-dependent fluorescence responses inside living cells include (1) a strong splitting of the fluorescence peak for a DNA hairpin construct, (2) an excitation and emission shift of up to 120 nm for a single-stranded DNA construct, and (3) a sequence robust in fluorescence properties. Additionally, the cytotoxicity of these Ag-DNA constructs is tunable, ranging from highly cytotoxic to biocompatible Ag-DNA, independent of their optical sensing capability. Thus, Ag-DNA represents a versatile live-cell nanoagent addressable towards anti-cancer, patient-specific and anti-bacterial applications.