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Sharma A, Sharma D, Zhao F. Updates on Recent Clinical Assessment of Commercial Chronic Wound Care Products. Adv Healthc Mater 2023; 12:e2300556. [PMID: 37306401 DOI: 10.1002/adhm.202300556] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/01/2023] [Indexed: 06/13/2023]
Abstract
Impaired wound healing after trauma, disorders, and surgeries impact millions of people globally every year. Dysregulation in orchestrated healing mechanisms and underlying medical complications make chronic wound management extremely challenging. Besides standard-of-care treatments including broad spectrum antibiotics and wound-debridement, novel adjuvant therapies are clinically tested and commercialized. These include topical agents, skin substitutes, growth factor delivery, and stem cell therapies. With a goal to overcome factors playing pivotal role in delayed wound healing, researchers are exploring novel approaches to elicit desirable healing outcomes in chronic wounds. Although recent innovations in wound care products, therapies, and devices are extensively reviewed in past, a comprehensive review summarizing their clinical outcomes is surprisingly lacking. Herein, this work reviews the commercially available wound care products and their performance in clinical trials to provide a statistically comprehensive understanding of their safety and efficacy. The performance and suitability of various commercial wound care platforms, including xenogeneic and allogenic products, wound care devices, and novel biomaterials, are discussed for chronic wounds. The current clinical evaluation will provide a comprehensive understanding of the benefits and drawbacks of the most-recent approaches and will enable researchers and healthcare providers to develop next-generation technologies for chronic wound management.
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Affiliation(s)
- Archita Sharma
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77840, USA
| | - Dhavan Sharma
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77840, USA
| | - Feng Zhao
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77840, USA
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Stynes G, Haertsch P, O'Hara J, Knight R, Issler-Fisher AC, Maitz PKM. Alginate dressings continuously for fourteen days on uncontaminated, superficial, partial thickness burns. J Burn Care Res 2022:6743261. [PMID: 36181757 DOI: 10.1093/jbcr/irac143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Indexed: 01/27/2023]
Abstract
Calcium alginate dressings are commonly used on split-thickness skin donor sites, where they are typically removed after 14 days. Alginates have been used previously on superficial, partial thickness burns, but changed every 3-4 days. In this study, alginates were applied to superficial, partial thickness burns on adults within 36 hours of injury, then left intact for up to 14 days. Wound healing (≥95% wound epithelialisation) and pain were measured. Twenty-one burns were reviewed on ten patients. Per the initial protocol, six patients were reviewed every 3-5 days, with removal of only secondary dressings, until day 13-14, when the alginate dressings were removed. One patient was reviewed every 3-5 days until day 10, when a clinic nurse removed the alginate dressing. Restrictions on movement during the COVID pandemic necessitated a protocol change, with only one review at approximately day 14 for removal of alginate and secondary dressings; three patients were reviewed in this manner. Burns on all patients were 100% epithelialised at the time of final review and there were no complications, such as scarring, infection, or need for grafting. Following initial debridement and dressings, patients reported minimal pain. Dressing costs appeared to be significantly decreased. This protocol may be particularly useful for patients managed in rural and remote locations, with telemedicine support if required.
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Affiliation(s)
- Gil Stynes
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW.,ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia.,Department of Surgery, Wollongong Hospital, 252 Loftus St, Wollongong 2500, NSW, Australia
| | - Peter Haertsch
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW.,Department of Surgery, Wollongong Hospital, 252 Loftus St, Wollongong 2500, NSW, Australia
| | - Justine O'Hara
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW
| | - Robert Knight
- Department of Surgery, Wollongong Hospital, 252 Loftus St, Wollongong 2500, NSW, Australia
| | - Andrea C Issler-Fisher
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW.,ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Hospital Rd, Concord NSW 2139, Australia.,University of Sydney, Camperdown, NSW.,ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia
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Deng X, Gould M, Ali MA. A review of current advancements for wound healing: Biomaterial applications and medical devices. J Biomed Mater Res B Appl Biomater 2022; 110:2542-2573. [PMID: 35579269 PMCID: PMC9544096 DOI: 10.1002/jbm.b.35086] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 12/12/2022]
Abstract
Wound healing is a complex process that is critical in restoring the skin's barrier function. This process can be interrupted by numerous diseases resulting in chronic wounds that represent a major medical burden. Such wounds fail to follow the stages of healing and are often complicated by a pro‐inflammatory milieu attributed to increased proteinases, hypoxia, and bacterial accumulation. The comprehensive treatment of chronic wounds is still regarded as a significant unmet medical need due to the complex symptoms caused by the metabolic disorder of the wound microenvironment. As a result, several advanced medical devices, such as wound dressings, wearable wound monitors, negative pressure wound therapy devices, and surgical sutures, have been developed to correct the chronic wound environment and achieve skin tissue regeneration. Most medical devices encompass a wide range of products containing natural (e.g., chitosan, keratin, casein, collagen, hyaluronic acid, alginate, and silk fibroin) and synthetic (e.g., polyvinyl alcohol, polyethylene glycol, poly[lactic‐co‐glycolic acid], polycaprolactone, polylactic acid) polymers, as well as bioactive molecules (e.g., chemical drugs, silver, growth factors, stem cells, and plant compounds). This review addresses these medical devices with a focus on biomaterials and applications, aiming to deliver a critical theoretical reference for further research on chronic wound healing.
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Affiliation(s)
- Xiaoxuan Deng
- Centre for Bioengineering & Nanomedicine (Dunedin), Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Maree Gould
- Centre for Bioengineering & Nanomedicine (Dunedin), Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - M Azam Ali
- Centre for Bioengineering & Nanomedicine (Dunedin), Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Mbese Z, Alven S, Aderibigbe BA. Collagen-Based Nanofibers for Skin Regeneration and Wound Dressing Applications. Polymers (Basel) 2021; 13:4368. [PMID: 34960918 PMCID: PMC8703599 DOI: 10.3390/polym13244368] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 12/13/2022] Open
Abstract
Skin regeneration after an injury is very vital, but this process can be impeded by several factors. Regenerative medicine is a developing biomedical field with the potential to decrease the need for an organ transplant. Wound management is challenging, particularly for chronic injuries, despite the availability of various types of wound dressing scaffolds in the market. Some of the wound dressings that are in clinical practice have various drawbacks such as poor antibacterial and antioxidant efficacy, poor mechanical properties, inability to absorb excess wound exudates, require frequent change of dressing and fails to offer a suitable moist environment to accelerate the wound healing process. Collagen is a biopolymer and a major constituent of the extracellular matrix (ECM), making it an interesting polymer for the development of wound dressings. Collagen-based nanofibers have demonstrated interesting properties that are advantageous both in the arena of skin regeneration and wound dressings, such as low antigenicity, good biocompatibility, hemostatic properties, capability to promote cellular proliferation and adhesion, and non-toxicity. Hence, this review will discuss the outcomes of collagen-based nanofibers reported from the series of preclinical trials of skin regeneration and wound healing.
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Early non-excisional debridement of paediatric burns under general anaesthesia reduces time to re-epithelialisation and risk of skin graft. Sci Rep 2021; 11:23753. [PMID: 34887486 PMCID: PMC8660833 DOI: 10.1038/s41598-021-03141-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/23/2021] [Indexed: 11/21/2022] Open
Abstract
Reported advantages of early excision for larger burn injuries include reduced morbidity, mortality, and hospital length of stay for adult burn patients. However, a paucity of evidence supports the best option for paediatric burns and the advantages of non-excisional (mechanical) debridement. Procedural sedation and analgesia in the emergency department is a popular alternative to debridement in operating theatres under general anaesthesia. This study aims to evaluate the association between early (< 24 h post-injury) non-excisional debridement under general anaesthesia with burn wound re-epithelialisation time and skin graft requirements. Cohort study of children younger than 17 years who presented with burns of five percent total body surface area or greater. Data from January 2013 to December 2019 were extracted from a prospectively collected state-wide paediatric burns' registry. Time to re-epithelialisation was tested using survival analysis, and binary logistic regression for odds of skin graft requirementto analyse effects of early non-excisional debridement in the operating theatre. Overall, 292 children met eligibility (males 55.5%). Early non-excisional debridement under general anaesthesia in the operating theatre, significantly reduced the time to re-epithelialisation (14 days versus 21 days, p = 0.029)) and the odds of requiring a skin graft in comparison to paediatric patients debrided in the emergency department under Ketamine sedation (OR: 6.97 (2.14-22.67), p < 0.001. This study is the first to demonstrate that early non-excisional debridement under general anaesthesia in the operating theatre significantly reduces wound re-epithelialisation time and subsequent need for a skin graft in paediatric burn patients. Analysis suggests that ketamine procedural sedation and analgesia in the emergency department used for burn wound debridement is not an effective substitute for debridement in the operating theatre.
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Guang Ho CW, See JL, Yang SH, Tan BK. Early Experience with Biobranetm for Definitive Coverage of Tangentially Excised Partial-Thickness Thermal Burns. World J Plast Surg 2021; 10:119-124. [PMID: 33833964 PMCID: PMC8016370 DOI: 10.29252/wjps.10.1.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BiobraneTM is a popular biosynthetic semi-permeable skin substitute conventionally applied onto non-excised partial thickness burn wounds to facilitate healing. The use of BiobraneTM for definitive coverage after excision of partial-thickness thermal burns has not been reported. We highlighted our experience of immediate BiobraneTM application for definitive coverage of tangentially-excised partial thickness thermal burn wounds in four patients. This technique is safe and efficient, minimizes painful and costly dressing changes, avoids the complications associated with autologous skin grafting, and eliminates the unpredictability of burns wound conversion. We believe this method expands the indications for BiobraneTM usage, accelerates wound healing, and provides better aesthetic outcomes.
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Affiliation(s)
- Christopher Wei Guang Ho
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Jia Le See
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Shi-Hui Yang
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Bien Keem Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
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Ryder C, Mackean T, Hunter K, Towers K, Rogers K, Holland AJA, Ivers R. Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury. Inj Epidemiol 2020; 7:52. [PMID: 33012291 PMCID: PMC7534159 DOI: 10.1186/s40621-020-00278-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander children have higher incidence, severity and hospital length of stay for their acute burn injuries than other Australian children. We examined factors contributing to longer length of stay for Aboriginal and Torres Strait Islander children with an acute burn injury. METHODS Burns Registry of Australia and New Zealand admissions of children < 16 years of age between October 2009 and July 2018 were analysed. Descriptive statistics explored patient and injury characteristics; Cox-regression models estimated characteristics associated with longer length of stay. Knowledge Interface methodology and Indigenous research methods were used throughout. RESULTS A total of 723 children were identified as Aboriginal and Torres Strait Islander and 6257 as other Australian. The median hospital length of stay for Aboriginal and Torres Strait Islander children (5 days [CI 5-6]) was 4 days longer than other Australian children (1 day [CI 1-2]). Remoteness, flame burns, high percentage total body surface area (%TBSA) and full thickness burns were factors associated with longer length of stay for Aboriginal and Torres Strait Islander children. Similar prognostic factors were identified for other Australian children along with Streptococcus sp. and Staphylococcus sp. infection. CONCLUSION Remoteness, flame burns, %TBSA, and full thickness burns are prognostic factors contributing to extended hospital length of stay for all Australian children. These factors are more prevalent in Aboriginal and Torres Strait Islander children, impacting length of stay. Treatment programs, clinical guidelines, and burns policies should engage with the unique circumstances of Aboriginal and Torres Strait Islander children to mitigate inequities in health.
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Affiliation(s)
- Courtney Ryder
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia.
- Aboriginal and Torres Strait Islander Health, College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Tamara Mackean
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia
- Aboriginal and Torres Strait Islander Health, College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Kate Hunter
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia
| | - Kurt Towers
- Watto Paruna Aboriginal Health for the Northern Adelaide Local Health Network, Corner of Mark and Oldham Roads, Elizabeth Vale, SA, 5112, Australia
| | - Kris Rogers
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia
- Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Andrew J A Holland
- Sydney Medical School, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia
| | - Rebecca Ivers
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, Sydney, NSW, 2050, Australia
- School of Public Health and Community Medicine, UNSW, Sydney, 2052, Australia
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