Use of oxidized regenerated cellulose (ORC)/collagen/silver-ORC dressings to help manage skin graft donor site wounds

Comparative Effectiveness of Negative Pressure Wound Therapy with and Without Oxidized Regenerated Cellulose/Collagen/Silver-ORC Dressing

Objective: Negative pressure wound therapy (NPWT) and oxidized regenerated cellulose (ORC)/collagen/silver-ORC (OCSO) dressings have individually demonstrated effectiveness in supporting wound healing, but few studies have examined their combined use. This retrospective data analysis compared wound outcomes following outpatient NPWT with and without OCSO dressings. Approach: A search of deidentified records from the U.S. Wound Registry resulted in 485 cases of wounds managed with NPWT with OCSO dressings. A matched cohort of patients who received NPWT without any collagen dressing (n = 485) was created using propensity scoring. For patients in the NPWT + OCSO group, OCSO was applied topically on or after the day of NPWT initiation and stopped on or before the day of NPWT termination. Results: Wounds managed with NPWT + OCSO were significantly more likely to improve and/or heal compared with wounds that received NPWT alone (p = 0.00029). The relative wound area reduction was 40% for patients receiving NPWT + OCSO, compared with 9% for patients receiving only NPWT (p = 0.0099). The median time to achieve 75-100% granulation coverage with no measurable wound depth was shorter by 8 days with NPWT + OCSO in all wound types (p = 0.00034), and by 14 days in surgical wounds (p = 0.0010), than with NPWT alone. Innovation: This is the first study examining the clinical outcomes associated with the integration of NPWT and OCSO dressings compared with the use of NPWT alone. These data support the novel practice of applying NPWT concurrently with OCSO dressings. Conclusion: This retrospective comparative analysis using real-world data demonstrated improved healing outcomes with integrated use of NPWT with OCSO dressings versus NPWT alone.

Antibacterial and Antibiofilm Potential of Bacterial Cellulose Hydrogel Containing Vancomycin against Multidrug-Resistant Staphylococcus aureus and Staphylococcus epidermidis

The present study aimed to evaluate the in vitro antibacterial and antibiofilm activity of bacterial cellulose hydrogel produced by Zoogloea sp. (HYDROGEL) containing vancomycin (VAN) against bacterial strains that cause wound infections, such as multidrug-resistant (MDR) Staphylococcus aureus and Staphylococcus epidermidis. Initially, HYDROGEL was obtained from sugar cane molasses, and scanning electron microscopy (SEM) was performed to determine morphological characteristics. Then, VAN was incorporated into HYDROGEL (VAN-HYDROGEL). The antibacterial activity of VAN, HYDROGEL, and VAN-HYDROGEL was assessed using the broth microdilution method to determine the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) against methicillin-sensitive S. aureus (MSSA) ATCC 25923, methicillin-resistant S. aureus (MRSA) ATCC 33591, S. epidermidis INCQS 00016 (ATCC 12228), five clinical isolates of MRSA, and nine clinical isolates of methicillin-resistant S. epidermidis, following the Clinical and Laboratory Standards Institute (CLSI) guidelines. Additionally, the antibacterial activity of VAN, HYDROGEL, and VAN-HYDROGEL was studied using the time-kill assay. Subsequently, the antibiofilm activity of VAN, HYDROGEL, and VAN-HYDROGEL was evaluated using crystal violet and Congo red methods, as well as SEM analysis. VAN and VAN-HYDROGEL showed bacteriostatic and bactericidal activity against MRSA and methicillin-resistant S. epidermidis strains. HYDROGEL did not show any antibacterial activity. Analysis of the time-kill assay indicated that HYDROGEL maintained the antibacterial efficacy of VAN, highlighting its efficiency as a promising carrier. Regarding antibiofilm activity, VAN and HYDROGEL inhibited biofilm formation but did not demonstrate biofilm eradication activity against methicillin-resistant S. aureus and S. epidermidis strains. However, it was observed that the biofilm eradication potential of VAN was enhanced after incorporation into HYDROGEL, a result also proven through images obtained by SEM. From the methods carried out in this study, it was possible to observe that HYDROGEL preserved the antibacterial activity of vancomycin, aside from exhibiting antibiofilm activity and enhancing the antibiofilm effect of VAN. In conclusion, this study demonstrated the potential of HYDROGEL as a candidate and/or vehicle for antibiotics against MDR bacteria that cause wound infections.

Impact of moist wound dressing on wound healing time: A meta-analysis

Among the assortment of available dressings aimed at promoting wound healing, moist dressings have gained significant popularity because of their ability to create an optimal environment for wound recovery. This meta-analysis seeks to compare the effects of moist dressing versus gauze dressing on wound healing time. A comprehensive literature search was conducted, encompassing publications up until April 1, 2023, across multiple databases including PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Cochrane Library. Stringent criteria were used to determine study inclusion and evaluate methodological quality. Statistical analyses were performed utilizing Stata 17.0. A total of 13 articles, encompassing 866 participants, were included in the analysis. The findings indicate that moist dressing surpasses gauze dressing in terms of wound healing time (standard mean difference [SMD] -2.50, 95% confidence interval [CI] -3.35 to -1.66, p < 0.01; I2  = 97.24%), wound site infection rate (odds ratio [OR] 0.30, 95% CI 0.17 to 0.54, p < 0.01; I2  = 39.91%), dressing change times (SMD -3.65, 95% CI -5.34 to -1.97, p < 0.01; I2  = 96.48%), and cost (SMD -2.66, 95% CI -4.24 to -1.09, p < 0.01; I2  = 94.90%). Subgroup analyses revealed possible variations in wound healing time based on wound types and regions. This study underscores the significant advantages associated with the use of moist dressings, including expedited wound healing, reduced infection rates, decreased frequency of dressing changes, and lower overall treatment costs.

Comparison of skin graft donor site management using oxidised regenerated cellulose (ORC)/collagen/silver-ORC with absorptive silicone adhesive border and transparent film dressing vs semi-occlusive dressings

Split-thickness skin grafts (STSG) are widely used in wound reconstruction. However, donor site wounds are created as a result. Traditionally, moist wound healing and transparent film dressings have been used to promote donor site wound healing. This retrospective study evaluated the use of oxidised regenerated cellulose (ORC)/collagen/silver-ORC dressing (ORC/C/Ag-ORC) with an absorptive silicone adhesive border dressing and transparent film dressing (treatment) compared with petrolatum-based gauze dressing (control) over donor site wounds. Patients underwent an STSG procedure between January and December 2020. Donor sites received treatment (n = 10) or control (n = 10) dressings. Dressing changes occurred as necessary. Time to epithelialisation, narcotic pain medication requirements, and the number of office/hospital visits were examined. Twenty patients were managed (9 males, 11 females, average age: 49.7 ± 13.9 y). Patient comorbidities included hypertension, diabetes, and hyperlipidemia. Wound types included traumatic and cancer excision. Time to epithelialisation was significantly reduced in the treatment group (11.1 ± 1.4 d vs 18 ± 2.4 d, P < 0.0001). The number of office visits for dressing changes was significantly lower in the treatment group (0.1 ± 0.3 vs 2 ± 0.7, P < 0.0001). No patients in the treatment group required a hospital visit, compared with 3 patients in the control group. One patient in the treatment group required narcotic pain medication, compared with 5 in the control group. In this patient population, the use of ORC/C/Ag-ORC, an absorptive silicone adhesive border dressing, and transparent film dressing resulted in a shorter time to epithelialisation and less analgesic requirement compared with petrolatum-based gauze dressing use.

A meta‐analysis examined the effect of oxidised regenerated cellulose/collagen dressing on the management of chronic skin wounds

To assess the impact of oxidised regenerated cellulose/collagen dressing on the management of chronic skin wounds, we conducted a meta-analysis. A thorough review of the literature up to September 2022 revealed that 1521 participants had chronic skin wounds at the start of the investigations; 763 of them used oxidised regenerated cellulose/collagen dressing, while 758 received control. Using dichotomous or contentious methods and a random or fixed-effect model, odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CIs) were estimated to evaluate the impact of oxidised regenerated cellulose/collagen dressing on the management of chronic skin wounds. The oxidised regenerated cellulose/collagen dressing had significantly higher complete wound healing (OR, 1.74; 95% CI, 1.06-2.85; P = .03), higher wound relative reduction percent (MD, 13.50; 95% CI, 2.39-24.61; P = .02), and lower adverse events in wound healing (OR, 0.63; 95% CI, 0.41-0.98; P = .04) compared with control in chronic skin wounds. The oxidised regenerated cellulose/collagen dressing had significantly higher complete wound healing, higher wound relative reduction percent and lower adverse events in wound healing compared with control in chronic skin wounds. The low sample size of 8 out of 10 researches in the meta-analysis and the small number of studies in several comparisons calls for care when analysing the results.

Bacterial Cellulose-A Remarkable Polymer as a Source for Biomaterials Tailoring

Nowadays, the development of new eco-friendly and biocompatible materials using ‘green’ technologies represents a significant challenge for the biomedical and pharmaceutical fields to reduce the destructive actions of scientific research on the human body and the environment. Thus, bacterial cellulose (BC) has a central place among these novel tailored biomaterials. BC is a non-pathogenic bacteria-produced polysaccharide with a 3D nanofibrous structure, chemically identical to plant cellulose, but exhibiting greater purity and crystallinity. Bacterial cellulose possesses excellent physicochemical and mechanical properties, adequate capacity to absorb a large quantity of water, non-toxicity, chemical inertness, biocompatibility, biodegradability, proper capacity to form films and to stabilize emulsions, high porosity, and a large surface area. Due to its suitable characteristics, this ecological material can combine with multiple polymers and diverse bioactive agents to develop new materials and composites. Bacterial cellulose alone, and with its mixtures, exhibits numerous applications, including in the food and electronic industries and in the biotechnological and biomedical areas (such as in wound dressing, tissue engineering, dental implants, drug delivery systems, and cell culture). This review presents an overview of the main properties and uses of bacterial cellulose and the latest promising future applications, such as in biological diagnosis, biosensors, personalized regenerative medicine, and nerve and ocular tissue engineering.

Recent advancements in cellulose-based biomaterials for management of infected wounds

INTRODUCTION

Chronic wounds are a substantial burden on the healthcare system. Their treatment requires advanced dressings, which can provide a moist wound environment, prevent bacterial infiltration, and act as a drug carrier. Cellulose is biocompatible, biodegradable, and can be functionalized according to specific requirements, which makes it a highly versatile biomaterial. Antimicrobial cellulose dressings are proving to be highly effective against infected wounds.

AREAS COVERED

This review briefly addresses the mechanism of wound healing and its pathophysiology. It also discusses wound infections, biofilm formation, and progressive emergence of drug-resistant bacteria in chronic wounds and the treatment strategies for such types of infected wounds. It also summarizes the general properties, method of production, and types of cellulose wound dressings. It explores recent studies and advancements regarding the use of cellulose and its derivatives in wound management.

EXPERT OPINION

Cellulose and its various functionalized derivatives represent a promising choice of wound dressing material. Cellulose-based dressings loaded with antimicrobials are very useful in controlling infection in a chronic wound. Recent studies showing its efficacy against drug-resistant bacteria make it a favorable choice for chronic wound infections. Further research and large-scale clinical trials are required for better clinical evidence of its efficiency.

Efficacy of Oxidized Regenerated Cellulose/Collagen Dressing for Management of Skin Wounds: A Systematic Review and Meta-Analysis

OBJECTIVE

The purpose of this study was to evaluate the wound healing efficacy of oxidized regenerated cellulose (ORC)/collagen dressing and ORC/collagen/silver-ORC dressings compared to standard of care or control in treatment of chronic skin wounds such as diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), and pressure injuries sore ulcers (PISUs).

METHODS

An electronic search was carried out in four popular databases PubMed, Scopus, Embase, and CENTRAL to identify thirteen included studies, comparing the clinical efficacy of ORC/collagen dressings when compared to control in management of chronic skin wounds, especially DFUs, VLUs, and PISUs, and skin graft donor site wounds.

RESULTS

Consolidated data from thirteen comparative clinical studies undertaken for management of DFUs, VLUs, and PISUs showed favorable outcomes towards use of ORC/collagen compared to other traditional and hydrocolloid foam dressings in terms of wound healing rate (P=0.02) and percentage wound relative reduction (P=0.003). The time taken to achieve complete wound healing in the included studies did not show any statistical significant difference (P=0.24). There was no significant difference in adverse events between ORC/collagen-treated group and comparative group (P=0.19).

CONCLUSION

ORC/collagen wound dressings are beneficial in terms of improved wound healing rate and percentage wound relative reduction compared to already existing traditional standard of care with non-MMP, inhibiting biomaterials such as moistened gauze, autologous growth factors, hydrocolloid foam dressings, or ovine extracellular matrix.

Use of oxidised regenerated cellulose/collagen dressings versus standard of care over multiple wound types: A systematic review and meta-analysis

Oxidised regenerated cellulose (ORC)/collagen dressings help maintain physiologically moist wound environments conducive to wound healing. While evidence supporting ORC/collagen dressing use exists, comprehensive assessment is needed. This systematic review/meta-analysis evaluated the performance of ORC/collagen dressings compared with standard dressings. A systematic literature search was performed using PUBMED, EMBASE, and QUOSA Virtual Library. Published studies and conference abstracts were assessed between 1 January 1996 and 27 July 2020. Comparative studies in English completed by 31 December 2019, with a study population ≥10 were included. Patient demographics, wound healing, and protease concentrations were extracted. A random-effect model was used to assess the effect of ORC/collagen dressings. Twenty studies were included following removal of duplicates and articles not meeting inclusion criteria. A statistically significant effect in favour of ORC/collagen dressings was found for wound closure (P = 0.027) and percent wound area reduction (P = 0.006). Inconclusive evidence or limited reporting prevented assessment of time to complete healing, days of therapy, number of dressing applications, pain, matrix metalloproteinase, elastase, plasmin, and gelatinase concentration. Statistically significant increase in wound closure rates and percent wound area reduction were observed in patients receiving ORC/collagen dressings compared with standard dressings in this systematic review/meta-analysis.

Nanomedicine in Healing Chronic Wounds: Opportunities and Challenges

The poor healing associated with chronic wounds affects millions of people worldwide through high mortality rates and associated costs. Chronic wounds present three main problems: First, the absence of a suitable environment to facilitate cell migration, proliferation, and angiogenesis; second, bacterial infection; and third, unbalanced and prolonged inflammation. Unfortunately, current therapeutic approaches have not been able to overcome these main issues and, therefore, have limited clinical success. Over the past decade, incorporating the unique advantages of nanomedicine into wound healing approaches has yielded promising outcomes. Nanomedicine is capable of stimulating various cellular and molecular mechanisms involved in the wound microenvironment via antibacterial, anti-inflammatory, and angiogenetic effects, potentially reversing the wound microenvironment from nonhealing to healing. This review briefly discusses wound healing mechanisms and pathophysiology and then highlights recent findings regarding the opportunities and challenges of using nanomedicine in chronic wound management.

Original hardware-software method for treatment of infected superficial wounds in a liquid environment

Aim ― development of a hardware-software system allowing to treat infected superficial wounds in a liquid environment, designed to provide continuous flow of various irrigation solutions (depending on the wound healing stage) under airtight and water-resistant film tightly fixed over the wound. Methods ― in this experiment wound irrigation with antiseptic, oxidizing antiseptic and osmotically active agents with subsequent exposure and drainage was performed using the novel device. Efficacy of the proposed hardware-software system was evaluated by comparing it with standard wound dressings by planimetry and wound biopsy results. Results ― according to study results the novel device reduces the time of wound healing by 26.1%, while the time to wound proliferation is 1.7 times shorter when compared with standard wound dressings. Conclusion ― the proposed method stimulates wound repair and limits purulent inflammation in infected wounds. Using the novel method of superficial wound management helps to prevent the development of re-infection and suppuration.