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Khan MUA, Aslam MA, Rahman RA, Abdullah MFB, Mehmood A, Stojanović GM. Current progress of protein-based dressing for wound healing applications - A review. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2024; 35:2402-2445. [PMID: 39018238 DOI: 10.1080/09205063.2024.2380570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/24/2024] [Indexed: 07/19/2024]
Abstract
Protein-based wound dressings have garnered increasing interest in recent years owing to their distinct physical, chemical, and biological characteristics. The intricate molecular composition of proteins gives rise to unique characteristics, such as exceptional biocompatibility, biodegradability, and responsiveness, which contribute to the promotion of wound healing. Wound healing is an intricate and ongoing process influenced by multiple causes, and it consists of four distinct phases. Various treatments have been developed to repair different types of skin wounds, thanks to advancements in medical technology and the recognition of the diverse nature of wounds. This review has literature reviewed within the last 3-5 years-the recent progress and development of protein in wound dressings and the fundamental properties of an ideal wound dressing. Herein, the recent strides in protein-based state-of-the-art wound dressing emphasize the significant challenges and summarize future perspectives for wound healing applications.
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Affiliation(s)
- Muhammad Umar Aslam Khan
- Department of Mechanical and Industrial Engineering, Qatar University, Doha, Qatar
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Muhammad Azhar Aslam
- Department of Physics, University of Engineering and Technology, Lahore, Pakistan
| | - Roselinda Ab Rahman
- Oral and Maxillofacial Surgery Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Mohd Faizal Bin Abdullah
- Oral and Maxillofacial Surgery Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Oral and Maxillofacial Surgery Unit, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Azra Mehmood
- National Centre of Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Goran M Stojanović
- Department of Electronics, Faculty of Technical Sciences, University of Novi Sad, Novi Sad, Serbia
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Saberianpour S, Melotto G, Redhead L, Terrazzini N, Forss JR, Santin M. Harnessing the Interactions of Wound Exudate Cells with Dressings Biomaterials for the Control and Prognosis of Healing Pathways. Pharmaceuticals (Basel) 2024; 17:1111. [PMID: 39338276 PMCID: PMC11434639 DOI: 10.3390/ph17091111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/13/2024] [Accepted: 08/20/2024] [Indexed: 09/30/2024] Open
Abstract
The global socioeconomic challenge generated by wounds requires an understanding of healing and non-healing pathways in patients. Also, the interactions occurring between the wound dressing biomaterials with cells relevant to the healing process have not been sufficiently investigated, thus neglecting the role that wound dressing composition can play in healing. Through the study of six cases of acute surgical wounds, the present work analyses the early (24 h post-surgery) interactions of biochemical and cellular components with (i) Atrauman, a device made of knitted woven synthetic polymeric fibre when used as a primary dressing, and (ii) Melolin, a hydrocolloid engineered as two layers of synthetic and cellulose non-woven fibres when used as a secondary dressing. A pathway towards healing could be observed in those cases where endoglin-expressing cells and M2 macrophages were retained by Atrauman fibres at the interface with the wound bed. On the contrary, cases where the secondary dressing Melolin absorbed these cell phenotypes in its mesh resulted in a slower or deteriorating healing process. The data obtained indicate that a subtraction of progenitor cells by Melolin may impair the healing process and that the analysis of the retrieved wound dressings for biomarkers expressed by cells relevant to wound healing may become an additional tool to determine the patient's prognosis.
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Affiliation(s)
- Shirin Saberianpour
- Centre for Regenerative Medicine and Devices, University of Brighton, Huxley Building Lewes Road, Brighton BN2 4GJ, UK
- School of Applied Sciences, University of Brighton, Huxley Building Lewes Road, Brighton BN2 4GJ, UK
| | - Gianluca Melotto
- Centre for Regenerative Medicine and Devices, University of Brighton, Huxley Building Lewes Road, Brighton BN2 4GJ, UK
- School of Health and Sport Sciences, University of Brighton, Falmer Campus, Village Way, Brighton BN1 9PH, UK
| | - Lucy Redhead
- Centre for Regenerative Medicine and Devices, University of Brighton, Huxley Building Lewes Road, Brighton BN2 4GJ, UK
- School of Health and Sport Sciences, University of Brighton, Falmer Campus, Village Way, Brighton BN1 9PH, UK
| | - Nadia Terrazzini
- Centre for Regenerative Medicine and Devices, University of Brighton, Huxley Building Lewes Road, Brighton BN2 4GJ, UK
- School of Applied Sciences, University of Brighton, Huxley Building Lewes Road, Brighton BN2 4GJ, UK
| | - Jaqueline Rachel Forss
- Centre for Regenerative Medicine and Devices, University of Brighton, Huxley Building Lewes Road, Brighton BN2 4GJ, UK
- School of Health and Sport Sciences, University of Brighton, Falmer Campus, Village Way, Brighton BN1 9PH, UK
| | - Matteo Santin
- Centre for Regenerative Medicine and Devices, University of Brighton, Huxley Building Lewes Road, Brighton BN2 4GJ, UK
- School of Applied Sciences, University of Brighton, Huxley Building Lewes Road, Brighton BN2 4GJ, UK
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Imani A, Panahipour L, Kühtreiber H, Mildner M, Gruber R. RNAseq of Gingival Fibroblasts Exposed to PRF Membrane Lysates and PRF Serum. Cells 2024; 13:1308. [PMID: 39120336 PMCID: PMC11311358 DOI: 10.3390/cells13151308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/19/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024] Open
Abstract
Platelet-rich fibrin (PRF) is prepared by spontaneous coagulation of fractionated blood. When squeezed between two plates, PRF is separated into solid PRF membranes and a liquid exudate, the PRF serum. The question arises regarding how much the overall activity remains in the PRF membranes and what is discarded into the PRF serum. To this end, we have exposed gingival fibroblasts to lysates prepared from PRF membranes and PRF serum, followed by bulk RNA sequencing. A total of 268 up- and 136 down-regulated genes in gingival fibroblasts exposed to PRF membrane lysates were significantly regulated under the premise of a minimum log2 with 2.5-fold change and a minus log10 significance level of two, respectively. PRF serum only caused 62 up- and 32 down-regulated genes under these conditions. Among the 46 commonly up-regulated genes were CXCL1, CXCL5, CXCL6, CXCL8, IL33, IL6, and PTGS2/COX2, stanniocalcin-1-all linked to an inflammatory response. PRF membrane lysates further increased chemokines CCL2, CCL7, CXCL2, CXCL3, and IL1R1, IL1RL1, and IL1RN, as well as the paracrine factors IL11, LIF, IGF1, BMP2, BMP6, FGF2, and CCN2/CTGF, and all hyaluronan synthases. On the other hand, PRF serum increased DKK1. The genes commonly down-regulated by PRF membrane lysates and PRF serum included interferon-induced protein with tetratricopeptide repeats (IFIT1, IFIT2, IFIT3) and odd-skipped-related transcription factors (OSR1 and OSR2), as well as FGF18 and GDF15, respectively. Taken together, PRF membrane lysates, compared to PRF serum, cause a more complex response in gingival fibroblasts, but each increased chemokine expression in gingival fibroblasts.
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Affiliation(s)
- Atefe Imani
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria; (A.I.); (L.P.)
| | - Layla Panahipour
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria; (A.I.); (L.P.)
| | - Hannes Kühtreiber
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (H.K.); (M.M.)
- Applied Immunology Laboratory, Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Mildner
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (H.K.); (M.M.)
| | - Reinhard Gruber
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria; (A.I.); (L.P.)
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
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Woo K. The Chronic Wound-Related Pain Model: Holistic Assessment and Person-Centered Treatment. Clin Geriatr Med 2024; 40:501-514. [PMID: 38960540 DOI: 10.1016/j.cger.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Chronic wound-related pain is a complex biopsychosocial experience that is experienced spontaneously at rest and exacerbated during activities. Tissue debridement, trauma at dressing change, increased bioburden or infection, exposure of periwound skin to moisture, and related treatment can modulate chronic wound-related pain. Clinicians should consider multimodal and multidisciplinary management approach that take into account the biology, emotions, cognitive thinking, social environment, and other personal determinants of pain. Unresolved pain can have a significant impact on wound healing, patients' adherence to treatment, and individual's quality of life.
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Affiliation(s)
- Kevin Woo
- Faculty of Health Sciences, Queen's University, 92 Barrie Street, Kingston, Ontario K7L 3N6, Canada.
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Woo K, González CVS, Amdie FZ, de Gouveia Santos VLC. Exploring the effect of wound related pain on psychological stress, inflammatory response, and wound healing. Int Wound J 2024; 21:e14942. [PMID: 38946527 PMCID: PMC11215315 DOI: 10.1111/iwj.14942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024] Open
Abstract
AIMS AND OBJECTIVES The relationship between pain and poor healing is intricate, potentially mediated by psychological stress and aberrations in inflammatory response. The purpose of this study was to examine the biopsychosocial model of pain by assessing the relationships between pain, stress, inflammation and healing in people with chronic wounds. DESIGN This was a 4-week prospective observational study to explore the relationship of pain, stress, inflammation and wound healing in a convenience sample of patients with chronic wounds in a chronic care hospital in Canada. METHODS Only subjects over 18 with chronic wounds were recruited into the study. Chronic wounds were defined by the duration of wounds for more than 4 weeks of various aetiologies including wounds caused by pressure injuries, venous disease, arterial insufficiency, surgery or trauma and diabetic neuropathy. Participants were evaluated for pain by responding to the Brief Pain Inventory-Short Form, the McGill Pain Questionnaire-Short Form and the Leeds Assessment of Neuropathic Symptoms and Signs scale. Stress was measured by the Perceived Stress Scale (PSS). All wounds were assessed with the Pressure Ulcer Scale for Healing tool. The levels of matrix metalloproteinases were analysis by obtaining wound fluid from all participants. RESULTS A total of 32 individuals with chronic wounds participated in the study. Correlation analysis indicated pain severity was positively and significantly related to pain interference, McGill Pain Questionnaire scores, neuropathic pain and matrix metalloproteinase levels. Logistic regression was used to determine the predictors for high or low perceived stress. The only significant variable that contributed to the stress levels was BPI-I. Results suggested that participants who experienced higher levels of pain interference also had an increased odds to report high level of stress by 1.6 times controlling for all other factor in the model. CONCLUSION Pain is a complex biopsychosocial phenomenon affecting quality of life in people with chronic wounds. Results of this study identified a significant relationship between pain, stress and wound healing.
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Affiliation(s)
- Kevin Woo
- Faculty of Health Sciences, School of NursingQueen's UniversityKingstonONCanada
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Yadav RB, Pathak DP, Varshney R, Arora R. Elucidation of the Role of TRPV1, VEGF-A, TXA2, Redox Homeostasis, and Inflammatory Cascades in Protection against Cold Injuries by Herbosomal-Loaded PEG-Poloxamer Topical Formulation. ACS APPLIED BIO MATERIALS 2024; 7:2836-2850. [PMID: 38717017 DOI: 10.1021/acsabm.3c01197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
High-altitude regions, cold deserts, permafrost regions, and the polar region have some of the severest cold conditions on earth and pose immense perils of cold injuries to exposed individuals. Accidental and unintended exposures to severe cold, either unintentionally or due to occupational risks, can greatly increase the risk of serious conditions including hypothermia, trench foot, and cold injuries like frostbite. Cold-induced vasoconstriction and intracellular/intravascular ice crystal formation lead to hypoxic conditions at the cellular level. The condition is exacerbated in individuals having inadequate and proper covering and layering, particularly when large area of the body are exposed to extremely cold environments. There is a paucity of preventive and therapeutic pharmacological modalities that have been explored for managing and treating cold injuries. Given this, an efficient modality that can potentiate the healing of frostbite was investigated by studying various complex pathophysiological changes that occur during severe cold injuries. In the current research, we report the effectiveness and healing properties of a standardized formulation, i.e., a herbosomal-loaded PEG-poloxamer topical formulation (n-HPTF), on frostbite. The intricate mechanistic pathways modulated by the novel formulation have been elucidated by studying the pathophysiological sequelae that occur following severe cold exposures leading to frostbite. The results indicate that n-HPTF ameliorates the outcome of frostbite, as it activates positive sensory nerves widely distributed in the epidermis transient receptor potential vanilloid 1 (TRPV1), significantly (p < 0.05) upregulates cytokeratin-14, promotes angiogenesis (VEGF-A), prominently represses the expression of thromboxane formation (TXA2), and significantly (p < 0.05) restores levels of enzymatic (glutathione reductase, superoxide dismutase, and catalase) and nonenzymatic antioxidants (glutathione). Additionally, n-HPTF attenuates oxidative stress and the expression of inflammatory proteins PGF-2α, NFκB-p65, TNF-α, IL-6, IL-1β, malondialdehyde (MDA), advanced oxidative protein products (AOPP), and protein carbonylation (PCO). Masson's Trichrome staining showed that n-HPTF stimulates cellular proliferation, and increases collagen fiber deposition, which significantly (p < 0.05) promotes the healing of frostbitten tissue, as compared to control. We conclude that protection against severe cold injuries by n-HPTF is mediated via modulation of pathways involving TRPV1, VEGF-A, TXA2, redox homeostasis, and inflammatory cascades. The study is likely to have widespread implications for the prophylaxis and management of moderate-to-severe frostbite conditions.
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Affiliation(s)
- Renu Bala Yadav
- Disruptive and Deterrence Technologies Division, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi 110054, India
- Delhi Pharmaceutical Science and Research University, Pushp Vihar, New Delhi 110017, India
| | - Dharam Pal Pathak
- Delhi Pharmaceutical Science and Research University, Pushp Vihar, New Delhi 110017, India
| | - Rajeev Varshney
- Disruptive and Deterrence Technologies Division, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi 110054, India
| | - Rajesh Arora
- Disruptive and Deterrence Technologies Division, Defence Institute of Physiology and Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi 110054, India
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Hecker A, Watzinger N, Pignet AL, Michelitsch B, Kotzbeck P, Kamolz LP. Ceramic Dressings-A New Non-Pharmacological Therapeutic Option in the Management of Chronic Wounds? J Pers Med 2024; 14:498. [PMID: 38793080 PMCID: PMC11122284 DOI: 10.3390/jpm14050498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
A new ceramic dressing, free from active antimicrobial or pharmaceutical agents, uses physical binding mechanisms for its absorption capacities and bacterial-binding properties. The purpose of this study was to evaluate wound healing, bacterial-related retention, and diagnostic properties of ceramic dressings in patients with stagnated chronic wounds. METHODS In this monocentric, intra-individually controlled, prospective study, patients with conservatively treated refractory chronic wounds were enrolled. One week before the start of the application with ceramic dressing, it was ensured during a screening phase that chronic wounds showed less than a 10% reduction in wound size. During the 4-week ceramic dressing treatment wound size measurements, wound scoring, measurement of wound exudate amount, wound swabs, and ceramic dressing sonication (low-intensity ultrasound) were carried out. The sonication fluid of the removed ceramic dressing was used for analysis of bacterial retention and compared to wound swabs. RESULTS A total of 20 patients with a mean age of 64.6 years (±26.2) and 21 chronic wounds were included in this study. After a 4-week treatment, a significant reduction of median wound size from 1178 mm2 (range 104-6300) to 751.5 mm2 (range 16-4819) and better total wound scores were observed (p < 0.001). The sensitivity of bacteria detection was 90.7% in the sonication fluid from the ceramic dressings, while only 76.9% in the conventional wound swabs. CONCLUSION The new ceramic dressing seems to have a positive impact on wound healing in chronic wounds. Bacteria-binding characteristics of the investigated ceramic dressing, in combination with its debridement, absorption, and detoxification properties, could contribute to its healing abilities. Based on those results, the investigated ceramic dressing seems to be a promising new treatment option for chronic wounds without the use of any active antimicrobial or pharmacological agents. Moreover, ceramic dressings can also be considered for microbiological diagnostic purposes.
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Affiliation(s)
- Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Nikolaus Watzinger
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Anna-Lisa Pignet
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Birgit Michelitsch
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
| | - Petra Kotzbeck
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/4, 8036 Graz, Austria; (A.H.); (L.-P.K.)
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstraße 2, 8010 Graz, Austria
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Ma Y, Li Y, Wang C, Zhang Y, Wang L, Hu R, Yin Y, He F. Effects of non-pharmacological interventions on pain in wound patients during dressing change: A systematic review. Nurs Open 2024; 11:e2107. [PMID: 38391098 PMCID: PMC10830920 DOI: 10.1002/nop2.2107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/12/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Changes to the wound dressing frequently cause pain. Some adverse side effects of pharmacologic pain management may cause problems or even impede wound healing. There is no systematic study of non-pharmacologic therapies for pain during wound dressing changes, despite the gradual promotion of non-pharmacologic pain reduction methods. OBJECTIVES To give clinical wound pain management a new direction, locating and assessing non-pharmacological interventions regarding pain brought on by wound dressing changes are necessary. METHOD The researchers conducted a comprehensive literature review on non-pharmacological interventions for pain during wound dressing changes across five databases: PubMed, Web of Science, Medline, Embase, and the Cochrane Library spanning the period from January 2010 to September 2022. The evaluation of literature and data extraction was carried out independently by two researchers, and in cases of disagreement, a third researcher participated in the deliberation. To assess the risk of bias in the literature, the researchers utilised the Cochrane Handbook for Reviews of Interventions, version 5.1.0. RESULTS In total, 951 people were involved in 11 investigations covering seven non-pharmacological therapies. For pain triggered by dressing changes, virtual reality (VR) distraction, auditory and visual distractions, foot reflexology, religious and spiritual care, and guided imaging demonstrated partially positive effects, with hypnosis therapy and jaw relaxation perhaps having a weak effect. CONCLUSION The key to managing wounds is pain management. According to our review, there is some indication that non-pharmacologic interventions can help patients feel less discomfort when having their wound dressings changed. However, the evidence supporting this view is weak. It needs to be corroborated by future research studies with multicentre and large samples. To promote and use various non-pharmacologic interventions in the future, it is also necessary to build standardised and homogenised paths for their implementation.
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Affiliation(s)
- Yanfei Ma
- Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangSichuanP.R. China
| | - Yeping Li
- Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangSichuanP.R. China
| | - Chunyan Wang
- Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangSichuanP.R. China
| | - Yaqing Zhang
- Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangSichuanP.R. China
| | - Lihui Wang
- Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangSichuanP.R. China
| | - Rong Hu
- Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangSichuanP.R. China
| | - Yang Yin
- Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangSichuanP.R. China
| | - Fang He
- Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangSichuanP.R. China
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Horta-Velázquez A, Mota-Morales JD, Morales-Narváez E. Next-generation of smart dressings: Integrating multiplexed sensors and theranostic functions. Int J Biol Macromol 2024; 254:127737. [PMID: 38287589 DOI: 10.1016/j.ijbiomac.2023.127737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 01/31/2024]
Abstract
Non-healing wounds represent a significant burden for healthcare systems and society, giving rise to severe economic and human issues. Currently, the use of dressings and visual assessment represent the primary and standard care for wounds. Conventional dressings, like cotton gauze, provide only passive physical protection. Besides, they end up paradoxically hampering the wound-healing process by producing tissue damage and pain when removed during routine check-ups. In response to these limitations, researchers, engineers, and technologists are developing innovative dressings that incorporate advanced diagnostic and therapeutic functionalities, coined as "smart dressings". Now, the maturation of smart dressing is bringing them closer to real-life applications, leading to an exciting new generation of these devices. The next generation of smart dressings is capable of monitoring in real-time multiple biomarkers while including pro-healing capabilities in a single platform. Such multiplexed and theranostic smart dressings are expected to offer a timely biomarker-directed diagnosis of non-healing wounds while enabling rapid, automated, and personalized treatments of infection and chronicity. Herein, we provide an insightful overview of these advantageous devices, delving into the diverse spectrum of possible engineering strategies. This encompasses the use of electrochemical and optical platforms with diverse multiplexing architectures, such as multi-zone sensing arrays and multi-layered devices. Open or closed-loop theranostic mechanisms using various stimuli-responsive materials that could be internally or externally controlled are also included. Finally, a critical discussion on the main challenges and future directions of smart dressings is also offered.
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Affiliation(s)
| | - Josué D Mota-Morales
- Centro de Física Aplicada y Tecnología Avanzada (CFATA), Universidad Nacional Autónoma de México (UNAM), Querétaro 76230, Mexico
| | - Eden Morales-Narváez
- Centro de Física Aplicada y Tecnología Avanzada (CFATA), Universidad Nacional Autónoma de México (UNAM), Querétaro 76230, Mexico.
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Mohan S, Khan A. Pain and Wound Management in Fungating Merkel Cell Carcinoma within a Palliative Setting: The First Case Report of this Predicament. Indian J Palliat Care 2024; 30:81-84. [PMID: 38633689 PMCID: PMC11021067 DOI: 10.25259/ijpc_259_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/25/2023] [Indexed: 04/19/2024] Open
Abstract
Merkel cell carcinoma (MCC) is a rare type of skin cancer of the neuroendocrine Merkel mechanoreceptors. These cells are closely associated with nerve terminals and, given their proximity to cutaneous tissue, have the propensity to develop into deeply ulcerated, fungating malignancies. These friable wounds are easily irritated, and can cause significant pain for patients. We report a palliative case of severe, fungating MCC of the left scalp where the main contributor to the patient's illness burden is pain. Having been referred to palliative care by the Tissue Viability team, this 90-year-old gentleman was complaining of episodic burning pain during dressing changes, which was associated with radiation to the forehead, nausea, and significant trait anxiety. It was theorised that this pain could be in part due to tension headache, not just nociception, and anticipatory lorazepam was prescribed to relieve trait anxiety. All symptoms were majorly relieved following this administration. A specialist dressing was implemented to absorb exudate and balance moisture, which we believe may have stopped further deterioration of pain. Overall, this report emphasises the need to consider alternative pain aetiologies other than nociception in a presentation that is not found in the literature.
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Affiliation(s)
- Shaan Mohan
- School of Medicine, College of Life Sciences, Leicester Medical School, Leicester, United Kingdom
| | - Ahmad Khan
- School of Medicine, College of Life Sciences, Leicester Medical School, Leicester, United Kingdom
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Healy CR, Gethin G, Pandit A, Finn DP. Chronic wound-related pain, wound healing and the therapeutic potential of cannabinoids and endocannabinoid system modulation. Biomed Pharmacother 2023; 168:115714. [PMID: 37865988 DOI: 10.1016/j.biopha.2023.115714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Chronic wounds represent a significant burden on the individual, and the healthcare system. Individuals with chronic wounds report pain to be the most challenging aspect of living with a chronic wound, with current therapeutic options deemed insufficient. The cutaneous endocannabinoid system is an important regulator of skin homeostasis, with evidence of system dysregulation in several cutaneous disorders. Herein, we describe the cutaneous endocannabinoid system, chronic wound-related pain, and comorbidities, and review preclinical and clinical evidence investigating endocannabinoid system modulation for wound-related pain and wound healing. Based on the current literature, there is some evidence to suggest efficacy of endocannabinoid system modulation for promotion of wound healing, attenuation of cutaneous disorder-related inflammation, and for the management of chronic wound-related pain. However, there is 1) a paucity of preclinical studies using validated models, specific for the study of chronic wound-related pain and 2) a lack of randomised control trials and strong clinical evidence relating to endocannabinoid system modulation for wound-related pain. In conclusion, while there is some limited evidence of benefit of endocannabinoid system modulation in wound healing and wound-related pain management, further research is required to better realise the potential of targeting the endocannabinoid system for these therapeutic applications.
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Affiliation(s)
- Catherine R Healy
- Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway City, Ireland; Galway Neuroscience Centre, University of Galway, Galway City, Ireland; Centre for Pain Research, University of Galway, Galway City, Ireland; CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland
| | - Georgina Gethin
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland; School of Nursing and Midwifery, University of Galway, Galway City, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway City, Ireland
| | - Abhay Pandit
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland
| | - David P Finn
- Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway City, Ireland; Galway Neuroscience Centre, University of Galway, Galway City, Ireland; Centre for Pain Research, University of Galway, Galway City, Ireland; CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland.
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12
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Kim J, Stechmiller J, Weaver M, Gibson DJ, Horgas A, Kelly DL, Lyon DE. The association of wound factors and symptoms of fatigue and pain with wound healing in chronic venous leg ulcers. Int Wound J 2023; 20:1098-1111. [PMID: 36181308 PMCID: PMC10031222 DOI: 10.1111/iwj.13966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was: (1) to characterise the association of wound area, wound exudate C-reactive protein (CRP), broad-spectrum matrix metalloprotease protein (MMPs), and symptoms of fatigue and pain in individuals with chronic venous leg ulcers (CVLUs) over time and (2) to identify factors associated with the wound healing trajectory in CVLUs. Seventy four participants with CVLU who received weekly sharp debridement were recruited from a wound care clinic during the 8-week study period. To examine associations among wound CRP, MMPs, pain, fatigue, and wound healing trajectory over time, we calculated Bayes factors (BF) based on a linear mixed model. The mean age of participants was 71.8 (SD = 9.8) and the mean wound area was 2278 mm2 (SD = 7085 mm2 ) at baseline. Higher fatigue was strongly associated with higher MMPs (BF = 9, 95% HDI: [-.05, .43]), lower CRP (BF = 11, 95% HDI: [-.02, .002]), and large areas of wound (BF = 20, 95% HDI: [-.001, .01]). Higher CRP and MMPs activity in wound exudate and higher fatigue were associated with a larger wound area. To facilitate wound healing, clinicians need to utilise the multifactorial approach, which includes wound treatment and management of symptoms such as pain and fatigue, because of the molecular and psycho-behavioural factors involved in wound healing.
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Affiliation(s)
- Junglyun Kim
- College of Nursing, Chungnam National University College of Nursing, Daejeon, South Korea
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Joyce Stechmiller
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Michael Weaver
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Daniel J Gibson
- University of Alabama Capstone College of Nursing, Tuscaloosa, Alabama, USA
| | - Ann Horgas
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Debra L Kelly
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Debra E Lyon
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
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13
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Alpan AL, Cin GT. Comparison of hyaluronic acid, hypochlorous acid, and flurbiprofen on postoperative morbidity in palatal donor area: a randomized controlled clinical trial. Clin Oral Investig 2023:10.1007/s00784-022-04848-5. [PMID: 36595064 PMCID: PMC9808727 DOI: 10.1007/s00784-022-04848-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study aims to evaluate the effects of topical hyaluronic acid (HA), hypochlorous acid (HOCl), and flurbiprofen on postoperative morbidity of palatal donor sites after free gingival graft (FGG) surgery. MATERIALS AND METHODS Sixty patients requiring FGG were randomly assigned into four groups: control, HA gel (600 mg/100 g high molecular weight hyaluronic acid), HOCl spray (170-200 ppm, ph7.1), flurbiprofen spray (0.075gr flurbiprofen). Topical agents were applied for 14 days, according to groups. Patients were followed for 28 days. Palatal healing was assessed with the Laundry wound healing index (WHI). Complete epithelization (CE) was evaluated with photographs and H2O2 bubbling. Pain, burning sensation, chewing efficacy, and tissue color match (CM) were evaluated using a visual analog scale (VAS). Postoperative analgesic consumption and delayed bleeding (DB) were also recorded. RESULTS HA provided better WHI values on the 7th, 14th, and 21st days compared to the other groups, respectively (p < 0.05). CE was formed on the 21st day in the HA group but on the 28th day in the other groups. HOCl and flurbiprofen groups were not different from the control group or each other in terms of WHI. HOCl had the lowest VAS scores of all time periods. DB was not observed in any group. Significantly fewer analgesics were taken in the topical agent-applied groups compared to the control group. CONCLUSIONS HA exhibits a positive impact on the epithelization of palatal wound healing and color matching. HOCl and flurbiprofen provided less pain; however, they might have negative effects on palatal wound healing. CLINICAL RELEVANCE As a result of obtaining free gingival grafts from palatal tissue for mucogingival surgical procedures, secondary wound healing of the donor area occurs. This wound in the palatal region can cause discomfort and pain every time patients use their mouths. The use of HA can reduce postoperative complications by accelerating wound healing and reducing pain. The topical use of flurbiprofen and HOCl can reduce patients' pain.
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Affiliation(s)
- Aysan Lektemur Alpan
- Department of Periodontology, Faculty of Dentistry, Pamukkale University, Kınıklı Campus, 20160 Denizli, Turkey
| | - Gizem Torumtay Cin
- Department of Periodontology, Faculty of Dentistry, Pamukkale University, Kınıklı Campus, 20160 Denizli, Turkey
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Permyakova ES, Konopatsky AS, Ershov KI, Bakhareva KI, Sitnikova NA, Shtansky DV, Solovieva AO, Manakhov AM. Ag-Contained Superabsorbent Curdlan–Chitosan Foams for Healing Wounds in a Type-2 Diabetic Mice Model. Pharmaceutics 2022; 14:pharmaceutics14040724. [PMID: 35456559 PMCID: PMC9032745 DOI: 10.3390/pharmaceutics14040724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 12/13/2022] Open
Abstract
This study focused on the synthesis and characterization of pure curdlan–chitosan foams (CUR/CS), as well as foams containing Ag nanoparticles (CUR/CS/Ag), and their effect on the skin repair of diabetic mice (II type). The layer of antibacterial superabsorbent foam provides good oxygenation, prevents bacterial infection, and absorbs exudate, forming a soft gel (moist environment). These foams were prepared from a mixture of hydrolyzed curdlan and chitosan by lyophilization. To enhance the antibacterial properties, an AgNO3 solution was added to the curdlan/chitosan mixture during the polymerization and was then reduced by UV irradiation. The membranes were further investigated for their structure and composition using optical microscopy, scanning electron microscopy, energy-dispersive spectroscopy, FT-IR spectroscopy, and XPS analysis and modeling. In vivo tests demonstrated that CUR/CS/Ag significantly boosted the regeneration process compared with pure CUR/CS and the untreated control.
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Affiliation(s)
- Elizaveta S. Permyakova
- Laboratory of Inorganic Nanomaterials, National University of Science and Technology “MISiS”, Leninsky Prospekt 4, 119049 Moscow, Russia; (A.S.K.); (D.V.S.)
- Laboratory of Pharmacological Active Compounds, Research Institute of Clinical and Experimental Lymphology—Branch of the ICG SB RAS, 2 Timakova Str., 630060 Novosibirsk, Russia; (K.I.E.); (K.I.B.); (N.A.S.); (A.O.S.)
- Correspondence: (E.S.P.); (A.M.M.); Tel.: +7-916-278-01-99 (E.S.P.)
| | - Anton S. Konopatsky
- Laboratory of Inorganic Nanomaterials, National University of Science and Technology “MISiS”, Leninsky Prospekt 4, 119049 Moscow, Russia; (A.S.K.); (D.V.S.)
| | - Konstantin I. Ershov
- Laboratory of Pharmacological Active Compounds, Research Institute of Clinical and Experimental Lymphology—Branch of the ICG SB RAS, 2 Timakova Str., 630060 Novosibirsk, Russia; (K.I.E.); (K.I.B.); (N.A.S.); (A.O.S.)
| | - Ksenia I. Bakhareva
- Laboratory of Pharmacological Active Compounds, Research Institute of Clinical and Experimental Lymphology—Branch of the ICG SB RAS, 2 Timakova Str., 630060 Novosibirsk, Russia; (K.I.E.); (K.I.B.); (N.A.S.); (A.O.S.)
| | - Natalya A. Sitnikova
- Laboratory of Pharmacological Active Compounds, Research Institute of Clinical and Experimental Lymphology—Branch of the ICG SB RAS, 2 Timakova Str., 630060 Novosibirsk, Russia; (K.I.E.); (K.I.B.); (N.A.S.); (A.O.S.)
| | - Dmitry V. Shtansky
- Laboratory of Inorganic Nanomaterials, National University of Science and Technology “MISiS”, Leninsky Prospekt 4, 119049 Moscow, Russia; (A.S.K.); (D.V.S.)
| | - Anastasiya O. Solovieva
- Laboratory of Pharmacological Active Compounds, Research Institute of Clinical and Experimental Lymphology—Branch of the ICG SB RAS, 2 Timakova Str., 630060 Novosibirsk, Russia; (K.I.E.); (K.I.B.); (N.A.S.); (A.O.S.)
| | - Anton M. Manakhov
- Laboratory of Pharmacological Active Compounds, Research Institute of Clinical and Experimental Lymphology—Branch of the ICG SB RAS, 2 Timakova Str., 630060 Novosibirsk, Russia; (K.I.E.); (K.I.B.); (N.A.S.); (A.O.S.)
- Correspondence: (E.S.P.); (A.M.M.); Tel.: +7-916-278-01-99 (E.S.P.)
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15
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Song Y, Jo Y, Sohn J, Kim R. A Pilot Study to Explore a Correlation between Inflammatory Markers and the Wound Healing Rate in Diabetic Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030390. [PMID: 35334566 PMCID: PMC8951608 DOI: 10.3390/medicina58030390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 01/08/2023]
Abstract
Background and objectives: We examined whether there is a significant correlation between inflammatory markers and the wound healing rate (WHR) in diabetic patients. Materials and Methods: A total of 60 patients were divided into two groups depending on the completion of wound healing (WH) at 5 weeks: the early WH group (period of WH < 5 weeks; n = 27) and the late WH group (period of WH > 5 weeks; n = 33). The baseline characteristics and wound measurements were compared between the two groups. To identify the correlation between inflammatory markers (e.g., white blood cell counts (WBCs), serum C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR)) and WHR, we performed a Pearson correlation analysis. Results: The WHR was 8.06 ± 4.02 mm2/day in the early WH group and 2.71 ± 0.88 mm2/day in the late group. This difference reached statistical significance (p < 0.001). Moreover, WBC counts were significantly higher and serum levels of CRP and ESR were significantly lower in the early WH group than in the late group (p = 0.027, 0.036 and 0.043, respectively). Conclusions: Our results indicate that WBC as well as serum CRP and ESR levels have a significant correlation with WHR in diabetic patients.
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Affiliation(s)
- Yukwan Song
- Department of Plastic and Reconstructive Surgery, Soonsoo Hospital, Hwaseong-si 18617, Gyeonggi, Korea
- Correspondence: (Y.S.); (J.S.); Tel.: +82-31-319-0119 (Y.S.); +82-64-740-5476 (J.S.); Fax: +82-31-8059-1181 (Y.S.)
| | - Yongkyu Jo
- Department of Anesthesiology and Pain Medicine, Cheju Halla General Hospital, Jeju 63127, Korea;
| | - Jeongeun Sohn
- Department of Anesthesiology and Pain Medicine, Cheju Halla General Hospital, Jeju 63127, Korea;
- Correspondence: (Y.S.); (J.S.); Tel.: +82-31-319-0119 (Y.S.); +82-64-740-5476 (J.S.); Fax: +82-31-8059-1181 (Y.S.)
| | - Robert Kim
- Department of Medical and Pharmaceutical Affairs, Doctor CONSULT, Seoul 06296, Korea;
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Lustig A, Gefen A. The performance of gelling fibre wound dressings under clinically relevant robotic laboratory tests. Int Wound J 2022; 19 Suppl 1:3-21. [PMID: 35142062 PMCID: PMC9478960 DOI: 10.1111/iwj.13761] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
The effectiveness of wound dressing performance in exudate management is commonly gauged in simple, non‐realistic laboratory setups, typically, where dressing specimens are submersed in vessels containing aqueous solutions, rather than by means of clinically relevant test configurations. Specifically, two key fluid–structure interaction concepts: sorptivity—the ability of wound dressings to transfer exudate, including viscous fluids, away from the wound bed by capillary action and durability—the capacity of dressings to maintain their structural integrity over time and particularly, at removal events, have not been properly addressed in existing test protocols. The present article reviews our recent published research concerning the development of clinically relevant testing methods for wound dressings, focussing on the clinical relevance of the tests as well as on the standardisation and automation of laboratory measurements of dressing performance. A second objective of this work was to compile the experimental results characterising the performance of gelling fibre dressings, which were acquired using advanced testing methods, to demonstrate differences across products that apparently belong to the same “gelling fibre” family but differ remarkably in materials, structure and composition and, thereby, in performance.
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Affiliation(s)
- Adi Lustig
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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