A narrative review of the epidemiology and economics of chronic wounds

Self-assembling Bletilla polysaccharide nanogels facilitate healing of acute and infected wounds via inflammation control and antibacterial activity

Wound healing is one of the fundamental problems faced by the medical profession. Thus, there is a need for the development of biomaterials that are safe, economically viable, possess anti-inflammatory and antibacterial characteristics, and enhance wound healing. In this study, we designed a nanomicelle of Bletilla striata polysaccharide (BSP) self-loaded with Azithromycin (AZI). The properties are improved by physically blending Carbomer 940 (CBM) with Gelatin (GEL) to serve as the hydrogel matrix. The preparation was made by combining the nanomicelle, used as the precursor solution, with the gel matrix. It was designed to treat wound infections and promote healing. Relevant experiments indicate its excellent biocompatibility. The hydrogel not only promotes cell migration, proliferation, angiogenesis, and collagen deposition associated with skin healing, but also regulates the polarization of macrophages from the M1 to M2 phenotype, as well as the expression of related factors. Additionally, in vitro experiments demonstrate its good antibacterial activity. In addition, we demonstrated the gel's anti-inflammatory, antibacterial, and pro-healing effects in acute wounds and methicillin-resistant Staphylococcus aureus (MRSA) wounds. Therefore, the nanomicellar gel enhances antibacterial activity and related immune regulation, offering a new direction in the treatment of acute and chronic wounds.

Genetic Evidence of Obesity-Induced Chronic Wounds Mediated by Inflammatory Biomarkers

Background: Obese patients are increasingly recognized as being at higher risk for skin diseases, particularly chronic wounds. While the exact mechanisms remain unclear, obesity is suspected to influence the development of chronic injuries via inflammatory biomarkers. Single nucleotide polymorphisms (SNPs) may further influence gene expression, protein function, and levels of inflammatory biomarkers through various mechanisms, thereby modulating inflammatory responses that contribute to wound pathogenesis. Methods: A two-sample two-step Mendelian Randomization (MR) was employed to explore the causal relationship between obesity and chronic wounds, focusing on the mediating role of inflammatory biomarkers. SNPs were used as instrumental variables (IVs) to infer causality. Obesity-related genetic data were sourced from the UK Biobank and GIANT consortium. Genome-wide association studies provided data on 92 inflammatory biomarkers, involving 14,824 and 575,531 individuals. Pressure injuries, lower limb venous ulcers, and diabetic foot ulcer data were obtained from FinnGen R10 and the Pan-UK Biobank. Results: Obesity significantly increased the risk of pressure injuries, lower limb venous ulcers, and diabetic foot ulcers. CCL19, hGDNF, IL-12B, and TNFRSF9 were identified as mediators in obesity-induced lower limb venous ulcers. Conclusion: This study provides genetic evidence that obesity leads to lower limb venous ulcers via inflammatory biomarkers, suggesting potential therapeutic targets for intervention.

Fabrication and characterization of silver nanowire-coated porous alginate wet-laid webs for wound dressing applications

Wound care presents an imposed financial burden for healthcare organizations, prompting the need for novel and cost-efficient dressings. In this study, we address this challenge by introducing a novel approach to fabricate antibacterial alginate-based fibrous materials using a combination of wet spinning and the wet-laying method, which offer advantages including structural and functional properties such as breathability, nontoxicity, biocompatibility, and cost-effectiveness. The wet spinning method was employed to develop porous and non-porous Ca-alginate fibers with diameters of 100 ± 4.3 nm and 132 ± 1.2 nm, respectively. Porous Ca-alginate fibers were fabricated with the utilization of polyvinyl alcohol (PVA) as a pore-forming polymer. Obtained fibers were cut into 1-2 cm lengths to fabricate wet-laid webs. Finally, silver nanowires (AgNWs) were synthesized and then coated on the wet-laid webs at concentrations of 1 % and 3 % to impart antibacterial properties. FTIR analyses confirmed the successful removal of PVA, and swelling tests demonstrated that both porous and non-porous samples exhibit high swelling ability. The porous wet-laid materials swelled 12 times their initial weight, while this amount was 5 times their initial weight in non-porous wet-laid materials at a 60-min timepiece. SEM analysis verified fiber integrity, and MTT assays showed excellent cytocompatibility. Additionally, in vitro tests highlighted the scaffold's potential to support cell attachment and proliferation. The results demonstrate that wet-laid alginate-based fibrous dressings have low cytotoxicity, superior swelling capacity, antibacterial activity, and biocompatibility. This study underscores the potential of the silver nanowires-coated wet-laid webs as a novel and effective approach for producing multifunctional wound care materials.

Inflammatory memory-activated biomimetic nanovesicles regulate neutrophil plasticity and metabolic reprogramming for rapid diabetic wound healing via targeting miR-193a-5p/TLR4/JNK/P38 MAPK pathways

Diabetic wound therapy faces significant challenges due to the complexity of the wound microenvironment, especially dysregulated immune cell responses and persistent pro-inflammatory sate. Targeting immune cells to reverse pathological wound conditions has increasingly become a promising strategy to promote diabetic wound healing. It has been reported that prolonged memory to acute inflammation sensitizes epidermal stem cells (EpSCs) to tissue damage. The increasing importance of interactions between immune cells and tissue stem cells has raised interest in the potential of EpSCs to induce inflammatory adaptations in diabetic wounds, and meanwhile, the inflammation memory patterns also provide new insight in EpSCs for tissue repair. Here, bioinspired cell-derived mimetic nanovesicles (MNVs) were obtained from inflammation memory-activated EpSCs. LPS treatment could trigger acute inflammation response and activate inflammation memory. MNVs derived from LPS-pretreated EpSCs (LEM) can effectively promote diabetic wound healing by manipulating crucial neutrophil regulatory mechanisms. The in vitro and in vivo studies demonstrated that LEM could stimulate neutrophil mitochondrial metabolic reprogramming, overcome phenotypic switching deficiency of neutrophils, and skew neutrophils toward N2 anti-inflammatory phenotype via regulating miR-193a-5p/TLR4/ JNK/P38 MAPK pathways in diabetic models. Our findings highlighted the great potential of inflammation memory in EpSCs, and also provided an alternative for diabetic wound treatment.

L-PRF in extra-oral wound care

Leukocyte- and platelet-rich fibrin (L-PRF), a by-product of centrifuged autologous whole blood, contains high concentrations of platelets, leukocytes, and fibrin (the latter spontaneously creating a strong 3-D network (a membrane)). L-PRF membranes possess several characteristics essential in wound healing, including a barrier function, an antibacterial and analgesic activity, and the release of growth factors enhancing tissue regeneration and neo-vasculogenesis. This review investigated the role of L-PRF in treating non-responding chronic wounds such as diabetic foot, venous leg ulcers, pressure ulcers, complex wounds, leprosy ulcers (Hansen's Disease), and other demanding wounds. Chronic wounds affect millions worldwide, negatively impacting their quality of life, productivity, and life expectancy while incurring high treatment costs for themselves and private and public health systems. L-PRF has demonstrated clear adjunctive advantages in treating chronic skin wounds, shortening the time to complete wound closure, and improving patient-reported outcome measures (including reducing pain and minimizing the need for analgesics). Also, in other demanding wounds, L-PRF facilitates healing. To help clinicians, this article also proposes recommendations for the use of L-PRF in the treatment of extra-oral wounds.

The paradoxical activity of BRAF inhibitors: potential use in wound healing

The area of wound healing presents a promising field of interest for clinicians as well as the scientific community. A major concern for physicians is the rising number of elderly people suffering from diabetes, leprosy, tuberculosis and the associated chronic wounds. While traditional therapies target basic wound care, innovative strategies that accelerate wound healing are needed. V-RAF murine sarcoma viral oncogene homolog B1 (BRAF) inhibitors are anti-cancer drugs used primarily for melanoma. They also exhibit paradoxical activity, a phenomenon characterized by unintended activation of the Mitogen-Activated Protein Kinase (MAPK) signalling pathway leading to skin hyperproliferation. Studies have demonstrated that BRAF inhibitors can be repurposed to accelerate the healing of acute and chronic wounds by exploiting their paradoxical activity. This review evaluates studies on BRAF inhibitors by employing a systematic search strategy using databases such as PubMed, Scopus, Google Scholar, and Web of Science. Articles were screened based on relevance to the paradoxical activity of BRAF inhibitors, their mechanisms, and applications in wound healing. Evidence from in vitro, in vivo, and clinical studies demonstrates that BRAF inhibitors can enhance processes such as epithelialization and angiogenesis, essential for wound repair. This review summarizes the reports on the paradoxical activity of BRAF inhibitors, the predicted mechanisms behind the paradoxical activity, and their potential use in wound healing.

Red and blue LED light increases the survival rate of random skin flaps in rats after MRSA infection

Skin flap transplantation is a conventional wound repair method in plastic and reconstructive surgery, but infection and ischemia are common complications. Photobiomodulation (PBM) therapy has shown promise for various medical problems, including wound repair processes, due to its capability to accelerate angiogenesis and relieve inflammation. This study investigated the effect of red and blue light on the survival of random skin flaps in methicillin-resistant Staphylococcus aureus (MRSA)-infected Sprague Dawley (SD) rats. Forty male SD rats were divided into control and light-emitting diode-red and blue light-treated (LED-RBL) groups at a ratio of 1:1 and a McFarland flap procedure was performed, which was subsequently infected with MRSA strains. After 7 days, the appearance and survival of the flaps were evaluated. The microvascular density was determined by hematoxylin and eosin (HE) staining. The expression levels of vascular endothelial growth factor (VEGF), hypoxia inducible factor 1α (HIF-1α), phosphatidylinositol 3-kinase (PI3K), and protein kinase B (normally expressed as AKT) were detected by immunohistochemistry. The flap survival rate and microvascular density in the LED-RBL group were significantly higher than those in the control group (P < 0.05). In addition, the VEGF, HIF1-α, PI3K, and AKT levels were significantly higher in the LED-RBL group compared to the control group (P < 0.05). Red and blue light increased the survival area of the infected flap in rats by promoting angiogenesis, relieving oxidative stress, and reducing bacterial loads, indicating that PBM therapy is a convenient, simple, analgesic, and safe treatment intervention in promoting the survival rate of transplanted flaps after wound repair surgery.

The provision of wound care and management in a community healthcare setting: an exploratory study

OBJECTIVE

Wound management can be costly and challenging to the health services' scarce resources. Information regarding the number of wounds in a community care setting and their associated aetiology will provide nurses and nurse managers with an insight into the specific needs of these clients with wounds and highlight areas where care or services can be improved or further developed. This research aimed to establish the prevalence and aetiology of wounds, the current delivery of wound care, wound documentation and referral pathways in an Irish community care setting.

METHOD

A retrospective chart review was carried out on all clients in the community care area who received wound care from the Public Health Nursing Service over a specified one-year period.

RESULTS

A total of 331 individuals were identified as having wounds, and nearly half presented with more than one wound, equating to 632 wounds in total (point prevalence (PP)=0.46%). A total of 56% (n=186; PP=0.14%) had leg ulcers (LUs), 18% (n=58; PP=0.04%) had pressure ulcers (PUs), 15% (n=49; PP=0.04%) had developed a diabetic foot ulcer (DFUs) and a further 11% (n=38; PP=0.03%) had wounds of other aetiologies. The mean duration of wounds was 11.37 months. Comorbidities were present in 99% (n=327) of clients with wounds, with cardiovascular disease observed in 87% (n=288) of clients and diabetes in 45% (n=148). Nursing wound-related concerns resulted in 52% (n=171) of clients receiving antibiotics, with 71% (n=121) being prescribed more than one dose. As many as 61% (n=104) of clients prescribed antibiotics did not have completed documentation to demonstrate a suspected wound infection. It was established that 16% of the Public Health Nursing Service's active caseload was made up of clients with wounds and the management of these wounds accounted for 65% of nursing time, equating to 28 full-time community nurses.

CONCLUSION

This study has identified that people with chronic (hard-to-heal) wounds often present with more than one chronic disease, which may negatively influence the wound's healing trajectory, lengthening its duration. The criteria for onward referral for suspected wound infections have been examined and resulted in large numbers of poorly documented wound assessments, leading to a high reliance on the use of oral antibiotics as commonplace for the management of hard-to-heal wounds. Hard-to-heal wounds, such as lower LUs, PUs and DFUs, are either caused or significantly affected by the presence of underlying comorbidities. Therefore, aligning the prevention and management of these burdensome wounds with National Clinical Programmes will deliver efficient, cost-effective, holistic quality care to clients in Irish community healthcare settings.

The Use of a Specialized Oral Nutritional Supplement in the Management of Chronic Wounds in Patients With and Without Diabetes Mellitus: Cost-Effectiveness Analysis

OBJECTIVES

To analyze the cost-effectiveness of the use of a specialized oral nutritional supplement (ONS) with proline, arginine, vitamins, and micronutrients to stimulate the healing of chronic wounds in patients with and without diabetes mellitus.

METHODS

This is a quantitative study on cost-effectiveness. This model used a decision-tree model followed by a budget impact analysis from the Brazilian public healthcare system's perspective. For this analysis, the population and data from a randomized trial of an oral specialized-ONS-containing supplement were considered. For budget impact analysis, an epidemiologic approach was used to estimate the eligible population. The eligible population comprised 3 different groups: patients with pressure ulcers, patients with vascular ulcers, and patients with diabetic feet. The budget impact analysis used the results of the cost-effectiveness analysis.

RESULTS

The results demonstrate that the use of specialized ONS, when compared with control ONS, proved to be cost saving (cheaper and more effective), considering the presence of predictive scar factor. The aggregated budget impact analysis results shows that the total reduction of costs after 5 years is USD 332 628 437.00.

CONCLUSIONS

The use of a specialized ONS was cost-effective in the healing of chronic wounds, when compared with control. The budget impact analysis showed a significant decrease in costs in a 5-year time horizon for the management of pressure ulcers, vascular ulcers, and diabetic feet.

Dried tangerine peel polysaccharide accelerates wound healing by recruiting anti-inflammatory macrophages

Macrophage polarization is a key process involved in wound healing. The continuous release of proinflammatory cytokines by macrophages inhibits the healing process of chronic wounds, such as diabetic wounds. To promote wound healing, it is important to change the phenotype of resident macrophages to prevent inflammation. We previously reported that dried tangerine peel polysaccharide (DTPP) binds to and inhibits the TLR4/MD-2 complex, which is crucial for the inflammatory activation of macrophages, suggesting the potential of DTPP in wound healing applications. Both zebrafish and mouse models were used to evaluate the therapeutic efficacy of DTPP. Moreover, we found that DTPP recruited macrophages to the wound area and promoted their M2 repolarization. Using hyperglycaemic zebrafish and db/db mouse models, we discovered that DTPP accelerated wound healing in vivo in metabolic disorders. Our results suggest that DTPP promotes the recruitment of macrophages, shifts macrophages towards the anti-inflammatory M2 phenotype, and ultimately accelerates the wound healing process.

Deciphering microbiome and fungi-bacteria interactions in chronic wound infections using metagenomic sequencing

PURPOSE

Chronic wounds caused by infections impose a considerable global healthcare burden. The microbial features of these infections and possible correlations between bacteria and fungi may influence wound healing. However, metagenomic next-generation sequencing (mNGS) analyses of these features remain sparse. Therefore, we performed mNGS on chronic wound infection samples to investigate features and correlations between the bacteriome and mycobiome in 66 patients (28: chronic wounds; 38: non-chronic wounds).

METHODS

Microbial community characteristics in patients with wound infections, microbiome-systemic inflammation associations, and bacteria-fungi correlations were analyzed.

RESULTS

Infections constituted the primary cause of wounds in this study. Nontuberculous mycobacteria (23%) and Mycobacterium tuberculosis (13%) were the most common pathogens associated with chronic wounds, whereas Staphylococcus aureus (15%) was the most prevalent in non-chronic wound infections. Patients with chronic wound infections had a higher abundance of Pseudomonas aeruginosa than those without chronic wounds. Microbes with a high relative abundance in chronic wound infections were less significantly associated with plasma inflammatory factors than those in non-chronic wound infections. Additionally, a positive correlation between Candida glabrata and P. aeruginosa and an association between Malassezia restricta and anaerobic species were detected in patients with chronic wound infections.

CONCLUSION

Our results further support the hypothesis that P. aeruginosa is a microbial biomarker of chronic wound infection regardless of the causative pathogens. Moreover, we propose a positive correlation between C. glabrata and P. aeruginosa in chronic wound infections, which advances the current understanding of fungi-bacteria correlations in patients with chronic wound infections.

Transformation of Natural Resin Resina Draconis to 3D Functionalized Fibrous Scaffolds for Efficient Chronic Wound Healing

Chronic wound healing is a major challenge in clinical practice. Secondary dressing damage and antibiotic resistance are the main obstacles for traditional wound dressings. Resina draconis (RD), a natural resin traditionally used in powder form for wound care, is now considered unsuitable due to the lack of gas permeability and moist environment required for wound healing. Here, RD is incorporated in situ by constructing a 3D coiled fibrous scaffold with polycaprolactone/polyethylene oxide. Due to the high porosity of 3D scaffold, the RD-3D dressings have a favorable swelling capacity, providing permeability and moisture for wound repair. Meanwhile, the transformation of RD powder into 3D dressings fully demonstrates capabilities of RD in rapid hemostasis, bactericidal, and inflammation-regulating activities. In vivo evaluations using pressure ulcer and infected wound models confirm the high efficacy of RD-3D dressing in early wound healing, particularly beneficial in the infected wound model compared to recombinant bovine FGF-basic. Further biological analysis shows that resveratrol, loureirin A, and loureirin B, as potentially bioactive components of RD, individually contribute to different aspects of wound healing. Collectively, RD-3D integrated dressings represent a simple, cost-effective, and safe approach to wound healing, providing an alternative therapy for translating medical dressings from bench to bedside.

How Nanoparticles Help in Combating Chronic Wound Biofilms Infection?

Chronic wound infection has become a global health problem, with bacterial biofilms, which are difficult to penetrate using traditional antibiotics, considered the primary cause of recurrent infection and delayed healing in chronic wounds. In recent years, the outstanding performance of nanomaterials in controlling biofilm infections has been widely acknowledged, and these materials are regarded as highly promising for chronic wound infection management. The formation and structure of chronic wound biofilms undergo complex dynamic changes. Therefore, a deep understanding of the underlying causes of repeated wound infections and the specific antibacterial mechanisms of nanomaterials at different stages of biofilm formation is crucial for effective "chronic wound infection management". This review first reveals the relationship between biofilms, wound chronicity, and recurrent infections. Secondly, it focuses on the four stages of chronic wound biofilm formation: (1) adhesion stage, (2) aggregation and promotion stage, (3) maturation stage, and (4) regeneration and dissemination stage. It also comprehensively summarizes the specific antibacterial mechanisms of nanomaterials. This study analyzes essential factors affecting the control of chronic wound biofilms by nanoparticles from various perspectives, such as the material itself, the local wound environment, and the systemic host response. Finally, the limitations and potential future trends in current research are discussed. In summary, nanoparticles represent a promising strategy for combating chronic wound biofilm infections, and this review provides new insights for alternative adjuvant therapies in managing bacterial biofilm infections in chronic wounds.

Polydopamine-coated chondroitin sulfate methacryloyl multifunctional microspheres for wound treatment

The disappearance of the protective barrier after skin injury leads to the overproduction of reactive oxygen species (ROS) in response to various stimuli. Oxidative stress is one of the most important causes of delayed wound healing, leading to negative outcomes, such as excessive inflammatory response and impaired angiogenesis. In this study, we used microfluidic technology to integrate Prussian blue nanozymes and vascular endothelial growth factor and constructed multifunctional microspheres that improved local oxidative stress. In order to enhance the adhesion of the microspheres on the wound surface and prolong the release of the drug, we coated them with dopamine, ensuring uniform encapsulation on their surface. The microspheres adhered well to the wound surface and promoted wound healing by scavenging ROS, reducing the inflammatory response, and promoting angiogenesis. This strategy of integrating nanozymes and growth factors can have a synergistic effect, which is significant for wound healing.

Efficacy and safety of allogeneic platelet-rich plasma in chronic wound treatment: a meta-analysis of randomized controlled trials

Allogeneic platelet-rich plasma (al-PRP) is gaining attention in clinical practice for treating chronic refractory wounds, though research results remain controversial. To assess the clinical efficacy of al-PRP for chronic refractory wounds. Databases including PubMed, Cochrane Library, Embase, CNKI, SinoMed, VIP, and WFPD were searched for randomized controlled trials comparing al-PRP with conventional treatments up to October 2023. Two researchers independently screened studies, extracted data, and assessed quality. Statistical analysis was conducted using RevMan 5.4, and potential publication bias was assessed and corrected using funnel plots and Egger's test. Twelve studies with 717 cases were included. Meta-analysis showed al-PRP significantly improved outcomes compared to non-al-PRP treatments: increased healing rate (RR 2.72, 95% CI 1.77-4.19, p < 0.00001), shortened healing time (SMD - 1.03, 95% CI -1.31 to -0.75, p < 0.00001), improved efficacy rate (RR 1.19, 95% CI 1.10-1.28, p < 0.00001), increased wound shrinkage (MD 35.65%, 95% CI 21.65-49.64, p < 0.00001), and reduced hospital stays (MD -2.62, 95% CI -4.35 to -0.90, p = 0.003). Al-PRP is a feasible, effective, and safe biological therapy for chronic refractory wounds.Trial registration: PROSPERO Identifier CRD42022374920.

Cost-effectiveness analysis of the geko™ device (an NMES technology) in managing venous leg ulcers in UK healthcare settings

This study evaluates the cost-effectiveness of the geko device a neuromuscular electro-stimulator technology with standard of care (SoC) versus SoC alone for venous leg ulcer (VLU) treatment, from the UK National Health Service (NHS) perspective over 12 months. Research was conducted across NHS UK facilities, primarily within community services and outpatient leg ulcer clinics, encompassing a total of 51 patients. A partitioned survival model, based on a two-arm randomised controlled trial, assessed wound healing rates using Kaplan-Meier curves and parametric extrapolations over a 12-month time horizon. Costs were derived from UK reference costs the British National Formulary, and the Personal Social Services Research Unit (2021/22). The primary outcome measured was the incremental cost per quality-adjusted life-year gained. The geko device provides additional benefits by stimulating the lateral popliteal nerve, augmenting venous, arterial, and microvascular flow. The addition of the geko device to SoC significantly enhanced outcomes, increasing healing probability by 68% compared to SoC. This integration would result in a cost saving of £774.14 per patient when compared to the SoC alone across the NHS. Economic analyses indicate that integrating the geko device into SoC protocols would reduce the overall NHS expenditure on VLU wound management by as much as 15%. The approach also positively impacted health-related quality of life. The geko™ device when used adjunctively with SoC would be a cost-effective method for managing chronic VLUs within the NHS, improving healing rates and offering economic benefits.

A low-cost, antimicrobial aloe-alginate hydrogel film containing Australian First Nations remedy 'lemon myrtle oil' (Backhousia citriodora) - Potential for incorporation into wound dressings

Chronic wounds pose a global public health challenge, particularly in remote settings where access to specialised wound care and dressings can be limited and cost-prohibitive. First Nations communities in Australia are at a significantly higher risk for developing chronic wounds and this risk further increases for people living in remote regions. There is an urgent need to develop inexpensive but effective wound dressings to improve wound outcomes. Over the past decade, sodium alginate (SA)-based hydrogel polymers have emerged as a cost-effective and biocompatible component in wound dressings, and many have been successfully commercialised. In this study, we have developed and evaluated various prototypes of SA-based hydrogels with the addition of another low-cost component, aloe vera (AV) to further tailor the physicochemical properties of the hydrogel. Since the presence of microbes is a major contributor to the pathophysiology of chronic wounds, we also evaluated the antimicrobial activity of lemon myrtle oil (LMO) (Backhousia citriodora) incorporated into the hydrogel, a remedy used traditionally by First Nations Australians. Novel formulations of AV-SA-LMO hydrogel prototypes in the absence and presence of lemon myrtle oil (at a concentration of 5 μg/mL) were assessed for their physicochemical and antimicrobial properties and compared to a commercially available hydrogel-based dressing. The addition of lemon myrtle oil imparted viscoelastic behaviour for improved processability of AV-SA-LMO hydrogel prototypes, while increasing protein adhesion, enhancing physical properties, and demonstrating antimicrobial activity against the common wound-infecting microbes Staphylococcus epidermidis and Candida albicans. Fourier transmission infrared (FTIR) spectra confirmed the molecular structures of the hydrogel prototypes as predicted. The prototypes also demonstrated biocompatibility with the HaCaT human keratinocyte cell line. This study has provided preliminary evidence that a 25:75 aloe vera:sodium alginate hydrogel with 5 μg/mL lemon myrtle oil has comparable physicochemical characteristics to a commercial hydrogel-based wound dressing and antimicrobial properties against S. epidermidis and C. albicans.

Identification of High-Risk Lower Extremity Wounds Using Point-of-Care Test for Bacterial Protease Activity; A Single-Centre, Single-Blinded, Prospective Study

Clinician observation is the mainstay to determine if wound infection is present, and focuses on presence of erythema, purulence, and odour. However, non-visible bacterial protease activity can delay wound healing and lead to complications. In this study, a point-of-care test to detect the presence of bacterial protease activity (BPA, tested with Woundchek Bacterial Status test) was appraised. A total of 130 patients with lower extremity wounds were recruited in vascular and podiatry clinics, and across two time-points 182 BPA tests were conducted subsequent to initial (blinded) clinician's wound appraisal. Clinical opinion ('no infection', 'possible' or 'definite' infection) and BPA result (negative or positive test) had a moderate Kendall's tau-c rank correlation coefficient of 0.32 (P < 0.001). Binary logistic regression analysis and principal component analysis showed that infection determined by clinical opinion was significantly associated with abovementioned clinical signs and a positive BPA test. However, a positive BPA result was also significantly linked with wound severity, such as number of lesions, chronicity and size. Throughout a 12-week follow-up period, median ulcer size was larger for wounds positive for BPA test at baseline (P 0.001) and week-12 (P 0.036; both Mann-Whitney U-test) respectively. As a pilot initiative, clinical staff were allowed to act on the BPA result if they wished; in 11 out of 71 test-positive cases (15%) this happened and antimicrobial dressing was applied instead of planned standard dressing. These results show that protease-releasing bacteria may be active in ulcers that do not (yet) exhibit hallmark signs of infection, and are associated with delayed healing. Targeted point-of-care testing for bacterial protease activity may have the potential to identify and enable pro-active (antimicrobial) management of these high-risk wounds.

Research Progress of Hydrogel Microneedles in Wound Management

Microneedles are a novel drug delivery system that offers advantages such as safety, painlessness, minimally invasive administration, simplicity of use, and controllable drug delivery. As a type of polymer microneedle with a three-dimensional network structure, hydrogel microneedles (HMNs) possess excellent biocompatibility and biodegradability and encapsulate various therapeutic drugs while maintaining drug activity, thus attracting significant attention. Recently, they have been widely employed to promote wound healing and have demonstrated favorable therapeutic effects. Although there are reviews about HMNs, few of them focus on wound management. Herein, we present a comprehensive overview of the design and preparation methods of HMNs, with a particular emphasis on their application status in wound healing, including acute wound healing, infected wound healing, diabetic wound healing, and scarless wound healing. Finally, we examine the advantages and limitations of HMNs in wound management and provide suggestions for future research directions.

Performance of a silicone foam dressing in management of wounds in a community setting: a sub-analysis of the VIPES study

OBJECTIVE

Managing the gap between the dressing and the wound bed can facilitate the healing of exuding wounds. A silicone foam dressing (Biatain Silicone; Coloplast A/S, Denmark) was developed for application to exuding wounds. A sub-analysis of the real-world, prospective, observational VIPES (Observatoire en Ville des Plaies ExSudatives) study was conducted to investigate the use and performance of the silicone foam dressing in a community nursing setting in France.

METHOD

The sub-analysis included patients from the VIPES study who received the silicone foam dressing as a primary dressing for an acute or hard-to-heal (chronic) wound. Epidemiological and wound healing outcomes were reported via a smartphone application.

RESULTS

Overall, 64 patients were included in the sub-analysis. At baseline, most wounds (n=33/40; 82.5%) were in treatment failure (i.e., were stagnant, non-healing or had poor exudate management). At the last follow-up visit, a median of 22.5 (range: 3-151) days post baseline, 48.4% of wounds had healed and 25.0% were progressing towards healing. From baseline to the last follow-up visit, significant reductions in exudate level (p<0.0001) and exudate pooling (p<0.0001), and significant improvements in wound edges (p≤0.0001) and periwound skin (p<0.01) were observed. A total of 62.3% of patients had re-epithelialising wounds at the last follow-up visit. The majority of nurses (88.3%) and patients (85.0%) reported that the wound had improved and, at most dressing removals (93.5%), nurses reported that the dressing conformed closely to the wound bed.

CONCLUSION

Overall, the data suggest that use of the silicone foam dressing in community practice supported the healing of wounds, illustrating the importance of exudate and gap management.

Biopolymeric Insulin Membranes for Antimicrobial, Antioxidant, and Wound Healing Applications

Delayed wound healing increases the wound's vulnerability to possible infections, which may have lethal outcomes. The treatments available can be effective, but the urgency is not fully encompassed. The drug repositioning strategy proposes effective alternatives for enhancing medical therapies for chronic diseases. Likewise, applying wound dressings as biodegradable membranes is extremely attractive due to their ease of application, therapeutic effectiveness, and feasibility in industrial manufacturing. This article aims to demonstrate the pleiotropic effects during insulin repositioning in wound closure by employing a biopolymeric membrane-type formulation with insulin. We prepared biopolymeric membranes with sodium alginate cross-linked with calcium chloride, supported in a mixture of xanthan gum and guar gum, and plasticized with glycerol and sorbitol. Human insulin was combined with poloxamer 188 as a protein stabilizing agent. Our investigation encompassed physicochemical and mechanical characterization, antioxidant and biological activity through antibacterial tests, cell viability assessments, and scratch assays as an in vitro and in vivo wound model. We demonstrated that our biopolymeric insulin membranes exhibited adequate manipulation and suitable mechanical resistance, transparency, high swelling capability (1100%), and 30% antioxidant activity. Furthermore, they exhibited antibacterial activity (growth inhibition of S. aureus at 85% and P. aeruginosa at 75%, respectively), and insulin promoted wound closure in vitro with a 5.5-fold increase and 72% closure at 24 h. Also, insulin promoted in vivo wound closure with a 3.2-fold increase and 92% closure at 10 days compared with the groups without insulin, and this is the first report that demonstrates this therapeutic effect with two administrations of 0.7 IU. In conclusion, we developed a multifunctional insulin-loaded biopolymeric membrane in this study, with the main activity derived from insulin's role in wound closure and antioxidant activity, augmented by the antimicrobial effect attributed to the polymer poloxamer 188. The synergistic combination of excipients enhances its usefulness and highlights our innovation as a promising material in wound healing materials.

A Double-Blind Study on the Effectiveness of Polarized Light Therapy in the Treatment of Venous leg Ulcers-Pilot Study

Vein diseases are one of the most common civilization diseases. The most advanced form chronic venous insufficiency are venous leg ulcers. The study included 40 patients, 20 male (50%) and 20 female (50%) in age between 52 and 88 years (mean age: 68.00 ± 8.55 years) with venous leg ulcers lasting 12.50 ± 5.45 months. Patients were distributed randomly in a double-blind study into two equal groups including 20 patients each (group 1-polarized light therapy and group 2-sham exposure). Patients from both groups received routine pharmacological treatment, specialistic medical dressings and compression therapy. In addition, patients were exposed to a cycle of polarized light therapy procedures or to sham exposures (30 procedures performed in two series of 15 procedures). Wound surface area was evaluated by computerized planimetry and pain intensity was assessed with the use of Visual Analog Scale (VAS) before and after therapy (2.5 months). The analysis showed a statistically significant reduction of surface ulcers area between groups 1 and 2. The median (IQR) size of wounds in group 1 was 2.4 (1.95-2.9) cm2, in group 2; 2.8 (2.6-3.1) cm2 (p = 0.038). The level of pain (VAS) after treatment was assessed in group 1, median (IQR): 2 (2-3) points, in group 2 4.5 (4-5) points; and the observed difference was also statistically significant (p < 0.001). In group 1, after treatment, the area of ulcers decreased-median (IQR): 33.05 (28.7-41.48) %, in group 2 by 18.99 (15-24.4) % (p < 0.001). In group 1, the pain intensity measured using the VAS scale decreased with a median (IQR): 71.42 (61.25-71.42) %, in group 2: 37.5 (28.57-50) % (p < 0.001). Complex therapy with polarized light therapy added to standard care was more effective than standard care alone in reducing of ulcers surface area and intensity of pain ailments in patients with chronic venous leg ulcers.

Wellbeing, quality of life and satisfaction of patients with hard-to-heal wounds: a descriptive study

OBJECTIVE

A hard-to-heal wound is defined as a wound that failed to proceed through the normal phases of wound healing in an orderly and timely manner. The purpose of this article is to describe the impact of hard-to-heal wounds on the wellbeing, quality of life (QoL) and satisfaction with QoL of patients in Oman with hard-to-heal wounds.

METHOD

A descriptive cross-sectional study of patients with hard-to-heal wounds attending three tertiary care hospitals using a self-reported questionnaire was conducted.

RESULTS

A total of 275 patients took part in the study. Patients reported a low wellbeing score (67.06±19.72), moderate QoL score (52.18±25.07) and moderate satisfaction scores (68.91±23.88). Significant mean differences were reported with age, sex, educational level, monthly income and type of wound all at p<0.05.

CONCLUSION

The findings of this study demonstrated that hard-to-heal wounds could influence the wellbeing, QoL and overall satisfaction with QoL of patients.

DECLARATION OF INTEREST

Funding was received through an internal grant of the Sultan Qaboos University to conduct the research conducting the research (IG/CON/FACN/20/01). The authors have no conflicts of interest to declare.

Nurses' experiences of hospital-acquired pressure injury prevention in acute healthcare services in Victoria, Australia: A qualitative study using the Theoretical Domains Framework

We investigated nurses' experiences of hospital-acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence-based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital-acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self-blame related to PI identification, and exacerbating impacts of the COVID-19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital-acquired PI.

VOLKSMED Database: A Source for Forgotten Wound Healing Plants in Austrian Folk Medicine

The global increase in the incidence of wounds is concerning and fuels the search for new treatment options. The use of traditional medicinal plants in wound healing represents an appreciated available therapeutic possibility. This work introduces the VOLKSMED database, which contains plants and other materials used in Austrian folk medicine, either as monographs or mixtures. This work focuses on the monographs of the database. Concerning wound healing, Hypericum sp., Arnica montana, Calendula officinalis, Plantago sp., and Malva sp. are the most commonly used plants. The focus of this paper is set on selected lesser-known plants (Abies alba, Anthyllis vulneraria, Brassica sp., Gentiana sp., Larix decidua, Picea abies, Sambucus sp., Sanicula europaea) and their status quo in literature concerning wound healing. A systematic search using the databases SciFinder, SCOPUS, and PubMed yielded substantial evidence for the wound healing potential of Brassica sp., Gentiana sp., the Pinaceae A. abies, L. decidua, and P. abies, as well as Sambucus nigra. In vivo and clinical studies substantiate their use in Austrian folk medicine. According to the literature, especially A. vulneraria, Sambucus racemosa, and S. europaea would be worth investigating in-depth since data concerning their wound healing effects - even though scarce - are convincing. In conclusion, the VOLKSMED database contains promising opportunities for further treatment options in the field of wound healing. Future research should consider the listed plants to support their traditional use in Austrian folk medicine and possibly promote the implementation of old knowledge in modern medicine.

Pressure ulcer point prevalence, classification, locations, and preventive measures: Insights from a Norwegian nursing home survey

OBJECTIVE

To report data from a point pressure ulcer (PU) prevalence survey on prevalence, PU categories, locations and preventive interventions at one Norwegian nursing home.

METHODS

A cross-sectional research design was used. One nursing home in Norway participated in the prevalence survey in 2020. The data were collected on one selected day. A total of 74 out of 88 residents (84.1%) participated. Descriptive statistical analyses were run.

RESULTS

The overall prevalence of PUs was 27% amongst all participants in the nursing home, who together had a total of 57 PUs categorised as category I-III. One major finding was that the most common site of the PUs was on the residents' toes. Interestingly, the prevalence of PUs in the residents' sacrum was considerably low. The most frequently used PU preventive interventions were foam chair cushions, nutritional supplements and pressure-reducing heel protection.

CONCLUSION

This study identified a high prevalence of PUs, predominantly on residents' toes. Although preventive strategies were implemented, their application appeared limited. Implementing obligatory care packages and annual nationwide PU surveys might be worth considering in municipalities.

IL-17 in wound repair: bridging acute and chronic responses

Chronic wounds, resulting from persistent inflammation, can trigger a cascade of detrimental effects including exacerbating inflammatory cytokines, compromised blood circulation at the wound site, elevation of white blood cell count, increased reactive oxygen species, and the potential risk of bacterial infection. The interleukin-17 (IL-17) signaling pathway, which plays a crucial role in regulating immune responses, has been identified as a promising target for treating inflammatory skin diseases. This review aims to delve deeper into the potential pathological role and molecular mechanisms of the IL-17 family and its pathways in wound repair. The intricate interactions between IL-17 and other cytokines will be discussed in detail, along with the activation of various signaling pathways, to provide a comprehensive understanding of IL-17's involvement in chronic wound inflammation and repair.

Antimicrobial liposomes-in-nanofiber wound dressings prepared by a green and sustainable wire-electrospinning set-up

Increasing prevalence of infected and chronic wounds demands improved therapy options. In this work an electrospun nanofiber dressing with liposomes is suggested, focusing on the dressing's ability to support tissue regeneration and infection control. Chloramphenicol (CAM) was the chosen antibiotic, added to the nanofibers after first embedded in liposomes to maintain a sustained drug release. Nanofibers spun from five different polymer blends were tested, where pectin and polyethylene oxide (PEO) was identified as the most promising polymer blend, showing superior fiber formation and tensile strength. The wire-electrospinning setup (WES) was selected for its pilot-scale features, and water was applied as the only solvent for green electrospinning and to allow direct liposome incorporation. CAM-liposomes were added to Pectin-PEO nanofibers in the next step. Confocal imaging of rhodamine-labelled liposomes indicated intact liposomes in the fibers after electrospinning. This was supported by the observed in vitroCAM-release, showing that Pectin-PEO-nanofibers with CAM-liposomes had a delayed drug release compared to controls. Biological testing confirmed the antimicrobial efficacy of CAM and good biocompatibility of all CAM-nanofibers. The successful fiber formation and green production process with WES gives a promising outlook for industrial upscaling.

Multifunctional antibacterial hydrogels for chronic wound management

Chronic wounds have gradually evolved into a global health challenge, comprising long-term non-healing wounds, local tissue necrosis, and even amputation in severe cases. Accordingly, chronic wounds place a considerable psychological and economic burden on patients and society. Chronic wounds have multifaceted pathogenesis involving excessive inflammation, insufficient angiogenesis, and elevated reactive oxygen species levels, with bacterial infection playing a crucial role. Hydrogels, renowned for their excellent biocompatibility, moisture retention, swelling properties, and oxygen permeability, have emerged as promising wound repair dressings. However, hydrogels with singular functions fall short of addressing the complex requirements associated with chronic wound healing. Hence, current research emphasises the development of multifunctional antibacterial hydrogels. This article reviews chronic wound characteristics and the properties and classification of antibacterial hydrogels, as well as their potential application in chronic wound management.

Porous Functionally Graded Scaffold prepared by a single-step freeze-drying process. A bioinspired approach for wound care

Nowadays, chronic wounds are the major cause of morbidity worldwide and the healthcare costs related to wound care are a billion-dollar issue; chronic wounds involve a non-healing process that makes necessary the application of advanced wound dressings to promote skin integrity recovery. Functionally Graded Scaffolds (FGSs) are currently driving interest as promising candidates in mimicking the skin tissue environment and, thus, in enhancing a faster and more effective wound healing process. Aim of the present work was to design and develop a porous FGS based on κ-carrageenan (κCG) for the management of chronic skin wounds; a freeze-drying process was optimized to obtain in a single-step a three-layered FGS characterized by a pore size gradient functional to mimic the structure of native skin tissue. In addition to κCG, arginine and whey protein isolate were used as multifunctional agents for FGS preparation; these substances can not only intervene in some stages of wound healing but are able to establish non-covalent interactions with κCG, which were responsible for the production of layers with different pore size, water content capability and mechanical properties. Cell migration, adhesion and proliferation within the FGS structure were evaluated in vitro on fibroblasts and FGS wound healing potential was also studied in vivo on a murine model.

Multiomics Analysis Unravels Alteration in Molecule and Pathways Involved in Nondiabetic Chronic Wounds

The prevalence of chronic wounds (CW) continues to grow. A thorough knowledge of the mechanism of CW formation remains elusive due to a lack of relevant studies. Furthermore, most previous studies concentrated on diabetic ulcers with relatively few investigations on other types. We performed this multiomics study to investigate the proteomic and metabolomic changes in wound and surrounding tissue from a cohort containing 13 patients with nondiabetic CW. Differentially expressed proteins (DEPs) and metabolites (DEMs) were filtered out and analyzed through multiomic profiling. The DEPs were further confirmed with the use of parallel reaction monitoring. Compared with the surrounding tissue, there were 82 proteins and 214 metabolites altered significantly in wound tissue. The DEPs were mainly enriched in focal adhesion (FA), extracellular matrix-receptor interaction (ERI), and the PI3K-Akt (PA) signaling pathway. Moreover, the DEMs were significantly enriched in amino sugar and nucleotide sugar metabolism and biosynthesis of nucleotide sugar pathways. In correlation analysis, we discovered that the PA signaling pathway, as well as its upstream and downstream pathways, coenriched some DEPs and DEMs. Additionally, we found that FBLN1, FBLN5, and EFEMP1 (FBLN3) proteins dramatically elevated in wound tissue and connected with the above signaling pathways. This multiomics study found that changes in FA, ERI, and PA signaling pathways had an impact on the cellular activities and functions of wound tissue cells. Additionally, increased expression of those proteins in wound tissue may inhibit vascular and skin cell proliferation and degrade the extracellular matrix, which may be one of the causes of CW formation.

An enzyme-responsive hydrogel of ferrocene-grafted carboxymethyl chitosan as a soft electrochemical sensor for MMP-9 detection

Matrix metalloproteinase 9 (MMP-9) plays an important role in wound healing. However, overexpression of MMP-9 leads to the degradation of the newly formed extracellular matrix, which delays wound healing, ultimately leading to chronic wounds. Therefore, timely monitoring of the MMP-9 activity using simple, cost-effective methods is important to prevent the formation of chronic wounds. In this work, ferrocene-modified MMP-9 cleavage peptide (Fc-MG) modified carboxymethyl chitosan hydrogels were prepared as electrochemical biosensors. In the presence of MMP-9, the peptide chain is sheared, and the electrochemically active ferrocene segment is released. Therefore, analyzing the electrochemical activity of hydrogels using differential pulse voltammetry (DPV) can be used to determine MMP-9 activity. The results showed that the DPV peaks were correlated with the MMP-9 concentration in phosphate-buffered saline (PBS, pH 7.4) and Dulbecco's modified Eagle's medium (DMEM). Specifically, the corresponding coefficient of determination (R2) were 0.918 and 0.993. The limit of detections were 73.08 ng/mL and 131.71 ng/mL, respectively. Compared with the enzyme-linked immunosorbent assay, the hydrogel biosensor determined the concentration of MMP-9 in solution with simpler steps. This study demonstrates a novel strategy based on Fc-MG-modified hydrogels to monitor MMP-9 activity in cell secretion samples and shows the potential application in chronic wounds.

M.O.I.S.T. Concept for the Local Therapy of Chronic Wounds: An International Update

Chronic wounds remain a significant clinical challenge both for those affected and for healthcare systems. The treatment is often comprised and complex. All patients should receive wound care that is integrated into a holistic approach involving local management that addresses the underlying etiology and provides for gold standard therapy to support healing, avoid complications and be more cost effective. There have been significant advances in medicine over the last few decades. The development of new technologies and therapeutics for the local treatment of wounds is also constantly increasing. To help standardize clinical practice with regard to the multitude of wound products, the M.O.I.S.T. concept was developed by a multidisciplinary expert group. The M stands for moisture balance, O for oxygen balance, I for infection control, S for supporting strategies, and T for tissue management. Since the M.O.I.S.T. concept, which originated in the German-speaking countries, is now intended to provide healthcare professionals with an adapted instrument to be used in clinical practice, and a recent update to the concept has been undertaken by a group of interdisciplinary experts to align it with international standards. The M.O.I.S.T. concept can now be used internationally both as an educational tool and for the practical implementation of modern local treatment concepts for patients with chronic wounds and can also be used in routine clinical practice.

A review of the current state of natural biomaterials in wound healing applications

Skin, the largest biological organ, consists of three main parts: the epidermis, dermis, and subcutaneous tissue. Wounds are abnormal wounds in various forms, such as lacerations, burns, chronic wounds, diabetic wounds, acute wounds, and fractures. The wound healing process is dynamic, complex, and lengthy in four stages involving cells, macrophages, and growth factors. Wound dressing refers to a substance that covers the surface of a wound to prevent infection and secondary damage. Biomaterials applied in wound management have advanced significantly. Natural biomaterials are increasingly used due to their advantages including biomimicry of ECM, convenient accessibility, and involvement in native wound healing. However, there are still limitations such as low mechanical properties and expensive extraction methods. Therefore, their combination with synthetic biomaterials and/or adding bioactive agents has become an option for researchers in this field. In the present study, the stages of natural wound healing and the effect of biomaterials on its direction, type, and level will be investigated. Then, different types of polysaccharides and proteins were selected as desirable natural biomaterials, polymers as synthetic biomaterials with variable and suitable properties, and bioactive agents as effective additives. In the following, the structure of selected biomaterials, their extraction and production methods, their participation in wound healing, and quality control techniques of biomaterials-based wound dressings will be discussed.

Fabrication of Quercetin-Functionalized Morpholine and Pyridine Motifs-Laden Silk Fibroin Nanofibers for Effective Wound Healing in Preclinical Study

Choosing suitable wound dressings is crucial for effective wound healing. Spun scaffolds with bioactive molecule functionalization are gaining attention as a promising approach to expedite tissue repair and regeneration. Here, we present the synthesis of novel multifunctional quercetin with morpholine and pyridine functional motifs (QFM) embedded in silk fibroin (SF)-spun fibers (SF-QFM) for preclinical skin repair therapies. The verification of the novel QFM structural arrangement was characterized using ATR-FTIR, NMR, and ESI-MS spectroscopy analysis. Extensive characterization of the spun SF-QFM fibrous mats revealed their excellent antibacterial and antioxidant properties, biocompatibility, biodegradability, and remarkable mechanical and controlled drug release capabilities. SF-QFM mats were studied for drug release in pH 7.4 PBS over 72 h. The QFM-controlled release is mainly driven by diffusion and follows Fickian's law. Significant QFM release (40%) occurred within the first 6 h, with a total release of 79% at the end of 72 h, which is considered beneficial in effectively reducing bacterial load and helping expedite the healing process. Interestingly, the SF-QFM-spun mat demonstrated significantly improved NIH 3T3 cell proliferation and migration compared to the pure SF mat, as evidenced by the complete migration of NIH 3T3 cells within 24 h in the scratch assay. Furthermore, the in vivo outcome of SF-QFM was demonstrated by the regeneration of fresh fibroblasts and the realignment of collagen fibers deposition at 9 days post-operation in a preclinical rat full-thickness skin defect model. Our findings collectively indicate that the SF-QFM electrospun nanofiber scaffolds hold significant capability as a cost-effective and efficient bioactive spun architecture for use in wound healing applications.

Anticipation and Verification of Dendrobium-Derived Nanovesicles for Skin Wound Healing Targets, Predicated Upon Immune Infiltration and Senescence

Background

Dendrobium, with profound botanical importance, reveals a rich composition of bioactive compounds, including polysaccharides, flavonoids, alkaloids, and diverse amino acids, holding promise for skin regeneration. However, the precise mechanism remains elusive. Seeking a potent natural remedy for wound healing, exocyst vesicles were successfully isolated from Dendrobium.

Aims of the Study

This investigation aimed to employ bioinformatics and in vivo experiments to elucidate target genes of Dendrobium-derived nanovesicles in skin wound healing, focusing on immune infiltration and senescence characteristics.

Materials and Methods

C57 mice experienced facilitated wound healing through Dendrobium-derived nanovesicles (DDNVs). Bioinformatics analysis and GEO database mining identified crucial genes by intersecting immune-related, senescence-related, and PANoptosis-associated genes. The identified genes underwent in vivo validation.

Results

DDNVs remarkably accelerated skin wound healing in C57 mice. Bioinformatics analysis revealed abnormal expression patterns of immune-related, senescence-related, and pan-apoptosis-related genes, highlighting an overexpressed IL-1β and downregulated IL-18 in the model group, Exploration of signaling pathways included IL-17, NF-kappa B, NOD-like receptor, and Toll-like receptor pathways. In vivo experiments confirmed DDNVs' efficacy in suppressing IL-1β expression, enhancing wound healing.

Conclusion

Plant-derived nanovesicles (PDNV) emerged as a natural, reliable, and productive approach to wound healing. DDNVs uptake by mouse skin tissues, labeled with a fluorescent dye, led to enhanced wound healing in C57 mice. Notably, IL-1β overexpression in immune cells and genes played a key role. DDNVs intervention effectively suppressed IL-1β expression, accelerating skin wound tissue repair.

Unique combination of hyaluronic acid and amino acids in the management of patients with a range of moderate-to-severe chronic wounds: Evidence from international clinical trials

Chronic wounds present a prolonged burden to patients, their families and healthcare systems. There is evidence that the unique combination of hyaluronic acid (HA) and amino acids (Vulnamin®) promotes re-epithelialization of wounds and stimulates activation and proliferation of fibroblasts with a significant increase in the regeneration of epithelial cells. Tissue regeneration and tissue repair are considered to be the fundamental activities of this unique combination of HA and amino acids that distinguishes it from other wound healing products. A review of trials over the last 15 years indicates distinct advantages of the unique combination of HA and amino acids, in terms of healing rate and induction of granulation tissue production compared with HA alone.

Green synthesis of epigallocatechin gallate-ferric complex nanoparticles for photothermal enhanced antibacterial and wound healing

Bacterial infections are a significant global health concern, particularly in the context of skin infections and chronic wounds, which was further exacerbated by the emerging of antibiotic resistance. Therefore, there are urgent needs to develop alternative antibacterial strategies without inducing significant resistance. Photothermal therapy (PTT) is a promising alternative approach but usually faces limitations such as the need for stable and environmental-friendly PTT agents and ensuring biocompatibility with living tissues, necessitating ongoing research for its clinical advancement. Herein, in this study, with the aim to develop a green synthesized PTT agent for photothermal enhanced antibacterial and wound healing, we proposed a facile one-pot method to prepare epigallocatechin gallate-ferric (EGCG-Fe) complex nanoparticles. The obtained nanoparticles showed improved good size distribution and stability with high reproducibility. More importantly, EGCG-Fe complex nanoparticles have additional photothermal conversion ability which can give photothermal enhanced antibacterial effect on various pathogens, including Gram-positive Staphylococcus aureus (S. aureus) and Gram-negative Escherichia coli (E. coli) strains. EGCG-Fe complex nanoparticles also showed powerful biofilm prevention and destruction effects with promoted antibacterial and wound healing on mice model. In conclusion, EGCG-Fe complex nanoparticles can be a robust green material with effective and novel light controllable antibacterial properties for photothermal enhanced antibacterial and wound healing applications.

Network Pharmacology Study on Herb Pair Bletilla striata-Galla chinensis in the Treatment of Chronic Skin Ulcers

BACKGROUND

Herb pair Bletilla striata-Galla chinensis (BS-GC) is a classic combination of topical traditional Chinese medicine formulae in the treatment of chronic skin ulcers (CSUs).

OBJECTIVE

The aim of this study is to explore the effective active ingredients of BS-GC, as well as the core targets and signal transduction pathways of its action on CSUs.

METHODS

The ingredients of BS-GC were obtained from TCMSP and HERB databases. The targets of all active ingredients were retrieved from the SwissTargetPrediction database. The targets of CSUs were obtained from OMIM, GeneCards, Drugbank, and DisGeNET databases. A drug-disease target protein-protein interaction (PPI) network was constructed to select the most core targets, and an herb-ingredient-target network was built by utilizing Cytoscape 3.7.2. Furthermore, we performed Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes database (KEGG) analysis and verified the results of network pharmacology through molecular docking.

RESULTS

A total of 40 active ingredients from the herb pair BS-GC were initially screened, and a total of 528 targets were retrieved. Meanwhile, the total number of CSU targets was 1032. Then, the number of common targets between BS-GC and CSUs was 107. The 13 core targets of herb pair BS-GC with CSUs were filtered out according to the PPI network, including AKT1, TNF, EGFR, BCL2, HIF1A, MMP-9, etc. The 5 main core active ingredients were 1-(4-Hydroxybenzyl)-2-methoxy-9,10-dihydrophenanthrene-4,7-diol, 1-(4- Hydroxybenzyl)-4-methoxy-9,10-dihydrophenanthrene-2,7-diol, physcion, dihydromyricetin, and myricetin. The main biological processes were inflammation, oxidative stress, and immune response, involving the AGE-RAGE signaling pathway in diabetic complications, HIF-1 signaling pathway, NF-κB signaling pathway, and calcium signaling pathway. Molecular docking results showed good binding activity between the 5 main core active ingredients and 13 core targets.

CONCLUSION

This study predicted the core targets and signal transduction pathways in the treatment of CSUs to provide a reference for further molecular mechanism research.

Smart Responsive and Controlled-Release Hydrogels for Chronic Wound Treatment

Chronic wounds are a major health challenge that require new treatment strategies. Hydrogels are promising drug delivery systems for chronic wound healing because of their biocompatibility, hydration, and flexibility. However, conventional hydrogels cannot adapt to the dynamic and complex wound environment, which involves low pH, high levels of reactive oxygen species, and specific enzyme expression. Therefore, smart responsive hydrogels that can sense and respond to these stimuli are needed. Crucially, smart responsive hydrogels can modulate drug release and eliminate pathological factors by changing their properties or structures in response to internal or external stimuli, such as pH, enzymes, light, and electricity. These stimuli can also be used to trigger antibacterial responses, angiogenesis, and cell proliferation to enhance wound healing. In this review, we introduce the synthesis and principles of smart responsive hydrogels, describe their design and applications for chronic wound healing, and discuss their future development directions. We hope that this review will inspire the development of smart responsive hydrogels for chronic wound healing.

Effects of home-based chronic wound care training for patients and caregivers: A systematic review

We aimed to review and synthesise the evidence of the interventions of patients' and informal caregivers' engagement in managing chronic wounds at home. The research team used a systematic review methodology based on an updated guideline for reporting systematic reviews (PRISMA) and recommendations from the Synthesis Without Meta-analysis. Cochrane Central Register of Controlled Trial of the Cochrane Library, Pubmed, Embase, CINAHL, Wanfang (Chinese), and CNKI database (Chinese) were searched from inception to May 2022. The following MESH terms were used: wound healing, pressure ulcer, leg ulcer, diabetic foot, skin ulcer, surgical wound, educational, patient education, counselling, self-care, self-management, social support, and family caregiver. Experimental studies involving participants with chronic wounds (not at risk of wounds) and their informal caregivers were screened. Data were extracted and the narrative was synthesised from the findings of included studies. By screening the above databases, 790 studies were retrieved, and 16 met the inclusion and exclusion criteria. Studies were 6 RCTs and ten non-RCTs. Outcomes of chronic wound management included patient indicators, wound indicators, and family/caregiver indicators. Home-based interventions of patients or informal caregivers' engagement in managing chronic wounds at home may effectively improve patient outcomes and change wound care behaviour. What's more, educational/behavioural interventions were the primary type of intervention. Multiform integration of education and skills training on wound care and aetiology-based treatment was delivered to patients and caregivers. Besides, there are no studies entirely targeting elderly patients. Home-based chronic wound care training was important to patients with chronic wounds and their family caregivers, which may advance wound management outcomes. However, the findings of this systematic review were based on relatively small studies. We need more exploration of self and family-oriented interventions in the future, especially for older people affected by chronic wounds.

The hemostatic effect and wound healing of novel collagen-containing polyester dressing

Collagen plays an important role in hemostasis and tissue repair processes. Traditional passive wound dressings like gauze, bandage, and cotton wool could hardly fit the open wounds and exerted no active effect on wound healing. Even worse, they would adhere to the skin tissue, causing dehydration and second injury upon replacement. Polyester is commonly used in the medical field and is a safe and inexpensive polymer. Due to the hydrophobic surface, polyester does not adhere to tissue; however, polyester does not have the hemostatic properties. We designed a material composed of collagen and polyester, encapsulated hydrolyzed collagen in polyester particles, and made collagen-polyester non-woven fabric by melt blowing method, The collagen content was 1% and the collagen-polyester dressing exhibited a hydrophobic nature, preventing moisture from sticking to its surface. The purpose of this study was to compare the hemostatic effect of collagen-polyester nonwovens with conventional polyester pads, and to observe the adhesion of the pads to the wound. The wound healing and shrinkage rates of collagen-polyester dressings and conventional pads were compared in a rat wound healing test. The hemostatic test showed that the polyester pads containing 1% collagen significantly shortened the bleeding time compared with the traditional polyester pads, and retained the hydrophobicity and non-adhesion properties. The collagen-polyester dressing had better angiogenesis and granulation degree than the control group on the 14th day, and reduced the wound shrinkage rate. Collagen polyester dressings have excellent hemostasis, regeneration, shrinkage reduction and non-adhering for wounds. Overall, the novel collagen-containing polyester dressing is ideal choice for wound dressings.

Chronic wounds in a multiethnic Asian population: a cost of illness study

OBJECTIVE

To estimate the 'cost of illness' arising from chronic wounds in Singapore.

DESIGN

Incidence-based cost of illness study using evidence from a range of sources.

SETTING

Singapore health services.

PARTICIPANTS

We consider 3.49 million Singapore citizens and permanent residents. There are 16 752 new individuals with a chronic wound in 2017, with 598 venous ulcers, 2206 arterial insufficiency ulcers, 6680 diabetic ulcers and 7268 pressure injuries.Primary outcome measures expressed in monetary terms are the value of all hospital bed days lost for the population; monetary value of quality-adjusted life years (QALYs) lost in the population; costs of all outpatient visits; and costs of all poly clinic, use of Community Health Assist Scheme (CHAS) and emergency departments (EDs) visits. Intermediate outcomes that inform the primary outcomes are also estimated.

RESULTS

Total annual cost of illness was $350 million (range $72-$1779 million). With 168 503 acute bed days taken up annually (range 141 966-196 032) that incurred costs of $139 million (range 117-161 million). Total costs to health services were $184 million (range $120-$1179 million). Total annual costs of lost health outcomes were 2077 QALYs (range -2657 to 29 029) valued at $166 million (range -212 to 2399 million).

CONCLUSIONS

The costs of chronic wounds are large to Singapore. Costs can be reduced by making positive investments for comprehensive wound prevention and treatment programmes.

Lignin-Cobalt Nano-Enabled Poly(pseudo)rotaxane Supramolecular Hydrogel for Treating Chronic Wounds

Chronic wounds (CWs) are a growing issue for the health care system. Their treatment requires a synergic approach to reduce both inflammation and the bacterial burden. In this work, a promising system for treating CWs was developed, comprising cobalt-lignin nanoparticles (NPs) embedded in a supramolecular (SM) hydrogel. First, NPs were obtained through cobalt reduction with phenolated lignin, and their antibacterial properties were tested against both Gram-negative and Gram-positive strains. The anti-inflammatory capacity of the NPs was proven through their ability to inhibit myeloperoxidase (MPO) and matrix metalloproteases (MMPs), which are enzymes involved in the inflammatory process and wound chronicity. Then, the NPs were loaded in an SM hydrogel based on a blend of α-cyclodextrin and custom-made poly(ether urethane)s. The nano-enabled hydrogel showed injectability, self-healing properties, and linear release of the loaded cargo. Moreover, the SM hydrogel's characteristics were optimized to absorb proteins when in contact with liquid, suggesting its capacity to uptake harmful enzymes from the wound exudate. These results render the developed multifunctional SM material an interesting candidate for the management of CWs.

Oxygen-releasing biomaterials for chronic wounds breathing: From theoretical mechanism to application prospect

Chronic wounds have always been considered as "gordian knots" in medicine, in which hypoxia plays a key role in blocking healing. To address this challenge, although tissue reoxygenation therapy based on hyperbaric oxygen therapy (HBOT) has been performed clinically for several years, the bench to bedside still urges the evolution of oxygen-loading and -releasing strategies with explicit benefits and consistent outcome. The combination of various oxygen carriers with biomaterials has gained momentum as an emerging therapeutic strategy in this field, exhibiting considerable application potential. This review gives an overview of the essential relationship between hypoxia and delayed wound healing. Further, detailed characteristics, preparation methods and applications of various oxygen-releasing biomaterials (ORBMs) will be elaborated, including hemoglobin, perfluorocarbon, peroxide, and oxygen-generating microorganisms, those biomaterials are applied to load, release or generate a vast of oxygen to relieve the hypoxemia and bring the subsequent cascade effect. The pioneering papers regarding to the ORBMs practice are presented and trends toward hybrid and more precise manipulation are summarized.

Implementation of a patient-centered remote wound monitoring system for management of diabetic foot ulcers

Background

Regular clinical assessment is critical to optimize lower extremity wound healing. However, family and work obligations, socioeconomic, transportation, and time barriers often limit patient follow-up. We assessed the feasibility of a novel, patient-centered, remote wound management system (Healthy.io Minuteful for Wound Digital Management System) for the surveillance of lower extremity wounds.

Methods

We enrolled 25 patients from our outpatient multidisciplinary limb preservation clinic with a diabetic foot ulcer, who had undergone revascularization and podiatric interventions prior to enrollment. Patients and their caregivers were instructed on how to use the digital management system and asked to perform one at-home wound scan per week for a total of 8 weeks using a smartphone application. We collected prospective data on patient engagement, smartphone app useability, and patient satisfaction.

Results

Twenty-five patients (mean age 65.5 ± 13.7 years, 60.0% male, 52.0% Black) were enrolled over 3 months. Mean baseline wound area was 18.0 ± 15.2 cm2, 24.0% of patients were recovering from osteomyelitis, and post-surgical WiFi stage was 1 in 24.0%, 2 in 40.0%, 3 in 28.0%, and 4 in 8.00% of patients. We provided a smartphone to 28.0% of patients who did not have access to one that was compatible with the technology. Wound scans were obtained by patients (40.0%) and caregivers (60.0%). Overall, 179 wound scans were submitted through the app. The mean number of wound scans acquired per patient was 0.72 ± 0.63 per week, for a total mean of 5.80 ± 5.30 scans over the course of 8 weeks. Use of the digital wound management system triggered an early change in wound management for 36.0% of patients. Patient satisfaction was high; 94.0% of patients reported the system was useful.

Conclusion

The Healthy.io Minuteful for Wound Digital Management System is a feasible means of remote wound monitoring for use by patients and/or their caregivers.

PRP of T2DM Patient Immobilized on PCL Nanofibers Stimulate Endothelial Cells Proliferation

Diabetic foot ulcers (DFU) are a common complication of Type 2 Diabetes Mellitus (T2DM). Development of bioactive wound healing covers is an important task in medicine. The use of autologous platelet-rich plasma (PRP) consisting of growth factors, cytokines and components of extracellular matrix is a perspective approach for DFU treatment, but we previously found that some T2DM PRP samples have a toxic effect on mesenchymal stem cells (MSCs) in vitro. Here, we covalently immobilized T2DM PRP proteins on polycaprolactone (PCL) nanofibers, and the growth of endothelial cells on the PCL-COOH-PRP was investigated. Additionally, the level of NO reflecting the cytotoxic effects of PRP, angiogenin, and VEGF levels were measured in T2DM PRP samples. The results showed that the application of PCL-COOH-PRP nanofibers allows to remove the cytotoxicity of T2DM PRP and to improve endothelial cell adhesion and proliferative activity. We showed that the origin of T2DM PRP (the level of PRP toxicity or presence/absence of DFU) does not influence the efficiency of cell growth on PCL-COOH-PRP, and on the level of angiogenin, vascular epidermal growth factor (VEGF) in PRP itself.

The biological and physiological impact of the performance of wound dressings

Chronic wounds affect millions globally and are a huge financial burden. Whilst there are many wound dressings commercially available to manage these wounds, the complexity of the repair process makes it difficult to select the right dressing for the right wound at the right time. Thus, in this narrative review, we have examined reasons why wounds fail to heal, summarised the pathophysiology of the chronic wound environment and provided an evidence-based, clinically-relevant compilation of the published literature relevant to dressing design and evaluation. This has highlighted the need for a deeper understanding of wound exudates, how exudates change throughout the healing process, and how they are impacted by different dressing materials. Studies assessing biochemical and biophysical changes in exudates throughout the healing process are extremely valuable in this regard, enhancing both our understanding of the wound healing process and the ability to assess dressing performance. In addition, this knowledge allows us to replicate various wound conditions in the laboratory, and develop clinically-relevant models for testing current and new dressings, therefore providing a more comprehensive understanding of how and when they should be used. This approach makes the use of dressings more effective, thereby improving outcomes, and reducing the economic burden of chronic wounds.

Human In Vitro Skin Models for Wound Healing and Wound Healing Disorders

Skin wound healing is essential to health and survival. Consequently, high amounts of research effort have been put into investigating the cellular and molecular components involved in the wound healing process. The use of animal experiments has contributed greatly to the knowledge of wound healing, skin diseases, and the exploration of treatment options. However, in addition to ethical concerns, anatomical and physiological inter-species differences often influence the translatability of animal-based studies. Human in vitro skin models, which include essential cellular and structural components for wound healing analyses, would improve the translatability of results and reduce animal experiments during the preclinical evaluation of novel therapy approaches. In this review, we summarize in vitro approaches, which are used to study wound healing as well as wound healing-pathologies such as chronic wounds, keloids, and hypertrophic scars in a human setting.

Advances in Zebrafish for Diabetes Mellitus with Wound Model

Diabetic foot ulcers cause great suffering and are costly for the healthcare system. Normal wound healing involves hemostasis, inflammation, proliferation, and remodeling. However, the negative factors associated with diabetes, such as bacterial biofilms, persistent inflammation, impaired angiogenesis, inhibited cell proliferation, and pathological scarring, greatly interfere with the smooth progress of the entire healing process. It is this impaired wound healing that leads to diabetic foot ulcers and even amputations. Therefore, drug screening is challenging due to the complexity of damaged healing mechanisms. The establishment of a scientific and reasonable animal experimental model contributes significantly to the in-depth research of diabetic wound pathology, prevention, diagnosis, and treatment. In addition to the low cost and transparency of the embryo (for imaging transgene applications), zebrafish have a discrete wound healing process for the separate study of each stage, resulting in their potential as the ideal model animal for diabetic wound healing in the future. In this review, we examine the reasons behind the delayed healing of diabetic wounds, systematically review various studies using zebrafish as a diabetic wound model by different induction methods, as well as summarize the challenges and improvement strategies which provide references for establishing a more reasonable diabetic wound zebrafish model.