A sprayable luminescent pH sensor and its use for wound imagingin vivo

Enhancing wound healing through deep reinforcement learning for optimal therapeutics

Finding the optimal treatment strategy to accelerate wound healing is of utmost importance, but it presents a formidable challenge owing to the intrinsic nonlinear nature of the process. We propose an adaptive closed-loop control framework that incorporates deep learning, optimal control and reinforcement learning to accelerate wound healing. By adaptively learning a linear representation of nonlinear wound healing dynamics using deep learning and interactively training a deep reinforcement learning agent for tracking the optimal signal derived from this representation without the need for intricate mathematical modelling, our approach has not only successfully reduced the wound healing time by 45.56% compared to the one without any treatment, but also demonstrates the advantages of offering a safer and more economical treatment strategy. The proposed methodology showcases a significant potential for expediting wound healing by effectively integrating perception, predictive modelling and optimal adaptive control, eliminating the need for intricate mathematical models.

Advances in ionic liquids as fluorescent sensors

Ionic liquids (ILs) are a class of liquid salts with characteristics such as a low melting point, an ionic nature, non-volatility, and tunable properties. Because of their adaptability, they have a significant influence in the field of fluorescence. This paper reviews the primary literature on the use of ILs in fluorescence sensing technologies. The kind of target material is utilized to classify the fluorescence sensors made with the use of ILs. They include using ILs as probes for metals, nitro explosives, small organic compounds, anions, and gases. The efficacy of an IL-based fluorescence sensor depends on the precise design to guarantee specificity, sensitivity, and a consistent reaction to the desired analyte. The precise method can differ depending on the chemical properties of the IL, the choice of fluorophore, and the interactions with the analyte. Overall, the viability of the aforementioned materials for chemical analysis is evaluated, and prospective possibilities for further development are identified.

Recent advances in biosensors for real time monitoring of pH, temperature, and oxygen in chronic wounds

Chronic wounds are among the major healthcare issues affecting millions of people worldwide with high rates of morbidity, losses of limbs and mortality. Microbial infection in wounds is a severe problem that can impede healing of chronic wounds. Accurate, timely and early detection of infections, and real time monitoring of various wound healing biomarkers related to infection can be significantly helpful in the treatment and care of chronic wounds. However, clinical methodologies of periodic assessment and care of wounds require physical visit to wound care clinics or hospitals and time-consuming frequent replacement of wound dressing patches, which also often adversely affect the healing process. Besides, frequent replacements of wound dressings are highly expensive, causing a huge amount of burden on the national health care systems. Smart bandages have emerged to provide in situ physiochemical surveillance in real time at the wound site. These bandages integrate smart sensors to detect the condition of wound infection based on various parameters, such as pH, temperature and oxygen level in the wound which reduces the frequency of changing the wound dressings and its associated complications. These devices can continually monitor the healing process, paving the way for tailored therapy and improved quality of patient's life. In this review, we present an overview of recent advances in biosensors for real time monitoring of pH, temperature, and oxygen in chronic wounds in order to assess infection status. We have elaborated the recent progress in quantitative monitoring of several biomarkers important for assessing wounds infection status and its detection using smart biosensors. The review shows that real-time monitoring of wound status by quantifying specific biomarkers, such as pH, temperature and tissue oxygenation to significantly aid the treatment and care of chronic infected wounds.

Spray-On Colorimetric Sensors for Distinguishing the Presence of Lead Ions

Sprayable stimuli-responsive material coatings represent a new class of detection system which can be quickly implemented to transform a surface into a color-responsive sensor. In this work, we describe a dipicolylamine-terminated diacetylene-containing amphiphile formulation for spray coating on to a simple paper substrate to yield disposable test strips that can be used to detect the presence of lead ions in solution. We find the response to be very selective to only lead ions and that the sensitivity can be modulated by altering the UV curing time after spraying. Sensitive detection to at least 0.1 mM revealed a clear color change from a blue to red phase. This represents the first demonstration of a spray-on sensor system capable of detection of lead ions in solution.

Development of green and sustainable smart biochromic and therapeutic bandage using red cabbage (Brassica oleracea L. Var. capitata) extract encapsulated into alginate nanoparticles

Novel multifunctional wound dressing with the ability to protect, cure and sense the healing process, was developed. Red-cabbage extract has been reported to exhibit bioactive compounds with the ability to function as antioxidant, antiinflammatory, anticancer, antibacterial, antifungal, and antiviral agent, as well as a natural pH-sensory chromophoric material. An anthocyanin extract was prepared from Red-cabbage (Brassica oleracea L. Var. capitata). The anthocyanins extract was encapsulated into calcium alginate in the presence of potash alum mordant, which was then applied to the surface of the cotton gauze. Red-cabbage based anthocyanin chromophoric extract was encapsulated at different concentrations into alginate-based hydrogel and immobilized into cotton gauze to provide a smart therapeutic pH-responsive wound dress to function as an antimicrobial and biochromic matrix providing a comfortable dress sensor to monitor the wound status. Decreasing the pH of a wound mimic solution caused a blue shift from 579 to 437 nm. The anthocyanin spectroscopic probe's halochromic activity demonstrated a colorimetric change from purple to pink, which was critical to the dyed cotton diagnostic assay's biochromic performance. The colorimetric parameters of the prepared dressing sensor were proved by UV-Vis absorbance and CIE Lab coordinates. Both mechanical and morphological properties of the prepared dressing were studied using different analytical methods. The effect of anthocyanin concentration on the mechanical, water vapor permeability, water absorption and morphological properties of the wound dressing were investigated. No substantial flaws in air-permeability or bend length were detected after dyeing. The colored cotton gauze samples were tested for their high colorfastness. The cytotoxicity and antimicrobial activity of the prepared biochromic cotton gauze were explored. The dyed cotton samples exhibited no cytotoxicity and improved antimicrobial activity with increasing the anthocyanin ratio on cotton surface.

Near-Infrared Fluorogenic Spray for Rapid Tumor Sensing

Surgical resection of cancerous tissues is a critical procedure for solid tumor treatment. During the operation, the surgeon mostly identifies the cancerous tissues by naked-eye visualization under white light without aid, therefore, the outcome heavily relies on the surgeon's experience. A near-infrared pH-responsive fluorogenic dye, CypH-11, was designed to be used as a sensitive cancer spray to highlight cancerous tissues during surgical operations, minimizing the surgeon's subjective judgment. CypH-11, pK_a 6.0, emits almost no fluorescence at neutral pH but fluoresces brightly in an acidic environment, a ubiquitous consequence of cancer cell proliferation. After topical application, CypH-11 was absorbed quickly, and its fluorescence signal in the cancerous tissue was developed within a minute. The signal-to-background ratio was 1.3 and 1.5 at 1 and 10 min, respectively. The fluorogenic property and near-instant signal development capability enable the "spray-and-see" concept. This fast-acting CypH-11 spray could be a handy and effective tool for fluorescence-guided surgery, identifying small cancerous lesions in real time for optimal resection without systemic toxicity.

Optode Based Chemical Imaging-Possibilities, Challenges, and New Avenues in Multidimensional Optical Sensing

Seeing is believing, as the saying goes, and optical sensors (so-called optodes) are tools that can make chemistry visible. Optodes react reversibly and quickly (seconds to minutes) to changing analyte concentrations, enabling the spatial and temporal visualization of an analyte in complex environments. By being available as planar sensor foils or in the form of nano- or microparticles, optodes are flexible tools suitable for a wide array of applications. The steadily grown applications of in particular oxygen (O₂) and pH optodes in fields as diverse as medical, environmental, or material sciences is proof for the large demand of optode based chemical imaging. Nevertheless, the full potential of this technology is not exhausted yet, challenges have to be overcome, and new avenues wait to be taken. Within this Perspective, we look at where the field currently stands, highlight several successful examples of optode based chemical imaging and ask what it will take to advance current state-of-the-art technology. It is our intention to point toward some potential blind spots and to inspire further developments.

Fluorescein Derivatives as Fluorescent Probes for pH Monitoring along Recent Biological Applications

Potential of hydrogen (pH) is one of the most relevant parameters characterizing aqueous solutions. In biology, pH is intrinsically linked to cellular life since all metabolic pathways are implicated into ionic flows. In that way, determination of local pH offers a unique and major opportunity to increase our understanding of biological systems. Whereas the most common technique to obtain these data in analytical chemistry is to directly measure potential between two electrodes, in biological systems, this information has to be recovered in-situ without any physical interaction. Based on their non-invasive optical properties, fluorescent pH-sensitive probe are pertinent tools to develop. One of the most notorious pH-sensitive probes is fluorescein. In addition to excellent photophysical properties, this fluorophore presents a pH-sensitivity around neutral and physiologic domains. This review intends to shed new light on the recent use of fluorescein as pH-sensitive probes for biological applications, including targeted probes for specific imaging, flexible monitoring of bacterial growth, and biomedical applications.

Optical Sensing and Imaging of pH Values: Spectroscopies, Materials, and Applications

This is the first comprehensive review on methods and materials for use in optical sensing of pH values and on applications of such sensors. The Review starts with an introduction that contains subsections on the definition of the pH value, a brief look back on optical methods for sensing of pH, on the effects of ionic strength on pH values and pKa values, on the selectivity, sensitivity, precision, dynamic ranges, and temperature dependence of such sensors. Commonly used optical sensing schemes are covered in a next main chapter, with subsections on methods based on absorptiometry, reflectometry, luminescence, refractive index, surface plasmon resonance, photonic crystals, turbidity, mechanical displacement, interferometry, and solvatochromism. This is followed by sections on absorptiometric and luminescent molecular probes for use pH in sensors. Further large sections cover polymeric hosts and supports, and methods for immobilization of indicator dyes. Further and more specific sections summarize the state of the art in materials with dual functionality (indicator and host), nanomaterials, sensors based on upconversion and 2-photon absorption, multiparameter sensors, imaging, and sensors for extreme pH values. A chapter on the many sensing formats has subsections on planar, fiber optic, evanescent wave, refractive index, surface plasmon resonance and holography based sensor designs, and on distributed sensing. Another section summarizes selected applications in areas, such as medicine, biology, oceanography, bioprocess monitoring, corrosion studies, on the use of pH sensors as transducers in biosensors and chemical sensors, and their integration into flow-injection analyzers, microfluidic devices, and lab-on-a-chip systems. An extra section is devoted to current challenges, with subsections on challenges of general nature and those of specific nature. A concluding section gives an outlook on potential future trends and perspectives.

Imaging in Chronic Wound Diagnostics

Significance: Chronic wounds affect millions of patients worldwide, placing a huge burden on health care resources. Although significant progress has been made in the development of wound treatments, very few advances have been made in wound diagnosis. Recent Advances: Standard imaging methods like computed tomography, single-photon emission computed tomography, magnetic resonance imaging, terahertz imaging, and ultrasound imaging have been widely employed in wound diagnostics. A number of noninvasive optical imaging modalities like optical coherence tomography, near-infrared spectroscopy, laser Doppler imaging, spatial frequency domain imaging, digital camera imaging, and thermal and fluorescence imaging have emerged over the years. Critical Issues: While standard diagnostic wound imaging modalities provide valuable information, they cannot account for dynamic changes in the wound environment. In addition, they lack the capability to predict the healing outcome. Thus, there remains a pressing need for more efficient methods that can not only indicate the current state of the wound but also help determine whether the wound is on track to heal normally. Future Directions: Many imaging probes have been fabricated and shown to provide real-time assessment of tissue microenvironment and inflammatory responses in vivo. These probes have been demonstrated to noninvasively detect various changes in the wound environment, which include tissue pH, reactive oxygen species, fibrin deposition, matrix metalloproteinase production, and macrophage accumulation. This review summarizes the creation of these probes and their potential implications in wound monitoring.

Peptide Bond Cleavage by Ni(II) Ions within the Nuclear Localization Signal Sequence

Nickel is harmful to humans, being both carcinogenic and allergenic. However, the mechanisms of this toxicity are still unresolved. We propose that Ni(II) ions disintegrate proteins by hydrolysis of peptide bonds preceding the Ser/Thr-Xaa-His sequences. Such sequences occur in nuclear localization signals (NLSs) of human phospholipid scramblase 1, Sam68-like mammalian protein 2, and CLK3 kinase. We performed spectroscopic experiments showing that model nonapeptides derived from these NLSs bind Ni(II) at physiological pH. We also proved that these sequences are prone to Ni(II) hydrolysis. Thus, the aforementioned NLSs may be targets for nickel toxicity. This implies that Ni(II) ions disrupt the transport of some proteins from cytoplasm to cell nucleus.

Imaging of pH and pO2 gives insight in molecular processes of irradiated cells

One of the major challenges in radiation therapy is the interference with tissue repair processes due to hypoxic characteristics and pH dysregulation. In this study, we present dual imaging of pH and oxygenation in vitro based on luminescent biocompatible sensor foils that allow studying the effects of irradiation on different cell types in culture. Different sensitivities of fibroblast and oral squamous carcinoma cells were observed by complementing oxygen and pH differences with proliferation assays. This study highlights especially the distinct role of oxygen after irradiation and the difference in proliferation processes of irradiated normal dermal cells in contrast to irradiated tumor cells.

Novel color standards for digital color analysis of optochemical sensor arrays

The indicator-based polymeric color standards for color referencing in digital color analysis (DCA) of optical chemical sensors (optodes) are proposed. In the novel standards, the colors referring to the actual absorption bands of the protonated and deprotonated forms of the indicator are mixed in constant proportions. The standards are based on the lipophilic pH-indicators: ETH5350 and ETH2439, commonly used in optodes, and the lipophilic electrolyte TBATBB. The dependence of the standard color on the TBATBB concentration in the optode is established and found to be linear. The standard colors remain unchanged upon varying the solution pH and the nature and the concentration of the electrolyte. Calibration curves of the indicator pH-optodes obtained in horse serum and referenced to the developed standards demonstrate lower error to span ratio, broader span and higher sensitivity as compared to the same data processed with the conventional gray standard. The colorimetric signal of the pH-optodes array measured in serum sample and referenced to the developed standards allowed accurate determination of the sample pH thus demonstrating practical prospects of the proposed color standards.

Smart Wound Dressings for Diabetic Chronic Wounds

Given their severity and non-healing nature, diabetic chronic wounds are a significant concern to the 30.3 million Americans diagnosed with diabetes mellitus (2015). Peripheral arterial diseases, neuropathy, and infection contribute to the development of these wounds, which lead to an increased incidence of lower extremity amputations. Early recognition, debridement, offloading, and controlling infection are imperative for timely treatment. However, wound characterization and treatment are highly subjective and based largely on the experience of the treating clinician. Many wound dressings have been designed to address particular clinical presentations, but a prescriptive method is lacking for identifying the particular state of chronic, non-healing wounds. The authors suggest that recent developments in wound dressings and biosensing may allow for the quantitative, real-time representation of the wound environment, including exudate levels, pathogen concentrations, and tissue regeneration. Development of such sensing capability could enable more strategic, personalized care at the onset of ulceration and limit the infection leading to amputation. This review presents an overview of the pathophysiology of diabetic chronic wounds, a brief summary of biomaterial wound dressing treatment options, and biosensor development for biomarker sensing in the wound environment.

Extracellular pH imaging of a plant leaf with a polyelectrolyte multilayered nanosheet

We have developed a sheet-like pH imaging sensor based on a flexible and physically adhesive polymer thin film (referred to as a “pH sensing nanosheet”). The pH sensing nanosheet was composed of two films: one is a pH-sensitive layer-by-layer (LbL) film constructed from fluorescein-conjugated poly(acrylic acid) and poly(allylamine hydrochloride) and the other is a pH-insensitive film made from Nile red-embedded poly(d,l-lactic acid). The pH sensing nanosheet enabled the ratiometric imaging of pH changes in a leaf (500 × 500 μm²), namely the apoplastic ion milieu responding to an external NaCl stress. It was successfully mapped out that the alkalization of the leaf apoplast spread from the leaf base to the tip at 20 min after the stimulation and the pH value increased up to approximately pH 6.3 from less than pH 4.5 within 60 min when a 100 mM NaCl aqueous solution was added. The pH sensing nanosheet should be useful for energy metabolic mapping in tissue biology.

We have developed a sheet-like pH imaging sensor based on a flexible and physically adhesive polymer thin film (referred to as a “pH sensing nanosheet”).

Drug-Porous Silicon Dual Luminescent System for Monitoring and Inhibition of Wound Infection

Wound monitoring and curing is of great importance in biomedical research. This work created a smart bandage that can simultaneously monitor and inhibit wound infection. The main components of the smart bandage are luminescent porous silicon (LuPSi) particles loaded with ciprofloxacin (CIP). This dual luminescent system can undergo accelerated fluorescent color change from red to blue upon the stimulation of reactive oxygen species (ROS) and elevated pH, which are main biomarkers in the infected wound. The mechanism behind the chemical-triggered fluorescent color change was studied in detail. In vitro experiment showed that the ratiometric fluorescent intensity (I_Red/I_Blue) of CIP-LuPSi particles decreased from 10 to 0.03 at pH 7.5 after 24 h, while the value deceased from 10 to 2.15 at pH 7.0. Strong correlation can be also found between the I_Red/I_Blue value and ROS concentration ranging from 0.1 to 10 mM. In addition, the oxidation of LuPSi also simultaneously triggered the release of CIP molecules, which exhibited bacterial inhibition activity. Therefore, the ratiometric fluorescent intensity change at red and blue channels can indicate not only the wound infection status but also the release of antibiotics. In vivo test proved that the smart bandage could distinguish infected wounds from acute wounds, just relying on the naked eyes or a cell phone camera. On the basis of the Si nanotechnology established in this work, theranostic wound care will be realized in future.

Implantable Tin Porphyrin-PEG Hydrogels with pH-Responsive Fluorescence

Tetracarboxy porphyrins can be polymerized with polyethylene glycol (PEG) diamines to generate hydrogels with intense, near-infrared, and transdermal fluorescence following subcutaneous implantation. Here, we show that the high density porphyrins of the preformed polymer can be chelated with tin via simple incubation. Tin porphyrin hydrogels exhibited increasing emission intensities, ratios, and lifetimes from pH 1 to 10. Tin porphyrin hydrogel emission was strongly reversible and pH responsiveness was observed in the physiological range between pH 6 and pH 8. pH-sensitive emission was detected via noninvasive transdermal fluorescence imaging in vivo following subcutaneous implantation in mice.

An overview of nanoparticles commonly used in fluorescent bioimaging

This article gives an overview of the various kinds of nanoparticles (NPs) that are widely used for purposes of fluorescent imaging, mainly of cells and tissues. Following an introduction and a discussion of merits of fluorescent NPs compared to molecular fluorophores, labels and probes, the article assesses the kinds and specific features of nanomaterials often used in bioimaging. These include fluorescently doped silicas and sol-gels, hydrophilic polymers (hydrogels), hydrophobic organic polymers, semiconducting polymer dots, quantum dots, carbon dots, other carbonaceous nanomaterials, upconversion NPs, noble metal NPs (mainly gold and silver), various other nanomaterials, and dendrimers. Another section covers coatings and methods for surface modification of NPs. Specific examples on the use of nanoparticles in (a) plain fluorescence imaging of cells, (b) targeted imaging, (c) imaging of chemical species, and (d) imaging of temperature are given next. A final section covers aspects of multimodal imaging (such as fluorescence/nmr), imaging combined with drug and gene delivery, or imaging combined with therapy or diagnosis. The electronic supplementary information (ESI) gives specific examples for materials and methods used in imaging, sensing, multimodal imaging and theranostics such as imaging combined with drug delivery or photodynamic therapy. The article contains 273 references in the main part, and 157 references in the ESI.

Turn-on pH nano-fluorosensor based on imidazolium salicylaldehyde ionic liquid-labeled silica nanoparticles

A turn-on pH nano-fluorosensor based on a new probe labeled SiNPs was designed. The new probe is based on ESIPT process for Sal bearing 2-MeIm ionic liquid terminal. The pH sensing performance of the nanosensor has been investigated.

Simultaneous imaging of intracellular pH and O2 using functionalized semiconducting polymer dots

We developed novel functionalized semiconducting polymer dots (Pdots) for the simultaneous imaging of intracellular pH and oxygen.

Ni(ii) ions cleave and inactivate human alpha-1 antitrypsin hydrolytically, implicating nickel exposure as a contributing factor in pathologies related to antitrypsin deficiency

Ni(ii) ions cleave AAT hydrolytically, inactivating the protein.

Luminescent dual sensors reveal extracellular pH-gradients and hypoxia on chronic wounds that disrupt epidermal repair

Wound repair is a quiescent mechanism to restore barriers in multicellular organisms upon injury. In chronic wounds, however, this program prematurely stalls. It is known that patterns of extracellular signals within the wound fluid are crucial to healing. Extracellular pH (pH_e) is precisely regulated and potentially important in signaling within wounds due to its diverse cellular effects. Additionally, sufficient oxygenation is a prerequisite for cell proliferation and protein synthesis during tissue repair. It was, however, impossible to study these parameters in vivo due to the lack of imaging tools. Here, we present luminescent biocompatible sensor foils for dual imaging of pH_e and oxygenation in vivo. To visualize pH_e and oxygen, we used time-domain dual lifetime referencing (tdDLR) and luminescence lifetime imaging (LLI), respectively. With these dual sensors, we discovered centripetally increasing pH_e-gradients on human chronic wound surfaces. In a therapeutic approach, we identify pH_e-gradients as pivotal governors of cell proliferation and migration, and show that these pH_e-gradients disrupt epidermal barrier repair, thus wound closure. Parallel oxygen imaging also revealed marked hypoxia, albeit with no correlating oxygen partial pressure (pO₂)-gradient. This highlights the distinct role of pH_e-gradients in perturbed healing. We also found that pH_e-gradients on chronic wounds of humans are predominantly generated via centrifugally increasing pH_e-regulatory Na⁺/H⁺-exchanger-1 (NHE1)-expression. We show that the modification of pH_e on chronic wound surfaces poses a promising strategy to improve healing. The study has broad implications for cell science where spatial pH_e-variations play key roles, e.g. in tumor growth. Furthermore, the novel dual sensors presented herein can be used to visualize pH_e and oxygenation in various biomedical fields.

Recent developments in topical wound therapy: impact of antimicrobiological changes and rebalancing the wound milieu

Wound therapy improves every year by developing new wound treatment options or by advancing already existing wound materials, for example, adding self-releasing analgesic drugs or growth factors to wound dressings, or by binding and inactivating excessive proteases. Also new dressing materials based on silk fibers and enhanced methods to reduce bacterial burden, for example, cold argon plasma, might help to fasten wound healing.

Organotypic culture of human amnion cells in air-liquid interface as a potential substitute for skin regeneration

BACKGROUND AIMS

The aim of the present study was to evaluate the effects of air-liquid interface on the differentiation potential of human amnion epithelial cells (HAECs) to skin-like substitute in organotypic culture.

METHODS

HAECs at passage 1-2 were seeded onto a fibrin layer populated with human amnion mesenchymal cells to form the organotypic cultures. The organotypic HAECs were then cultured for 7, 14 and 21 d in two types of culture system: the submerged culture and the air-liquid interface culture. Cell morphogenesis was examined under the light and electron microscopes (transmission and scanning) and analyzed by immunohistochemistry.

RESULTS

Organotypic HAECs formed a single layer epithelium after 3 wk in submerged as well as air-liquid interface cultures. Ultrastructurally, desmosomes were observed in organotypic HAECs cultured in the air-liquid interface but not in the submerged culture. The presence of desmosomes marked the onset of early epidermal differentiation. Organotypic HAECs were positive against anti-CK18 and anti-CK14 in both the submerged and the air-liquid interface cultures. The co-expression of CK14 and CK18 suggested that differentiation of HAECs into skin may follow the process of embryonic skin development. However, weak expression of CK14 was observed after 2 and 3 wk of culture in air-liquid interface. CK10, involucrin, type IV collagen and laminin-5 expression was absent in organotypic HAECs. This observation reflects the initial process of embryonic epidermal differentiation and stratification.

CONCLUSIONS

Results from the present study suggest that the air-liquid interface could stimulate early differentiation of organotypic HAECs to epidermal cells, with a potential use for skin regeneration.

Evidence-based topical management of chronic wounds according to the T.I.M.E. principle

The number of patients suffering from chronic wound healing disorders in Germany alone is estimated to be 2.5-4 million. Therapy related expenses reach 5-8 billion Euros annually. This number is partially caused by costly dressing changes due to non-standardized approaches and the application of non-evidence-based topical wound therapies. The purpose of this paper is to elucidate a straightforward principle for the management of chronic wounds, and to review the available evidence for the particular therapy options. The T.I.M.E.-principle (Tissue management, Inflammation and infection control, Moisture balance, Epithelial [edge] advancement) was chosen as a systematic strategy for wound bed preparation. Literature was retrieved from the PubMed and Cochrane Library databases and subjected to selective analysis. Topical wound management should be carried out according to a standardized principle and should further be synchronized to the phases of wound healing. Despite the broad implementation of these products in clinical practice, often no benefit exists in the rate of healing, when evaluated in meta-analyses or systematic reviews. This insufficient evidence is additionally limited by varying study designs. In case of non-superiority, the results suggest to prefer relatively inexpensive wound dressings over expensive alternatives. Arbitrary endpoints to prove the effectiveness of wound dressings, contribute to the random use of such therapies. Defining rational endpoints for future studies as well as the deployment of structured therapy strategies will be essential for the economical and evidence-based management of chronic wounds.