Effectiveness of collagen/oxidised regenerated cellulose/silver-containing composite wound dressing for the treatment of medium-depth split-thickness skin graft donor site wounds in multi-morbid patients: a prospective, non-comparative, single-centre study

Biosynthesis of positively charged bacterial cellulose hydrogel with antibacterial and anti-inflammatory function for efficient wound healing

In bacterial cellulose (BC)-based living materials, the effective and permanent incorporation of bactericidal agents into BC remains a persistent challenge. In this study, midazole quaternary ammonium salt was grafted onto a dispersion of bacterial cellulose, which was subsequently directly added to the fermentation medium of BC-producing bacteria to obtain BC-based hydrogel materials (BC/BC-[PQVI]Br) with inherent antibacterial properties. The BC/BC-[PQVI]Br hydrogel prepared in this study exhibits favorable tensile properties, with a maximum tensile stress of 970 KPa and water retention for up to 6 h. Moreover, it demonstrates acceptable antibacterial activity against S. aureus (93 %) and E. coli (71 %), respectively. Additionally, the hydrogel displays a high cell survival rate of 98 % after contact with NIH 3T3 cells, indicating its non-cytotoxic nature. Furthermore, the mouse wound experiment confirms the excellent wound healing effect of the hydrogel. This research presents an innovative approach towards developing environmentally friendly active wound dressings with microbial-derived antibacterial functionality.

Comparison of Biatain Ag and Biatain Alginate Ag dressings on skin graft donor sites: a prospective clinical trial

OBJECTIVE

The aim of this study was to compare Biatain Ag and Biatain Alginate Ag (both Coloplast, Denmark) as skin graft donor site dressings.

METHOD

A single-centre, prospective, randomised clinical study was conducted. In patients who had undergone a skin graft operation, adjacent split-thickness skin graft donor sites were dressed with Biatain Ag and Biatain Alginate Ag, respectively. The primary outcomes were time to re-epithelialisation and pain score after the operation. The secondary outcomes were scar scores of the donor site after the operation, haematoma rates, infection rates, and exudation rates before wound healing. Results were compared using the Wilcoxon test and the Chi-squared test.

RESULTS

A total of 16 paired wounds in 16 patients were studied. The donor sites dressed with Biatain Ag needed more time for >90% re-epithelialisation than those dressed with Biatain Alginate Ag. On day 3 postoperatively, the pain scores with Biatain Ag were significantly less severe than those with Biatain Alginate Ag. On days 6, 9 and 12, the pain scores of both dressings did not differ significantly. The scar scores of the donor site dressed with Biatain Ag were significantly worse than those dressed with Biatain Alginate Ag at 6 months. With respect to infection rates, no significant differences were detected between these two groups. However, the exudation rates of the donor site dressed with Biatain Ag were significantly lower than those dressed with Biatain Alginate Ag.

CONCLUSION

As skin graft donor site dressings, both Biatain Ag and Biatain Alginate Ag have advantages.

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

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

Comparison of the Effect of Using Collective Plus Ag Dressing and Vaseline Gauze Dressing in the Donor of Split-Thickness Burn Grafts

Background

Skin graft involves removing a part of the skin and using it in another part of the body. One of the most common reasons for using a graft is burns. We aimed to compare the effect of Colactive plus Ag dressing with Vaseline gauze dressing in donor sites of split-thickness skin grafts of burned patients.

Methods

The present study was conducted as a randomized clinical trial (RCT) in the Motahari burn Hospital, Tehran, Iran in 1401. The sampling method was done using Cochran's formula and available patients so 15 people were enrolled. The findings of the study were collected using a researcher-made form.

Results

The average duration of recovery, the amount and intensity of pain, and the amount of itching between the two types of Colative plus Ag plus Ag dressing with Vaseline gauze are statistically significant at the 95% confidence level. (P-value<0.05). In addition, the findings showed that the average amount of scar left by the wound in the two types of dressings examined is not statistically significant at the 95% confidence level (P-value > 0.05).

Conclusion

The use of Colactive silver dressing has less pain, less itching in the donor area, and a shorter average recovery time than Vaseline gauze. The use of the Colactive plus Ag will be more effective than Vaseline gauze.

Direct Synthesis of Photosensitizable Bacterial Cellulose as Engineered Living Material for Skin Wound Repair

Living materials based on bacterial cellulose (BC) represent a natural and promising candidate for wound dressing. Both physical adsorption and chemical methods have been applied to BC for realizing antibacterial function. However, effective and long-lasting incorporation of bactericidal moieties to BC remains challenging. Herein, a Komagataeibacter sucrofermentans-based direct synthetic method to fabricate photosensitizer-grafted BC through in situ bacterial metabolism in the presence of TPEPy-modified glucose is explored. The results verify that the direct biosynthesis method is efficient and convenient to endow BC with outstanding fluorescence and light-triggered photodynamic bactericidal activity for skin wound repair. This work presents a new approach to fabricate eco-friendly and active wound dressing with light-controlled bactericidal activity by microbial metabolism. The successful modification of the glucose carbon source of microorganisms also offers insights for biosyntheses of other living materials through microbial metabolism.

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

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

Reducing pain at split thickness donor sites with silicone dressing compared to petrolatum gauze dressing

Many modalities have been introduced to reduce devastating pain at the donor area. This is a prospective, randomized study to assess the effect of silicone dressing in reducing pain at split-thickness skin donor sites, and compare it with traditional petrolatum gauze. The patients were allocated to receive standard dressing (petrolatum gauze) or silicone dressing over skin donor sites. Pattern and severity of pain at the sites were assessed in both groups using the Visual Analog Scale for pain. Pattern of pain at the donor site during the postoperative period was consistently lower with silicone dressing (p<0.005). Regarding severity of pain, there were differences between the two groups (p.<005), but there were no significant differences between the two sexes regarding pattern and severity of pain (p>0.5). This study showed silicone dressing to be superior to petrolatum gauze in reducing severity and pattern of pain. It may increase patient satisfaction.

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

Harvesting donor site explants for split-thickness skin grafting creates an iatrogenic wound that presents additional challenges to clinicians due to morbidities such as persistent bleeding, pain, infection, and delayed epithelialization. Although there have been several randomized controlled trials to compare wound dressing effectiveness, there is still a lack of standardization for donor site wound dressings.

A retrospective comparison of 59 patients that underwent split-thickness skin graft reconstructions between January 2017 and September 2018 was performed. Donor sites of Group 1 patients (n = 29) were treated with a transparent film dressing and transitioned to petrolatum gauze dressings if exudate management became problematic; Group 2 patients (n = 30) were treated with oxidized regenerated cellulose/collagen/silver-oxidized regenerated cellulose (ORC/C/Ag-ORC) dressings. Evaluations of time to epithelialization, number of dressings required, signs of inflammation, and objective pain were compared between groups.

Group 1 was comprised of 18 female and 11 male patients, whereas Group 2 was comprised of 14 females and 16 males. There were no significant differences between groups when comparing age, sex, comorbidities, or donor site size (area or depth). Patients in Group 2 had a significantly shorter time to complete re-epithelialization (P < .0001), fewer dressing changes (P < .0001), and less objective pain as measured by the need for opioid pain mediation (P < .0001) when compared to Group 1. The percentage of patients with signs of inflammation was also lower for Group 2, although this difference was not statistically significant (P = .0797).

Although prospective, controlled studies are still needed, data from this study suggest that ORC/C/Ag-ORC dressings could become a more effective alternative for the management of donor site wounds, especially in patients with known risk factors for wound healing.

Highly transparent, highly flexible composite membrane with multiple antimicrobial effects used for promoting wound healing

In recent years, bacterial cellulose (BC)-based dressings or patches for skin or soft tissue repair have become investigative emphasis. However, most of the BC-based products used for biomedical applications present limitations due to their low flexibility, poor gas permeability and no inherent antibacterial activity. Herein, we proposed and designed a novel composite composed of natural bacterial cellulose (BC), polyethylene glycol (PEG) and polyhexamethylene biguanidine (PHMB) through new synthetic approaches. The composite membrane exhibited favorable physicochemical performance, especially transparency, water retention ability, flexibility as well as the characteristic of anti-adhesion. In vitro biochemical experiment results indicated that the composite had excellent biocompatibility and exhibited strong and sustained antibacterial effect. In vivo test further demonstrated that the composite could efficiently promote skin wound healing and regeneration in a rat model. This composite membrane possesses multiple mechanisms of promoting cutaneous wound healing and will provide new ideas for future development of wound dressings.

Flexible Amoxicillin-Grafted Bacterial Cellulose Sponges for Wound Dressing: In Vitro and in Vivo Evaluation

In this study, we report the design and fabrication of a novel biocompatible sponge with excellent antibacterial property, making it a promising material for wound dressings. The sponge is formed by grafting amoxicillin onto regenerated bacterial cellulose (RBC). It was observed that the grafted RBC could enhance the antibacterial activity against fungus, Gram-negative, and Gram-positive bacteria. The morphology of strains treated with the grafted RBC and fluorescent stain results further demonstrated the antibacterial ability of the fabricated sponge. Moreover, a cytocompatibility test evaluated in vitro and in vivo illustrates the nontoxicity of the prepared sponge. More importantly, the wound infection model reveals that this sponge can accelerate the wound healing in vivo. This work indicates the novel sponge has the huge potential in wound dressing application for clinical use.

Oxidized Regenerated Cellulose/Collagen Dressings: Review of Evidence and Recommendations

OBJECTIVE

Healthcare systems are being challenged to manage increasing numbers of nonhealing wounds. Wound dressings are one of the first lines of defense in wound management, and numerous options exist. The oxidized regenerated cellulose (ORC)/collagen dressing may offer healthcare providers a robust and cost-effective tool for use in a variety of wounds.

DESIGN

A multidisciplinary panel meeting was convened to discuss the use of ORC/collagen dressings in wound care and provide practice recommendations. A literature search was conducted to provide a brief review of the peer-reviewed studies published between January 2000 and March 2016 to inform the meeting.

SETTING

A 2-day panel meeting convened in February 2017.

PARTICIPANTS

Healthcare providers with experience using ORC/collagen dressings. This multidisciplinary panel of 15 experts in wound healing included podiatrists, wound care specialists (doctors, certified wound care nurses, and research scientists), and an orthopedist.

RESULTS

The literature search identified 58 articles, a majority of which were low levels of evidence (69.3% were level 3 or lower). Panel members identified wound types, such as abrasions, burns, stalled wounds, diabetic foot ulcers, and pressure injuries, where ORC/collagen dressing use could be beneficial. Panel members then provided recommendations and technical pearls for the use of ORC/collagen dressings in practice. Barriers to ORC/collagen dressing use were discussed, and potential resolutions were offered.

CONCLUSIONS

An ORC/collagen dressing can be a critical tool for clinicians to help manage a variety of wounds. Clinical and economic studies comparing standard-of-care dressings and plain collagen dressings to ORC/collagen dressings are needed.