Hydrocolloid dressings in the management of acute wounds: a review of the literature

Wound healing, scarring and management

Understanding wound healing is imperative for the dermatological physician to optimize surgical outcomes. Poor healing may result in negative functional, cosmetic and psychological sequelae. This review briefly outlines the physiology of wound healing, with a view to improving the management of wounds and scars, and minimizing the long-term scarring complications.

Fabrication and characterization of a hydrocolloid wound dressing functionalized with human placental derived extracellular matrix for management of skin wounds: An animal study

BACKGROUND

Functionalization of wound dressing is one of the main approaches for promoting wound healing in skin wound management. In this study, our aim is to fabricate a bio-functionalized hydrocolloid wound dressing.

METHODS

The extracellular matrix (ECM) was extracted from human placental tissue. A hydrocolloid film was fabricated using Na-CMC, pectin, gelatin, styrene-isoprene-styrene adhesive, glycerol, and 0.5%-2.5% powdered ECM. A polyurethane film and a release liner were used in the hydrocolloid/ECM films. The mechanical, adhesion, swelling rate, and integrity of the films were investigated. Cell proliferation, adhesion, and migration assays, as well as, SEM and FTIR spectroscopy were also conducted. Macroscopic and microscopic evaluations of wound healing process and formation of blood vessels were conducted in mouse animal models.

RESULTS

We successfully fabricated a three-layered ECM-functionalized hydrocolloid dressing with a water vapor transmission rate of 371 g/m2 /day and an adhesion peel strength of 176 KPa. Cellular adhesion, proliferation and migration were promoted by ECM. In the animal tests, ECM-functionalized hydrocolloids significantly improved wound closure and re-epithelialization at days 14 and 21. Also, ECM-functionalized hydrocolloids promoted the formation of hair follicles.

CONCLUSIONS

Our findings suggest that ECM could enhance the wound healing properties of hydrocolloid wound dressings. This wound dressing could be considered for application in hard-to-heal acute wounds.

Electrospun Antimicrobial Drug Delivery Systems and Hydrogels Used for Wound Dressings

Wounds and chronic wounds can be caused by bacterial infections and lead to discomfort in patients. To solve this problem, scientists are working to create modern wound dressings with antibacterial additives, mainly because traditional materials cannot meet the general requirements for complex wounds and cannot promote wound healing. This demand is met by material engineering, through which we can create electrospun wound dressings. Electrospun wound dressings, as well as those based on hydrogels with incorporated antibacterial compounds, can meet these requirements. This manuscript reviews recent materials used as wound dressings, discussing their formation, application, and functionalization. The focus is on presenting dressings based on electrospun materials and hydrogels. In contrast, recent advancements in wound care have highlighted the potential of thermoresponsive hydrogels as dynamic and antibacterial wound dressings. These hydrogels contain adaptable polymers that offer targeted drug delivery and show promise in managing various wound types while addressing bacterial infections. In this way, the article is intended to serve as a compendium of knowledge for researchers, medical practitioners, and biomaterials engineers, providing up-to-date information on the state of the art, possibilities of innovative solutions, and potential challenges in the area of materials used in dressings.

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

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

Functional hydrogel-based wound dressings: A review on biocompatibility and therapeutic efficacy

Chronic wounds, burns, and surgical incisions represent critical healthcare challenges that significantly impact patient quality of life and strain healthcare resources. In response to these pressing needs, the field of wound healing has witnessed a radical advancement with the emergence of functional hydrogel-based dressings. This review article underscores the severity and importance of this transformative study in the domain of wound healing. The hydrogel matrix offers a moist and supportive environment that facilitates cellular migration, proliferation, and tissue regeneration, vital for efficient wound closure. Their conformable nature ensures patient comfort, reducing pain and uneasiness during dressing changes, particularly in chronic wounds where frequent interventions are required. Beyond their structural merits, functional hydrogel dressings possess the capability of incorporating bioactive molecules such as growth factors and antimicrobial agents. This facilitates targeted and sustained delivery of therapeutics directly to the wound site, addressing the multifactorial nature of chronic wounds and enhancing the healing trajectory. The integration of advanced nanotechnology has propelled the design of hydrogel dressings with enhanced mechanical strength and controlled drug release profiles, amplifying their therapeutic potential. In conclusion, the significance of this study lies in its ability to revolutionize wound healing practices and positively impact the lives of countless individuals suffering from chronic wounds and burns. As this transformative technology gains momentum, it holds the promise of addressing a major healthcare burden worldwide, thus heralding a new era in wound care management.

The emerging progress on wound dressings and their application in clinic wound management

BACKGROUND

In addition to its barrier function, the skin plays a crucial role in maintaining the stability of the body's internal environment and normal physiological functions. When the skin is damaged, it is important to select proper dressings as temporary barriers to cover the wound, which can exert significant effects on defence against microbial infection, maintaining normal tissue/cell functions, and coordinating the process of wound repair and regeneration. It now forms an important approach in clinic practice to facilitate wound repair.

SEARCH STRATEGIES

We conducted a comprehensive literature search using online databases including PubMed, Web of Science, MEDLINE, ScienceDirect, Wiley Online Library, CNKI, and Wanfang Data. In addition, information was obtained from local and foreign books on biomaterials science and traumatology.

RESULTS

This review focuses on the efficacy and principles of functional dressings for anti-bacteria, anti-infection, anti-inflammation, anti-oxidation, hemostasis, and wound healing facilitation; and analyses the research progress of dressings carrying living cells such as fibroblasts, keratinocytes, skin appendage cells, and stem cells from different origins. We also summarize the recent advances in intelligent wound dressings with respect to real-time monitoring, automatic drug delivery, and precise adjustment according to the actual wound microenvironment. In addition, this review explores and compares the characteristics, advantages and disadvantages, mechanisms of actions, and application scopes of dressings made from different materials.

CONCLUSION

The real-time and dynamic acquisition and analysis of wound conditions are crucial for wound management and prognostic evaluation. Therefore, the development of modern dressings that integrate multiple functions, have high similarity to the skin, and are highly intelligent will be the focus of future research, which could drive efficient wound management and personalized medicine, and ultimately facilitate the translation of health monitoring into clinical practice.

Spider Bite Wound Care and Review of Traditional and Advanced Treatment Options

Background

Approaches to chronic wound care are worlds apart: In developing nations, the care of chronic wounds often involves traditional management with local products (eg, honey, boiled potato peels, aloe vera gel, banana leaves); whereas in developed nations, more expensive and technologically advanced products are available (eg, wound vacuum, saline wound chamber, hyperbaric oxygen therapy, antibacterial foam). The cost for wound care plays a significant role in total health care costs, and that cost is expected to rise dramatically.

Case Presentation

A healthy, 60-year-old man presented after being bitten by a spider 6 days earlier. He was treated and prescribed clindamycin 300 mg 4 times daily for 14 days. Despite treatment, the wound continued to enlarge, and the patient showed symptoms of septicemia. The patient was admitted to the hospital and remained for 3 days. On discharge the patient was given a prescription for doxycycline 100 mg twice a day for 10 days and instructed to use iodoform gauze to pack the wound during daily dressing changes. However, the gauze was ineffective. The patient's dressing was switched to an antibacterial foam dressing impregnated with gentian violet and methylene blue.

Conclusions

There is a disparity in available wound care product availability. Modern products may yield faster healing times with fewer adverse effects than traditional products. Products used by local healers can produce satisfactory results when more modern products are unavailable and at a fraction of the cost.

Considerations for an ideal post-surgical wound dressing aligned with antimicrobial stewardship objectives: a scoping review

OBJECTIVE

Most surgical wounds heal by primary or secondary intention. Surgical wounds can present specific and unique challenges including wound dehiscence and surgical site infection (SSI), either of which can increase risk of morbidity and mortality. The use of antimicrobials to treat infection in these wounds is prevalent, but there is now an imperative to align treatment with reducing antimicrobial resistance and antimicrobial stewardship (AMS). The aim of this review was to explore the published evidence identifying general considerations/criteria for an ideal post-surgical wound dressing in terms of overcoming potential wound healing challenges (including infection) while supporting AMS objectives.

METHOD

A scoping review examining evidence published from 1954-2021, conducted by two authors acting independently. Results were synthesised narratively and have been reported in line with PRISMA Extension for Scoping Reviews.

RESULTS

A total of 819 articles were initially identified and subsequently filtered to 178 for inclusion in the assessment. The search highlighted six key outcomes of interest associated with post-surgical wound dressings: wound infection; wound healing; physical attributes related to comfort, conformability and flexibility; fluid handling (e.g., blood and exudate); pain; and skin damage.

CONCLUSION

There are several challenges that can be overcome when treating a post-surgical wound with a dressing, not least the prevention and treatment of SSIs. However, it is imperative that the use of antimicrobial wound dressings is aligned with AMS programmes and alternatives to active antimicrobials investigated.

Biomedical materials for wound dressing: recent advances and applications

Wound healing is vital to maintain the physiological functions of the skin. The most common treatment is the use of a dressing to cover the wound and reduce infection risk and the rate of secondary injuries. Modern wound dressings have been the top priority choice for healing various types of wounds owing to their outstanding biocompatibility and biodegradability. In addition, they also maintain temperature and a moist environment, aid in pain relief, and improve hypoxic environments to stimulate wound healing. Due to the different types of wounds, as well as the variety of advanced wound dressing products, this review will provide information on the clinical characteristics of the wound, the properties of common modern dressings, and the in vitro, in vivo as well as the clinical trials on their effectiveness. The most popular types commonly used in producing modern dressings are hydrogels, hydrocolloids, alginates, foams, and films. In addition, the review also presents the polymer materials for dressing applications as well as the trend of developing these current modern dressings to maximize their function and create ideal dressings. The last is the discussion about dressing selection in wound treatment and an estimate of the current development tendency of new materials for wound healing dressings.

Characteristics and Safety Profiles of a Hydrocolloid Polyester Dressing Incorporated with Herbal Extract: In Vitro, in Vivo and Randomized Clinical Studies

The polyester dressing containing herbal extract had been used for several years. However, some properties had not been investigated. This study examined three parts including in vitro studies, skin irritation in an animal model, and the pilot clinical study in traumatic wounds. In in vitro studies, six different wound dressings consisted of hydrocolloid polyester containing herbal extract (SI-HERB®), hydrofiber (Aquacel®), hydrocolloid polyester (Urgotul®), soft paraffin gauze (Bactigras®), foam (Mepilex®), and biocellulose (Suprasorb® X + PHMB) dressings were comparatively evaluated in physical properties including the fluid absorption, desorption, and fluid drainage ability. The skin irritation test was examined in a rabbit model using SI-HERB® as a tested group. In a clinical study, traumatic patients with leg wounds were randomly assigned to six wound dressings. The primary outcome was the pain level and the secondary outcomes were non-adherence and peri-wound reaction evaluating score. From the study, Bactigras® had the largest pore size but the total area of pore size per field of it was similar to SI-HERB®. There were no significant differences between SI-HERB®, Urgotul®, and Bactigras® in the percentage of absorption and desorption. No dermatologic effect was found in the animal study. In the irritation test on leg wounds, pain level, and peri-wound reaction in hydrocolloid polyester dressing group were significantly lower compared with Aquacel® and Bactigras®. The polyester dressing had the pain level after removal lower than before application while the Mepilex® and Suprasorb® presented that insignificantly increase the pain level. Erythema could be observed in Bactigras®, Aquacel®, and Suprasorb® but the edema scores were not different. A hydrocolloid polyester dressing containing herbal extract had good drainage ability. No skin irritation was reported. Pain scores, removal ability, and peri-wound reaction were also significantly lower with other types of wound dressings. These results suggested that this dressing be an alternative in wound treatment.

Bilayer Hydrogels for Wound Dressing and Tissue Engineering

A large number of different skin diseases such as hits, acute, and chronic wounds dictate the search for alternative and effective treatment options. The wound healing process requires a complex approach, the key step of which is the choice of a dressing with controlled properties. Hydrogel-based scaffolds can serve as a unique class of wound dressings. Presented on the commercial market, hydrogel wound dressings are not found among proposals for specific cases and have a number of disadvantages—toxicity, allergenicity, and mechanical instability. Bilayer dressings are attracting great attention, which can be combined with multifunctional properties, high criteria for an ideal wound dressing (antimicrobial properties, adhesion and hemostasis, anti-inflammatory and antioxidant effects), drug delivery, self-healing, stimulus manifestation, and conductivity, depending on the preparation and purpose. In addition, advances in stem cell biology and biomaterials have enabled the design of hydrogel materials for skin tissue engineering. To improve the heterogeneity of the cell environment, it is possible to use two-layer functional gradient hydrogels. This review summarizes the methods and application advantages of bilayer dressings in wound treatment and skin tissue regeneration. Bilayered hydrogels based on natural as well as synthetic polymers are presented. The results of the in vitro and in vivo experiments and drug release are also discussed.

A Review on Recent Progress of Stingless Bee Honey and Its Hydrogel-Based Compound for Wound Care Management

Stingless bee honey has a distinctive flavor and sour taste compared to Apis mellifera honey. Currently, interest in farming stingless bees is growing among rural residents to meet the high demand for raw honey and honey-based products. Several studies on stingless bee honey have revealed various therapeutic properties for wound healing applications. These include antioxidant, antibacterial, anti-inflammatory, and moisturizing properties related to wound healing. The development of stingless bee honey for wound healing applications, such as incorporation into hydrogels, has attracted researchers worldwide. As a result, the effectiveness of stingless bee honey against wound infections can be improved in the future to optimize healing rates. This paper reviewed the physicochemical and therapeutic properties of stingless bee honey and its efficacy in treating wound infection, as well as the incorporation of stingless bee honey into hydrogels for optimized wound dressing.

Composite Membrane Dressings System with Metallic Nanoparticles as an Antibacterial Factor in Wound Healing

Wound management is the burning problem of modern medicine, significantly burdening developed countries’ healthcare systems. In recent years, it has become clear that the achievements of nanotechnology have introduced a new quality in wound healing. The application of nanomaterials in wound dressing significantly improves their properties and promotes the healing of injuries. Therefore, this review paper presents the subjectively selected nanomaterials used in wound dressings, including the metallic nanoparticles (NPs), and refers to the aspects of their application as antimicrobial factors. The literature review was supplemented with the results of our team’s research on the elements of multifunctional new-generation dressings containing nanoparticles. The wound healing multiple molecular pathways, mediating cell types, and affecting agents are discussed herein. Moreover, the categorization of wound dressings is presented. Additionally, some materials and membrane constructs applied in wound dressings are described. Finally, bacterial participation in wound healing and the mechanism of the antibacterial function of nanoparticles are considered. Membranes involving NPs as the bacteriostatic factors for improving wound healing of skin and bones, including our experimental findings, are discussed in the paper. In addition, some studies of our team concerning the selected bacterial strains’ interaction with material involving different metallic NPs, such as AuNPs, AgNPs, Fe₃O₄NPs, and CuNPs, are presented. Furthermore, nanoparticles’ influence on selected eukaryotic cells is mentioned. The ideal, universal wound dressing still has not been obtained; thus, a new generation of products have been developed, represented by the nanocomposite materials with antibacterial, anti-inflammatory properties that can influence the wound-healing process.

An Up-to-Date Review of Biomaterials Application in Wound Management

Whether they are caused by trauma, illness, or surgery, wounds may occur throughout anyone's life. Some injuries' complexity and healing difficulty pose important challenges in the medical field, demanding novel approaches in wound management. A highly researched possibility is applying biomaterials in various forms, ranging from thin protective films, foams, and hydrogels to scaffolds and textiles enriched with drugs and nanoparticles. The synergy of biocompatibility and cell proliferative effects of these materials is reflected in a more rapid wound healing rate and improved structural and functional properties of the newly grown tissue. This paper aims to present the biomaterial dressings and scaffolds suitable for wound management application, reviewing the most recent studies in the field.

Comparison of Hydrocolloid Dressings and Silver Nanoparticles in Treatment of Pressure Ulcers in Patients with Spinal Cord Injuries: A Randomized Clinical Trial

Introduction: There are numerous dressings used to treat pressure ulcers (PUs), depending on their advantages to achieve optimum patient outcomes. This study aimed to compare hydrocolloid dressings and silver nanoparticles in treating PUs among patients with spinal cord injury (SCI).

Methods: This randomized clinical trial was conducted on 70 patients with SCI in Iran. Participants were randomly divided into two equal groups (n=35) receiving silver nanoparticle dressing and hydrocolloid dressing, respectively. The groups were evaluated in four assessment periods using the Bates-Jensen Wound Assessment Tool (BWAT). Data analysis was performed using SPSS software version 13, repeated measures ANOVA, non-parametric tests, and chi-square.

Results: Chi-square test was used to investigate the difference between the scores before the intervention, the results of which were not statistically significant. In repetitive measurements, the results of the analysis of variance showed that the average assessment score in both groups decreased and both dressings were effective in the treatment process. Although PU improvement status in the group that received silver nanoparticles was better, between-group analysis of variance did not show any statistically significant difference between the two groups.

Conclusion: Our results indicated that silver nanoparticles and hydrocolloid dressings can be used interchangeably in the treatment of PUs.

Semi-interpenetrating Polyurethane Network Foams Containing Highly Branched Poly(N-isopropyl acrylamide) with Vancomycin Functionality

Highly branched poly(N-isopropylacrylamide) (HB-PNIPAM), functionalized with vancomycin at the chain ends, acted as a bacterial adhesive and was incorporated into polyurethane foams to form semi-interpenetrating networks. PNIPAM was labeled with a solvatochromic dye, Nile red. It was found that the thermal response of the polymer was dependent on the architecture, and temperature-dependent color changes were observed within the foam. The foams had open pore structures, and the presence of HB-PNIPAM substantially reduced the shrinkage of the foam as the temperature was increased up to 20 °C. The foams were selectively adhesive for Staphylococcus aureus (Gram-positive bacteria) compared to Pseudomonas aeruginosa (Gram-negative bacteria), and the presence of S. aureus was indicated by increased fluorescence intensity (590-800 nm).

Classification and Production of Polymeric Foams among the Systems for Wound Treatment

This work represents an overview on types of wounds according to their definition, classification and dressing treatments. Natural and synthetic polymeric wound dressings types have been analyzed, providing a historical overview, from ancient to modern times. Currently, there is a wide choice of materials for the treatment of wounds, such as hydrocolloids, polyurethane and alginate patches, wafers, hydrogels and semi-permeable film dressings. These systems are often loaded with drugs such as antibiotics for the simultaneous delivery of drugs to prevent or cure infections caused by the exposition of blood vessel to open air. Among the presented techniques, a focus on foams has been provided, describing the most diffused branded products and their chemical, physical, biological and mechanical properties. Conventional and high-pressure methods for the production of foams for wound dressing are also analyzed in this work, with a proposed comparison in terms of process steps, efficiency and removal of solvent residue. Case studies, in vivo tests and models have been reported to identify the real applications of the produced foams.

Gelatin/Chitosan Bilayer Patches Loaded with Cortex Phellodendron amurense/Centella asiatica Extracts for Anti-Acne Application

Acne is a chronic inflammatory skin disease that often occurs with anaerobic Propionibacterium acnes (P. acnes). Anti-acne patches, made of hydrocolloid or hydrogel, have become a popular way of topical treatment. The outer water-impermeable layer of commercial patches might create hypoxic conditions and promote P. acnes growth. In this study, gelatin/chitosan (GC) bilayer patches were prepared at different temperatures that included room temperature (RT), −20 °C/RT, and −80 °C/RT. The most promising GC bilayer patch (−80 °C /RT) contained a dense upper layer for protection from bacteria and infection and a porous lower layer for absorbing pus and fluids from pimples. The anti-acne bilayer patch was loaded with Cortex Phellodendri amurensis (PA) and Centella asiatica (CA) extracts. PA extract could inhibit the growth of P. acnes and CA extract was reported to improve wound healing and reduce scar formation. Moreover, the water retention rate, weight loss rate, antibacterial activity, and in vitro cytotoxicity of the patches were investigated. The porous structure of the patches promoted water retention and contributed to absorbing the exudate when used on open acne wounds. The GC bilayer patches loaded with PA/CA extracts were demonstrated to inhibit the growth of P. acnes, and accelerate the skin fibroblast cell viability. Based on their activities and characteristics, the GC bilayer patches with PA/CA extract prepared at −80 °C/RT obtain the potential for the application of acne spot treatment.

Hydrogel-Based Strategies to Advance Therapies for Chronic Skin Wounds

Chronic skin wounds are the leading cause of nontraumatic foot amputations worldwide and present a significant risk of morbidity and mortality due to the lack of efficient therapies. The intrinsic characteristics of hydrogels allow them to benefit cutaneous healing essentially by supporting a moist environment. This property has long been explored in wound management to aid in autolytic debridement. However, chronic wounds require additional therapeutic features that can be provided by a combination of hydrogels with biochemical mediators or cells, promoting faster and better healing. We survey hydrogel-based approaches with potential to improve the healing of chronic wounds by reviewing their effects as observed in preclinical models. Topics covered include strategies to ablate infection and resolve inflammation, the delivery of bioactive agents to accelerate healing, and tissue engineering approaches for skin regeneration. The article concludes by considering the relevance of treating chronic skin wounds using hydrogel-based strategies.

Efficacy of chitosan derivative films versus hydrocolloid dressing on superficial wounds

Objectives

Chitosan, the N-deacetylated derivative of chitin, has useful biological properties that promote haemostasis, analgesia, wound healing, and scar reduction; chitosan is bacteriostatic, biocompatible, and biodegradable. This study determined the efficacy of chitosan derivative film as a superficial wound dressing.

Methods

This multicentre randomised controlled trial included 244 patients, of whom 86 were treated with chitosan derivative film and 84 with hydrocolloid. The percentage of epithelisation, as well as patient comfort, clinical signs, and patient convenience in application and removal of the dressings were assessed.

Results

The primary outcome of this study was the percentage of epithelisation. Except for race (p = 0.04), there were no significant differences between groups in sex, age, antibiotic usage, or initial wound size (p > 0.05). There was no significant difference in the mean epithelisation percentage between groups (p = 0.29). Patients using chitosan derivative film experienced more pain during removal of dressing than those in the hydrocolloid group (p = 0.007). The chitosan derivative film group showed less exudate (p = 0.036) and less odour (p = 0.024) than the control group. Furthermore, there were no significant differences between groups in terms of adherence, ease of removal, wound drainage, erythema, itchiness, pain, and tenderness. No oedema or localised warmth was observed during the study.

Conclusion

This study concluded that chitosan derivative film is equivalent to hydrocolloid dressing and can be an option in the management of superficial and abrasion wounds.

Clinical trial No

NMRR-11-948-10565.

Bacterial Contribution in Chronicity of Wounds

A wound is damage of a tissue usually caused by laceration of a membrane, generally the skin. Wound healing is accomplished in three stages in healthy individuals, including inflammatory, proliferative, and remodeling stages. Healing of wounds normally starts from the inflammatory phase and ends up in the remodeling phase, but chronic wounds remain in an inflammatory stage and do not show progression due to some specific reasons. Chronic wounds are classified in different categories, such as diabetic foot ulcer (DFU), venous leg ulcers (VLU) and pressure ulcer (PU), surgical site infection (SSI), abscess, or trauma ulcers. Globally, the incidence rate of DFU is 1-4 % and prevalence rate is 5.3-10.5 %. However, colonization of pathogenic bacteria at the wound site is associated with wound chronicity. Most chronic wounds contain more than one bacterial species and produce a synergetic effect that results in previously non-virulent bacterial species becoming virulent and causing damage to the host. While investigating bacterial diversity in chronic wounds, Staphylococcus, Pseudomonas, Peptoniphilus, Enterobacter, Stenotrophomonas, Finegoldia, and Serratia were found most frequently in chronic wounds. Recently, it has been observed that bacteria in chronic wounds develop biofilms that contribute to a delay in healing. In a mature biofilm, bacteria grow slowly due to deficiency of nutrients that results in the resistance of bacteria to antibiotics. The present review reflects the reasons why acute wounds become chronic. Interesting findings include the bacterial load, which forms biofilms and shows high-level resistance toward antibiotics, which is a threat to human health in general and particularly to some patients who have acute wounds.

Comparative effectiveness of different wound dressings for patients with partial-thickness burns: study protocol of a systematic review and a Bayesian framework network meta-analysis

INTRODUCTION

Selecting a suitable wound dressing for patients with partial-thickness burns (PTBs) is important in wound care. However, the comparative effectiveness of different dressings has not been studied. We report the protocol of a network meta-analysis designed to combine direct and indirect evidence of wound dressings in the management of PTB.

METHODS AND ANALYSIS

We will search for randomised controlled trials (RCTs) evaluating the wound-healing effect of a wound dressing in the management of PTB. Searches will be conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Wounds Group Specialised Register and CINAHL. A comprehensive search strategy is developed to retrieve articles reporting potentially eligible RCTs. Besides, we will contact the experts in the field and review the conference proceedings to locate non-published studies. The reference lists of articles will be reviewed for any candidate studies. Two independent reviewers will screen titles and abstracts of the candidate articles. All eligible RCTs will be obtained in full text to perform a review. Disagreement on eligibility of an RCT will be solved by group discussion. The information of participants, interventions, comparisons and outcomes from included RCTs will be recorded and summarised. The primary outcome is time to complete wound healing. Secondary outcomes include the proportion of burns completely healed at the end of treatment, change in wound surface area at the end of treatment, incidence of adverse events, etc.

ETHICS AND DISSEMINATION

The result of this review will provide evidence for the comparative effectiveness of different wound dressings in the management of PTB. It will also facilitate decision-making in choosing a suitable wound dressing. We will disseminate the review through a peer-review journal and conference abstracts or posters.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42016041574; Pre-results.

Electrospinning of natural polymers for advanced wound care: towards responsive and adaptive dressings

Nanofibrous dressings produced by electrospinning proteins and polysaccharides are highly promising candidates in promoting wound healing and skin regeneration.

Preparation and characterization of silver nanoparticle loaded amorphous hydrogel of carboxymethylcellulose for infected wounds

There is a growing demand for an appropriate and safe antimicrobial dressing to treat infected deep wounds. An amorphous gel formulation (SNP-CMC), containing silver nanoparticles (SNPs) and carboxymethylcellulose (CMC), was prepared in one step by the reduction of silver nitrate in situ. Spectrophotometric and microscopic analysis revealed that the SNPs were 7-21 nm in diameter. In simulated wound experiments, SNP-CMC gel was found to absorb 80.48 ± 4.69% w/w of saline and donate 17.43 ± 0.76% w/w of moisture within 24h indicating its dual fluid affinity. Cytocompatibility of the gel was assessed by proliferation studies with primary human skin cells. The antimicrobial activity studies showed that SNP-CMC containing 50 ppm of SNPs was effective against the growth of both Gram negative and Gram positive strains including methicillin-resistant Staphylococcus aureus (MRSA). These results indicate that SNP-CMC could be ideal for the treatment of deep infected wounds.

Successful Treatment of a Patient With Complicated Diabetic Foot Wound: A Case Report

Foot ulceration is one of the most serious complications of diabetes mellitus and may lead to amputation of the lower extremity. Timely prophylaxis and treatment of diabetic foot ulceration are important to maintain a good quality of life. This article reports a complicated diabetic patient with severe limb-threatening necrotizing infection. We successfully applied endovascular stent insertion, digit amputation, negative pressure wound therapy, and advanced dressings in different wound phases to achieve definitive wound healing after 12 months of treatment. Based on this case report, we would like to emphasize the importance of combined multiple therapies and patient compliance for severe diabetic foot ulcers.

Evaluation of skin regeneration after burns in vivo and rescue of cells after thermal stress in vitro following treatment with a keratin biomaterial

Thermal burns typically display an injury pattern dictated by the transfer of the thermal energy into the skin and underlying tissues and creation of three zones of injury represented by a necrotic zone of disrupted cells and tissue, an intermediate zone of injured and dying cells, and a distant zone of stressed cells that will recover with proper treatment. The wound healing capabilities of a keratin biomaterial hydrogel were studied in two pilot studies, one using a chemical burn model in mice and the other a thermal burn model in swine. In both studies, keratin was shown to prevent enlargement of the initial wound area and promote faster wound closure. Interestingly, treating thermally stressed dermal fibroblast in culture demonstrated that soluble keratin was able to maintain cell viability and promote proliferation. Separation of so-called alpha and gamma fractions of the keratin biomaterial had differential effects, with the gamma fraction producing more pronounced cell survival and recovery. These results suggest that the gamma fraction, composed essentially of degraded alpha keratin proteins, may facilitate cell rescue after thermal injury. Treatment of burns with gamma keratin may therefore represent a potential therapy for wounds with an intermediate zone of damaged tissue that has the potential to contribute to spontaneous healing.

Prospective RCT comparing two hydrocolloid dressings in acute trauma wounds in South Korea

OBJECTIVE

To compare the efficacy of two hydrocolloid dressings (Medifoam H; Genewel Co. Ltd. and DuoDERM; ConvaTec Inc.) for the management of lacerations, abrasions, and minor operation incisions.

METHOD

Patients with lacerations, abrasions, and minor operation incisions were randomly allocated to receive either Medifoam H or DuoDERM. Data collected included wound assessment (amount of exudate, wound infection, rate of wound closure, and the percentage of necrotic, sloughy, fibrous,granulation, and epithelial tissue present in the wound bed) and patient evaluation of itching, burning,leakage of exudate, pain and discomfort incurred from dressing and dressing change.

RESULTS

In total, 66 patients were included in the study. No significant difference in wound assessment or in patient evaluation was detected between two groups.

CONCLUSION

The data collected from this study gave no evidence for any difference in efficacy between Medifoam H and DuoDERM for minor, acute trauma wound management.

A new tool for real-time pain assessment in experimental and clinical environments

Pain measurement largely depends on the ability to rate personal subjective pain. Nevertheless, pain scales can be difficult to use during medical procedures. We hypothesized that pain can be expressed intuitively and in real-time by squeezing a pressure sensitive device. We developed such a device called “Painmouse®” and tested it on healthy volunteers and patients in two separate studies: Sixteen male participants rated different painful heat stimuli via Painmouse® and a Visual Analog Scale (VAS). Retest was done one week later. Participants clearly distinguished four distinct pain levels using both methods. Values from the first and second sessions were comparable. Thereafter, we tested the Painmouse® by asking twelve female and male leg- ulcer patients to continuously squeeze it during the whole length of their wound-dressing change. Patients rated each step of dressing change on an 11-point numeric rating scale. Painmouse® ratings were highest for the wound cleaning and debridement step. Application of the new dressing was not evaluated as very painful. On the other hand, numeric scale ratings did not differentiate between dressing change steps. We conclude that the Painmouse® enables pain assessment even under difficult clinical circumstances, such as during a medical treatment in elderly patients.

Effectiveness of hydrocolloid dressing in postoperative hip and knee surgery: literature review and our experience

Hydrocolloid dressings are impermeable dressings that provide an optimal environment for wound healing. These dressings are very effective in healing chronic wounds but evidence regarding their use for the post-operative knee and hip surgery is scarce. Our experience shows that hydrocolloid dressing (Duoderm) helps in preventing not only superficial surgical site infection (SSSI) but also blister formation in patients undergoing lower limb orthopaedic surgery.

Wound healing: a new approach to the topical wound care

Cutaneous wound healing is a complex and well-coordinated interaction between inflammatory cells and mediators, establishing significant overlap between the phases of wound healing. Wound healing is divided into three major phases: inflammatory phase, proliferative phase, and remodeling phase. Unlike the acute wound, the nonhealing wound is arrested in one of the phases of healing, typically the inflammatory phase. A systematic approach to the management of the chronic nonhealing wound emphasizes three important elements of wound bed preparation in chronic wounds: debridement, moisture, and countering bacterial colonization and infection. In this article, wound-healing process and new approaches to the topical wound care have been reviewed.