Factors affecting wound healing

Clinical observations on super relaxation suture in the resection of benign skin tumor in children

BACKGROUND AND OBJECTIVE

This study compares the clinical effectiveness of super relaxation suture technique using barbed polydioxanone suture (PDS) with in-situ return needle horizontal mattress suture against conventional subcutaneous heart-shaped suture technique in resecting benign skin tumors in children.

METHODS

40 children with benign skin tumors who underwent outpatient surgery and received super relaxation suture were assigned to the observation group. The control group comprised 24 children treated with conventional subcutaneous heart-shaped suture technique after the resection of benign skin tumors. The postoperative scars of the two patient groups were evaluated.

RESULTS

After a postoperative follow-up period of 3-24 months, 38 out of the 40 patients in the observation group exhibited linear wound scars, while 2 patients presented with hyperplastic scars on their chests. In the control group comprising of 24 patients, one patient had depression scar on face, two patients displayed noticeable hyperplastic scars on scalps, and one patient developed keloid on lower limb.

CONCLUSION

Super relaxation suture technique using PDS in situ backstitch horizontal mattress suture is more effective than conventional subcutaneous heart-shaped suture technique in reducing tension post-benign skin tumor resection in children, promoting wound healing, and minimizing scar formation.

Advancements in chitosan-based nanocomposites with ZIF-8 nanoparticles: multifunctional platforms for wound healing applications

The integration of chitosan and zeolitic imidazolate framework-8 (ZIF-8) nanoparticles has demonstrated significant potential in enhancing wound healing through their multifunctional capabilities. This review explores recent developments in chitosan-based nanocomposites incorporating ZIF-8 nanoparticles, emphasizing their antibacterial properties, pH-responsive drug release, angiogenesis promotion, and mechanical stability. Applications span hydrogel scaffolds, electrospun nanofibers, and sprayable membranes, all tailored for addressing challenges such as bacterial resistance, delayed tissue regeneration, and chronic wound management. Key findings highlight the synergistic benefits of ZIF-8's bioactivity with chitosan's biocompatibility, yielding innovative therapeutic strategies for complex wound healing scenarios. The discussed advancements not only underline their clinical relevance but also set a foundation for future explorations in regenerative medicine.

Use of Platelet-Rich Fibrin (PRF) on Palatal Wound Healing: A Narrative Review With Clinical Recommendations

This clinical narrative review aimed to comprehensively evaluate the effects of platelet-rich fibrin (PRF) on clinically related and patient-reported outcomes during palatal wound healing following autologous palatal graft harvesting. To gather all available evidence, a comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar, along with a manual search of reference lists from eligible studies, up to November 22, 2024. A total of 28 clinical comparative studies were identified, including 21 randomized clinical trials (RCTs), two non-RCTs, and five case series. Most studies investigated the application of PRF following free gingival grafts (FGG) rather than subepithelial connective tissue grafts (SCTG), with the majority also using solid PRF as opposed to liquid PRF. For FGG harvesting sites, PRF demonstrated positive outcomes in enhancing wound healing-related outcomes, reducing postoperative pain and other complications, lowering analgesic consumption, and improving quality of life (QoL). For SCTG harvesting sites, PRF also showed beneficial effects in promoting wound healing, reducing postoperative pain, and eliminating the need for analgesics. Based on the current findings, PRF application following either FGG and SCTG harvesting appears to be a promising approach for enhancing wound healing, minimizing postoperative complications, reducing analgesic consumption, and improving patient satisfaction. Clinical recommendations, along with step-by-step protocols, are also provided in this review article to guide clinicians in optimized efficiency for use of PRF for palatal wound healing following FGG and SCTG harvesting. A recommended simplified use of solid PRF prepared using horizontal centrifugation, in combination with a palatal stent, is suggested. The addition of sutures alongside the stent may provide enhanced stabilization of PRF in place for larger graft sites. Nevertheless, further well-designed RCTs with standardized methods and larger sample sizes are needed to strengthen the evidence base and confirm the therapeutic advantages of PRF in palatal wound healing.

Prevalence, incidence, systemic, behavioral, and patient-related risk factors and indicators for peri-implant diseases: An AO/AAP systematic review and meta-analysis

BACKGROUND

A profound understanding of the epidemiology of peri-implant diseases (PIDs) is essential for the development of preventive approaches to mitigate the occurrence and progression of peri-implant biological complications. The present systematic review and meta-analysis aimed to assess the incidence, prevalence, systemic, behavioral, and patient-related risk indicators and factors for PIDs in adult patients with dental implants.

METHODS

Clinical studies assessing the prevalence, incidence, systemic risk indicators, and risk factors for PIDs were considered eligible for inclusion. MEDLINE-PubMed, EMBASE, Cochrane Central Library, and ClinicalTrials.gov electronic databases were searched for published articles. Pooled data analyses were performed using random-effects models to identify risk indicators and factors for PIDs.

RESULTS

Of 1120 potentially eligible records, 102 studies met the eligibility criteria and were included in this systematic review. Prevalence rates at the patient level for peri-implant mucositis and peri-implantitis were 46% (95% confidence interval [CI], 41-51) and 21% (95% CI, 17-24), respectively. Weighted mean incidence rates at the patient level for peri-implant mucositis and peri-implantitis were 53% and 22%, respectively, within 20 years of function. Pooled estimates identified periodontitis, obesity, and smoking habits as significant systemic risk indicators for mucositis. For peri-implantitis, the significant risk indicators were periodontitis, diabetes mellitus, smoking habits, and alcohol consumption. Only risk indicators could be identified in the selected evidence.

CONCLUSION

More than half of the patients treated with dental implants were affected by PID over a 10-year follow-up period, with peri-implant mucositis being the most prevalent condition. Periodontitis and smoking were identified as risk indicators for the development of both PID. Obesity was identified as a potential risk indicator for mucositis, while diabetes mellitus and alcohol consumption were recognized as potential risk indicators for peri-implantitis.

PLAIN LANGUAGE SUMMARY

This systematic review looked at the causes and frequency of problems around dental implants, known as PID, which include conditions like peri-implant mucositis (inflammation around the implant) and peri-implantitis (more serious infection around the implant). Understanding these conditions and their etiology is important for finding ways to prevent them. This research reviewed 102 studies (including 13,030 patients) to gather data on how often these problems occur and what factors might increase the risk of developing them. The meta-analyses revealed that nearly half of people with dental implants had peri-implant mucositis, and about one in five had peri-implantitis. Over a period of 20 years, the incidence rates for developing these conditions were about 53% for mucositis and 22% for peri-implantitis. The study identified certain health and lifestyle factors that could increase the risk of these conditions. For mucositis, risk factors included having gum disease (periodontitis), obesity, and smoking. For peri-implantitis, the risks were similar, with periodontitis, smoking, and diabetes and alcohol use being important factors.

Comparative efficacy of different functional hydrogel dressings in healing diabetic foot ulcer: A systematic review and network meta-analysis

AIMS

Functional hydrogel dressings offer a promising therapeutic approach, and optimizing their formulations is crucial for improving diabetic foot ulcers (DFUs) outcomes. This study explores the comparative efficacy of different functional hydrogel dressings in DFUs treatment.

MATERIALS AND METHODS

We conducted a systematic review and Bayesian network meta-analysis of randomized controlled trials evaluating functional hydrogel dressings for DFUs treatment. A comprehensive search was performed across PubMed, Embase, CENTRAL, CNKI and Web of Science from inception to June 2024. Bayesian network meta-analysis was employed to synthesize and compare the relative efficacy of hydrogel interventions, defined as the number of patients with complete wound closure.

RESULTS

In total, 23 studies involving 1671 patients with DFUs were included. The analysis revealed that immuno-regulating hydrogels (IRHs) had the highest effect estimate (2.2, 95% CI: 1.6, 3.2), compared with anti-bacterial hydrogels (ABHs) ranked last (1.3, 95% CI: 0.78, 2.3). Multi-functional hydrogels (MFHs) and proliferation-promoting hydrogels (PPHs) displayed intermediate effects (1.7, 95% CI: 1.2, 2.4). The relative efficacy ranking was IRH > MFH/PPH > ABH > placebo. The risk of adverse events was lower in functional hydrogel groups relative to placebo (0.75, 95% CI: 0.56, 0.96). Node-splitting analysis confirmed the consistency between direct and indirect evidence for IRH versus ABH. A funnel plot analysis indicated no significant publication bias, affirming the robustness of our findings.

CONCLUSION

This study provides a comprehensive evaluation of functional hydrogel dressings for DFUs treatment, highlighting the potential of IRH as the most effective option. These insights will guide future research and clinical applications to improve DFUs management.

Indications and Regenerative Techniques for Lateral Window Sinus Floor Elevation With Ridge Augmentation

Maxillary sinus elevation is a critical procedure in dental implantology, often necessary to address bone deficiencies in the posterior maxilla. However, various medical conditions, local factors, and surgical complexities can significantly influence the outcomes. This article delves into the implications of systemic conditions such as smoking, diabetes, osteoporosis, antiresorptive and antiangiogenic medications, radiotherapy, immunocompromised states, cardiovascular diseases, chronic alcoholism, and oxidative stress on sinus floor elevation and associated dental implant placements. Each condition presents unique challenges and necessitates tailored clinical considerations to mitigate risks and enhance surgical success. A comprehensive pre-operative assessment is essential, including detailed patient history and radiographic evaluation. Local conditions affecting the maxillary sinus, such as sinusitis, require careful examination and possible otolaryngologist consultation. The article discusses a standardized Digital Surgical Planning (DSP) protocol involving CBCT imaging, intraoral scans, virtual diagnostic wax-ups, and guided implant placement to optimize surgical planning and outcomes. Surgical techniques for lateral window antrostomy are examined, including flap design, window size and location, and piezoelectric and rotary instrumentation. Subsequent regenerative procedures involve meticulous membrane elevation and particulate graft placement, with considerations for graft material and technique to ensure stability and volume retention. Post-operative care, encompassing antibiotic prophylaxis, corticosteroid use, and decongestants, is outlined to prevent infections and manage edema. Conclusively, the article stresses the necessity for implantologists to be proficient in various techniques and make evidence-based decisions tailored to individual patient needs, ensuring optimal implant therapy outcomes. The lateral window approach remains a cornerstone of regenerative dental procedures, maintaining its significance through evolving methodologies and clinical advances. The lateral window sinus elevation procedure has demonstrated consistent success as a pre-prosthetic surgical intervention for over four decades, supported by multiple reviews. Initially a hospital-based procedure requiring autogenous bone harvesting, it has evolved into a minimally invasive, office-based procedure without the need for donor bone. Smaller access windows and flaps have further reduced morbidity. Despite the emergence of less invasive techniques such as the transcrestal approach and the use of tilted or short implants, the lateral window procedure remains relevant due to its unique advantages: Provides greater access to overcome obstacles like septa. Facilitates single-surgery management of multiple implant sites. Remains applicable regardless of residual crestal bone height. Allows intraoperative management of complications such as membrane perforations.

Evaluation of topical vitamin k cream on repair of full thickness wound in diabetic rat

BACKGROUND

diabetic Wound is one of the most common complications throughout the world. .This experiment was conducted in order to study the effects of vitamin k cream on repair of full thickness wound in diabetic rat.

METHODS

75 adult Male Wistar rats were randomly divided into five groups of equal numbers; each group consists of 15 animals. After diabetes induction, full thickness wound in the shape of 2.25 CM2 square was created on the back of the rats. Group one was not treated and served as control. The woud areas in the second, third and fourth groups were covered twice a day with phenytoin (PHT) cream,0.05 and 1 % vitamin k creams, respectively. Group five treated with eucerin(vichel group) The size of wound area were measured in the 1, 4, 7, 10, 14, 18 and 21 days after wound induction. and histopathological observation and tissue parameters (hydroxyprolin(HP), collagen, glutation(GSH), malondialdeid (MDA), superoxiddesmutase(SOD), glutation peroxidase(GPX), catalase(CAT),tumor necrosis factor alpha (TNF-α), interlukin 1 bata(IL-1β)) were analysed as onther indicators of wound healing on days of 7, 14 and 21.

RESULTS

the findings indicated that PHT and 1 % vitamin k creams significantly elevated HP and collagen in contrast with control group. furthermore, in all time points, the average wound size in PHT and 1 % vitamin k groups was significantly greater than other groups (P < 0.05). Also, PHT and vitamin K 1 % creams improved oxidative and inflammatory stress parameters at all times courses. Theses findings were confirmed by histological examination.

CONCLUSION

The findings showed that 1 % vitamin k creams have potential effects on wound healing. Vitamin K exerts this effect through its antioxidant and anti-inflammatory properties, as well as stimulating collagen synthesis.

Harnessing the power of stem cell-derived exosomes: a rejuvenating therapeutic for skin and regenerative medicine

Exosomes are small extracellular vesicles produced by most cell types and contain proteins, lipids, and nucleic acids (non-coding RNAs, mRNA, and DNA) that can be released by donor cells to influence the function of recipient cells. Skin photoaging is the premature aging of skin structures caused by prolonged exposure to ultraviolet (UV), as demonstrated by depigmentation, roughness, rhytides, elastosis, and precancerous alterations. Exosomes are associated with aging processes such as oxidative damage, inflammation, and senescence. Exosomes' anti-aging properties have been linked to various in vitro and preclinical investigations. There are still several unanswered questions about the use of MSC exosomes for skin rejuvenation, despite encouraging results. Uncertainty surrounds the precise processes by which exosomes stimulate the creation of collagen, skin tissue via a variety of mechanisms, including reduced matrix metalloproteinase (MMP) expression, increased collagen and elastin production, and modulation of intracellular signaling pathways and intercellular communication. These findings suggest the therapeutic potential of exosomes in skin aging. This review provides information on the molecular mechanisms and consequences of exosome anti-aging.

Palliative oncodermatology: Management of malignancy-related cutaneous symptoms in the palliative care setting

Dermatologists play a critical role in interdisciplinary cancer care, and as the field of supportive oncodermatology has evolved, a new subdivision has emerged: palliative oncodermatology. In cancer patients awaiting definitive treatment, those unable to undergo surgery or other invasive interventions, and those in the terminal stages of their illness, there is a need for symptom-based, noncurative strategies that address symptoms of cutaneous malignancies as well as cutaneous complications of systemic malignancies. The integration of palliative care principles in the management of such cutaneous complications strives to alleviate suffering and enhance quality of life. Here, we review the complications associated with cutaneous malignancies and metastases, along with skin symptoms of systemic malignancies. We also explore treatment options that emphasize symptom relief and comfort, highlighting the role of dermatologists in managing these challenges and coordinating supportive care in palliative settings.

The effects of silk sheets derived from germ-free silkworms on wound healing of full-thickness epithelial defects

Collagen is widely used as a scaffold for full-thickness epithelial defects but has poor biostability and often induces hypertrophic scarring. Silk, especially silk derived from germ-free silkworms (SGFS), has high biocompatibility and controllable durability. Therefore, SGFS is possibly for medicine. Herein, we evaluated the effects of SGFS as a scaffold in the wound healing of full-thickness epithelial defects. Epithelial defects were made in the dorsal skin of C57BL/6 J mice, and an SGFS or a collagen sheet was applied to each defect and compared. On days 1, 3, 7, and 14 after surgery, re-epithelialization, inflammatory responses, and granulation tissue formation of each wound were assessed and compared between the groups. Re-epithelialization was observed in the SGFS group on day 3 but no re-epithelialization occurred in the collagen group. Histopathological examination showed less granulation tissue formation in the SGFS group than in the collagen group. IL-6 expression was significantly higher in the SGFS group than in the collagen group on day 1. TGF-β1 expression in the SGFS group was significantly lower than that in the collagen sheet group on days 7 and 14. Based on these results, SGFS promoted re-epithelialization and reduced hypertrophic scarring in the wound healing process compared with collagen.

Awareness of scar management post lower segment caesarean section - A survey

OBJECTIVE

Unhealed caesarean section scars accompany risks of complications which can lead to morbidity, mortality, and complications in future pregnancies. Thorough knowledge of scar healing and management strategies in females undergoing caesarean section is of utmost importance. Our study aims to study the level of awareness of scar healing, management, and scar precaution in females undergoing C-sections.

METHODOLOGY

330 females who underwent C-sections from 2019to to 2021 were included. A self-administered validated questionnaire translated into regional languages was used. The questionnaire assessed level of awareness in 3 domains-scar healing, scar management, and scar precautions.

RESULTS

59% of females were aware of scar management strategies. 52% of females gained knowledge concerning scar healing, management, and precaution through relatives and friends; followed by 35% by gynaecologists/medical camps. Multigravida females were more aware of domains of scar healing and management strategies, whereas primigravida were more aware of precautions concerning caesarean scar.

CONCLUSION

Awareness regarding overall scar management will aid in coping with physical stressors postpartum and its complications. Awareness programs should be initiated by health-care professionals to increase awareness among females undergoing C-sections. Primigravida's should be enlightened regarding scar healing and treatment strategies while multigravida should be explained thoroughly regarding scar precautions.

Unveiling the therapeutic journey of snail mucus in diabetic wound care

A diabetic wound (DW) is an alteration in the highly orchestrated physiological sequence of wound healing especially, the inflammatory phase. These alterations result in the generation of oxidative stress and inflammation at the injury site. This further leads to the impairment in the angiogenesis, extracellular matrix, collagen deposition, and re-epithelialization. Additionally, in DW there is the presence of microbial load which makes the wound worse and impedes the wound healing cycle. There are several treatment strategies which have been employed by the researchers to mitigate the aforementioned challenges. However, they failed to address the multifactorial pathogenic nature of the disease. Looking at the severity of the disease researchers have explored snail mucus and its components such as achacin, allantoin, elastin, collagen, and glycosaminoglycan due to its multiple therapeutic potentials; however, glycosaminoglycan (GAGs) is very important among all because they accelerate the wound-healing process by promoting reepithelialization, vascularization, granulation, and angiogenesis at the site of injury. Despite its varied applications, the field of snail mucus in wound healing is still underexplored. The present review aims to highlight the role of snail mucus in diabetic wound healing, the advantages of snail mucus over conventional treatments, the therapeutic potential of snail mucus, and the application of snail mucus in DW. Additionally, clinical trials, patents, structural variations, and advancements in snail mucus characterization have been covered in the article.

Considerations in the treatment of individuals with obesity and periodontitis

Two common non-communicable diseases, obesity and periodontitis, are responsible for and affected by systemic inflammation, sharing common risk factors and mechanistic pathways. Periodontitis is an irreversible immune-mediated inflammatory disease of hard and soft tissue supporting teeth. If left untreated, periodontitis can lead to tooth loss, affecting food choices and healthy eating, therefore affecting overall health. Obesity is an independent predictive factor for worsened periodontal inflammation, increased onset, progression, severity, and recurrence of infection, as well as delayed wound healing. Thus, managing obesity and associated metabolic dysfunctions may improve periodontal therapy outcomes. The chronic inflammatory state of obesity impairs immune regulation exacerbating the inflammatory gingival tissue destruction of periodontitis, which can also systemically contribute to inflammatory mediators. Furthermore, bariatric surgeons and dietitians should educate patients with obesity regarding the risk of elevated caries, xerostomia, and periodontitis risk from acid reflux and frequent food intake. Non-dental healthcare professionals should recognise periodontal disease signs to prompt dental referral when warranted. Asking patients about recent dental visits promotes patient involvement in cross-discipline dialogue to enhance patient care coordination between medicine and dentistry. This article discusses the association between these two diseases, the challenges of achieving optimal periodontal treatment outcomes, and the clinical strategies to enhance holistic care. It also explores oral health considerations in dietary and surgical interventions in the treatment of obesity.

Polypharmacy is Associated with Diabetic Foot Ulcers in Type 2 Diabetes mellitus

Objectives: This observational study aimed to investigate the relationship between polypharmacy and the existence of diabetic foot ulcers in patients with type 2 diabetes. Methods: Patients with T2DM with and without diabetic foot ulcers who presented to the endocrinology outpatient clinic between August 2020 and November 2021 were involved in the study. Overall, five hundred and twelve patients with T2DM (293 patients with diabetic foot ulcer and 219 patients without diabetic foot ulcer) were included. The exclusion criteria were pregnancy, lactation, type 1 diabetes, patients under 18 years and over 65 years of age, and history of malignancy. The information of drugs administered, demographic and clinical data were obtained from the patient files. The Wagner score was used to evaluate the severity of ulcers. Results: The comparison of the two groups revealed that patients with diabetic foot ulcers had significantly higher rates of diabetic retinopathy (p = 0.017). The patients with diabetic foot ulcers who had polypharmacy had significantly higher rates of hypertension, ischaemic heart disease, diabetic retinopathy, and complaints of diabetic neuropathy (P < 0.001, P < 0,001, p = 0.021 and P = 0.004, respectively). In the binary logistic regression analyses, polypharmacy was independently associated with diabetic foot ulcers in all models. Conclusion: Polypharmacy should be seriously concerned in type 2 diabetes mellitus in patients with diabetic foot ulcers and polypharmacy was related to diabetic foot ulcers.

Correlation Between Bacteria Count Using a Rapid Bacterium Counting System and Changes in Wound Area on Diabetic Foot Ulcers in Indonesia: A Prospective Study

This study aimed to clarify the correlation between changes in bacterial number and wound area in diabetic foot ulcers (DFUs). This study used a prospective longitudinal cohort design. A total of 30 participants met the inclusion criteria. Changes in bacterial number and wound area were evaluated weekly until week 4. The chi-square test indicated no significant correlation between biofilm formation and wound area (p = 0.32) but a significant correlation between bacterial count and wound area (p = 0.05). Logistic regression analysis showed a significant correlation between bacterial count and changes in wound area (odds ratio, 0.60; 95% confidence interval [CI], 0.372-0.997; p = 0.04). The receiver operating characteristic analysis showed an area under the curve of 0.660 (95% CI, 0.52-0.79; p = 0.03) with a sensitivity of 97% and specificity of 88%. The present prospective longitudinal cohort study demonstrated the correlation between bacterial count changes and wound area in DFUs. Our results suggest that changes in bacterial count could help wound healing evaluations.

Wound morphologies of sclerotomies closed with scleral massage and scleral needling techniques: A comparative study

BACKGROUND

This prospective study aimed to compare scleral needling with the conventional scleral massage technique for sclerotomy closure, using anterior segment optical coherence tomography (AS-OCT) to assess postoperative wound morphology.

METHODS

Thirty eyes of 30 patients undergoing pars plana vitrectomy with a 25G vitrectomy system (Constellation; Alcon Laboratories, Fort Worth, TX, USA) were included. In each eye, one superior sclerotomy site (superonasal or superotemporal) was closed with scleral needling (Group A), while the other was closed with scleral massage (Group B), eliminating the impact of individual variability.

RESULTS

Most sclerotomies (80%) could be closed with a single attempt of needling (mean 1.2 ± 0.4). The mean outer and inner sclerotomy incision diameters on the postoperative first day were 119 ± 22 and 94 ± 17 µm, respectively, for group A, and 118 ± 19 and 94 ± 16 µm, respectively, for group B ( P = 0.658 and 0.871, respectively). Sclerotomy wound diameters of both groups A and B decreased significantly on postoperative day 14 ( P < 0.001 and P < 0.001, respectively). None of the patients developed postoperative hypotony or any severe complication. A conjunctival bleb in four Group A patients resolved by day 3.

CONCLUSION

The newly described scleral needling technique was as successful and safe as the conventional scleral massage technique. AS-OCT imaging also confirmed that scleral needling did not cause any disruption on wound morphology.

Grading criteria on radionecrosis of skin (GCRNS) in adult patients: Insights from Delphi study and validation process

BACKGROUND

Radionecrosis of skin (RNS) is the severe consequence of radiodermatitis (RD), which is a common complication experienced in up to 95 % of cancer patients after radiation therapy (RT). Recent publications revealed an absence of grading criteria for RNS and only crude forms for RD. However, treatments for RNS of different severity vary widely in terms of treatment difficulty and prognosis. This Delphi study aims to provide wound repair surgeons and oncologists a comprehensive guide for accurate RNS diagnosis, facilitating more effective surgical or operative interventions.

METHODS

A three-round Delphi method was conducted between May and September 2022, involving 24 experts who specialize in the care or research of RNS. The process identified and weighted primary and secondary items to create a scale that reflects the severity of RNS. A receiver operating characteristic (ROC) curve was generated using the expert's ratings (n = 15) as the benchmark to establish the grading criteria on RNS (GCRNS) with patient data (n = 64). To assess test-retest reliability, 32 physicians re-evaluate 64 patients' files 2 weeks after their initial evaluation. The correlation between expert ratings and physician's re-evaluated grading was calculated to confirm concurrent validity.

RESULTS

The final GCRNS consisted of 18 secondary items categorized under 6 primary items, including ulcer duration, peripheral skin, ulcer area, underlying disease, ulcer depth, and severe complications. Severity classification thresholds were proposed by ROC curve, defining severity levels as mild, moderate, and severe. Six primary items were positively correlated the severity of RNS with affirming its concurrent validity (r = 0.751, p < 0.001). Good internal consistency (α=0.831) and test-retest reliability (r = 0.969, p < 0.001) were demonstrated.

CONCLUSIONS

GCRNS is an expert-driven and comprehensive approach to RNS assessment for further wound repair. By improving diagnostic accuracy, particularly among junior surgeons, GCRNS with strong concurrent validity and reliability, enhances clinical decision-making and supports more effective treatment planning.

The Clinical Utility of Autofluorescence Imaging for Bacterial Detection in Wounds: A Systematic Review

This systematic review evaluated the clinical utility and diagnostic accuracy of autofluorescence imaging in detecting bacterial presence in wounds. A literature search was conducted in January 2025 across PubMed, Scopus, Cochrane, and EMBASE databases. Eligible studies included clinical trials and observational studies assessing autofluorescence imaging for wound bacterial detection. Seventeen studies were included; sixteen assessed the MolecuLight i:X device, and one evaluated PRODIGI. Autofluorescence imaging demonstrated higher accuracy than White Light and Clinical Signs and Symptoms-based assessment in detecting bacterial burden. Five studies highlighted its role in enhancing swabbing techniques, with fluorescence-guided sampling yielding higher bacterial counts than conventional methods. Ten studies reported significant bacterial reduction with autofluorescence-guided debridement. Six studies emphasized its role in refining treatment decisions and accelerating wound healing. Quality appraisal was undertaken using Evidence-Based Librarianship criteria, which deemed 10 studies valid, while 7 had limitations related to population representation. In conclusion, autofluorescence imaging enhances wound assessment by improving bacterial detection and may support more targeted clinical interventions. However, further research is needed to clarify its impact on infection control and long-term healing outcomes.

Revealing the promising era of silk-based nanotherapeutics: a ray of hope for chronic wound healing treatment

Chronic wounds significantly contribute to disability and affect the mortality rate in diabetic patients. In addition, pressure ulcers, diabetic foot ulcers, arterial ulcers, and venous ulcers pose a significant health burden due to their associated morbidity and death. The complex healing process, environmental factors, and genetic factors have been identified as the rate-limiting stages of chronic wound healing. Changes in temperature, moisture content, mechanical strain, and genetics can result in slow wound healing, increased susceptibility to bacterial infections, and poor matrix remodelling. These obstacles can be addressed with natural biomaterials exhibiting antimicrobial, collagen synthesis, and granulation tissue formation properties. Recently, silk proteins have gained significant attention as a natural biomaterial owing to good biocompatibility, biodegradability, reduced immunogenicity, ease of sterilization, and promote the wound healing process. The silk components such as sericin and fibroin in combination with nano(platforms) effectively promote wound repair. This review emphasises the potential of sericin and fibroin when combined with nano(platforms) like nanoparticles, nanofibers, and nanoparticles-embedded films, membranes, gels, and nanofibers.

Preparation of Novel Marine Enterococcus faecium MSD8 Exopolysaccharide Ointment and In Vivo Evaluation of Its Impact on Cutaneous Wound Healing in Male Albino Rats

The current study describes the isolation of exopolysaccharide (EPS) producing lactic acid bacteria (LAB) from marine samples and testing different sugar additives with different proportions for enhanced EPS yield. The isolate MSD8 showed the most potential, yielding 200 mg/L of EPS after being cultivated at 37 °C for 48 h on de Man Rogosa and Sharpe medium (MRS) supplemented with 3% sucrose. The marine isolate MSD8 was identified as Enterococcus faecium with 99.58% probability using 16S rRNA gene sequencing. The obtained sequence was deposited in GenBank and assigned the accession number MW924065. The feature of MSD8-EPS was characterized by estimating the total carbohydrate content by UV-vis to be ~ 71%. The FTIR analysis further indicated the presence of characteristic bands of polysaccharide. The cytotoxicity of the produced MSD8-EPS was assessed using human skin fibroblasts (HSF). The IC50 was determined to be > 100 μg/mL, which signifies that MSD8-EPS is safe for skin application. The produced EPS was used to prepare a novel ointment, which was tested for wound healing ability in male albino rats. The ointment significantly (P ≤ 0.05) shortened the time needed for wound healing, as it successfully healed the wounds by 94.93% on the 7th day and completely (100%) healed the wound by the 12th day. In comparison, the control group was healed by 73.2% and 84.83%, respectively. The data confirm that the prepared ointment can safely be used for pharmaceutical wound care products.

Autophagic degradation of SQSTM1 enables fibroblast activation to accelerate wound healing

Wound healing is a meticulously coordinated and intricate progression that necessitates precise regulation of fibroblast behavior. Macroautophagy/autophagy is a degradation system for clearing damaged cellular components. SQSTM1/p62 (sequestosome 1), a well-established autophagy receptor, also functions as a signaling hub beyond autophagy. Here, we observed a significant upregulation of autophagy in fibroblasts after wounding. Using mice with fibroblast-specific deletion of Atg7 (autophagy related 7), we found that fibroblast autophagy governed wound healing. Fibroblast autophagy deficiency delayed proper dermal repair that was mired in insufficient fibroblast proliferation, migration, and myofibroblast transition. In vitro experiments further revealed that autophagy deficiency disrupted TGFB1 (transforming growth factor beta 1)-induced fibroblast proliferation, migration, and myofibroblast differentiation. Mechanistically, autophagy deficiency led to SMAD2 (SMAD family member 2) and SMAD3 sequestration within SQSTM1 bodies and attenuated TGFB1-induced receptor-regulated SMAD (R-SMAD) phosphorylation in an SQSTM1-dependent manner. Furthermore, sqstm1 deletion rescued the delayed skin wound healing caused by autophagy deficiency, and autophagy inducers promoted wound healing in an SQSTM1-dependent manner. Our findings highlight the critical role of fibroblast autophagy in wound healing and elucidate the underlying mechanisms by which autophagy regulates fibroblast behavior.Abbreviation: 3-MA: 3-methyladenine; ACTA2/α-SMA: actin alpha 2, smooth muscle; ACTB: actin beta; AMPK: AMP-activated protein kinase; ATG: autophagy related; BiFC: bimolecular fluorescence complementation; COL1A2: collagen type I alpha 2 chain; ECM: extracellular matrix; FGF: fibroblast growth factor; GAPDH: glyceraldehyde-3-phosphate dehydrogenase; HDF: human dermal fibroblast; HVGs: highly variable genes; KO: knockout; LMNB1: lamin B1; MAP1LC3/LC3: microtubule associated protein 1 light chain 3; MKI67/Ki-67: marker of proliferation Ki-67; MTOR/mTOR: mechanistic target of rapamycin kinase; NFE2L2/NRF2: NFE2 like bZIP transcription factor 2; NFKB: nuclear factor kappa B; NLRP3: NLR family pyrin domain containing 3; PCA: principal component analysis; PI3K: phosphoinositide 3-kinase; R-SMAD: receptor-regulated SMAD; SBE: SMAD binding element; shCON: small hairpin negative control; siNC: negative control; siRNA: small interfering RNA; SMAD: SMAD family member; SQSTM1/p62: sequestosome 1; ssGSEA: single-sample gene set enrichment analysis; TGFB/TGF-β: transforming growth factor beta; TGFBR1: transforming growth factor beta receptor 1; TGFBR2: transforming growth factor beta receptor 2; VIM: vimentin; WT: wild-type; ZFYVE9/SARA: zinc finger FYVE-type containing 9.

Is injectable platelet-rich fibrin really effective in alveolar osteitis? a randomised controlled clinical trial

BACKGROUND

Alveolar osteitis(AO) is an inflammatory and painful condition that occurs due to distruption of the fibrin matrix within the extraction socket following tooth extraction. This study investigates the effectiveness of I-PRF in reducing pain in AO patients compared to conventional treatment.

MATERIALS AND METHODS

This prospective randomized controlled study included patients experiencing localized AO treated at the Oral, Dental, and Maxillofacial Surgery clinic between October 2024 and February 2025. Sixty patients diagnosed with AO were randomly assigned to two groups. The control group (Group 1) received standard treatment consisting of socket curettage followed by saline irrigation. The I-PRF group (Group 2) received I-PRF application after curettage and irrigation. Pain levels were assessed using the Visual Analog Scale (VAS) on postoperative days 3 and 7.

RESULTS

The study included 60 patients (28 males, 32 females) aged between 19 and 68 (mean 37.40 ± 12.81). There was no significant difference in preoperative VAS scores between the groups (p>0.05). On postoperative day 7, the I-PRF group showed a significant reduction in VAS scores compared to the control group (1.27 vs. 2.27, p<0.05). Our results show that I-PRF significantly reduces pain levels, offering a promising alternative to traditional therapies.

CONCLUSION

I-PRF significantly reduces pain in AO patients compared to conventional treatment. These findings suggest that I-PRF could be a valuable addition to clinical practice, but further studies are needed to confirm its long-term effectiveness.

TRIAL REGISTRATION

Clinical Trials.gov Registration ID NCT06761001. Registered 30/12/ 2024- Retrospectively registered.

Synergistic effect of gold nanorods coated with type I collagen and LED irradiation on wound healing in human skin fibroblast cells

Delayed wound healing poses a significant risk to human health, especially when wounds are infected by pathogens. Therefore, the development of effective methods for accelerating wound healing is important. This study investigated the synergistic effect of gold nanorods (GNRs) coated with type I collagen (GNRs@C) combined with light-emitting diode (LED) irradiation on wound healing in scratched human skin fibroblast (HSF) cells. Scratched HSF cells were treated with 3 μg mL-1 GNRs@C, followed by LED irradiation. This combined treatment significantly enhanced cell proliferation, increasing from the control cell base line (scratched HSF cells without any treatment) to 104.08 ± 2.96% and 107.82 ± 3.25% after 24 and 48 h of incubation, respectively. GNRs@C demonstrated superior cellular uptake compared to uncoated GNRs. Notably, complete closure of scratched HSF cells was observed in scratched HSF cells treated with GNRs@C with LED irradiation and then incubated for 40 h. Additionally, the treatment significantly reduced interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) levels, while upregulating key growth factors, including vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). These findings demonstrate the wound healing potential of GNRs@C combined with LED irradiation.

Design and evaluation of sodium alginate-based hydrogel containing green tea for the treatment of diabetic ulcers in rat model

A functional and biocompatible biomaterial is essential for accelerating the regeneration of skin tissue at the wound site. Hydrogel scaffolds in three dimensions show promising candidates for this purpose. This study was conducted to design a novel porous cross-linked alginate (Alg) hydrogel containing green tea (GT) and assess its morphology, swelling, weight loss, hemocompatibility, and cytocompatibility. Ultimately, the created hydrogel's therapeutic effectiveness was examined in a complete dermal diabetes wound model. The findings indicated that the hydrogel prepared had significant porosity, with interconnected pores around 75.821 µm in size. The weight loss evaluation indicated that the created hydrogel can be degraded naturally, with a weight loss ratio of about 74% for Alg/GT 80 mg after being incubated for 24 hours. Additionally, the study indicated that hydrogel dressings exhibited greater wound closure compared to gauze-treated wounds, which served as the control. The group with GT at a concentration of 80 mg showed the highest percentage of wound closure. The histopathological studies and IHC evaluation for TGF-β1 confirmed the in vivo finding. This study proposes utilizing 3D Alg hydrogels with GT as a wound dressing, but further studies are needed.

A prolactin-targeting antibody to prevent stress-induced peripheral nociceptor sensitization and female postoperative pain

Scheduled surgeries elicit stress in many patients. Levels of preoperative stress, anxiety, and female gender are known risk factors for increased and prolonged postoperative pain. The mechanisms by which psychological stress increases postoperative pain, especially in women, remain unknown. We hypothesized that stress amplifies postoperative pain by sensitizing dorsal root ganglion (DRG) nociceptors. Prolactin (PRL) is a female-predominant neurohormone that is controlled by estrogen and stress. PRL signals at the prolactin receptor long (PRLR-L) and short (PRLR-S) isoforms to induce gene transcription and nociception, respectively. Critically, prolactin sensitizes female, but not male, murine, Macaque and human nociceptors, revealing an evolutionarily conserved mechanism with high translational potential for human therapy. Prior restraint stress (RS) increased the magnitude and duration of incisional injury-induced postoperative pain hypersensitivity in both male and female mice. In females, RS or incisional injury downregulated PRLR-L and increased PRL-dependent nociceptor excitability. Female selective inhibition of postoperative pain hypersensitivity was produced by a) pharmacological inhibition of pituitary PRL b) overexpression of DRG PRLR-L to bias PRL signaling away from PRLR-S and c) CRISPR/Cas9 editing of PRLR isoforms. PL200,019, our recently discovered monoclonal antibody against human PRL (hPRL), prevented hPRL-induced sensitization of human female nociceptors. Using female mice genetically modified to express hPRL, rather than murine PRL, PL200,019 prevented both stress and incisional injury-induced hypersensitivity. Preemptive inhibition of stress-induced nociceptor sensitization with a monoclonal antibody to sequester PRL can improve female postoperative pain, diminish the need for postoperative opioids and decrease the risks of transition to chronic pain.

Estrogen induces the alternative activation of macrophages through binding to estrogen receptor-alpha

Age-related impaired wounds represent a major health burden resulting in considerable morbidity and mortality in the elderly. When injury occurs, monocytes migrate to the damaged site and undergo differentiation into tissue-resident macrophages, which are crucial for wound repair. For proper resolution of the inflammatory response, macrophages differentiate into two distinct phenotypes classified as classically-activatedpro-inflammatory and alternatively-activatedanti-inflammatory macrophages. Pro-inflammatory macrophages are commonly linked with pro-inflammatory events, while anti-inflammatory macrophages are known to be pro-regenerative. The age-related delay in wound repair is often attributed to the age-related decrease in local and systemic estrogen levels in both genders. However, despite its well-documented anti-inflammatory effect in wound healing, the role of estrogen and involvement of Estrogen Receptors (ERs) in macrophage polarization has gained little attention to date. To investigate the impact of estrogen and ERs on the polarization of macrophages, monocyte-derived macrophages were pre-treated with estrogen, ER-alpha agonist/antagonist or ER-beta agonist/antagonist prior to stimulation with LPS/IFN-γ or IL-4/IL-13 to produce pro-inflammatory or anti-inflammatory macrophages. Our findings confirm that estrogen promotes the alternative activation of macrophages via possible ER-α signalling. Selective targeting of ER-α with agents like PPT could potentially lead to the development of novel therapies to treat excessive inflammation in impaired wounds.

Exploring the mechanism by which UCHL3 alleviates diabetic foot ulcers: FOXM1/NLRP3 inflammasome-mediated angiogenesis and endothelial cell pyroptosis

BACKGROUND

This study investigated the role of ubiquitin C-terminal hydrolase L3 (UCHL3) in regulating endothelial cell (EC) pyroptosis and angiogenesis in diabetic foot ulcers (DFUs), with a focus on FOXM1 and NLRP3 inflammasomes.

METHODS

Differentially expressed genes in DFUs were identified using the GSE134431 dataset and cross-referenced with vascular formation-related factors from GeneCard and deubiquitinases from the UbiNet 2.0 database. A rat DFU model was used to evaluate wound healing, with or without UCHL3 overexpression and FOXM1 knockdown. Histological analysis and immunohistochemistry were employed to assess tissue morphology and the expression of CD31, eNOS, UCHL3, and FOXM1. In vitro, high glucose-induced human umbilical vein ECs (HUVECs) were transfected with UCHL3 overexpression and FOXM1 knockdown constructs. Cell viability, migration, and angiogenesis were assessed.

RESULTS

UCHL3 expression was significantly reduced in DFU tissues. UCHL3 overexpression promoted wound healing in a rat model, while FOXM1 knockdown impaired wound healing and vascular formation. In HUVECs, UCHL3 overexpression enhanced cell viability, migration, and angiogenesis, accompanied by reduced NLRP3 and N-GSDMD levels. FOXM1 knockdown reversed these effects, but treatment with the NLRP3 inhibitor, MCC950, alleviated this damage.

CONCLUSION

UCHL3 enhances FOXM1 deubiquitination, inhibits NLRP3 inflammasome activation, and reduces EC pyroptosis, thereby contributing to DFU healing. UCHL3 and FOXM1 are potential therapeutic targets for DFU.

Burns and Trauma Branch of Chinese Geriatrics Society. [Expert consensus on systematic assessment and treatment of refractory wounds in the elderly (2025 edition)]

Early prevention and standardized management of refractory wounds in the elderly are very important for improving prognosis, reducing disability rate, and improving the quality of life of patients. For the diagnosis and treatment of refractory wounds in the elderly, it is necessary to comprehensively consider the primary disease or comorbidity of patients and systematically evaluate the overall condition and the local characteristics of wounds of patients. The treatment principles include controlling or slowing down the development of the primary disease, nutritional support, infection control, improving circulation, sealing wounds, and paying attention to the water balance of wounds, at the same time selecting a reasonable treatment plan according to different types of wounds. The goal of treatment is to close the wound as much as possible if conditions permit, while in some cases, palliative management may be appropriate. In the future, the development of smart wear, big data, and artificial intelligence will play a significant role in promoting the assessment and treatment of refractory wounds in the elderly. The Burns and Trauma Branch of Chinese Geriatrics Society organized domestic experts engaged in wound repair and related fields to jointly formulate this consensus, aiming to establish a full-process standard covering prevention, assessment, treatment, and rehabilitation and to promote the standardization and intelligence of diagnosis and treatment of refractory wounds in the elderly, thus providing efficient and homogeneous solutions for clinical practice.

Relationships between anxiety, depression and wound healing outcomes in adults: A systematic review and meta-analysis

OBJECTIVES

To examine whether there is a relationship between anxiety and/or depression and wound healing.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Searches were conducted on PsycINFO, MEDLINE, EMBASE, CINAHL and Web of Science on the 06-March-2023.

METHODS

Eligible studies explored the effects of anxiety and/or depression on wound healing in adults. Healing outcomes included time to heal and complication rates. Anxiety and depression outcomes were considered separately.

RESULTS

Fifty-five studies were included in the narrative synthesis (26,612,809 participants), and 26 studies in the meta-analysis. Studies utilised a range of observational and experimental designs. Wounds included in the review were: surgical, ulcer, burn and experimental wounds. The narrative synthesis gave mixed results, with some studies noting positive associations between increased anxiety or depression and wound healing, while others did not find an association. Results from the meta-analysis found no significant effect of anxiety on wound healing outcomes. However, depression was associated with significantly higher odds of delayed wound healing, OR = 2.10, [1.02, 4.33]; higher risk of wound complications, RR = 1.30, [1.11, 1.53] and increased risk of wound infection RR = 1.25, [1.09, 1.44].

CONCLUSION

These findings suggest depression negatively impacts wound healing. There is less evidence for an association with anxiety, but this may be due to less research in this area. Future studies should explore the mechanism of associations between depression and wound healing to inform clinical interventions.

Tissue engineered implants derived from sustainable nanocellulose and polyethylene glycol (PEG) loaded with polyphenols: An in vivo study on albino rats for wound dressing

Nanocellulose-based sustainable tissue engineering implants are becoming the most promising dressings because of their superior drug loading capacity, structure mimicking the extracellular matrix, and biocompatibility. However, the therapeutic impact and functionality of current wound dressings are severely limited due to their low breathability, poor environmental adaptation, potential for drug resistance, and limited pharmacological alternatives. This study aimed to develop a PEG-nanocellulose submicron fibrous scaffold from sugarcane bagasse, incorporating polyphenols from H. alternata leaf extract. The polyphenols were screened using HR-LCMS analysis followed by in silico studies and HPLC quantification. The phytochemicals were selected based on biological activities, binding energy, and LCMS score. The prepared scaffolds were optimized using physical, mechanical, and chemical characterization techniques. The in vitro cytocompatibility and wound healing efficacy of the modified implant were assessed using L929 fibroblast cell lines. NCF scaffolds' tissue engineering potential was evaluated using confocal fluorescence imaging. The in vivo implantation of the scaffolds revealed that PEG: NCF-8%HA scaffolds exhibited significant wound-healing activity. Additionally, these scaffolds demonstrated promising cytocompatibility (98.3 ± 2.99), good blood compatibility (0.43 ± 0.02), and excellent wound closure (100 %). The histopathology studies also suggested that the implants showed good biocompatibility, promoted better angiogenesis, and resulted in a low tissue inflammation response.

The Role of Omics Techniques in Diabetic Wound Healing: Recent Insights into the Application of Single-Cell RNA Sequencing, Bulk RNA Sequencing, Spatial Transcriptomics, and Proteomics

Diabetic foot ulcers (DFUs) are a devastating complication of diabetes mellitus (DM) that affect millions of people worldwide every year. They have a long-term impact on patients' quality of life and pose a significant challenge for both patients and clinicians, alongside negative economic implications on affected individuals. The current therapeutic approaches are costly and, in many cases, ineffective, highlighting the urgent need to develop novel, affordable, more efficient, and personalized treatments. Recent advances in high-throughput omics technologies, including proteomics, bulk RNA sequencing (bulk RNA-seq), single-cell RNA sequencing (scRNA-seq), and spatial transcriptomics in both preclinical animal and human clinical studies, have enhanced our understanding of the molecular function and mechanisms of DFUs, thereby offering potential for targeted therapies. Additionally, these technologies provide valuable insights behind the mechanism of action of novel wound dressings and treatments. In this review, we outline the latest application of omics technologies in DFU preclinical animal and human clinical research on diabetic wound healing, and spotlight recent findings.A graphical abstract is available with this article.

Impact of postoperative dairy consumption on oral wound healing: critical analysis from a prospective, randomized and controlled trial

INTRODUCTION

In the German-speaking community of surgeons addressing the oral cavity, there has long been a prevailing opinion that dairy products could be harmful to oral wound healing, but is this true? This study sheds light on this issue based on clinical data of wound healing impairment rates.

METHODS

A patient questionnaire, clinical examination prior to surgery of the oral cavity and a postoperative examination at suture removal were used to assess whether altered wound healing impairment rates occurred because of dairy product consumption. This was done in the setting of a prospective, randomized, controlled, single-blinded, bicenter study in outpatient and inpatient settings.

RESULTS

Among the 257 patients participating 228 were included in the study, 227 had complete data sets and were used for our statistical analysis. The cohort was randomly divided into 105 dairy product consumers (intervention group) and 123 without dairy products (control group). In total, 45 wound healing impairments out of 227 patients (19.82%) were noted, including 20 (19.05%) in the group of dairy product consumers (intervention group) and 25 (20.33%) in the control group. The logistic regression model was unable to show a statistically significant association between dairy product consumption and wound healing impairment. (p = 0.26), (OR = 0.65). The study found no statistically significant associations that dairy product consumption has either a negative or positive effect on wound healing. (p = 0.26), (OR = 0.65).

Application of allogeneic adult mesenchymal stem cells in the treatment of venous ulcers: A phase I/II randomized controlled trial protocol

OBJECTIVE

To evaluate the feasibility, safety and efficacy of the cutaneous application of Bioengineered Artificial Mesenchymal Sheet (BAMS) in venous leg ulcers (VLUs) versus conventional treatment.

METHODS

This protocol is based on the design of a Phase I/II, multicenter, randomized, controlled, open-label clinical trial investigating the application of a biological dressing supplemented with mesenchymal stem cells (NCT05962931). The clinical trial is being conducted in 2 primary care units within the Granada Metropolitan Health District. A total of 20 patients with VLUs are being randomized (1:1) into 2 intervention arms: a control group and a treatment group. The intervention in the treatment group consists of the local application of 4 doses of BAMS, administered once per week, while the control group receives conventional therapy. Feasibility will be assessed based on the ability to complete the administration of 4 doses in at least 80% of the patients in the treatment group. Safety will be evaluated by analyzing the incidence of adverse effects and serious adverse effects. Efficacy will be assessed in terms of the percentage of wound closure (measured by wound area reduction), macroscopic assessment of the lesion (visual macroscopic analysis and RESVECH 2.0 scale), analysis of growth factors and inflammatory cytokines (ELISA test), pain levels (VAS scale) and quality of life (CIVIQ 20).

RESULTS

If confirmed, BAMS-based therapy may provide an effective treatment for VLUs, potentially reducing wound closure time and associated complications. This therapy could significantly enhance patients' quality of life due to the regenerative and analgesic properties of the biological dressing.

DISCUSSION

Given the biological activity of mesenchymal stem cells, an accelerated healing effect is expected in the treatment group. This could lead to shorter healing times for chronic wounds, resulting in significant benefits for patients, healthcare professionals, and overall healthcare costs.

TRIAL REGISTRATION

NCT05962931.

Rational engineering unlocks the therapeutic potential of WHP1: A revolutionary peptide poised to advance wound healing

Treatment of chronic or non-healing wounds has faced a considerable clinical challenge and impose several detrimental effects on individuals, society, the healthcare system, and the economy. Bioactive peptides have been employed to accelerate wound healing in active wound treatment efficiently and effectively. In the current study, a novel wound-healing peptide, WHP1, was designed from 23 existing wound-healing peptides by a rational template-assisted approach. It demonstrated the ability to enhance migration and proliferation of human keratinocyte cell lines (HaCaT) without exhibiting cytotoxic effects on human red blood cells and HaCaT cells. By quantitative proteomic analysis, WHP1 exerted a multifaceted role on diverse cellular processes in human keratinocyte. Notably, it increased the expression of intracellular proteins of HaCaT cells involved in cell cycle regulation and focal adhesion, including centromeric histone H3 variant CENPA, ubiquitin-conjugating enzyme E2 C, thyroid receptor-interacting protein 6, and ribosomal components essential for cell adhesion and migration. WHP1 upregulated the key enzyme glyceraldehyde-3-phosphate dehydrogenase, orchestrating metabolic biosynthesis particularly glycolysis, cell cycle regulation, and cytoskeletal processes. An intriguing observation was the antioxidant activity of WHP1, protecting cells from reactive oxygen species-induced senescence. This is consistent with the upregulation of GAPDH expression and reduction of histone H2A.J levels. WHP1 also stimulated macrophages to secrete transforming growth factor-β (TGF-β), a crucial growth factor necessary for the remodeling phase of wound healing. This investigation highlighted the feasibility of rational design to create novel wound-healing peptides. Such advancements hold promise for improving patients' quality of life and elevating the standard of care in contemporary healthcare.

Bronchial anastomotic complications as a microvascular disruption in a mouse model of airway transplantation

Lung transplantation (LTx) offers a last resort for patients battling end-stage lung disease. Even though short-term survival has improved, these patients still face several long-term challenges, such as chronic rejection and ischemic bronchial anastomosis. In lung transplant recipients, the bronchial anastomosis is prone to complications-such as poor wound healing, necrosis, stenosis, and dehiscence-due to the marginal blood supply at this site. During peri-LTx, hypoxia and ischemia stimulate fibrotic and inflammatory cytokines at anastomotic sites, leading to abnormal collagen production and excessive granulation, which impair wound healing. Despite meticulous techniques, bronchial anastomosis remains a major cause of morbidity and mortality among lung transplant recipients. After LTx, most bronchial complications are attributed to ischemic insult since normal bronchial blood flow is disrupted, and bronchial revascularization usually takes two to four weeks, making the anastomotic bronchial vessels dependent on pulmonary artery circulation. It is clear that hypoxia, inflammation, oxidative stress, and extracellular matrix remodeling play critical roles in bronchial complications, but there is no small animal model to study them. In the context of LTx, mouse tracheal models are essential tools for studying bronchial complications, particularly ischemia, fibrosis, and stenosis, as well as evaluating potential therapeutic interventions. A well-established mouse model of orthotopic tracheal transplantation (OTT) mimics the anastomosis of the bronchi and the subsequent microvascular injury, providing a pathological correlation with anastomotic complications. A series of previous studies using the OTT model explored the microvascularization, ischemia-reperfusion, airway epithelial injury, and fibrotic remodeling effects after airway anastomosis. This review describes OTT as a model of airway anastomotic complications, which is crucial for understanding the immunological and molecular pathways as seen in clinical bronchial anastomoses, as well as improving anastomotic healing and reducing complications through targeted therapeutic strategies.

Polyvinyl alcohol/casein hydrogels with oxymatrine eluting ability for cancer-related wound management

Malignant fungating wounds (MFWs) are cancer-related complications that arise from metastases in advanced cancers. They appear in 5-14% of cancer patients, with higher prevalence in breast (66%) and head and neck (24%) cancers. Novel therapeutic routes for the management of MFWs rely on plant-based treatments, e.g. oxymatrine (OXM), an alkaloid derived from a Chinese plant with anticancer and anti-inflammatory properties. The objective of this work was to assess the potential of polyvinyl alcohol/casein (PVA/CAS) hydrogels to be used as dressings for OXM delivery. CAS can stimulate the immune system, while PVA is one of the most used synthetic polymers in the composition of hydrogels for medical applications. Six different hydrogel formulations were prepared following different procedures: freeze-thawing (FT) and cast drying (CD) for 24 or 48 h, with and without the addition of genipin (GE), a crosslinking agent. The hydrogels were loaded with OXM, and their release behaviour was studied. PVA/CAS-24CD + GE showed the best release profile. After being subjected to sterilisation by high hydrostatic pressure, it was further investigated in terms of physicochemical properties, mechanical characteristics and biocompatibility. Overall, this hydrogel revealed adequate characteristics to be used as a biocompatible medicated dressing for OXM release.

Depletion of natural killer cells enhances wound healing in diabetic mice

Natural killer cells are known for their killing function in infection- and tumor-related responses but also can shape immune responses involved in physiological processes such as wound healing. We recently reported that natural killer cells accumulate in skin wounds and express proinflammatory cytokines that may impede healing. Since impaired wound healing in diabetes is associated with persistent inflammation, the purpose of the present study was to determine whether natural killer cells contribute to impaired skin wound healing in diabetic mice. Here, we show that natural killer cells accumulate at higher levels in wounds in diabetic mice and exhibit less mature phenotypes compared to nondiabetic mice. In addition, local neutralization of CX3CL1 reduced natural killer cell accumulation in wounds of diabetic mice, suggesting that CX3CL1 plays a role in the infiltration of these cells to the wound site. Finally, depletion of natural killer cells in diabetic wounds improved reepithelization and collagen deposition, suggesting that the elevated levels of natural killer cells contribute to impaired healing associated with diabetes.

Understanding the regulation of chronic wounds by tissue inhibitors of matrix metalloproteinases through mathematical modelling

Understanding the biochemistry and pharmacodynamics of chronic wounds is of key importance, due to the millions of people in the UK affected and the significant cost to the NHS. Chronic wounds are characterised by elevated concentrations of matrix metalloproteinases (MMPs) that destroy the surrounding extracellular matrix (ECM). However, fibroblasts can produce tissue inhibitors of MMPs (TIMPs) in order to regulate wound healing. Therefore, the role of TIMPs in both acute and chronic wounds needs to be properly understood in order to develop therapeutic treatments. In this work, we propose a reaction-diffusion system of four partial differential equations that describe the interaction of the ECM, fibroblasts, MMPs, and TIMPs in a wound. We observe that, subject to parameter sets corresponding to both acute and chronic wound healing, this mathematical model gives rise to travelling wave solutions. Using bifurcation analysis, we demonstrate that excessive degradation of the ECM results in the emergence of chronic wounds, and the reversal of these chronic wounds is prohibited for lower TIMP production values. These results are replicated within a simplified model obtained via a parameter sensitivity analysis. This model is further extended to more realistic spatial domains where we demonstrate the effectiveness of a therapeutic hydrogel containing TIMPs as a treatment for chronic wounds.

Development of a bioactive hyaluronic acid hydrogel functionalised with antimicrobial peptides for the treatment of chronic wounds

Chronic wounds present significant clinical challenges due to delayed healing and high infection risk. This study presents the development and characterisation of acrylated hyaluronic acid (AcHyA) hydrogels functionalised with gelatin (G) and the antimicrobial peptide (AMP) PP4-3.1 to enhance cellular responses while providing antimicrobial activity. AcHyA-G and AcHyA-AMP hydrogels were formed via thiol-acrylate crosslinking, enabling in situ AcHyA hydrogel formation with stable mechanical properties across varying gelatin concentrations. Biophysical characterisation of AcHyA-G hydrogels showed rapid gelation, elastic behaviour, uniform mesh size, and consistent molecular diffusion across all formulations. Moreover, the presence of gelatin enhanced stability without affecting the hydrogel's degradation kinetics. AcHyA-G hydrogels supported the adhesion and spreading of key cell types involved in wound repair (dermal fibroblasts and endothelial cells), with 0.5% gelatin identified as the optimal effective concentration. Furthermore, the conjugation of the AMP conferred bactericidal activity against Staphylococcus aureus and Escherichia coli, two of the most prevalent bacterial species found in chronically infected wounds. These results highlight the dual function of AcHyA-AMP hydrogels in promoting cellular responses and antimicrobial activity, offering a promising strategy for chronic wound treatment. Further in vivo studies are needed to evaluate their efficacy, including in diabetic foot ulcers.

Multifunctional nanocomposite hydrogels: an effective approach to promote diabetic wound healing

Diabetes, a metabolic disease that is becoming increasingly severe globally, presents a significant challenge in the medical field. Diabetic wounds are characterized by their chronicity, difficulty healing, and complex microenvironment that harbors multiple adverse factors, including elevated hyperglycemia, persistent inflammation, susceptibility to infections, and oxidative stress, all of which contribute to the impaired healing process. Nanocomposite hydrogels, as materials with unique physicochemical properties and biocompatibility, have gained growing attention in recent years for their potential applications in diabetic wound healing. These hydrogels provide a moist healing environment for wounds and regulate cellular behavior and signaling pathways, promoting wound repair and healing. By introducing specific functional groups and nanoparticles, nanocomposite hydrogels can respond to pathological features of wounds, enabling adaptive drug release. Owing to their diverse bioactive functions, nanocomposite hydrogels are powerful tools for the treatment of diabetic wounds. Thus, this article provides an overview of recent progress in the use of nanocomposite hydrogels for diabetic wound healing.

Efficacy of xenogeneic fresh and lyophilized amniotic membranes on the healing of experimentally induced full-thickness skin wounds in dogs

Wound healing is a complex process involving multiple phases aimed at repairing damaged tissues. Disruptions in this process can lead to chronic wounds and infections. Effective treatments that maintain cellular bioactivity while being cost-effective and easy to manufacture and store are needed. The amniotic membrane (AM) is highly biocompatible and rich in bioactive factors, making it valuable for regenerative medicine. Bovine AM is noteworthy for its large size, which facilitates its use in medical settings. However, preserving its bioactivity during storage is a challenge. Therefore, this study aimed to evaluate the effect of bovine lyophilized AM on full-thickness skin wound healing in dogs, compared to that of fresh AM. Bovine AM was collected, lyophilized, and characterized by quantifying growth factors, including vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), as well as collagen, glycosaminoglycans (GAGs), elastin, and DNA. Additionally, the surface morphology was imaged using scanning electron microscopy (SEM). The effects of conditioned media from fresh and lyophilized AM on fibroblast and endothelial cell proliferation were compared. In vivo, three full-thickness skin wounds were created on the back in twelve dogs and treated with saline (control), fresh AM, or lyophilized AM, and monitored for healing over 1, 3, and 5 weeks. The fresh AM contained 57.3 ± 6.21 µg/mg collagen, 5.62 ± 1.1 µg/mg GAGs, 11.6 ± 4.52 µg/mg elastin, and 46.3 ± 12.8 ng/mg DNA, with VEGF and bFGF levels of 5.43 ± 2.485 and 1.97 ± 0.482 ng/mg, respectively. The lyophilized AM contained 217.74 ± 8.78 µg/mg collagen, 14.4 ± 1.56 µg/mg GAGs, 43.2 ± 6.8 µg/mg elastin, and 234.6 ± 21.5 ng/mg DNA, with VEGF and bFGF levels of 28.12 ± 7.6 and 13.3 ± 6.89 ng/mg, respectively. SEM revealed a monolayer with poorly defined borders in fresh AM, whereas lyophilized AM displayed a well-defined apical border with few microvilli. Lyophilized AM-conditioned media promoted greater endothelial cell and fibroblast proliferation. Compared with those in the fresh AM and control groups, wounds treated with lyophilized AM healed faster, with narrower edges and more pronounced re-epithelization and collagen remodeling at 1-, 3-, and 5-weeks post-wounding. Histopathology revealed quicker granulation and inflammatory cell infiltration in the first week for lyophilized AM, and better re-epithelization and collagen remodeling in subsequent stages. In conclusion, the amniotic membrane, particularly in its lyophilized form, offers significant benefits for skin wound healing due to its bioactivity, availability, and cost-effectiveness.

Silver(I) complexes containing bioactive salicylic acid derivatives: Synthesis, characterization, antibacterial activity, and their underlying mechanism

Recognizing that silver-metallodrugs are a potential source of novel anti-infective therapeutic agents, this work adopts the complexation of biologically active salicylic acid derivatives with inherently antibacterial silver(I) ions as a strategy for developing new antibacterial agents. The synthesized silver(I) complexes were characterized by elemental analysis, spectroscopy, and X-ray diffraction analysis. The crystallographic results indicate that the silver(I) ion in complexes [Ag(imH)2](SalH) (1) and [Ag(imH)2](DiSalH)·H2O (2) only coordinates with the imidazole nitrogen atom, while the 4-aminosalicylic acid in complex [Ag(imH)2(AmSalH)]·H2O (3) additionally coordinate with the silver(I) ion through the amino nitrogen atom. Salicylic acid molecules play an important role in the construction of the three-dimensional network structure through weak interactions. In addition, thermogravimetric analysis, stability, and silver(I) ion release experiments indicate that these complexes have good stability and slow ion release rates. Cell toxicity and antibacterial tests were conducted on selected cell lines and microorganisms using complexes 1-3, and compared with silver(I) salts, organic ligands, and antibiotic. All complexes exhibit better biocompatibility and certain anti-tumor selectivity than silver(I) salts. From the perspective of microbial toxicity, complexes 1-3 all have significant inhibitory effects on three bacteria strains, with complex 1 having the strongest antibacterial activity, exhibiting 4-6 times higher activity against certain strains than AgNO3 and chloramphenicol. Mechanism studies have shown that cell wall perforation and imbalance of intracellular ROS levels may be possible reasons for silver(I) complexes induced bacterial cell death. The biofilm removal experiment further proves the potential use of silver(I) complexes 1-3 in the treatment of bacterial infections.

Secretome from prolonged high-density human Wharton's jelly stem cell culture accelerates wound healing in both in vitro and in vivo models

The complex of biofactors secreted by mesenchymal stem cells, termed the secretome, can promote wound healing. Studies using this secretome often utilise material collected from short term and sub-confluent lab-scale cultures. Secretome was derived from prolonged culture of high-density industrial scale human Wharton's jelly stem cells and its effects on wound healing was assessed. In vitro cell proliferation and scratch closure assays showed that secretome treatment dose-dependently increased cell proliferation and promoted scratch closure. Subsequently, using biopsy punch, circular wounds were created on three-dimensional de-epidermised dermis human skin equivalent (in vitro) where secretome-treated wounds showed accelerated wound closure, and enhanced epithelial proliferation and differentiation were observed and quantified. In an in vivo rat acute wound model, secretome applied to the back of test animals greatly enhanced wound healing by promoting re-epithelialisation, vascularisation and granulation maturation. In conclusion, secretome derived from prolonged culture of high-density industrial scale two-dimensional human Wharton's jelly stem cells possesses potent wound healing properties. This could greatly lower the cost of production and facilitate development of highly efficacious secretome-based wound healing products.

Chlorella-encapsulated living hydrogel based on gelatin and carrageenan with oxygen production, hemostatic and antibacterial capacity for promoting wound healing

Hypoxia can prolong the healing time of wounds and oxygen delivery to the hypoxic tissue has been reported an effective strategy for promoting wound regeneration. Bacterial infections can interfere with the wound healing process, leading to poor skin regeneration and even more serious complications, which is also an urgent issue to be solved during the process of wound healing. To address the problem of delayed wound healing caused by hypoxia and bacterial infections, we fabricated a series of Chlorella-loaded hydrogels (CK) using gelatin, κ-carrageenan and I-carrageenan as matrixes, which introduced Chlorella and ampicillin conferred oxygen-producing and antimicrobial capacity to the hydrogel. The CK hydrogels possessed good mechanical and adhesive properties, as well as the capability of efficient and sustained oxygen release. The hydrogels possessed outstanding hemostatic ability, excellent blood and cell compatibility, which also owned excellent antibacterial capacity against E. coli and S. aureus. More notably, the in vivo evaluation revealed that the hydrogel can accelerate wound healing by promoting collagen deposition, which may as a promising potential wound dressing for hypoxic wound healing.

Nanomaterial interventions for wound healing: Current status of preclinical and clinical studies

Wound healing is a complex, highly coordinated process involving a series of molecular and cellular phases-haemostasis, inflammation, proliferation, and remodelling. These phases are regulated by growth factors such as cytokines and chemokines, coordinating the actions of fibroblasts, keratinocytes, progenitor, and endothelial cells. Disruptions in this process can lead to chronic wounds, an escalating global health issue. Despite advancements, current wound healing technologies face several limitations. Conventional dressings often fail to provide optimal moisture balance, leading to delayed healing. Bioengineered skin substitutes and growth factor therapies, while promising, are restricted by high costs, limited availability, immune rejection, and inconsistent efficacy. Moreover, infection control remains a significant challenge, necessitating alternative strategies that can enhance antimicrobial protection while promoting tissue regeneration. In response, nanotechnology has emerged as a potential game-changer in wound care, offering precise targeting of cells and regulatory molecules, enhanced therapeutic delivery, and tailored interaction with the wound environment. This review explores the role of nanomaterials in wound healing, emphasising their unique physicochemical properties and ability to promote tissue regeneration. We provide an overview of recent advances in nanotechnology, including nanoparticles, nanoengineered scaffolds, and gene and stem cell therapies. Additionally, we highlight the preclinical and clinical advancements of nanotechnology-based treatments, aiming to address the limitations of traditional wound care strategies.

Effects of a PDGF-stem cell-hydrogel compound on skin wound healing in mice

BACKGROUND AIMS

The treatment of chronic refractory skin wounds still remains a serious clinical challenge. Stem cells and hydrogels are widely used in healing of skin wound of various types due to their superior bioactivities and biocompatibility. This study aimed to demonstrate the wound healing effect of a hydrogel compound loaded with enucleated stem cells expressing the platelet-derived growth factor (PDGF).

METHODS

An injectable hydrogel was formulated using 22% poloxamer 407, 1% poloxamer 188, and 1% hyaluronic acid. A PDGF-B transgenic cell line of mouse bone marrow mesenchymal stem cells (BMSCs) was generated by lentiviral infection. Cells were enucleated and embedded in hydrogel. The healing effects of the compound was tested in a full-thickness skin wound model of Balb/c mice. The wound models were randomly divided into four groups: the control group applied with PBS buffer; the hydrogel group with hydrogel only; the BMSC group with hydrogel mixed with normal BMSCs; and the BMSC-PDGF group with hydrogel mixed with enucleated BMSCs expressing PDGF.

RESULTS

Overexpression of PDGF-B in transgenic cell line of BMSCs was verified by RT-PCR, immunofluorescence staining and western blot. When enucleated, the viability measured by Calcein-AM staining reduced to 54.29% at 48 h. Conditioned medium was collected with or without hydrogel layered over cells. PDGF concentration measured by ELISA reached 14.66 ng/μL and 257.89 ng/μL respectively after 48-h cultivation, suggesting a possible slow releasing effect in the presence of hydrogel. When applied to the skin wound, the healing rates of the BMSC-PDGF group was significantly higher than that of the control group on day 3. BMSC-PDGF group had significantly more neovascularization and cutaneous appendages from day 7. The proliferation of collagen fibers in BMSC-PDGF group was significantly higher than the control group on day 3 and day 7. Finally, BMSC-PDGF group had significantly lower amount of the inflammatory factors TNF-α, IL-1β, IL-6, MMP-3 and MMP-9 than that of the control group on day 7.

CONCLUSIONS

PDGF-stem cell-hydrogel compound significantly improved wound healing and reduced wound inflammatory factor expression in Balb/c mice. This biomaterial-based approach provides a new powerful reference for the treatment of chronically wounded skin.

Trace elements: Clinical perspectives in the critically ill

Trace elements are required in minute quantities in the diet but play a vital role in a wide variety of functions, such as co-factors in antioxidant reactions and normal immune function to DNA and protein synthesis and skeletal and tissue remodelling and repair. Critically ill patients are at risk of trace element deficiency or excess, due to changes in intake, absorption, metabolism or excretion. Deficiency or excess can lead to a wide range of cellular and organ dysfunction that may be seen in patients with an acute or critical illness, including cardiomyopathy, impaired glucose tolerance and reduced oxygen delivery. In addition, various diseases, such as systemic inflammation and renal and intestinal failure, and intensive care treatments, such as parenteral nutrition, renal replacement therapy and diuretics, can increase the likelihood of deficient or excessive amounts of micronutrient levels. This narrative review discusses sources and normal physiology of trace element handling and how this may be impaired in critically ill patients. It then discusses various conditions seen in critically ill patients that may be caused or exacerbated by abnormal trace element status and the current evidence around whether supplementation is of benefit in particular critical illnesses.

Prospective prophylactic antibiotics regimen in scheduled spine surgery, or the PPARiSSS cohort

OBJECTIVE

To possibly define a minimum expected deep surgical site infection rate in elective lumbar reconstructive surgery.

METHODS

The senior author provides an extended postoperative antibiotics prophylaxis to all surgical cases. Combined with a standard program of wound care and drainage, the rate of deep surgical site infection requiring reoperation has been negligible. A cohort of 1000 qualifying cases had surgery over a 13-year period. Four independent observers were tasked with reviewing hospital records of the index operations and all patient contact going forward, specifically focused on evidence of postoperative infection requiring reoperation. We also scanned for the potential emergence of AROs colonization in the treated patients. The data produced were analyzed for inter-rater reproducibility using the Fleiss' kappa statistic.

RESULTS

The observed frequency of infections at 0.3 % was a small fraction of that predicted by meta-analysis in the literature. ARO frequency was within the expected range reported by Public Health Canada.

CONCLUSIONS

These data may be sufficient to justify prospective investigations going forward.

Secondary Intention healing time of postoperative surgical cancer skin wounds with a biosynthetic porcine type i collagen dressing: A 306-patient retrospective, observational study

BACKGROUND

Biosynthetic porcine type I collagen dressing is useful to close ulcers and secondary intention healing of surgical cancer wounds.

OBJECTIVE

To identify factors associated with the healing time of such wounds.

METHODS

We conducted a retrospective observational study of patients on oncological dermatological surgery in a cancer center. Healing time was studied based on age, sex, personal history of comorbidities, usual medication, anatomical location, type of surgery performed and size of the defect. Statistical analysis was performed using the ANOVA test and logistic regression.

RESULTS

A total of 306 patients were included with a median age of 73 years (62.4%, men). The statistically significantly characteristics associated with a healing time≤66 days were location-auricle, nose, inner canthus, hand, retroauricular region and nail bed-use of the Mohs technique and defect sizes≤5.28cm2.

LIMITATIONS

This is a retrospective study from a single center.

CONCLUSION

The use of biosynthetic porcine type I collagen dressings for the definitive closure of dermatological surgical cancer wounds seems particularly suitable for small defects of the inner canthus of the eye, hand, auricle, nose, forehead, retroauricular region, and nail bed.

α-Mangostin encapsulated gellan gum membranes for enhanced antibacterial, anti-inflammatory, antioxidant and wound healing activity

Hydrogel membranes resemble biological tissues and currently there is a tremendous interest in their development as wound healing dressings. Alpha mangostin (α-MG), being a highly active xanthone is well recognized for its wound repair potential. However, because of its poor solubility and relatively brief retention time on cutaneous wound sites, its effectiveness on wounds is compromised. Herein, α-MG was incorporated in gellan gum (GG) based hydrogel membranes by solvent casting crosslinking technique and presented excellent antibacterial, antioxidant and anti-inflammatory effects. Prepared films demonstrated optimal thickness, flexibility, homogeneity and swelling capacity, characterized by Fourier transform infrared spectroscopy (FTIR), X-ray diffractometery (XRD) and scanning electron microscopy (SEM). Prepared films were hemocompatible and showed minimum toxicity against vero cells thus confirming their biocompatible nature thus fulfilling the requirements of an optimal wound dressing. Amid all the film formulations MG4 and MG8 presented superior antioxidant and antibacterial capabilities. In comparison to control, MG4 film significantly accelerated the healing process in vivo, promoted re-epithelization and reduced the levels of pro inflammatory and apoptotic cytokines. Taken together, this novel gellan gum based hydrogel membranes containing α-mangostin would be a useful pharmaceutical candidate for cutaneous wound healing.