TenderWet: an innovation in moist wound healing

An NIR-responsive hydrogel loaded with polydeoxyribonucleotide nano-vectors for enhanced chronic wound healing

Chronic diabetic wounds are difficult to treat due to imbalanced inflammatory responses, high blood glucose levels, and bacterial infections. Novel therapeutic approaches based on nucleic acid analogues have been proposed, with unique advantages in improving angiogenesis, increasing collagen synthesis, and exerting anti-inflammatory effects. However, the inherent electronegativity of nucleic acids makes them less susceptible to cellular uptake. In this paper, a kind of near infrared (NIR)-responsive nanocomposite hydrogel loaded with nucleic acid vectors was proposed for promoting wound healing. The redox system composed of molybdenum disulphide nanosheets (MoS2 NSs) initiated the copolymerization of quaternized chitosan containing double bonds and N-isopropylacrylamide (NIPAAm) to form the matrix. In addition, MoS2 NSs with photothermal conversion performance endow the nanocomposite hydrogel to have NIR-response property and act as physical crosslinking points in the matrix. Polydeoxyribonucleotides (PDRN), which have the effect of promoting wound healing, were made into nucleic acid vectors, and loaded into the NIR-responsive hydrogel. MoS2 NSs can convert NIR irradiation into heat, causing phase transitions of temperature-sensitive segments that trigger volume contraction of the hydrogel to extrude the nucleic acid vector. Promoting angiogenesis, slowing inflammation, and guiding tissue regeneration were demonstrated in the diabetic wound model treated with the NIR-responsive nanocomposite hydrogel.

Hydro-responsive wound dressings for treating hard-to-heal wounds: a narrative review of the clinical evidence

A break in skin integrity must be repaired as quickly as possible to avoid excess blood and fluid loss, and to minimise the onset of infection. Hard-to-heal wounds, in which the progression of the wound healing response is compromised, present several challenges to healing (for example, the presence of devitalised tissue acting as a physical barrier to healing and as a focus for bacterial contamination with the potential for subsequent infection). The objective of this article is to present, as a narrative review, the clinical evidence supporting the use of a unique hydro-responsive wound dressing (HydroClean, HRWD1, PAUL HARTMANN AG, Germany). The dressing provides a simple treatment option to address a number of clinical challenges clinicians must overcome in order to facilitate wound healing progression. These studies demonstrated that this product supported successful debridement/cleansing of a wide variety of wounds, including hard-to-heal wounds, enabled wound bed preparation, and lead to positive healing outcomes, including in wounds that previously had failed to heal. The simplicity of using HRWD1 as a single dressing can help clinicians overcome a variety of challenges when treating both acute and hard-to-heal wounds, which, with the benefit of proven patient outcomes, could make it an ideal choice for a first-line treatment.

Polyglutamic acid grafted dopamine modified collagen-polyvinyl alcohol hydrogel for a potential wound dressing

Natural collagen has good biocompatibility and ability to promote tissue regeneration and repair, but the poor mechanical properties and intolerance of degradation of natural collagen limit its applications in the biomedical field. In this research, we synthesized a skin wound repair hydrogel with good biological activity, high strength and excellent water absorption properties. Inspired by the theory of wet healing, dopamine was introduced into the side chain of the water-absorbing polymer polyglutamic acid to synthesize a cross-linking agent (PGAD) with both water absorption and cell adhesion ablities, and then it was introduced into collagen/polyvinyl alcohol (PVA-COL) system to form a double network hydrogel. Scanning electron microscope observation of the morphological characteristics of the hydrogel showed that after the introduction of PGAD, the hydrogel formed an obvious pore structure, and the swelling rate showed that the introduction of PGAD significantly improved the water absorption rate of the hydrogel.In addition, PVA-COL-PGAD hydrogel has good mechanical properties and water absorption behavior.In vitro experimental results revealed that the hydrogel has good biocompatibility. In vivo wound healing experiments showed that hydrogel can promote wound healing process.These results indicated that our hydrogel has great potential as a medical wound dressing.

Hydro-responsive wound dressings simplify T.I.M.E. wound management framework

The development of wound management protocols and guidelines such as the T.I.M.E. acronym are useful tools to aid wound care practitioners deliver effective wound care. The tissue, infection/inflammation, moisture balance and edge of wound (T.I.M.E.) framework provides a systematic approach for the assessment and management of the majority of acute and chronic wounds. The debridement of devitalised tissue from the wound bed, the reduction in wound bioburden and effective management of wound exudate - i.e., wound bed preparation - are barriers to wound healing progression that are targeted by T.I.M.E. There are a large number of wound dressings available to experienced wound care practitioners to aid in their goal of healing wounds. Despite the systematic approach of T.I.M.E., the large number of wound dressings available can introduce a level of confusion when dressing choices need to be made. Any simplification in dressing choice, for example by choosing a dressing system comprising of a limited number of dressings that are able to address all aspects of T.I.M.E., would be a valuable resource for delivering effective wound care. This article briefly reviews the principles of T.I.M.E. and describes the evidence for the use of a two-dressing, moisture balance-oriented, dressing-based wound management system.

The local treatment and available dressings designed for chronic wounds

The great diversity of wounds and the broad range of available dressings complicate the selection of proper chronic wound treatment. Choosing the right treatment is the essential step in the healing process. In this review, we focus on chronic nonhealing ulcers, which are a critical problem in clinical practice, and current knowledge about persistent wound care. Here, we present the objectives of local treatment with description of several types of dressings and their ingredients, features, indications, and contraindications. These include hydrocolloid, alginate, hydrogel, and dextranomer dressings; polyurethane foam and membrane dressings; semipermeable polyurethane membrane dressings; and TenderWet (Hartmann, Rock Hill, SC) and flax dressings. There is also a brief section on the use of other alternative wound-healing accelerators, such as platelet-rich plasma and light-emitting diode therapy.

Clinical management of pyoderma gangrenosum

Pyoderma gangrenosum is a noninfectious neutrophilic dermatosis that usually starts with sterile pustules which rapidly progress to painful ulcers of variable depth and size with undermined violaceous borders. In 17 to 74% of cases, pyoderma gangrenosum is associated with an underlying disease, most commonly inflammatory bowel disease, rheumatological or hematological disease or malignancy. Diagnosis of pyoderma gangrenosum is based on a history of an underlying disease, typical clinical presentation and histopathology, and exclusion of other diseases that would lead to a similar appearance. Randomized, double-blinded prospective multicenter trials investigating the treatment of pyoderma gangrenosum are not available. The treatments with the best clinical evidence are systemic corticosteroids (in the initial phase usually 100 to 200 mg/day) and cyclosporine (mainly as a maintenance treatment). Combinations of corticosteroids with cytotoxic drugs such as azathioprine, cyclophosphamide or chlorambucil are used in patients with disease that is resistant to corticosteroids. The combination of corticosteroids with sulfa drugs, such as dapsone, or clofazimine, minocycline and thalidomide, has been used as a corticosteroid-sparing alternative. Limited experience has been documented with methotrexate, colchicine, nicotine, and mycophenolate mofetil, among other drugs. Alternative treatments include local application of granulocyte-macrophage colony-stimulating factor, intravenous immunoglobulins and plasmapheresis. Skin transplants (split-skin grafts or autologous keratinocyte grafts) and the application of bioengineered skin is useful in selected cases in conjunction with immunosuppression. Topical therapy with modern wound dressings is useful to minimize pain and the high risk of secondary infection. The application of topical antibacterials cannot be recommended because of their potential to sensitize and their questionable efficacy, but systemic antibacterial therapy is mandatory when infection is present. Despite recent advances in therapy, the prognosis of pyoderma gangrenosum remains unpredictable.

Above the knee amputation wound which dehisced following surgery

This case study describes the wound care of Mrs A, a female patient whose above the knee amputation wound dehisced after surgery. The management of this wound was complex and challenging and required that many members of the multidisciplinary team to work together to achieve a satisfactory outcome.

Pyoderma gangraenosum: exploring the treatment options

There is no uniform treatment for pyoderma gangraenosum. This case report describes how the use of several types of treatments, including larval therapy and VAC, achieved wound healing