Innovative approaches to wound healing: insights into interactive dressings and future directions

The objective of this review is to provide an up-to-date and all-encompassing account of the recent advancements in the domain of interactive wound dressings. Considering the gap between the achieved and desired clinical outcomes with currently available or under-study wound healing therapies, newer more specific options based on the wound type and healing phase are reviewed. Starting from the comprehensive description of the wound healing process, a detailed classification of wound dressings is presented. Subsequently, we present an elaborate and significant discussion describing interactive (unconventional) wound dressings. Latter includes biopolymer-based, bioactive-containing and biosensor-based smart dressings, which are discussed in separate sections together with their applications and limitations. Moreover, recent (2-5 years) clinical trials, patents on unconventional dressings, marketed products, and other information on advanced wound care designs and techniques are discussed. Subsequently, the future research direction is highlighted, describing peptides, proteins, and human amniotic membranes as potential wound dressings. Finally, we conclude that this field needs further development and offers scope for integrating information on the healing process with newer technologies.

Alginate/hyaluronic acid-based systems as a new generation of wound dressings: A review

Skin is the largest organ of the human body, which acts as a protective barrier against pathogens. Therefore, a lot of research has been carried out on wound care and healing. Creating an ideal environment for wound healing and optimizing the local and systemic conditions of the patient play critical roles in successful wound care. Many products have been developed for improving the wound environment and providing a protected and moist area for fast healing. However, there is still high demand for new systems with high efficiency. The first generation of wound dressings merely covered the wound, while the subsequent/last generations covered it and aided in healing it in different ways. In modern wound dressings, the kind of used materials and their complexity play a crucial role in the healing process. These new systems support wound healing by lowering inflammation, exudate, slough, and bacteria. This study addresses a review of alginate/hyaluronic acid-based wound dressings developed so far as well as binary and ternary systems and their role in wound healing. Our review corroborates that these systems can open up a new horizon for wounds that do not respond to usual treatments and have a long curing period.

Applications of drug delivery systems, organic, and inorganic nanomaterials in wound healing

The skin is known to be the largest organ in the human body, while also being exposed to environmental elements. This indicates that skin is highly susceptible to physical infliction, as well as damage resulting from medical conditions such as obesity and diabetes. The wound management costs in hospitals and clinics are expected to rise globally over the coming years, which provides pressure for more wound healing aids readily available in the market. Recently, nanomaterials have been gaining traction for their potential applications in various fields, including wound healing. Here, we discuss various inorganic nanoparticles such as silver, titanium dioxide, copper oxide, cerium oxide, MXenes, PLGA, PEG, and silica nanoparticles with their respective roles in improving wound healing progression. In addition, organic nanomaterials for wound healing such as collagen, chitosan, curcumin, dendrimers, graphene and its derivative graphene oxide were also further discussed. Various forms of nanoparticle drug delivery systems like nanohydrogels, nanoliposomes, nanofilms, and nanoemulsions were discussed in their function to deliver therapeutic agents to wound sites in a controlled manner.

Physical Properties and pH Environment of Foam Dressing Containing Eclipta prostrata Leaf Extract and Gelatin

Eclipta prostrata (E. prostrata) has several biological activities, including antibacterial and anti-inflammatory activities, that improve wound healing. It is well known that physical properties and pH environment are crucial considerations when developing wound dressings containing medicinal plant extracts in order to create an appropriate environment for wound healing. In this study, we prepared a foam dressing containing E. prostrata leaf extract and gelatin. Chemical composition was verified using Fourier-transform infrared spectroscopy (FTIR) and pore structure was obtained using scanning electron microscopy (SEM). The physical properties of the dressing, including absorption and dehydration properties, were also evaluated. The chemical properties were measured to determine the pH environment after the dressing was suspended in water. The results revealed that the E. prostrata dressings had a pore structure with an appropriate pore size (313.25 ± 76.51 µm and 383.26 ± 64.45 µm for the E. prostrata A and E. prostrata B dressings, respectively). The E. prostrata B dressings showed a higher percentage of weight increase in the first hour and a faster dehydration rate in the first 4 h. Furthermore, the E. prostrata dressings had a slightly acidic environment (5.28 ± 0.02 and 5.38 ± 0.02 for the E. prostrata A and E. prostrata B dressings at 48 h, respectively).

Cyclodextrin regulated natural polysaccharide hydrogels for biomedical applications-a review

Cyclodextrin and its derivative (CDs) are natural building blocks for linking with other components to afford functional biomaterials. Hydrogels are polymer network systems that can form hydrophilic three-dimensional network structures through different cross-linking methods and are developing as potential materials in biomedical applications. Natural polysaccharide hydrogels (NPHs) are widely adopted in biomedical field with good biocompatibility, biodegradability, low cytotoxicity, and versatility in emulating natural tissue properties. Compared with conventional NPHs, CD regulated natural polysaccharide hydrogels (CD-NPHs) maintain good biocompatibility, while improving poor mechanical qualities and unpredictable gelation times. Recently, there has been increasing and considerable usage of CD-NPHs while there is still no review comprehensively introducing their construction, classification, and application of these hydrogels from the material point of view regarding biomedical fields. To draw a complete picture of the current and future development of CD-NPHs, we systematically overview the classification of CD-NPHs, and provide a holistic view on the role of CD-NPHs in different biomedical fields, especially in drug delivery, wound dressing, cell encapsulation, and tissue engineering. Moreover, the current challenges and prospects of CD-NPHs are discussed rationally, providing an insight into developing vibrant fields of CD-NPHs-based biomedicine, and facilitating their translation from bench to clinical medicine.

Photothermal Hydrogel Encapsulating Intelligently Bacteria-Capturing Bio-MOF for Infectious Wound Healing

Chronic wounds are characterized by long-term inflammation and persistent infection, which make them difficult to heal. Therefore, an urgent desire is to develop a multifunctional wound dressing that can prevent wound infection and promote wound healing by creating a favorable microenvironment. In this study, a curcumin-based metal-organic framework (QCSMOF-Van), loaded with vancomycin and coated with quaternary ammonium salt chitosan (QCS), was prepared. Multifunctional composite hydrogels were conveniently synthesized by combining methacrylic anhydride modified gelatin and methacrylic anhydride modified oxidized sodium alginate with QCSMOF-Van through radical polymerization and Schiff base reaction. It is important to note that the QCSMOF-Van could capture bacteria through the positive charges on the surface of QCS. In this process, due to the synergistic effect of broad-spectrum antibacterial Zn²⁺ and vancomycin, the metabolism of bacteria was well inhibited, and the efficient capturing and rapid killing of bacteria were achieved. The QCSMOF-Van hydrogels could precisely regulate the balance of M1/M2 phenotypes of macrophages, thereby promoting the regeneration of nerves and blood vessels, which promotes the rapid healing of chronic wounds. This advanced cascade management strategy for tissue regeneration highlights the potential of multifunctional composite hydrogels in chronic wound dressings.

Fenugreek Extract-Loaded Polycaprolacton/Cellulose Acetate Nanofibrous Wound Dressings for Transplantation of Unrestricted Somatic Stem Cells: An In Vitro and In Vivo Evaluation

Complex pathophysiology of diabetic wounds causes a delayed wound healing response. Advanced wound dressing materials that deliver biochemical cues are of particular interest in wound healing research. Here, we developed a dual-function delivery vehicle for drug and cell delivery applications to treat diabetic wounds. The delivery system was developed via electrospinning of polycaprolacton/cellulose acetate solution containing fenugreek extract. The produced delivery vehicle was characterized using microstructural studies, cell viability assay, cytoprotection assay, cell migration assay, In Vitro anti-inflammatory assay, free radical scavenging assay, tensile strength studies, swelling studies, and protein adsorption test. Scaffolds were then seeded with 30000 unrestricted somatic stem cells and transplanted into the rat model of excisional diabetic wound. Wound healing assay showed that the co-delivery of fenugreek extract and unrestricted somatic stem cells led to a substantial improvement in the healing activity of electrospun dressings, as evidenced by higher wound contraction, epithelial thickness, and collagen deposition in this group compared with other experimental groups. Gene expression analysis showed that dual-function delivery system could increase the expression level of VEGF, b-FGF, and collagen type II genes. Furthermore, the tissue expression level of IL-1β and glutathione peroxidase genes was significantly reduced in this group compared with other groups. This study shows that the developed system may be considered as a potential treatment modality for diabetic wounds in the clinic.

Preparation and Characterization of Eco-Friendly Transparent Antibacterial Starch/Polyvinyl Alcohol Materials for Use as Wound-Dressing

In this study, eco-friendly and transparent starch-based/polyvinyl alcohol/citric acid composite films are evaluated for their efficacy as wound dressing materials. The starch/polyvinyl alcohol (PVA) materials with added citric acid (0.46-1.83 wt%) and glycerol were made and handled based on the modified casting method. This new formulation decreases the amount of PVA used in the conventional preparation method. Citric acid ensures an appropriate antibacterial environment for wound-dressing materials. The mechanical, chemical, and surface morphological properties of such films were assessed and analyzed by tensile strength tests, UV-Vis spectrometry, swelling index, and scanning electron microscopy (SEM). Furthermore, the water vapor transmission (WVT) quantity was measured for an ideal wound-healing process to investigate an optimal moisture environment around the wound bed. Moreover, the pH level of the dressings was measured to examine the possibility of bacterial growth around these starch-based films. Additionally, the films' in-vitro antibacterial activities were studied against the two most common Gram-positive and Gram-negative bacteria (Escherichia coli and Staphylococcus aureus). The new starch-based dressings demonstrated suitable degradation, antibacterial activity, fluid absorption, and adequate mechanical strength, representing wound-dressing materials' vital features.

Preparing and Characterizing Novel Biodegradable Starch/PVA-Based Films with Nano-Sized Zinc-Oxide Particles for Wound-Dressing Applications

Given recent worldwide environmental concerns, biodegradability, antibacterial activity, and healing properties around the wound area are vital features that should be taken into consideration while preparing biomedical materials such as wound dressings. Some of the available wound dressings present some major disadvantages. For example, low water vapor transmission rate (WVTR), inadequate exudates absorption, and the complex and high environmental cost of the disposal/recycling processes represent such drawbacks. In this paper, starch/polyvinyl alcohol (PVA) material with inserted nano-sized zinc-oxide particles (nZnO) (average size ≤ 100 nm) was made and altered using citric acid (CA). Both ensure an efficient antibacterial environment for wound-dressing materials. The film properties were assessed by UV–Vis spectrometry and were validated against the UV light transmission percentage of the starch/ polyvinyl alcohol (PVA)/ zinc-oxide nanoparticles (nZnO) composites. Analyses were conducted using X-ray Spectroscopy (EDX) and scanning electron microscopy (SEM) to investigate the structure and surface morphology of the materials. Moreover, to validate an ideal moisture content around the wound area, which is necessary for an optimum wound-healing process, the water vapor transmission rate of the film was measured. The new starch-based materials exhibited suitable physical and chemical properties, including solubility, gel fraction, fluid absorption, biodegradability, surface morphology (scanning electron microscopy imaging), and mechanical properties. Additionally, the pH level of the starch-based/nZnO film was measured to study the prospect of bacterial growth on this wound-dressing material. Furthermore, the in vitro antibacterial activity demonstrated that the dressings material effectively inhibited the growth and penetration of bacteria (Escherichia coli, Staphylococcus aureus).

Preparation and characterization of bifunctional edible gellan-polylysine fiber

A gellan-polylysine (GPL) fiber was prepared by wet spinning molding with gellan solution containing glucose, soybean peptide, fish collagen peptide as spinning liquid, and ε-poly-l-lysine as fixative liquid. Results showed that the material addition order affects the spinning and an acceptable material addition order was as follows: soybean peptides →glucose → fish collagen peptides. The mechanical strength of the GPL fiber decreased with the collagen peptide titer and the fiber strength can reach 0.99 cN/dtex. In addition, the GPL fiber showed comparable water absorption capacity. The GPL fiber demonstrated good antibacterial properties against Escherichia coli and Staphylococcus aureus. The GPL fiber also had no cytotoxicity on mouse embryo fibroblast L-929 cells and could effectively promote wound healing for rats. As a result, the bifunctional edible GPL fiber is potentially used as a military and rescue emergency equipment.

Naproxen release behaviour from graphene oxide/cellulose acetate composite nanofibers

The present study investigated the effect of graphene oxide in cellulose acetate-based composite nanofibers on the transdermal delivery of naproxen.

Nanostructured Lipid Carrier Gel Formulation of Recombinant Human Thrombomodulin Improve Diabetic Wound Healing by Topical Administration

Recombinant human thrombomodulin (rhTM), an angiogenesis factor, has been demonstrated to stimulate cell proliferation, keratinocyte migration and wound healing. The objective of this study was to develop nanostructured lipid carrier (NLC) formulations encapsulating rhTM for promoting chronic wound healing. RhTM-loaded NLCs were prepared and characterized. Encapsulation efficiency was more than 92%. The rate of rhTM release from different NLC formulations was influenced by their lipid compositions and was sustained for more than 72 h. Studies on diabetic mouse wound model suggested that rhTM-NLC 1.2 µg accelerated wound healing and was similar to recombinant human epidermal growth factor-NLC (rhEGF-NLC) 20 µg. By incorporating 0.085% carbopol (a highly crosslinked polyacrylic acid polymer) into rhTM NLC, the NLC-gel presented similar particle characteristics, and demonstrated physical stability, sustained release property and stability within 12 weeks. Both rhTM NLC and rhTM NLC-gel improved wound healing of diabetic mice and cell migration of human epidermal keratinocyte cell line (HaCaT) significantly. In comparison with rhTM solution, plasma concentrations of rhTM post applications of NLC and NLC-gel formulations were lower and more sustained in 24 h. The developed rhTM NLC and rhTM NLC-gel formulations are easy to prepare, stable and convenient to apply to the wound with reduced systemic exposure, which may warrant potential delivery systems for the care of chronic wound patients.

Development of Spanish Broom and Flax Dressings with Glycyrrhetinic Acid-Loaded Films for Wound Healing: Characterization and Evaluation of Biological Properties

The selection of an appropriate dressing for each type of wound is a very important procedure for a faster and more accurate healing process. So, the aim of this study was to develop innovative Spanish Broom and flax wound dressings, as alternatives to cotton used as control, with polymeric films containing glycyrrhetinic acid (GA) to promote wound-exudate absorption and the healing process. The different wound dressings were prepared by a solvent casting method, and characterized in terms of drug loading, water uptake, and in vitro release. Moreover, biological studies were performed to evaluate their biocompatibility and wound-healing efficacy. Comparing the developed wound dressings, Spanish Broom dressings with GA-loaded sodium hyaluronate film had the best functional properties, in terms of hydration ability and GA release. Moreover, they showed a good biocompatibility, determining a moderate induction of cell proliferation and no cytotoxicity. In addition, the wound-healing test revealed that the Spanish Broom dressings promoted cell migration, further facilitating the closure of the wound.

Highly stable collagen scaffolds crosslinked with an epoxidized natural polysaccharide for wound healing

As a biocompatible and bioactive natural tissue engineering collagen scaffold, porcine acellular dermal matrix (pADM) has limitations for the application in tissue regeneration due to its low strength and rapid biodegradation. Herein, to get a good wound dressing, the epoxy group was added to N-(2-hydroxypropyl)-3-trimethylammonium chitosan chloride (HTCC) to synthesize the epoxidized N-(2-hydroxypropyl)-3-trimethylammonium chitosan chloride (EHTCC), and the porcine acellular dermal matrix was modified with EHTCC at different dosage of 0, 4, 8, 12, 16 and 20%. The properties of the EHTCC-pADM were evaluated. The results indicated that the thermal stability and mechanical properties of EHTCC-pADM were remarkably improved, and the natural conformation of the matrix was maintained, which was beneficial to natural and excellent biological properties of the pADM. According to the test results of water contact angle, the hydrophilicity of the material was improved, which is conducive to cell adhesion, proliferation and growth. Cytotoxicity experiments showed that the introduction of EHTCC would not adversely affect the biocompatibility of the materials. In vivo experiments showed that EHTCC-pADM could promote wound healing. In conclusion, EHTCC-pADM is a potential collagen-based dressing for wound healing.

Liposome as a delivery system for the treatment of biofilm-mediated infections

Biofilm formation by pathogenic microorganisms has been a tremendous challenge for antimicrobial therapies due to various factors. The biofilm matrix sequesters bacterial cells from the exterior environment and therefore prevents antimicrobial agents from reaching the interior. In addition, biofilm surface extracellular polymeric substances can absorb antimicrobial agents and thus reduce their bioavailability. To conquer these protection mechanisms, liposomes have been developed into a drug delivery system for antimicrobial agents against biofilm-mediated infections. The unique characteristics of liposomes, including versatility for cargoes, target-specificity, nonimmunogenicity, low toxicity, and biofilm matrix-/cell membrane-fusogenicity, remarkably improve the effectiveness of antimicrobial agents and minimize recurrence of infections. This review summarizes current development of liposomal carriers for biofilm therapeutics, presents evidence in their practical applications and discusses their potential limitations.

Tribological, biocompatibility, and antibiofilm properties of tungsten-germanium coating using magnetron sputtering

In this study, borosilicate glass and 316 L stainless steel were coated with germanium (Ge) and tungsten (W) metals using the Magnetron Sputtering System. Surface structural, mechanical, and tribological properties of uncoated and coated samples were examined using SEM, X-ray diffraction (XRD), energy-dispersive spectroscopy, and tribometer. The XRD results showed that WGe2 chemical compound observed in (110) crystalline phase and exhibited a dense structure. According to the tribological analyses, the adhesion strength of the coated deposition on 316 L was obtained 32.8 N, and the mean coefficient of friction was around 0.3. Biocompatibility studies of coated metallic biomaterials were analyzed on fibroblast cell culture (Primary Dermal Fibroblast; Normal, Human, Adult (HDFa)) in vitro. Hoescht 33258 fluorescent staining was performed to investigate the cellular density and chromosomal abnormalities of the HDFa cell line on the borosilicate glasses coated with germanium-tungsten (W-Ge). Cell viabilities of HDFa cell line on each surface (W-Ge coated borosilicate glass, uncoated borosilicate glass, and cell culture plate surface) were analyzed by using (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) cytotoxicity assay. The antibiofilm activity of W-Ge coated borosilicate glass showed a significant reduction effect on Staphylococcus aureus (ATCC 25923) and Pseudomonas aeruginosa (ATCC 27853) adherence compared to control groups. In the light of findings, tungsten and germanium, which are some of the most common industrial materials, were investigated as biocompatible and antimicrobial surface coatings and recommended as bio-implant materials for the first time.

Kaolin-loaded chitosan/polyvinyl alcohol electrospun scaffold as a wound dressing material: in vitro and in vivo studies

OBJECTIVE

To evaluate the application of a fabricated dressing containing kaolin for skin regeneration in a rat model of excisional wounds.

METHOD

In the present study, kaolin was loaded into electrospun polyvinyl alcohol (PVA)/chitosan polymer blend to develop a composite nanofibrous dressing. To make the yarns, kaolin with weight ratio of 5% was added to PVA/chitosan polymer blend and subsequently formed into nanofibres using the electrospinning method. Scaffolds were evaluated for to their microstructure, mechanical properties, surface wettability, water vapour transmission rate, water-uptake capacity, blood uptake capacity, blood compatibility, microbial penetration test, the number of colonies, and cellular response with the L929 cell line. Rats with full-thickness excisional wounds were treated with kaolin-containing and kaolin-free dressings.

RESULTS

The study showed that rats treated with the kaolin-incorporated mats demonstrated a significant closure to nearly 97.62±4.81% after 14 days compared with PVA/chitosan and the sterile gauze, which showed 86.15±8.11% and 78.50±4.22% of wound closure, respectively. The histopathological studies showed that in the PVA/chitosan/kaolin group, dense and regular collagen fibres were formed, while wounds treated with sterile gauze or PVA/chitosan scaffolds had random and loose collagen fibres.

CONCLUSION

Our results show the potential applicability of PVA/chitosan/kaolin scaffolds as a wound care material.

Rational design and latest advances of polysaccharide-based hydrogels for wound healing

Acute and chronic wounds cause severe physical trauma to patients and also bring an immense socio-economic burden. Hydrogels are considered to be effective wound dressings. Polysaccharides possessing distinctive properties such as biocompatibility, biodegradability, and nontoxicity are promising candidates to structure hydrogels for wound healing. Polysaccharide-based hydrogels can provide suitable moisture for the wound and act as a shield against bacteria. Adequate mechanical properties, degradability, and therapeutic agent controlled release of polysaccharide-based hydrogels have been already characterized for effective utilization. This review presented several crucial design considerations about hydrogels for wound healing, and the current state of polysaccharide (chitosan, alginate, hyaluronic acid, cellulose, dextran, and starch)-based hydrogels as wound dressings was also summarized. The commonly used crosslinking techniques, including physical, chemical, and enzymatic crosslinking, are discussed in detail. Finally, we outline the challenges and perspectives about the improvement of polysaccharide-based hydrogels.

Ibuprofen-Loaded Heparin Modified Thermosensitive Hydrogel for Inhibiting Excessive Inflammation and Promoting Wound Healing

Hydrogels have been investigated as ideal biomaterials for wound treatment owing to their ability to form a highly moist environment which accelerates cell migration and tissue regeneration for prompt wound healing. They can also be used as a drug carrier for local delivery, and are able to activate immune cells to enhance wound healing. Here, we developed heparin-conjugated poly(N-isopropylacrylamide), an injectable, in situ gel-forming polymer, and evaluated its use in wound healing. Ibuprofen was encapsulated into the hydrogel to help reduce pain and excessive inflammation during healing. In addition to in vitro studies, a BALB/c mice model was used to evaluate its effect on would healing and the secretion of inflammatory mediators. The in vitro assay confirmed that the ibuprofen released from the hydrogel dramatically reduced lipopolysaccharide-induced inflammation by suppressing the production of NO, PGE2 and TNF-α in RAW264.7 macrophages. Moreover, an in vivo wound healing assay was conducted by applying hydrogels to wounds on the backs of mice. The results showed that the ibuprofen-loaded hydrogel improved healing relative to the phosphate buffered saline group. This study indicates that ibuprofen loaded in an injectable hydrogel is a promising candidate for wound healing therapy.

Fabrication of cellulose carbamate hydrogel-dressing with rarasaponin surfactant for enhancing adsorption of silver nanoparticles and antibacterial activity

Bacterial contamination on external wounds is known to be a factor that prevents wound healing and triggers tissue damage. Hydrogel-dressings with antibacterial activity is a useful medical device to avoid this contamination, wherein the antibacterial activity can be provided via incorporation of silver nanoparticles (AgNPs). Contrary to the conventional two-step preparation of an AgNPs-loaded hydrogel (AgNPs@hydrogel), this work aims to establish a new and facile synthesis method employing the adsorption principle. Once AgNO₃ adsorbed into active sites of the hydrogels, in situ reductions using NaBH₄ was employed to produce AgNPs@hydrogel. The effect of surfactant addition on the AgNO₃ loading and the antibacterial activity of the resulting hydrogel dressing was investigated. The outcome of this work indicates that the addition of rarasaponin not only can increase the loading of AgNPs on cellulose carbamate hydrogel (CCH) but also significantly enhance the antibacterial activity of the resulted hydrogel-dressing. Superior to the other studied surfactant, the loading capacity (LC) of AgNPs is found to be 10.15, 9.94, and 7.53 mg/g for CCH modified with rarasaponin, CTAB, and Tween80, respectively. These findings conclude that the addition of surfactant, especially rarasaponin, can effectively improve the loading of AgNPs onto hydrogel-dressing via adsorption and promote the antibacterial activity. Furthermore, the cytotoxic test shows that the hydrogel-dressings have good biocompatibility toward skin fibroblast cells.

Preparation and Characterization of Antibacterial Porcine Acellular Dermal Matrices with High Performance

Infection is a common complication in the process of wound management. An ideal wound dressing is supposed to reduce or even prevent the infection while promoting wound healing. A porcine acellular dermal matrix (pADM) has been already used as a wound dressing in clinic due to its capacity to accelerate wound healing. However, not only is pure pADM not antibacterial, its mechanical properties are poor. In this study, an antibacterial pADM with good performance was prepared by adding two natural products as modifiers, quercetin (QCT) and tea tree oil (TTO). The result of Fourier-transform infrared (FTIR) proved that the addition of modifiers did not break the natural triple-helical structure of collagen. Meanwhile, the results of differential scanning calorimetry (DSC), thermogravimetric analysis (TG), mechanic experiment, and enzymatic degradation demonstrated that pADM handled with QCT and TTO (termed QCT-TTO-pADM) had better thermal stability, mechanical strength, and resistance to enzymatic degradation than pADM. Meanwhile, QCT-TTO-pADM had excellent antibacterial activity and showed an antibacterial rate of over 80%. Furthermore, in the cytocompatibility analysis, QCT-TTO-pADM had no side effects on the adhesion, growth, and proliferation of fibroblasts. QCT-TTO-pADM could even accelerate wound healing more efficiently than pADM and glutaraldehyde-modified pADM (GA-pADM). In conclusion, QCT-TTO-pADM was a potential antibacterial wound dressing with good performance.

Polymeric films containing pomegranate peel extract based on PVA/starch/PAA blends for use as wound dressing: In vitro analysis and physicochemical evaluation

Chronic wounds constitute a serious public health problem, and developing pharmaceutical dosage forms to ensure patient comfort and safety, as well as optimizing treatment effectiveness, are of great interest in the pharmaceutical, medical and biomaterial fields. In this work, the preparation of films based on blends of poly(vinyl alcohol), starch and poly(acrylic acid), polymers widely used as pharmaceutical excipients, and pomegranate peel extract (PPE), a bioactive compound with antimicrobial and healing activities relevant to the use as a bioactive wound dressing, was proposed. Initially, the minimum inhibitory concentration (MIC) of the PPE was investigated by an in vitro method. Then, the best concentration of the PPE to be used to prepare the films was researched using an antimicrobial susceptibility test with the disc diffusion method. The microbiological assay was performed in films prepared by the solvent casting method in the presence of two concentrations of PPE: 1.25% w/v and 2.5% w/v. Films containing the lower PPE concentration showed antimicrobial activity against Staphylococcus aureus and Staphylococcus epidermidis, with a difference that was not considered statistically significant when compared to the higher concentration of the extract. Therefore, the films prepared with the lower proportion of PPE (1.25% w/v) were considered for the other studies. The miscibility and stability of the extract in the films were investigated by thermal analysis. Parameters that determine the barrier properties of the films were also investigated by complementary techniques. Finally, in vitro biological tests were performed for safety evaluation and activity research. Analysis of the results showed that the incorporation of the higher proportion of starch in the blend (15% v/v) (PVA:S:PAA:PPE4) yielded smooth, transparent, and domain-free films without phase separation. Additionally, the PVA:S:PAA:PPE4 film presented barrier properties suitable for use as a cover. These films, when subjected to the in vitro hemolytic activity assay, were nonhemolytic and biocompatible. No toxicity from the extract was observed at the concentrations studied. The results of the wound healing in vitro test showed that films containing 1.25% PPE are efficient in reducing the scratch open area, provoking almost total closure of the scratches within 48 h without cytotoxicity.

Recent advances of on-demand dissolution of hydrogel dressings

Wound management is a major global challenge and a big financial burden to the healthcare system due to the rapid growth of chronic diseases including the diabetes, obesity, and aging population. Modern solutions to wound management include hydrogels that dissolve on demand, and the development of such hydrogels is of keen research interest. The formation and subsequent on-demand dissolution of hydrogels is of keen interest to scientists and clinicians. These hydrogels have excellent properties such as tissue adhesion, swelling, and water absorption. In addition, these hydrogels have a distinctive capacity to form in situ and dissolve on-demand via physical or chemical reactions. Some of these hydrogels have been successfully used as a dressing to reduce bleeding in hepatic and aortal models, and the hydrogels remove easily afterwards. However, there is an extremely wide array of different ways to synthesize these hydrogels. Therefore, we summarize here the recent advances of hydrogels that dissolve on demand, covering both chemical cross-linking cases and physical cross-linking cases. We believe that continuous exploration of dissolution strategies will uncover new mechanisms of dissolution and extend the range of applications for hydrogel dressings.

Preparation and Characterization of Breathable Hemostatic Hydrogel Dressings and Determination of Their Effects on Full-Thickness Defects

Hydrogel-based wound dressings provide a cooling sensation, a moist environment, and act as a barrier to microbes for wounds. In this study, a series of soft, flexible, porous non-stick hydrogel dressings were prepared through the simple repeated freeze-thawing of a poly(vinyl alcohol), human-like collagen (or and carboxymethyl chitosan) mixed solution rather than chemical cross-linking and Tween80 was added as pore-forming agent for cutaneous wound healing. Some of their physical and chemical properties were characterized. Interestingly, hydrogel PVA-HLC-T80 and PVA-HLC-CS-T80 presented excellent swelling ratios, bacterial barrier activity, moisture vapor permeability, hemostasis activity and biocompatibility. Furthermore, in vivo evaluation of the healing capacity of these two hydrogels was checked by creating a full-thickness wound defect (1.3 cm × 1.3 cm) in rabbit. Macroscopic observation and subsequent hematoxylin eosin staining (H&E) staining and transmission electron microscopy (TEM) analysis at regular time intervals for 18 days revealed that the hydrogels significantly enhanced wound healing by reducing inflammation, promoting granulation tissue formation, collagen deposition and accelerating re-epithelialization. Taken together, the obtained data strongly encourage the use of these multifunctional hydrogels for skin wound dressings.

Hydroxypropyltrimethyl Ammonium Chloride Chitosan Functionalized-PLGA Electrospun Fibrous Membranes as Antibacterial Wound Dressing: In Vitro and In Vivo Evaluation

A novel poly(lactic-co-glycolic acid) (PLGA)-hydroxypropyltrimethyl ammonium chloride chitosan (HACC) composite nanofiber wound dressing was prepared through electrospinning and the entrapment-graft technique as an antibacterial dressing for cutaneous wound healing. HACC with 30% degrees of substitution (DS) was immobilized onto the surface of PLGA membranes via the reaction between carboxyl groups in PLGA after alkali treatment and the reactive groups (⁻NH₂) in HACC molecules. The naked PLGA and chitosan graft PLGA (PLGA-CS) membranes served as controls. The surface immobilization was characterized by scanning electron microscopy (SEM), atomic force microscopy (AFM), Fourier transform infrared (FTIR), thermogravimetric analysis (TGA) and energy dispersive X-ray spectrometry (EDX). The morphology studies showed that the membranes remain uniform after the immobilization process. The effects of the surface modification by HACC and CS on the biological properties of the membranes were also investigated. Compared with PLGA and PLGA-CS, PLGA-HACC exhibited more effective antibacterial activity towards both Gram-positive (S. aureus) and Gram-negative (P. aeruginosa) bacteria. The newly developed fibrous membranes were evaluated in vitro for their cytotoxicity using human dermal fibroblasts (HDFs) and human keratinocytes (HaCaTs) and in vivo using a wound healing mice model. It was revealed that PLGA-HACC fibrous membranes exhibited favorable cytocompatibility and significantly stimulated adhesion, spreading and proliferation of HDFs and HaCaTs. PLGA-HACC exhibited excellent wound healing efficacy, which was confirmed using a full thickness excision wound model in S. aureus-infected mice. The experimental results in this work suggest that PLGA-HACC is a strong candidate for use as a therapeutic biomaterial in the treatment of infected wounds.

Preparation, Characterization and Application of Polysaccharide-Based Metallic Nanoparticles: A Review

Polysaccharides are natural biopolymers that have been recognized to be the most promising hosts for the synthesis of metallic nanoparticles (MNPs) because of their outstanding biocompatible and biodegradable properties. Polysaccharides are diverse in size and molecular chains, making them suitable for the reduction and stabilization of MNPs. Considerable research has been directed toward investigating polysaccharide-based metallic nanoparticles (PMNPs) through host⁻guest strategy. In this review, approaches of preparation, including top-down and bottom-up approaches, are presented and compared. Different characterization techniques such as scanning electron microscopy, transmission electron microscopy, dynamic light scattering, UV-visible spectroscopy, Fourier-transform infrared spectroscopy, X-ray diffraction and small-angle X-ray scattering are discussed in detail. Besides, the applications of PMNPs in the field of wound healing, targeted delivery, biosensing, catalysis and agents with antimicrobial, antiviral and anticancer capabilities are specifically highlighted. The controversial toxicological effects of PMNPs are also discussed. This review can provide significant insights into the utilization of polysaccharides as the hosts to synthesize MPNs and facilitate their further development in synthesis approaches, characterization techniques as well as potential applications.

Spatiotemporal characterization of hydration process of asymmetric polymeric wound dressings for decubitus ulcers

Pressure ulcers belong to the most chalenging clinical problems. As hydration level of such wounds is important for optimal healing, preparation of new wound dressing (WD) materials for pressure ulcers requires thorough in vitro evaluation as prerequisite to final in vivo testing. The aims of the study were to: (a) develop a simple method of preparation of asymmetric polymeric membrane, (b) to propose a set of in vitro methods for membrane characterization during hydration. A polyvinyl alcohol asymmetric membrane with homogeneous skin layer and porous spongy layer was developed with nonadhesive properties and ability to absorb and retain the water. Complementary methods, including magnetic resonance imaging, allowed quantitative assessment of spatiotemporal aspects of membrane hydration, that is, global water uptake; swelling; local hydration in terms of proton density mapping; spatial distribution of T₂ relaxation time; Young's modulus; piercing resistance. The proposed method of initial wound dressing evaluation seems to be promising to compare various WD formulations, to assess the time required to prepare WD membrane to be applied to the wound and to assess how long WD retains desired working properties. The developed asymmetric membrane seems to be a good candidate for further evaluation. It was found that: Young's modulus of hydrated membrane was comparable to those of human skin; asymmetrical structure was retained during the entire hydration period; each layer had its own distinct, hydration related, properties and their spatiotemporal evolution; relatively slow changes of membrane properties during the potential WD application time-span of several hours was observed. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 843-853, 2018.

Probing Skin for Metabolites and Topical Drugs with Hydrogel Micropatches

Sampling the skin surface is a convenient way to obtain biological specimens bearing clinically relevant information. Hydrogel micropatches enable noninvasive collection of skin excretion specimens, which can subsequently be subjected to rapid mass spectrometric analysis providing insights into the skin metabolome.

Characterisation and in vitro antimicrobial activity of biosynthetic silver-loaded bacterial cellulose hydrogels

Wounds that remain in the inflammatory phase for a prolonged period of time are likely to be colonised and infected by a range of commensal and pathogenic microorganisms. Treatment associated with these types of wounds mainly focuses on controlling infection and providing an optimum environment capable of facilitating re-epithelialisation, thus promoting wound healing. Hydrogels have attracted vast interest as moist wound-responsive dressing materials. In the current study, biosynthetic bacterial cellulose hydrogels synthesised by Gluconacetobacter xylinus and subsequently loaded with silver were characterised and investigated for their antimicrobial activity against two representative wound infecting pathogens, namely S. aureus and P. aeruginosa. Silver nitrate and silver zeolite provided the source of silver and loading parameters were optimised based on experimental findings. The results indicate that both AgNO₃ and AgZ loaded biosynthetic hydrogels possess antimicrobial activity (p < .05) against both S. aureus and P. aeruginosa and may therefore be suitable for wound management applications.

Essential oils and metal ions as alternative antimicrobial agents: a focus on tea tree oil and silver

The increasing occurrence of hospital-acquired infections and the emerging problems posed by antibiotic-resistant microbial strains have both contributed to the escalating cost of treatment. The presence of infection at the wound site can potentially stall the healing process at the inflammatory stage, leading to the development of a chronic wound. Traditional wound treatment regimes can no longer cope with the complications posed by antibiotic-resistant strains; hence, there is a need to explore the use of alternative antimicrobial agents. Pre-antibiotic compounds, including heavy metal ions and essential oils, have been re-investigated for their potential use as effective antimicrobial agents. Essential oils have potent antimicrobial, antifungal, antiviral, anti-inflammatory, antioxidant and other beneficial therapeutic properties. Similarly, heavy metal ions have also been used as disinfecting agents because of their broad spectrum activities. Both of these alternative antimicrobials interact with many different intracellular components, thereby resulting in the disruption of vital cell functions and eventually cell death. This review will discuss the application of essential oils and heavy metal ions, particularly tea tree oil and silver ions, as alternative antimicrobial agents for the treatment of chronic, infected wounds.

Evaluation of a bilayered, micropatterned hydrogel dressing for full-thickness wound healing

Nearly 12 million wounds are treated in emergency departments throughout the United States every year. The limitations of current treatments for complex, full-thickness wounds are the driving force for the development of new wound treatment devices that result in faster healing of both dermal and epidermal tissue. Here, a bilayered, biodegradable hydrogel dressing that uses microarchitecture to guide two key steps in the proliferative phase of wound healing, re-epithelialization, and revascularization, was evaluated in vitro in a cell migration assay and in vivo in a bipedicle ischemic rat wound model. Results indicate that the Sharklet™-micropatterned apical layer of the dressing increased artificial wound coverage by up to 64%, P = 0.024 in vitro. In vivo evaluation demonstrated that the bilayered dressing construction enhanced overall healing outcomes significantly compared to untreated wounds and that these outcomes were not significantly different from a leading clinically available wound dressing. Collectively, these results demonstrate high potential for this new dressing to effectively accelerate wound healing.

Ionically Crosslinked Chitosan Hydrogels for the Controlled Release of Antimicrobial Essential Oils and Metal Ions for Wound Management Applications

The emerging problems posed by antibiotic resistance complicate the treatment regime required for wound infections and are driving the need to develop more effective methods of wound management. There is growing interest in the use of alternative, broad spectrum, pre-antibiotic antimicrobial agents such as essential oils (e.g., tea tree oil, TTO) and metal ions (e.g., silver, Ag⁺). Both TTO and Ag⁺ have broad spectrum antimicrobial activity and act on multiple target sites, hence reducing the likelihood of developing resistance. Combining such agents with responsive, controlled release delivery systems such as hydrogels may enhance microbiocidal activity and promote wound healing. The advantages of using chitosan to formulate the hydrogels include its biocompatible, mucoadhesive and controlled release properties. In this study, hydrogels loaded with TTO and Ag⁺ exhibited antimicrobial activity against P. aeruginosa, S. aureus and C. albicans. Combining TTO and Ag⁺ into the hydrogel further improved antimicrobial activity by lowering the effective concentrations required, respectively. This has obvious advantages for reducing the potential toxic effects on the healthy tissues surrounding the wound. These studies highlight the feasibility of delivering lower effective concentrations of antimicrobial agents such as TTO and Ag⁺ in ionically crosslinked chitosan hydrogels to treat common wound-infecting pathogens.

Characterisation and in vitro antimicrobial potential of liposome encapsulated silver ions against Candida albicans

Liposomes are biocompatible, biodegradable, controlled delivery systems with the ability to encapsulate both lipophilic and hydrophilic compounds, including metal ions. Liposome encapsulated Ag(+) (lipo-Ag(+)), prepared by reverse-phase evaporation, was used as a controlled delivery system against Candida albicans. Characterisation of the lipo-Ag(+) indicated that the multilamellar vesicles with diameters ranging between ≈ 0.5 and 5.0 μm showed potential as a controlled delivery system to consistently deliver Ag(+) to C. albicans. Results from inductively coupled plasma (ICP) analysis showed higher association of cell bound Ag(+) at 15 mins post exposure when compared to unencapsulated Ag(+). Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) indicate detrimental effects of Ag(+) on C. albicans cell structure. These effects along with the ICP results also correlate with previously reported time kill experiment observations.