Investigations on physiochemical and biomedical properties of Aloe vera - Sterculia gum copolymeric dressings impregnated with antibiotic-anesthetic drugs to enhance wound healing

Recently, various innovative advancements have been made in carbohydrate research to design versatile materials for biomedical applications. The current research focuses on the development of copolymeric hydrogel wound dressings (HWD) using a combination of aloe vera (AV) - sterculia gum (SG) - poly (vinylsulfonic acid) (VSA)-based with the aim to enhancing their efficacy in drug delivery (DD) applications. These hydrogel dressings were encapsulated with levofloxacin and lidocaine to address both microbial infection and pain. Copolymers were characterized by FESEM, SEM, EDS, AFM, 13C NMR, FTIR, XRD, and TGA-DTG analysis. Hydrogel exhibited a fluid absorption capacity of 4.52 ± 0.12 g per gram of polymeric dressing in simulated wound conditions. The hydrogels displayed a sustained release of drugs, demonstrating a non-Fickian diffusion mechanism. Polymer dressings revealed antibacterial, mucoadhesive, antioxidant, biocompatible and non-cytotoxic properties. Additionally, HWD displayed permeability to O2 and water vapour, yet was impermeable to microbial penetration. Overall, the findings of physiological, biochemical and drug delivery properties demonstrated the suitability of materials for wound dressing applications.

Towards promoting wound healing: A near-infrared light-triggered persistently antibacterial, synergistically hemostatic nanoarchitecture-integrated chitosan hydrogel

The skin, the primary barrier of the body, is inevitably broken. However, the development of materials that facilitate wound healing with sustained antimicrobial, hemostatic, and biocompatible properties remains a formidable challenge. In this article, we prepared a photopolymerizable composite hydrogel consisting of a hydrogel matrix, a hemostatic/antibacterial agent, and a photothermal therapy agent. The photopolymerizable hydrogel matrix was prepared by grafting the photoinitiator and polymerizable active monomer onto the chitosan chain segment, which exhibits excellent biocompatibility. Furthermore, linalool is adsorbed on the surface of halloysite nanotubes (HNTs) to form a hemostatic and antibacterial. Meanwhile, dopamine is employed as a coating material for hollow glass microsphere (HGM), which enables them to function as photothermal therapy agents. Upon exposure to near-infrared radiation, the PHA hydrogel releases linalool molecules from the surface of the HNTs, which diffuse into the hydrogel matrix, resulting in a sustained antimicrobial effect. At the same time, rapid curing of the photopolymerizable hydrogel under UV light forms a physical barrier that synergistically enhances the hemostatic properties of the HNTs. From the above, the results pave the way to develop a potential hemostatic antimicrobial dressing for clinical use in wound healing.

Recent advances in harnessing biological macromolecules for wound management: A review

Wound dressings (WDs) are an essential component of wound management and serve as an artificial barrier to isolate the injured site from the external environment, thereby helping to prevent exogenous infections and supporting healing. However, maintaining a moist wound environment, providing protection from infection, good biocompatibility, and allowing for gas exchange, remain a challenge in device design. Functional wound dressings (FWDs) prepared from hybrid biological macromolecule-based materials can enhance efficacy of these systems for skin wound management. This review aims to provide an overview of the state-of-the-art FWDs within the field of wound management, with a specific focus on hybrid biomaterials, techniques, and applications developed over the past five years. In addition, we highlight the incorporation of biological macromolecules in WDs, the emergence of smart WDs, and discuss the existing challenges and future prospects for the development of advanced WDs.

Chitosan-based films filled with nanoencapsulated essential oil: Physical-chemical characterization and enhanced wound healing activity

The economic burden of chronic wounds, the complexity of the process of tissue repair and the possibility of resistant bacterial infections, have triggered a significant research interest in the application of natural alternative therapies for wound healing. Biomolecules are intrinsically multi-active, as they affect multiple mechanisms involved in tissue repair phenomenon, including immunomodulatory, anti-inflammatory, cell proliferation, extra cellular matrix remodeling and angiogenesis. Chitosan features a unique combination of attributes, including intrinsic hemostatic, antimicrobial, and immunomodulatory properties, that make it an exceptional candidate for wound management, in the development of wound dressings and scaffolds. In this study, we produced nanoemulsions (NE) loaded with SFO, characterized them, and evaluated their tissue repairing properties. Dynamic light scattering (DLS) analysis confirmed the formation of a nanoemulsion with a droplet size of 21.12 ± 2.31 nm and a polydispersity index (PdI) of 0.159, indicating good stability for up to 90 days. To investigate the potential wound healing effects, SFO-loaded NE were applied on male C57BL/6 mice for seven consecutive days, producing a significantly higher wound closure efficiency (p < 0.05) for the group treated with SFO-loaded NE compared to the control group treated with the saline solution. This finding indicates that the SFO-loaded NE exhibits therapeutic properties that effectively promote wound healing in this experimental model. Then, SFO-loaded NE were incorporated into chitosan:polyvinyl alcohol (PVA)-based films. The inclusion of NE into the polymer matrix resulted in increased lipophilicity reflected by the contact angle results, while decreasing moisture absorption, water solubility, and crystallinity. Moreover, FTIR analysis confirmed the formation of new bonds between SFO-NE and the film matrix, which also impacted on porosity properties. Thermal analysis indicated a decrease in the glass transition temperature of the films due to the presence of SFO-NE, suggesting a plasticizing role of NE, confirmed by XRD results, that showed a decrease in the crystallinity of the blend films upon the addition of SFO-NE. AFM images showed no evidence of NE droplet aggregation in the Chitosan:PVA film matrix. Moisture absorption and water content decreased upon incorporation of SFO-loaded NE. Although the inclusion of NE increased hydrophobicity and water contact angle, the values remained within an acceptable range for wound healing applications. Overall, our results emphasize the significant tissue repairing properties of SFO-loaded NE and the potential of Chitosan:PVA films containing nanoencapsulated SFO as effective formulations for wound healing with notable tissue repairing properties.

On-demand release of enrofloxacin-loaded chitosan oligosaccharide-oxidized hyaluronic acid composite nanogels for infected wound healing

In this study, enrofloxacin (ENR) was encapsulated by oxidized hyaluronic acid (OHA) containing aldehyde groups and chitosan oligosaccharide (COS) containing amino groups through Schiff's base reaction to achieve on-demand release in the micro-environment (pH 5.5 and HAase) of bacterial-infected wounds (Escherichia coli and Staphylococcus aureus). The formation mechanism, physicochemical characterization, responsive release performance, in vitro and in vivo antimicrobial activities, and in vivo regeneration in full-thickness wounds in a bacterial-infected mouse model of the ENR nanogels were systematically studied. According to the single-factor experiment and Design-Expert software, the optimized formula was 3.8 mg/ml COS, 0.5 mg/ml OHA, and 0.3 mg/ml ENR, respectively. The mean particle diameter, polydispersity index, zeta potential, loading capacity, and encapsulation efficiency were 35.6 ± 1.7 nm, -6.7 ± 0.5 mV, 0.25 ± 0.02, 30.4 % ± 1.3 %, and 76.3 % ± 2.6 %, respectively. The appearance, optical microscopy images, SEM, TEM, PXRD, and FTIR showed that the ENR nanogels were successfully prepared. The ENR nanogels exhibited obvious pH and HAase-responsiveness by swelling ratios and in vitro release and had stronger antibacterial activity with time-dependent and concentration-dependent effects, as well as accelerating infected wound healing. In vitro and in vivo biosafety studies suggested the great promise of ENR nanogels as biocompatible wound dressings for infected wounds.

A focused review on hyaluronic acid contained nanofiber formulations for diabetic wound healing

The significant clinical challenge presented by diabetic wounds is due to their impaired healing process and increased risk of complications. It is estimated that a foot ulcer will develop at some point in the lives of 15-25 % of diabetic patients. Serious complications, including infection and amputation, are often led to by these wounds. In the field of tissue engineering and regenerative medicine, nanofiber-based wound dressings have emerged in recent years as promising therapeutic strategies for diabetic wound healing. Hyaluronic acid (HA), among various nanofiber materials, has gained considerable attention due to its unique properties, including biocompatibility, biodegradability, and excellent moisture retention capacity. By promoting skin hydration and controlling inflammation, a crucial role in wound healing is played by HA. Wounds are also helped to heal faster by HA through the regulation of inflammation levels and signaling the body to build more blood vessels in the damaged area. Great potential in various applications, including wound healing, has been shown by the development and use of nanofiber formulations in medicine. However, challenges and limitations associated with nanofibers in medicine exist, such as reproducibility, proper characterization, and biological evaluation. By providing a biomimetic environment that enhances re-epithelialization and facilitates the delivery of active substances, nanofibers promote wound healing. In accelerating wound healing, promising results have been shown by HA-contained nanofiber formulations in diabetic wounds. Key strategies employed by these formulations include revascularization, modulation of the inflammation microenvironment, delivery of active substances, photothermal nanofibers, and nanoparticle-loaded fabrics. Particularly crucial is revascularization as it restores blood flow to the wound area, promoting healing. Wound healing can also be enhanced by modulating the inflammation microenvironment through controlling inflammation levels. Future perspectives in this field involve addressing the current challenges and limitations of nanofiber technology and further optimizing HA-contained nanofiber formulations for improved efficacy in diabetic wound healing. This includes exploring new fabrication techniques, enhancing the biocompatibility and biodegradability of nanofibers, and developing multifunctional nanofibers for targeted drug delivery. Not only does writing a review in the field of nanofiber-based wound dressings, particularly those containing hyaluronic acid, allow us to consolidate our current knowledge and understanding but also broadens our horizons. An opportunity is provided to delve deeper into the intricacies of this innovative therapeutic strategy, explore its potential and limitations, and envision future directions. By doing so, a contribution can be made to the ongoing advancements in tissue engineering and regenerative medicine, ultimately improving the quality of life for patients with diabetic wounds.

Design, fabrication, evaluation, and in vitro study of green biomaterial and antibacterial polymeric biofilms of polyvinyl alcohol/tannic acid/CuO/ SiO2

In this study, a three-component biofilm for rapid wound dressing consisting of polyvinyl alcohol (PVA)/tannic acid (TA)/with CuO/SiO2 with different percentages (0, 5, 10, and 15 wt% NPs) is evaluated. In addition to controlling bleeding and absorption of blood and wound secretions, it protects the damaged tissue from the attack of microbes. It protects against viruses and thus reduces the treatment time. Analysis of biofilms morphology is performed by Field emission scanning electron microscopy (FE-SEM), phases in biofilms were analyzed by X-ray diffraction (XRD) analysis, chemical bonds, and functional groups are analyzed by Fourier transform infrared (FTIR) spectroscopy, and mechanical tests are performed to evaluate the strength of the samples. The thermogravimetric analysis (TGA) is applied to estimate the thermal stability of the biopolymer films with various percentages of CuO/SiO2 nanoparticles. Also, antibacterial test, bioactivity of the biofilms, the percentage of swelling ratio, and porosity of the samples were examined by immersing the samples in simulated body fluid (SBF) and Phosphate-buffered saline (PBS) for 14 days in vitro. The composite makeup of the TA/PVA sample, comprising 15 wt % CuO/SiO2 and containing 15 wt% of nanoparticles, exhibited superior heat resistance compared to other samples by an increase of 50 °C. This improvement can be attributed to the nanoparticles reaching their saturation point. The swelling ratio was assessed in both SBF and PBS, and in both instances, the sample increased by up to 10 wt% before decreasing, indicating the saturation of the nanoparticles.

Suprathel® or Mepilex® Ag for treatment of partial thickness burns in children: A case control study

AIM

The study aim was to investigate if Suprathel® can be an adequate alternative to Mepilex® Ag for the treatment of partial-thickness scalds in children.

METHODS

A retrospective study including 58 children admitted to The Burn Centre in Linköping, Sweden between year 2015 and 2022. Of the 58 children, 30 were dressed with Suprathel ® and 28 with Mepilex ® Ag. Outcomes investigated were healing time, burn wound infection (BWI), need for operations and number of dressing changes.

RESULTS

We found no significant differences in any of the outcomes. In the Suprathel ® group 17 children and in the Mepilex ® Ag group 15 children were healed within 14 days. Ten children from each group received antibiotics for suspected BWI and two from each group underwent an operation with skin grafting. Each group had on median four dressing changes.

CONCLUSIONS

Two different treatments were compared for children with partial-thickness scalds, and the data indicates that similar results are received with both dressings.

Topical application of Lactobacilli successfully eradicates Pseudomonas aeruginosa biofilms and promotes wound healing in chronic wounds

Chronic wounds are difficult to treat due to the presence of biofilm which prevents wound healing. Pseudomonas aeruginosa is one of the most common pathogens found in chronic wounds and conventional treatment strategies have been ineffective in the eradication of its biofilm, without harming the surrounding healthy tissue at the same time. Here, we introduced an innovative approach applying the probiotic product Bio-K+ (containing three lactobacilli) topically as an antimicrobial and antibiofilm agent. We identified lactic acid as the main active component. While antibiotics and antiseptics such as silver-ions only demonstrated limited efficacy, Bio-K+ was able to completely eradicate mature P. aeruginosa biofilms established in an in-vitro and ex-vivo human skin model. Furthermore, it demonstrated biocompatibility in the co-culture with human dermal fibroblasts and accelerated the migration of fibroblasts in a cell migration assay promoting wound healing. To enhance clinical practicability, we introduced Bio-K+ into the hydrocolloid dressing Aquacel, achieving sustained release of lactic acid and biofilm eradication. This new treatment approach applying probiotics could represent a major improvement in the management of chronic wounds and can be extended in treating other biofilm-associated infections.

Sustainable functionalized chitosan based nano-composites for wound dressings applications: A review

Functionalized chitosan nanocomposites have been studied for wound dressing applications due to their excellent antibacterial and anti-fungal properties. Polysaccharides show excellent antibacterial and drug-release properties and can be utilized for wound healing. In this article, we comprise distinct approaches for chitosan functionalization, such as photosensitizers, dendrimers, graft copolymerization, quaternization, acylation, carboxyalkylation, phosphorylation, sulfation, and thiolation. The current review article has also discussed brief insights on chitosan nanoparticle processing for biomedical applications, including wound dressings. The chitosan nanoparticle preparation technologies have been discussed, focusing on wound dressings owing to their targeted and controlled drug release behavior. The future directions of chitosan research include; a) finding an effective solution for chronic wounds, which are unable to heal completely; b) providing effective wound healing solutions for diabetic wounds and venous leg ulcers; c) to better understanding the wound healing mechanism with such materials which can help provide the optimum solution for wound dressing; d) to provide an improved treatment option for wound healing.

Carboxylated nanocellulose for wound healing applications - Increase of washing efficiency after chemical pre-treatment and stability of homogenized gels over 10 months

To commercialize a biomedical product as a medical device, reproducibility of production and time-stability are important parameters. Studies of reproducibility are lacking in the literature. Additionally, chemical pre-treatments of wood fibres to produce highly fibrillated cellulose nanofibrils (CNF) seem to be demanding in terms of production efficiency, being a bottleneck for industrial upscaling. In this study, we evaluated the effect of pH on the dewatering time and washing steps of 2,2,6,6-Tetramethylpiperidinyloxy (TEMPO)-mediated oxidized wood fibres when applying 3.8 mmol NaClO/g cellulose. The results indicate that the method does not affect the carboxylation of the nanocelluloses, and levels of approximately 1390 μmol/g were obtained with good reproducibility. The washing time of a Low-pH sample was reduced to 1/5 of the time required for washing a Control sample. Additionally, the stability of the CNF samples was assessed over 10 months and changes were quantified, the most pronounced were the increase of potential residual fibre aggregates, reduction of viscosity and increase of carboxylic acid content. The cytotoxicity and skin irritation potential were not affected by the detected differences between the Control and Low-pH samples. Importantly, the antibacterial effect of the carboxylated CNFs against S. aureus and P. aeruginosa was confirmed.

Assessment framework for the selection of a potential interactive dressing material for diabetic foot ulcer

Diabetic foot ulcer is a chronic health issue leading to lower leg amputations in approximately 15% of patients with diabetics. There are many factors directly or indirectly involved in the physiology of wound healing but being a multisystem disorder, wound healing in diabetic patients retard or worsen with heavy exudates and severe microbial infections. Wound management is of prime importance and is an emerging area to incorporate wound regenerative materials in natural or synthetic dressing materials along with proper microbial control. The article aim to identify suitable dressing materials which exhibit inherent wound healing properties at the same time flexible to be used as drug carriers for slow, consistent and effective delivery of 'functional drugs' to the wound environment. The authors selected nine materials from the popular and well accepted dressings of patient choice, analyzed them using graph theoretic approach and ranked them on the basis of graph index values obtained. A critical review has also been done on the basis of their ranking, providing insights to the advantages, disadvantage and potential of top 5 ranked candidate materials. Alginate, Honey, Medifoam, Saline, and Hydrogel dressings were the top five candidate materials ranked respectively, even then, the authors suggests that 'modified hydrogels' can have the potential to be used as a future candidate in DFU treatment as it is the only material (among the top ranked ones) which can effectively used as regenerative drug carrier, while providing all other wound healing properties in relative proportions. The proposed framework can be modified and applied in the selection and ranking of materials for any kind of applications both in industry and medical fields by identifying factors influencing the final outcome of study and by listing the characteristics of the materials selected.

Application of hydrogel wound dressings in cell therapy-approaches to assessment in vitro

Cell therapy is actively used to treat skin defects, particularly burn lesions. The effectiveness of its application may depend on the appropriate choice of wound dressings used together with any cellular material. The aim of the study was to investigate the interaction of 4 hydrogel dressings used in clinical practice with human cells in an in vitro model to determine if their use in combination with cell therapy is possible. The effect of the dressings on the growth medium was assessed by considering the changes caused in the medium's acid-base equilibrium (pH) and viscosity. Cytotoxicity was determined by applying an MTT-assay and by direct contact methods. Cell adhesion and viability on the dressing surfaces were analyzed using fluorescence microscopy. Proliferative and secretory cell activity were determined concurrently. Characterized human dermal fibroblast cultures were used as the test cultures. Results: The tested dressings interacted differently with the growth medium and the test cultures. 1-day extracts of all dressings had almost no effect on the acid-base balance, but, after 7 days, the pH of the dressing Type 2 extract had sharply acidified. The viscosity of the media under the influence of dressings of Types 2 and 3 had also markedly increased. MTT-assays showed nontoxicity of all the 1-day-incubated dressing extracts, while incubation for 7-days resulted in extracts with evident cytotoxicity, which was reduced upon dilution. Cell adhesion to the surfaces of the dressings differed, being observed occurring on dressings 2 and 3, and to a limited extent on dressing 4. Cells under dressing 1 showed evident proliferative and secretory activity whereas the other dressings impaired either proliferation or secretion processes. These effects indicate that, in general, comprehensive studies including a variety of methodological approaches at the in vitro stage are needed to allow the selection of appropriate dressings if they are to be used in combination with cell therapy to act as cell carriers. Of those investigated, the Type 1 dressing can be recommended as a protective dressing for use after transplantation of cells into a wound defect area by some other method.

Recent progress of antibacterial hydrogels in wound dressings

Hydrogels are essential biomaterials due to their favorable biocompatibility, mechanical properties similar to human soft tissue extracellular matrix, and tissue repair properties. In skin wound repair, hydrogels with antibacterial functions are especially suitable for dressing applications, so novel antibacterial hydrogel wound dressings have attracted widespread attention, including the design of components, optimization of preparation methods, strategies to reduce bacterial resistance, etc. In this review, we discuss the fabrication of antibacterial hydrogel wound dressings and the challenges associated with the crosslinking methods and chemistry of the materials. We have investigated the advantages and limitations (antibacterial effects and antibacterial mechanisms) of different antibacterial components in the hydrogels to achieve good antibacterial properties, and the response of hydrogels to stimuli such as light, sound, and electricity to reduce bacterial resistance. Conclusively, we provide a systematic summary of antibacterial hydrogel wound dressings findings (crosslinking methods, antibacterial components, antibacterial methods) and an outlook on long-lasting antibacterial effects, a broader antibacterial spectrum, diversified hydrogel forms, and the future development prospects of the field.

Injectable, self-healing, transparent, and antibacterial hydrogels based on chitosan and dextran for wound dressings

One major shortcoming of biopolymeric based wound dressing so far is the lack of an integrated multi-functional system that could provide suitable mechanical strength, fast self-healing, transparency, antibacterial and antioxidant effects. Benefiting from the dynamic and rapid reaction between glycidyl trimethyl ammonium chloride-graft- chitosan (QCS) and aldehyde-dextran (ODex) under physiological conditions, we designed hydrogels (QCS-ODex) with fast in situ gel-forming (< 70 s), porous structure (300-350 μm), stable storage modulus and the loss modulus, suitable swelling capacity (2.465 folds of chitosan), tissue adhesion, transmission property, free radical scavenging capacity, good self-healing behavior, and injectability, inherent antibacterial (against E. coli and S. aureus) and biocompatibility. Furthermore, Baicalein could be in situ encapsulated into QCS-ODex hydrogels, and the release behavior of Baicalein could be regulated by adjusting the ratio of QCS and ODex. The Baicalein-loaded QCS-ODex hydrogel further facilitated free radical scavenging and antibacterial bioactivities due to the cooperative therapeutic effects between QCS-ODex and Baicalein. This study may provide new insights into designing multi-functional QCS-ODex hydrogels with multiple therapeutic effects as a wound dressing.

Nanosilver-functionalized polysaccharides as a platform for wound dressing

Polysaccharides that are naturally sourced have enormous promise as wound dressings, due to their wider availability and reasonable cost and good biocompatibility. Furthermore, nanosilver extensively applied in wound treatment is attributed to its broad spectrum of antimicrobial effects and lesser drug resistance. Consequently, wound dressings in corporating nanosilver have attracted wide-scale interest in wound healing, and nanosilver-functionalized polysaccharide-based wound dressings present an affordable option for healing of chronic wounds. This review encompasses preparation methods, classification, and antibacterial performances of nanosilver wound dressings. The prospective research arenas of nanosilver-based wound polysaccharide dressings are also elaborated. The review attempts to include a summary of the most recent advancements in silver nanotechnology as well as guidance for the investigation of nanosilver-functionalized polysaccharide-based wound dressings.

Combined effect of SDF-1 peptide and angiogenic cues in co-axial PLGA/gelatin fibers for cutaneous wound healing in diabetic rats

Skin regeneration is hindered by poor vascularization, prolonged inflammation, and excessive scar tissue formation, which necessitate newer strategies to simultaneously induce blood vessel regeneration, resolve inflammation, and induce host cell recruitment. Concurrent deployment of multiple biological cues to realize synergistic reparative effects may be an enticing avenue for wound healing. Herein, we simultaneously deployed SDF (stromal cell-derived factor)- 1α, VEGF (vascular endothelial growth factor)-binding peptide (BP), and GLP (glucagon like peptide)- 1 analog, liraglutide (LG) in core/shell poly(L-lactide-co-glycolide)/gelatin fibers to harness their synergistic effects for skin repair in healthy as well as diabetic wound models in rats. Microscopic techniques, such as SEM and TEM revealed fibrous and core/shell type morphology of membranes. Boyden chamber assay and scratch-wound assay displayed significant migration of HUVECs (human umbilical vein endothelial cells) in SDF-1α containing fibers. Subcutaneous implantation of membranes revealed higher cellular infiltration in SDF-1α loaded fibers, especially, those which were co-loaded with LG or BP. Implantation of membranes in an excisional wound model in healthy rats further showed significant and rapid wound closure in dual cues loaded groups as compared to control or single cue loaded groups. Similarly, the implantation of dressings in type 2 diabetes rat model revealed fast healing, skin appendages regeneration, and blood vessel regeneration in dual cues loaded fibers (SDF-1α/LG, SDF-1α/BP). Taken together, core/shell type fibers containing bioactive peptides significantly promoted wound repair in healthy as well as diabetic wound models in rats.

Zwitterion and N-halamine functionalized cotton wound dressing with enhanced antifouling, antibacterial, and hemostatic properties

With emerging needs of wound care management, a multi-functional wound dressing is needed. To prevent infection and reduce patient suffering, antibacterial efficacy against a broad-spectrum of bacteria plus robust antifouling are among the most preferred properties. In this study, a wound dressing was created with antibacterial and anti-fouling capabilities is presented. The approaches used a synthesized tri-functional copolymer comprised of an N-halamine precursor moiety, a marine-inspired surface binding dopamine moiety, and a zwitterionic anti-adhesion moiety bonded onto a commercial cotton gauze. The resulting HaloCare™ wound dressing demonstrated >99.99 % inactivation within 5 min against E. coli and a panel of ESKAPE pathogens plus achieved 98.77 % reduction of non-specific protein binding. HaloCare was also shown to be compatible with hemostatic agents without impacting hemostatic efficacy. HaloCare shows great potential particularly in traumatic injury events as an infection preventing and hemostatic wound management system.

The wound healing effect of botanicals and pure natural substances used in in vivo models

Repairing the wound is a multistep process that includes the spatial and temporal synchronization of a different range of cell types to increase the speed of wound contraction, the proliferation of epithelial cells, and collagen formation. The need for proper management of acute wounds to be cured and not turned into chronic wounds is a significant clinical challenge. The traditional practice of medicinal plants in many regions of the world has been used in wound healing since ancient times. Recent scientific research introduced evidence of the efficacy of medicinal plants, their phyto-components, and the mechanisms underlying their wound-repairing activity. This review aims to briefly highlight the wound-curing effect of different plant extracts and purely natural substances in excision, incision, and burn experimental animal models with or without infection of mice, rats (diabetic and nondiabetic), and rabbits in the last 5 years. The in vivo studies represented reliable evidence of how powerful natural products are in healing wounds properly. They have good scavenging activity against Reactive oxygen species (ROS) and anti-inflammatory and antimicrobial effects that help in the process of wound healing. It is evident that incorporating bioactive natural products into wound dressings of bio- or synthetic polymers in nanofiber, hydrogel, film, scaffold, and sponge forms showed promising results in different phases of the wound-curing process of haemostasis, inflammation, growth, re-epithelialization, and remodelling.

A biocompatible double-crosslinked gelatin/ sodium alginate/dopamine/quaterniazed chitosan hydrogel for wound dressings based on 3D bioprinting technology

438Severe skin injuries can cause serious problems, which could affect the patient's normal life, if not dealt properly in a timely and effective manner. It is an urgent requirement to develop personalized wound dressings with excellent antibacterial activity and biocompatibility to match the shape of the wound to facilitate clinical application. In this study, a bioink (GAQ) based on gelatin (Gel)/sodium alginate (SA)/ quaternized chitosan (QCS) was prepared, and GAQ hydrogel dressing grafting with dopamine (GADQ) was fabricated by an extrusion three-dimensional (3D) printing technology. QCS was synthesized by modifying quaternary ammonium group on chitosan, and its structure was successfully characterized by nuclear magnetic resonance (1H NMR) and Fourier-transform infrared spectroscopy (FT-IR). Our results showed that the GADQ hydrogel dressing that was double-crosslinked by EDC/ NHS and Ca²⁺ had good tensile strength, considerable swelling ratio, and effective antioxidation properties. It also showed that GADQ1.5% had 93.17% and 91.06% antibacterial activity against Staphylococcus aureus and Escherichia coli, respectively. Furthermore, the relative survival ratios of fibroblast cells seeded on these hydrogels exceeded 350% after cultured for 7 days, which proved the biocompatibility of these hydrogels. Overall, this advanced 3D-printed GADQ1.5% hydrogels with effective antioxidation, excellent antibacterial activity and good biocompatibility had a considerable application potential for wound healing.

Polysaccharide-based hydrogels: New insights and futuristic prospects in wound healing

Polysaccharides elicit enormous and promising applications due to their extensive obtainability, innocuousness, and biodegradability. Various outstanding features of polysaccharides can be employed to fabricate biomimetic and multifunctional hydrogels as efficient wound dressings. These hydrogels mimic the natural extracellular matrix and also boost the proliferation of cells. Owing to distinctive architectures and abundance of functional groups, polysaccharide-derived hydrogels have exceptional physicochemical properties and unique therapeutic interventions. Hydrogels designed using polysaccharides can effectively safeguard wounds from bacterial attack. This review includes wound physiology and emphasises on numerous polysaccharide-based hydrogels for wound repair applications. Polysaccharide hydrogels for different wound types and diverse therapeutic agents loaded in hydrogels for wound repair with recent patents are portrayed in the current manuscript, debating the potential of fascinating hydrogels for effective wound healing. More research is required to engineer multifaceted advanced polysaccharide hydrogels with tuneable and adjustable properties to attain huge potential in wound healing.

Evaluation of poly(N-isopropylacrylamide)/tetraphenylethylene/amphotericin B-based visualized antimicrobial nanofiber wound dressing for whole skin wound healing in rats

The aim of this work is to develop a novel nanofiber wound dressing with multiple functional properties that combines suitable mechanical properties, slow and controlled drug release, antifungal activity, and visual drug monitoring to accelerate wound healing while reducing systemic circulation of the drug, achieving reduced dose and side effects, and achieving patient satisfaction and compliance. In this paper, visualized nanofiber films were prepared using electrostatic spinning technology. This nanofiber wound dressing has soft tissue-like mechanical and antifungal properties and is biocompatible. In particular, the poly(N-isopropylacrylamide) (PNIPAAm)/tetraphenylethylene (TPE)/amphotericin B (AMB) nanofiber films showed good performance in terms of antifungal activity and cytocompatibility compared with medical gauze, and significantly accelerated the wound healing process in a mouse total wound defect model with PCL+PVP+TPE+AMB+PNIPAAm. The wound healing rate of nanofibrous membrane group was 100% at 14 days. In addition, histological analysis, collagen deposition and immunohistochemistry showed, for example, fewer inflammatory cells, more fibroblasts around the damaged area, increased wound epithelial atrophy, reduced granulation tissue, connective tissue reconstruction, epithelial tissue formation, and abundant small angiogenesis in the dermis near the epidermis; a higher level of collagen deposition fraction of 49.97%; and a simultaneous reduction in HIF-1α production and upregulated the expression of CD31. In conclusion, this antifungal nanofiber film showed promising applications throughout the skin wound healing process.

Design strategies for adhesive hydrogels with natural antibacterial agents as wound dressings: Status and trends

The wound healing process is usually susceptible to different bacterial infections due to the complex physiological environment, which significantly impairs wound healing. The topical application of antibiotics is not desirable for wound healing because the excessive use of antibiotics might cause bacteria to develop resistance and even the production of super bacteria, posing significant harm to human well-being. Wound dressings based on adhesive, biocompatible, and multi-functional hydrogels with natural antibacterial agents have been widely recognized as effective wound treatments. Hydrogels, which are three-dimensional (3D) polymer networks cross-linked through physical interactions or covalent bonds, are promising for topical antibacterial applications because of their excellent adhesion, antibacterial properties, and biocompatibility. To further improve the healing performance of hydrogels, various modification methods have been developed with superior biocompatibility, antibacterial activity, mechanical properties, and wound repair capabilities. This review summarizes hundreds of typical studies on various ingredients, preparation methods, antibacterial mechanisms, and internal antibacterial factors to understand adhesive hydrogels with natural antibacterial agents for wound dressings. Additionally, we provide prospects for adhesive and antibacterial hydrogels in biomedical applications and clinical research.

Natural cocktail of bioactive factors conjugated on nanofibrous dressing for improved wound healing

Any interference in the timely and orderly progression through all the phases of healing process can turn a minor injury into a chronic wound. Most of the wound dressings available in the market are moderately effective and have not shown satisfactory improvement in healing. Along with the appropriate wound management, it is imperative for a dressing to facilitate the wound repair process too. In the present research, we hypothesize to improve the wound healing process by applying cost effective natural cocktail of various bioactive factors. Bovine colostrum contains high levels of immunoglobulins, lactoferrin, hormones and cytokines which play significant role in wound healing. Hence, multifunctional colostrum conjugated PCL-PEG based nanofibrous dressings were developed and analyzed for their physicochemical properties and cellular responses. The dressings were also evaluated for cell migration, antioxidant, anti-inflammatory and anti-bacterial properties. In-vivo wound healing ability was validated on a rat wound model. Numerous growth factors present in the colostrum showed their role in stimulation of skin repair and regeneration by direct action on genetic material. Significantly less inflammation in colostrum treated wounds was observed due to anti-inflammatory properties of lactoferrin. Thus obtained results confirmed the suitability of these multifunctional colostrum conjugated nanofibrous dressings for improved wound healing.

Electrospinning membranes with Au@carbon dots: Low toxicity and efficient antibacterial photothermal therapy

As bacterial infections continue to pose a significant challenge to healthcare globally, new therapeutic strategies, interventions, and complementary approaches that address both infection prevention and treatment are needed. As one such strategy, photothermal therapy (PTT) as a non-chemotherapeutic approach is considered a safe and potentially efficient strategy to combat bacterial infections, particularly for antibiotic-resistant pathogens given that PTT operates via a temperature-dependent process against which the development of bacterial resistance is unlikely. Here, we prepared Au@CDs composite nanoparticles (Au@CD) comprised of gold nanoparticles (AuNPs) and carbon dots (N,S-CDs), and investigated their use as a photothermal agent in PTT. The presence of the CDs as surface decorations conferred improved photothermal conversion efficiency, photostability, and biocompatibility to the Au@CD when compared to the parent AuNPs. To investigate if the Au@CD could serve as a PTT wound dressing and accelerate tissue repair, they were embedded within a PVA membrane via electrospinning. The resultant Au@CD membrane exhibited excellent biocompatibility and photothermal antimicrobial activity. In vitro photothermal antibacterial inactivation studies confirmed their efficacy against S. aureus and E. coli (99 + % inactivation of both pathogens under NIR irradiation). Moreover, in vivo studies employing Kunming male mice with S. aureus-infected wounds on their backs were chosen as a trauma model, with the Au@CD membranes serving as wound dressings. The results showed that a local temperature increased up to 50 °C upon NIR irradiation could effectively eradicate bacteria at the wound site, reduce the risk of bacterial infection, suppress inflammation as well as improve collagen deposition and angiogenesis, all of which together facilitated wound closure and resulted in a better therapeutic effect than the controls. Taken together, this work confirms that NIR-irradiated Au@CD-based membranes and related materials are promising photothermal antimicrobial platforms for wound dressings and related healthcare applications.

In-situ forming hydrogel based on thiolated chitosan/carboxymethyl cellulose (CMC) containing borate bioactive glass for wound healing

Suitable wound dressings for accelerating wound healing are actively being designed and synthesised. In this study, thiolated chitosan (tCh)/oxidized carboxymethyl cellulose (OCMC) hydrogel containing Cu-doped borate bioglass (BG) was developed as a wound dressing to improve wound healing in a full-thickness skin defect of mouse animal model. Thiolation was used to incorporate thiol groups into chitosan (Ch) to enhance its water solubility and mucoadhesion characteristics. Here, the in situ forming hydrogel was successfully developed using the Schiff-based reaction, and its physio-chemical and antibacterial characteristics were examined. Borate BG was also incorporated in the generated hydrogel to promote angiogenesis and tissue regeneration at the wound site. Investigations of in vitro cytotoxicity assays demonstrated that the synthesised hydrogels showed good biocompatibility and promoted cell growth. These results inspired us to investigate the effectiveness of skin wound healing in a mouse model. On the backs of animals, two full-thickness wounds were created and treated utilising two different treatment conditions: (1) OCMC/tCh hydrogel, (2) OCMC/tCh/borate BG, and (3) control defect. The wound closure ratio, collagen deposition, and angiogenesis activity were measured after 14 days to determine the healing efficacy of the in situ hydrogels used as wound dressings. Overall, the hydrogel containing borate BG was maintained in the defect site, healing efficiency was replicable, and wound healing was apparent. In conclusion, we found consistent angiogenesis, remodelling, and accelerated wound healing, which we propose may have beneficial effects on the repair of skin defects.

Germanene-modified chitosan hydrogel for treating bacterial wound infection: An ingenious hydrogel-assisted photothermal therapy strategy

The elaborate design of an ingenious hydrogel-assisted photothermal therapy (PTT) platform is a promising strategy for treating bacterial wound infections. Herein, a new generation of germanene nanocrystals (Ge NCs) with excellent photothermal performance are prepared via an ice-bath sonication liquid-phase exfoliation technique. Whereafter, by crosslinking interaction between chitosan and zinc acetate, as well as self-assembly property between Ge NCs and chitosan, we successfully construct an innovative germanene-modified chitosan antimicrobial hydrogel (CS/Ge NCs^0.8) integrating capture and killing bacteria performances. When co-cultured with bacteria, CS/Ge NCs^0.8 hydrogel with the positive charge can adsorb and restrict bacteria in the range of PTT destruction. Once the near-infrared laser is introduced, CS/Ge NCs^0.8 hydrogel will effectively convert light energy into localized heat, further inducing bacterial death. By this entirely novel modality, CS/Ge NCs^0.8 hydrogel exhibits marvelous antibacterial property against E. coli and S. aureus in vitro. Furthermore, in vivo studies demonstrate that CS/Ge NCs^0.8 hydrogel possesses the ability to significantly rescue S. aureus-induced skin wound infections, suggesting CS/Ge NCs^0.8 hydrogel can be served as an antibacterial dressing. Strikingly, this is the first-ever report of CS/Ge NCs^0.8 hydrogel in the antibacterial field, which may spur a wave of developing Ge-based biomaterials to benefit biomedical applications.

ε-Poly-l-lysine-modified natural silk fiber membrane wound dressings with improved antimicrobial properties

Many complex diseases, such as bacterial infections, frequently accompany cutaneous wound healing, adding to the difficulty of clinical wound management. Consequently, in addition to displaying strong biocompatibility and actively promoting wound healing, an optimal wound dressing should also possess antimicrobial qualities to address issues with bacterial infection. This paper developed natural silk fiber (SF) membranes (also known as a flat silk cocoon (FSC)) with antimicrobial properties as a dressing for skin wounds. By changing the spinning tools and environment of silkworm larvae, a novel natural SF membrane with a cocoon structure and controllable size was prepared. The functional SF membranes were obtained via a hot press process and grafted with ε-Poly-l-lysine (EPL). The results showed that the SF membrane dressing was adjustable in size with a similar structure to the extracellular matrix (ECM), displaying inherent mechanical properties, excellent antimicrobial qualities, and biocompatibility. In vivo experiments using a full-thickness skin defect model indicated that EPL-modified SF membranes significantly promoted the rate of wound healing, exhibiting thicker granulation tissue and higher collagen disposition than commercial dressings (Tegaderm™ film). Therefore, the excellent mechanical qualities and cytocompatibility of the antimicrobial EPL-modified SF membranes substantially promote their potential application as a chronic wound dressing.

Working in partnership to implement change in wound dressings use

BACKGROUND

Wound care provision relies on safety, effectiveness, patient acceptance and accessibility of selected wound management products, supported by a sound education programme. Challenges with changing patient needs and service provision before and during the COVID-19 pandemic have resulted in new training and service delivery programmes to manage increased prevalence of wounds with dwindling resources.

METHOD

South Warwickshire University NHS Foundation Trust incorporated a wound care audit identifying local challenges, available resources and areas for improvement, which led to changes in practice around training and the supply of dressings. This article sets out the rationale for change and steps taken to implement new practice, keeping the patient at the heart of care while following clinical governance.

RESULTS

The new practice resulted in a rigorous training programme to cover total wound management from assessment to standardised treatment that could encourage self-care where possible and improve patient outcomes. Wise use of all resources to manage stock levels released more qualified staff to focus on complex cases. Non-prescription ordering of dressings reduced stock wastage and the Trust recorded cost savings of more than 25% on the previous year.

CONCLUSION

Sound wound care practice aligned to the National Wound Care Strategy, training in partnership with industry and the use of an efficient dressings delivery system achieved positive patient outcomes and significant financial savings for the Trust.

The cross-linked bacterial cellulose impregnated with octenidine dihydrochloride-based antiseptic as an antibacterial dressing material for highly-exuding, infected wounds

The highly absorbent, antibacterial dressings with a sustained release of the antimicrobial are considered necessary measures to counteract chronic wound biofilm-based infections. This study aimed to analyze wet and dry bacterial cellulose (BC) materials, modified by chemical cross-linking, and impregnated with an antiseptic based on octenidine dihydrochloride (OCT) in the context of its antibiofilm/antibacterial activity, exudate absorption, and cytotoxicity. The native BC was obtained from cost-effective, ecological-friendly potato juice (leftover from the starch industry). The ability to absorb and retain OCT, exudate absorption capacity, the kinetics of OCT release as well as antibiofilm/antibacterial activity of modified BC materials against biofilm-forming and planktonic bacteria (Staphylococcus aureus and Pseudomonas aeruginosa) were investigated. The performed analyses revealed that modified BC materials, thanks to their layered structure with numerous air spaces, were characterized by sustained exudate absorption and OCT release profile, which allowed them to exhibit high antimicrobial activity for up to 7 days, with a reduction of planktonic and biofilm cells of 84-100% and 69-93%, respectively. The modified BC materials showed also no cytotoxicity against fibroblast cell line L929 in vitro and were characterized by firm adhesion to the curved surfaces. These results indicate that cross-linked BC impregnated with OCT may be a particularly promising dressing material (obtained using sustainable processes), especially in the treatment of biofilm-infected, highly-exuding wounds.

Commercial wound dressings for the treatment of exuding wounds: an in-depth physico-chemical comparative study

Background

Nowadays, a wide range of wound dressings is already commercially available. The selection of the dressing is of paramount importance as inappropriate wound management and dressing selection can delay the wound healing process. Not only can this be distressing for the patient, but it can also contribute to complications such as maceration and subsequent infection. Many researchers are targeting the design of dressings with superior properties over existing commercial dressings. However, reported results in the state-of-the-art are rarely benchmarked against commercial dressings. The aim of this study was to determine several characteristics of a large variety of the most frequently used commercial wound dressings, providing an overview for both practitioners and researchers.

Methods

For this comparative study, 11 frequently used commercial wound dressings were selected, representing the different types. The morphology was studied using scanning electron microscopy. The dressings were characterized in terms of swelling capacity (water, phosphate buffered saline and simulated wound fluid), moisture vapour transmission rate (MVTR) and moisture uptake capacity (via dynamic vapour sorption) as well as mechanical properties using tensile testing and texturometry.

Results

The selected dressings showed distinctive morphological differences (fibrous, porous and/or gel) which was reflected in the different properties. Indeed, the swelling capacities ranged between 1.5 and 23.2 g/g (water), 2.1 and 17.6 g/g (phosphate buffered saline) or 2.9 and 20.8 g/g (simulated wound fluid). The swelling capacity of the dressings in water increased even further upon freeze-drying, due to the formation of pores. The MVTR values varied between 40 and 930 g/m²/24 h. The maximal moisture uptake capacity varied between 5.8% and 105.7% at 95% relative humidity. Some commercial dressings exhibited a superior mechanical strength, due to either being hydrophobic or multi-layered.

Conclusions

The present work not only offers insight into a valuable toolbox of suitable wound dressing characterization techniques, but also provides an extensive landscaping of commercial dressings along with their physico-chemical properties, obtained through reproducible experimental protocols. Furthermore, it ensures appropriate benchmark values for commercial dressings in all forthcoming studies and could aid researchers with the development of novel modern wound dressings. The tested dressings either exhibited a high strength or a high swelling capacity, suggesting that there is still a strong potential in the wound dressings market for dressings that possess both.

Application of bacterial nanocellulose-based wound dressings in the management of thermal injuries: Experience in 92 children

BACKGROUND

Management of pediatric thermal injuries involves a high standard of care in a multidisciplinary setting. To avoid physical and psychological sequelae, wound dressings should minimize hospitalization time and anesthesia while maximizing patient comfort.

PATIENTS AND METHODS

190 children with thermal injuries of the torso, arms and legs were treated with polyurethane foam dressings or bacterial nanocellulose sheets. Data were analyzed retrospectively regarding hospitalization, procedures with general anesthesia, scar formation, rate of infection and need for skin grafting.

RESULTS

The groups did not differ significantly concerning age, gender distribution or percentage of injured total body surface area. Statistical analysis showed that length of hospitalized care and procedures undergoing anesthesia were significantly reduced in the nanocellulose group (each p < 0.0001). There was no significant difference in rate of complications, wound healing and rate of skin grafting between the two subgroups.

DISCUSSION

Acting as a temporary epidermal substitute, bacterial nanocellulose enables undisturbed reepithelialization without further wound dressing changes. In children, no additional topical antimicrobial agents are indicated for unimpaired wound healing.

CONCLUSIONS

Bacterial nanocellulose is superior to polyurethane foam regarding length of hospitalization and number of interventions under anesthesia. It offers a safe, cost-effective treatment option and provides excellent comfort in pediatric patients.

Recent progress of collagen, chitosan, alginate and other hydrogels in skin repair and wound dressing applications

Human understanding of skin is constantly ongoing. Great progress has been made in skin repair, wound dressing regeneration biomaterials research in recent years. This review introduced the clinical research and guiding principles of skin repair, wound dressing biomaterials at home and abroad, introduced the classification of various skin repair and wound dressing, listed the composition and performance of different dressing biomaterials, including traditional, natural, synthetic, tissue-engineered dressing materials were extensively reviewed. The biological molecular structures and biological function characteristics of different dressing biomaterials are comprehensively reviewed. Collagen, chitosan, alginate hydrogels et al. as the most popular biological macromolecules in skin repair and wound dressing applications were reviewed. The future development direction is also prospected. This paper reviews the research progress of advanced functional skin repair and wound dressing, which provides a reference for the modifications and applications of wound dressings.

Photo-induced adhesive carboxymethyl chitosan-based hydrogels with antibacterial and antioxidant properties for accelerating wound healing

Designing adhesive hydrogel wound dressings with inherent antibacterial and antioxidant properties is desirable to treat cutaneous full-thickness injuries in clinical care. Herein, a series of photo-induced Schiff base crosslinking-based adhesive hydrogels with promising traits are designed and prepared through Diels-Alder (DA) reactions between functional groups-grafted carboxymethyl chitosan (CMCS) and a photo-responsive polyethylene glycol (PEG) crosslinker. The quaternary ammonium and phenol groups in modified CMCS endows hydrogels excellent antibacterial and antioxidant properties. Upon UV (365 nm) irradiation, the generated o-nitrosobenzaldehyde from the photo-isomerization of o-nitrobenzyl in PEG derivative can subsequently crosslink with amino groups on tissue interfaces via Schiff base, endowing the hydrogel with well adhesiveness. Additionally, the hydrogel exhibits good BSA adsorption capacity, cytocompatibility and hemostatic property. The in vivo full-thickness skin defect study on mice indicates that the multi-functional hydrogel with considerable collagen deposition and vascularization capacities can be an effective and promising adhesive dressing for improving wound healing.

Rhein incorporated silk fibroin hydrogels with antibacterial and anti-inflammatory efficacy to promote healing of bacteria-infected burn wounds

Advanced dressings that can simultaneously prevent bacterial colonization/infection and reduce inflammation are highly desired. A simple strategy was developed to incorporate an anti-inflammatory and antibacterial drug rhein into the structure of silk fibroin (SF) matrix to fabricate a hydrogel dressing. The SF/Rhein hydrogels showed fibrous network nanostructure, high water content (~90%), high water adsorption ability (>2 folds of its own weight), acceptable mechanical strength, biocompatibility and antibacterial properties, suitable as dressings for the treatment of bacterial infected wounds. The SF/Rhein hydrogels enhanced the healing rate of burn wounds by reducing inflammation, expediting angiogenesis, and promoting skin appendages formation, being a promising candidate as wound dressings.

Design, preparation and in vitro characterization of biomimetic and bioactive chitosan/polyethylene oxide based nanofibers as wound dressings

Chitosan-based nanofibers (CS-NFs) are excellent artificial extracellular matrices (ECMs) due to the resemblance of CS with the glycosaminoglycans of the natural ECMs. Despite this excellent feature, the poor electrospinnability and mechanical properties of CS are responsible for important limitations in respect to its biomedical applications. To improve the CS's physico-chemical properties, new bioactive and biomimetic CS-NFs were formulated with polyethylene oxide (PEO), having incorporated different active components (ACs) with important beneficial effects for healing. Manuka honey (trophic and antimicrobial effects), propolis (antimicrobial effects), Calendula officinalis infusion (antioxidant effect, reepithelialization stimulating agent), insulin (trophic effect), and L-arginine (angiogenic effect) were selected as ACs. SEM morphology analysis revealed well-alignment, unidirectional arrays, with small diameters, no beads, and smooth surfaces for developed CS_PEO-ACs NFs. The developed NFs showed good biodegradability (NFs mats lost up to 60% of their initial weight in PBS), increased hemocompatibility (hemolytic index less than 4%), and a reduced cytotoxicity degree (cell viability degree more than 90%). In addition, significant antioxidant and antimicrobial effects were noted for the developed NFs which make them suitable for chronic wounds, due to the role of oxidative stress and infection risk in delaying normal wound healing. The most suitable for wound healing applications seems to be CS_PEO@P_C which showed an improved hemolysis index (2.92 ± 0.16%), is non-toxic (cell viability degree more than 97%), and has also significant radical scavenging effect (DPPH inhibition more than 65%). In addition, CS_PEO@P_C presents increased antimicrobial effects, more noticeably for Staphylococcus aureus strain, which is a key feature in preventing wound infection and delaying the healing process. It can be concluded that the developed CS/PEO-ACs NFs are very promising biomaterials for wound care, especially CS_PEO@P_C.

The Dorsal Skinfold Chamber as a New Tympanic Membrane Wound Healing Model: Intravital Insights into the Pathophysiology of Epithelialized Wounds

BACKGROUND

Tympanic membrane perforations (TMPs) are a common complication of trauma and infection. Persisting perforations result from the unique location of the tympanic membrane. The wound is surrounded by air of the middle ear and the external auditory canal. The inadequate wound bed, growth factor, and blood supply lead to circular epithelialization of the perforation's edge and premature interruption of defect closure. Orthotopic animal models use mechanical or chemical tympanic membrane laceration to identify bioactive wound dressings and overcome premature epithelialization. However, all orthotopic models essentially lack repetitive visualization of the biomaterial-wound interface. Therefore, recent progress in 3D printing of customized wound dressings has not yet been transferred to the unique wound setup of the TMP. Here, we present a novel application for the mice dorsal skinfold chamber (DSC) with an epithelialized full-thickness defect as TMP model.

METHODS

A circular 2-mm defect was cut into the extended dorsal skinfold using a biopsy punch. The skinfold was either perforated through both skin layers without prior preparation or perforated on 1 side, following resection of the opposing skin layer. In both groups, the wound was sealed with a coverslip or left unclosed (n = 4). All animals were examined for epithelialization of the edge (histology), size of the perforation (planimetry), neovascularization (repetitive intravital fluorescence microscopy), and inflammation (immunohistology).

RESULTS

The edge of the perforation was overgrown by the cornified squamous epithelium in all pre-parations. Reduction in the perforation's size was enhanced by application of a coverslip. Microsurgical preparation before biopsy punch perforation and sealing with a coverslip enabled repetitive high-quality intravital fluorescence microscopy. However, spontaneous reduction of the perforation occurred frequently. Therefore, the direct biopsy punch perforation without microsurgical preparation was favorable: spontaneous reduction did not occur throughout 21 days. Moreover, the visualization of the neovascularization was sufficient in intravital microscopy.

CONCLUSIONS

The DSC full-thickness defect is a valuable supplement to orthotopic TMP models. Repetitive intravital microscopy of the epithelialized edge enables investigation of the underlying pathophysiology during the transition from the inflammation to the proliferation phase of wound healing. Using established analysis procedures, the present model provides an effective platform for the screening of bioactive materials and transferring progress in tissue engineering to the special conditions of tympanic membrane wound healing.

Construction of chitosan/Ag nanocomposite sponges and their properties

Chitosan/Ag nanocomposite sponges were prepared by soaking the chitosan hydrogels in AgNO₃ aqueous solution, which was heated at 80 °C to synthesize Ag nanoparticles (AgNPs) in the porous chitosan matrix and freeze-dried. The structure and properties of the nanocomposite sponges were characterized by FT-IR, X-ray diffraction (XRD), scanning electron microscopy (SEM), and compressive testing. In our findings, the pores of the chitosan hydrogel were used as a microreactor to synthesize AgNPs, which could distribute evenly on the chitosan matrix. The chitosan/Ag nanocomposite sponges exhibited good mechanical properties, suitable water vapor transmission and noncytotoxicity. Antibacterial test revealed their excellent antibacterial activity against Staphylococcus aureus and E. coli. The chitosan/Ag nanocomposite sponges would have great potential as wound dressings due to their good properties and facile industrialization.

Enhanced blood coagulation and antibacterial activities of carboxymethyl-kappa-carrageenan-containing nanofibers

Ideal wound dressings should be biocompatible, exhibit high antibacterial activity, and promote blood coagulation. To impart these imperative functions, carboxymethyl-kappa-carrageenan was incorporated into poly(vinyl alcohol) nanofibers (PVA-CMKC). The antibacterial activity of the nanofibers was evaluated. Adsorption of two important blood proteins, fibrinogen and albumin, was also assessed. The adhesion and activation of platelets, and the clotting of whole blood were evaluated to characterize the ability of the nanofibers to promote hemostasis. Adhesion and morphology of both Staphylococcus aureus and Pseudomonas aeruginosa were evaluated using fluorescence microscopy and scanning electron microscopy. CMKC-containing nanofibers demonstrated significant increases in platelet adhesion and activation, percentage of coagulation in whole blood clotting test and fibrinogen adsorption, compared to PVA nanofibers, showing blood coagulation activity. Incorporating CMKC also reduces adhesion and viability of S. aureus and P. aeruginosa bacteria after 24 h of incubation. PVA-CMKC nanofibers show potential application as dressings for wound healing applications.

Coaxial fibers of poly(styrene-co-maleic anhydride)@poly(vinyl alcohol) for wound dressing applications: Dual and sustained delivery of bioactive agents promoting fibroblast proliferation with reduced cell adherence

The prevalence of chronic and acute wounds, as well as the complexity of their treatment represent a great challenge for health systems around the world. In this context, the development of bioactive wound dressings that release active agents to prevent infections and promote wound healing, appears as the most promising solution. In this work, we develop an antibacterial and biocompatible wound dressing material made from coaxial electrospun fibers of poly(styrene-co-maleic anhydride) and poly(vinyl alcohol) (PSMA@PVA). The coaxial configuration of the fibers consists of a shell of poly (styrene-co-maleic anhydride) containing a variable concentration of silver nanoparticles (AgNPs) 0.1-0.6 wt% as antibacterial agent, and a core of PVA containing 1 wt% allantoin as healing agent. The fibers present diameters between 0.72 and 1.7 µm. The release of Ag⁺ in a physiological medium was studied for 72 h, observing a burst release during the first 14 h and then a sustained and controlled release during the remaining 58 h. Allantoin release curves showed significant release only after 14 h. The meshes showed an antibacterial activity against Pseudomonas aeruginosa and Bacillus subtilis that correlates with the amount of AgNPs incorporated and the release rate of Ag⁺. Indeed, meshes containing 0.3 and 0.6 wt% of AgNPs showed a 99.99% inhibition against both bacteria. The adherence and cell viability of the meshes were evaluated in mouse embryonic fibroblasts NIH/3T3, observing a significant increase in cell viability after 72 h of incubation accompanied by a reduced adhesion of fibroblasts that decreased in the presence of the active agents. These results show that the material prepared here is capable of significantly promoting fibroblast cell proliferation but without strong adherence, which makes it an ideal material for wound dressings with non-adherent characteristics and with potential for wound healing.

Antibacterial, antioxidant and biocompatible nanosized quercetin-PVA xerogel films for wound dressing

Topical use of antimicrobial agents to treat wounds to inhibit bacterial invasion and facilitate wound healing is an effective strategy. In this work, an antibacterial xerogel film for potential applications in wound dressings was developed. First, a natural antibacterial agent, quercetin (Qu), was made into water-soluble quercetin-borate (QuB) nanoparticles by merging a solvent exchange method with the borate esterification reaction. QuB nanoparticles were then employed as the cross-linking agent to achieve gelation of poly(vinyl alcohol) (PVA) to obtain antimicrobial QuB-PVA composite microgels. Furthermore, QuB-PVA microgels were utilized as raw materials to produce xerogel films via an electrospray technique. The as-prepared QuB-PVA xerogel films exhibited excellent bacteriostasis, antioxidation, biocompatibility, self-healing, accelerated skin regeneration and functional restoration, and promoted skin wound healing. The QuB-PVA films significantly facilitated the in vivo healing speed of full-thickness skin wounds compared to commercial dressings. We believe that the present multifunctional QuB-PVA xerogel film is an excellent candidate for the wound dressings.

Nanofibrous scaffolds of carboxymethyl guargum potentiated with reduced graphene oxide for in vitro and in vivo wound healing applications

Nanofiber scaffolds mimic the extracellular matrix (ECM) and help in fibroblasts proliferation which is the main constituent for wound healing. This study aims to evaluate the wound healing potential of electrospun nanofibers fabricated by carboxymethyl guargum (CMGG), reduced graphene oxide (rGO) and polyvinyl alcohol. The nanofibers have shown desired properties like excellent porosity and good water holding capacities. The porosity of nanofibers helps in the movement of oxygen to cells and the removal of waste materials and the swelling capacity helps to maintain the moisture content at the wound site. In addition, the in vitro hemocompatibility and wound healing assay have shown excellent results rendering the nanofibers biocompatible. The in vitro fibroblasts (3T3-L1) proliferation was significantly more in rGO/CMGG/PVA nanofibers than CMGG/PVA and cell control. Further, the in vivo wound healing evaluation of these nanofiber dressings in rabbits has shown significant wound closure compared to control and standard. Histology studies revealed the fast collagen formation and re-epithelialization necessary for wound healing among rGO/CMGG/PVA treated rabbits. Therefore, the rGO/CMGG/PVA nanofiber scaffolds can be potential wound dressing candidates and be further evaluated for clinical use.

Cellulose nanocrystals-based materials as hemostatic agents for wound dressings: a review

Wound dressings are devices used to stop bleeding and provide appropriate environmental conditions to accelerate wound healing. The effectiveness of wound dressing materials can be crucial to prevent deaths from excessive bleeding in surgeries and promote complete restoration of the injury. Some requirements for an ideal wound dressing are rapid hemostatic effect, high swelling capacity, antibacterial properties, biocompatibility, biodegradability, and mechanical strength. However, finding all these properties in a single material remains a challenge. In this context, nanocomposites have demonstrated an excellent capacity for this application because of their multifunctionality. One of the emerging materials used in nanocomposite manufacture is cellulose nanocrystals (CNCs), which are rod-like crystalline nanometric structures present on cellulose chains. These nanoparticles are attractive for wound healing applications because of their high aspect ratio, high mechanical properties, functionality and low density. Hence, this work aimed to present an overview of nanocomposites constituted by CNCs for wound healing applications. The review focuses on the most common materials used as matrices, the types of dressing, and their fabrication techniques. Novel wound dressings composites have improved hemostatic, swelling, and mechanical properties compared to other pure biopolymers while preserving their other biological properties. Films, nanofibers mats, sponges, and hydrogels have been prepared with CNCs nanocomposites, and in vitro and in vivo tests have proved their suitability for wound healing.

Bioengineering for curcumin loaded carboxymethyl guargum/reduced graphene oxide nanocomposites for chronic wound healing applications

Biomimetic scaffolds engineering for improved collagen, epithelial cutaneous and fibrous tissue regeneration remains challenging for wound healing. To address these issues, this study aimed to report on the fabrication and characterization of electrospun of carboxymethyl guargum (CMGG), reduced graphene oxide (rGO) nanocomposite dressings loaded with curcumin for chronic wound healing applications. SEM and XRD examined the morphology of nanofibers and resulted in excellent porosity. TGA and FT-IR were done, which revealed the nanofibers' thermal and chemical interactions. CMGG, rGO nanocomposite with curcumin was investigated for in-vitro wound healing assay by scratch wound healing model using 3T3 L1 fibroblast cell lines and conducted in vitro drug-releasing studies. These nanocomposites showed 100% wound closure by the proliferation of fibroblast cell lines 3T3-L1 within 48 h and showed controlled drug release. Further, in vivo results also showed that the CMGG, rGO nanocomposite with curcumin has the potential wound healing effects. Histological studies showed that the CMGG, rGO nanocomposite with curcumin has the potential for wound healing, which indicates that the biomimetic CMGG nanofibers have an excellent healing effect on chronic wounds.

[Modern management of chronic wounds]

The treatment of patients with chronic wounds is a multiprofessional challenge. Based on a comprehensive diagnosis and integrated into a causal treatment concept, patients should always be treated with a modern wound therapy. This wound therapy should try to take into account many different factors such as the wound healing phases, infection status, exudate levels, but also individual patient wishes. Especially in the case of chronic wounds of the lower extremities and edema, compression therapy is also very important for therapy and recurrence prophylaxis. In addition, the pain, which is usually very distressing, should be recorded and adequately treated or avoided. Modern moist wound therapy can then support the healing of patients with chronic wounds, reduce complications and thus improve their quality of life.

Electrospun wound dressings containing bioactive natural products: physico-chemical characterization and biological assessment

Background

Current research on skin tissue engineering has been focusing on novel therapies for the effective management of chronic wounds. A critical aspect is to develop matrices that promote growth and uniform distribution of cells across the wound area, and at the same time offer protection, as well as deliver drugs that help wound healing and tissue regeneration. In this context, we aimed at developing electrospun scaffolds that could serve as carriers for the bioactive natural products alkannin and shikonin (A/S).

Methods

A series of polymeric nanofibers composed of cellulose acetate (CA) or poly(ε-caprolactone) (PCL) and varying ratios of a mixture of A/S derivatives, has been successfully fabricated and their physico-chemical and biological properties have been explored.

Results

Scanning electron microscopy revealed a uniform and bead-free morphology for CA scaffolds, while for PCL beads along the fibers were observed. The average diameters for all nanofibers ranged between 361 ± 47 and 487 ± 88 nm. During the assessment of physicochemical characteristics, CA fiber mats exhibited a more favored profile, while the assessment of the biological properties of the scaffolds showed that CA samples containing A/S mixture up to 1 wt.% achieved to facilitate attachment, survival and migration of Hs27 fibroblasts. With respect to the antimicrobial properties of the scaffolds, higher drug-loaded (1 and 5 wt.%) samples succeeded in inhibiting the growth of Staphylococcus epidermidis and S. aureus around the edges of the fiber mats. Finally, carrying out a structure-activity relationship study regarding the biological activities (fibroblast toxicity/proliferation and antibacterial activity) of pure A/S compounds – present in the A/S mixture – we concluded that A/S ester derivatives and the dimeric A/S augmented cell proliferation after 3 days, whereas shikonin proved to be toxic at 500 nM and 1 μM and alkannin only at 1 μM. Additionally, alkannin, shikonin and acetyl-shikonin showed more pronounced antibacterial properties than the other esters, the dimeric derivative and the A/S mixture itself.

Conclusions

Taken together, these findings indicate that embedding A/S derivatives into CA nanofibers might be an advantageous drug delivery system that could also serve as a potential candidate for biomedical applications in the field of skin tissue engineering.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40824-021-00223-9.

Therapy of infected wounds: overcoming clinical challenges by advanced drug delivery systems

In recent years, the incidence of infected wounds is steadily increasing, and so is the clinical as well as economic interest in effective therapies. These combine reduction of pathogen load in the wound with general wound management to facilitate the healing process. The success of current therapies is challenged by harsh conditions in the wound microenvironment, chronicity, and biofilm formation, thus impeding adequate concentrations of active antimicrobials at the site of infection. Inadequate dosing accuracy of systemically and topically applied antibiotics is prone to promote development of antibiotic resistance, while in the case of antiseptics, cytotoxicity is a major problem. Advanced drug delivery systems have the potential to enable the tailor-made application of antimicrobials to the side of action, resulting in an effective treatment with negligible side effects. This review provides a comprehensive overview of the current state of treatment options for the therapy of infected wounds. In this context, a special focus is set on delivery systems for antimicrobials ranging from semi-solid and liquid formulations over wound dressings to more advanced carriers such as nano-sized particulate systems, vesicular systems, electrospun fibers, and microneedles, which are discussed regarding their potential for effective therapy of wound infections. Further, established and novel models and analytical techniques for preclinical testing are introduced and a future perspective is provided.

A novel hydrogel with self-healing property and bactericidal activity

In this study, we have designed and synthesized a novel poly (4 - vinyl benzene boronic acid - co - N - vinyl pyrrolidone - co - 1 - vinyl - 3 - butylimidazolium bromide) hydrogel (VNV hydrogel) dressing with good self-healing properties and bactericidal activity. The gelation and self-healing of this hydrogel are mainly achieved by the formation of a dynamic B-O-B bond between the polymer chains, which is fractured by external forces and subsequently reformed. This self-healing mechanism is studied in detail through the molecular design of the hydrogel. The introduction of hydrophilic chemical groups can effectively improve the porous structures, water absorption and molecular migration. These properties have a positive effect on improving self-healing properties of dynamic crosslinked hydrogels. Furthermore, this VNV hydrogel dressing displays good antibacterial activity against E. coli, S. aureus, and C. albicans. The application of VNV hydrogel dressing on rat wound surface can effectively accelerate wound healing. These results indicate that this novel VNV hydrogel dressing with good self-healing properties and bactericidal activity has potential applications in wound dressings.

Polymer-based biomaterials for chronic wound management: Promises and challenges

Chronic non-healing wounds tender a great challenge to patients, physicians, and wound care professionals. In view of the increasing prevalence of chronic wounds due to ischemia, diabetic foot, venous, and pressure ulcers, their appropriate management requires significant attention. Along with the basic techniques of medical and surgical treatments; an ideal dressing is essential for a speedy recovery and rapid healing of such wounds. Mechanistic understanding of chronic wound pathology will not only help towards future directions for an ideal dressing model but also to resonant advance research related to specific dressings for various wound types. This review provides key insights into causes, pathophysiology, and critical issues pertaining to chronic wounds and their management. It also summarizes the challenges faced for chronic wound treatment and specified factors responsible for delayed healing. Moreover, this review delivers a detailed discussion on available polymeric materials (alginate, chitosan, hyaluronic acid, collagen, polyurethane, cellulose, dextran, gelatin, silk, and polyaniline), their functional characteristics, and usage as chronic wound healing agents for polymeric wound dressing development. Incorporation and comparison of the research studies for their thermal behavior, structural analysis, and microscopic studies by Fourier transform infrared spectroscopy, thermogravimetric analysis and scanning electron microscopy, respectively and swelling studies of different polymeric materials are discussed. Additionally, studies of anatomy cum physiology of wound healing, pathophysiology, tissue engineering and advance healing management approaches makes the content of this review a significant tool for future studies on chronic wounds healing by polymeric wound dressings. In this review, polymeric wound dressings have been explained in terms of their structures, function, chemistry, and key characteristics. These features are directly linked to the polymeric systems' potential in the management of chronic wounds. These polymeric systems have gained promising success in solving real word global health problems. More recently, innovative approaches to fabricate the polymer dressings have been introduced, but their commercial, sustainable, and high-scale production largely remains unexplored. This review also summarizes the promises of polymeric wound dressings and provides a future perspective on how the clinical and commercial landscape could potentially be propelled by utilizing polymers in wound care management.

A journey to the world of fascinating ZnO nanocomposites made of chitosan, starch, cellulose, and other biopolymers: Progress in recent achievements in eco-friendly food packaging, biomedical, and water remediation technologies

Green chemistry or in other words "green world" is referred to a sustainable environment using biocompatible, biodegradable, renewable, economical, and simple materials, and methods. Without any exaggeration, the exceptional chemical and physical properties of ZnO bionanocomposites beside various utilizations, make it vital materials in research and green chemistry field. Biocompatible ZnO nanoparticles with fascinating antimicrobial, physicochemical, as well as photocatalytic performance could be applied as a prominent candidate to reinforce diverse biopolymer matrixes, for instance, chitosan, starch, cellulose, gelatin, alginate, poly(hydroxyalkanoates), carrageenan, and so on. With a combination of advantageous properties of these materials, they could be illustrated specific utilizations in different areas. In this regard, the following context focuses on highlighting the recent achievements of this category of material on three important and widely used scopes: eco-friendly food packaging, biomedical specially wound dressings, and water remediation technologies.