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The importance of hydration in wound healing: Reinvigorating the clinical perspective
Abstract
Balancing skin hydration levels is important as any disruption in skin integrity will result in disturbance of the dermal water balance. The discovery that a moist environment actively supports the healing response when compared with a dry environment highlights the importance of water and good hydration levels for optimal healing.
The benefits of ‘wet’ or ‘hyper-hydrated’ wound healing appear similar to those offered by moist over a dry environment. This suggests that the presence of free water may not be detrimental to healing, but any adverse effects of wound fluid on tissues is more likely related to the biological components contained within chronic wound exudate, for example elevated protease levels.
Appropriate dressings applied to wounds must not only be able to absorb the exudate, but also retain this excess fluid together with its protease solutes, while concurrently preventing desiccation. This is particularly important in the case of chronic wounds where peri-wound skin barrier properties are compromised and there is increased permeation across the injured skin. This review discusses the importance of appropriate levels of hydration in skin, with a particular focus on the need for optimal hydration levels for effective healing.
Declaration of interest
This paper was supported by Paul Hartmann Ltd. The authors have provided consultative services to Paul Hartmann Ltd.
... [15,16] and inflammatory mediators (e.g., cytokines) [8,10,14], involving numerous signaling pathways [8,10,14]. Under optimal wound healing conditions (e.g., appropriate moisture control, presence and balance of required factors and mediators) [17,18], wounds will completely heal in a timely and organized manner, both functionally and anatomically, usually within three months after the initial injury [9]. This type of wound is known as an acute or nonchronic wound [9]. ...
... A delay of such orderly spatiotemporal wound healing progression in any shape or form, in any of the healing stages, especially in the inflammatory stage, causes the skin to lose some of its functional and structural properties as it leads to the development of a non-healing, chronic wound [9] such as pressure ulcers, and diabetic leg and foot ulcers [9,19]. The development of a chronic wound is usually caused by a range of unfavorable wound healing parameters: (1) a lack of moisture [17,18]; (2) an overabundance of inflammatory cytokines such as tumor necrosis factor (TNF/TNF-α) [14]; (3) elevated accumulation of MMPs (e.g., MMP2) responsible for the degradation of the ECM components [14]; (4) restricted angiogenesis [14]; and (5) impaired autophagy modulation [10,20]. Such parameters can influence wound healing by preventing the commencement of the proliferative stage [14], which in turn can result in a persistent, self-perpetuating and aberrant inflammation and prolonged healing time, usually associated with pain [6,9]. ...
... Appropriate hydration and immunomodulation are hypothesized to modulate autophagy, which in turn acts as a "switch" to turn a chronic wound to an acute one, facilitating healing and recovery, and ultimately leading to wound resolution. Conversely, a lack of hydration and immunomodulation at the wound site prevents the modulated autophagy-induced switch from chronic to acute wounds [5,6,10,17,18,[20][21][22][23][24][25]. Schematic diagram of progression steps of autophagymediated modulation in skin wound healing was created with BioRender (https://Biorender.com/). ...
As a highly regulated and dynamically balanced intracellular degradation mechanism, macroautophagy/autophagy plays an essential housekeeping role in different successive stages of skin wound healing; from the homeostasis and inflammatory stages to the proliferative and remodeling stages. Under both progressive and defective skin wound healing conditions, autophagy operates at different levels with a precise extent of activity, at the interface of inflammation, stress signaling and cell metabolism through a complex spatiotemporal cascade of molecular and cellular events. Depending on the wound healing conditions autophagic activity is fine-tuned and differentially modulated at each stage of skin wound healing in order to cope with stage-specific requirements. Here, we postulate that under favorable conditions autophagy may act as the key modulator of skin wound healing by making chronic wounds acute. Enhancing autophagy through the topical application of pro-autophagy biologics in an appropriate hydrating vehicle/moisturizing base such as hydrogels, onto a chronic skin wound may provide moisture and immune modulation, thus contributing to rapid and efficient skin wound healing. A moist environment is more conducive to skin wound healing as it helps to not only accelerate cell proliferation and migration, and extracellular matrix reorganization, but also promotes autophagy and reduces the incidence of inflammation.
Abbreviation: AKT: AKT serine/threonine protein kinase; ECM: extracellular matrix; FN1: fibronectin 1; LAM: laminin; MMPs: matrix metallopeptidases; MMP2: matrix metallopeptidase 2; MRSA: methicillin-resistant Staphylococcus aureus; MTOR: mechanistic target of rapamycin kinase; PI3K: phosphoinositide 3-kinase; TNF/TNF-α: tumor necrosis factor.
... Збільшення резистентності мікроорганізмів до антибактеріальних препаратів є одним із гострих питань в акушерській практиці. Виявлено високу антибактеріальну стійкість у більшості мікроорганізмів до пеніциліну -97,9%, стрептоміцину -92,6%, тетрацикліну і мономіцину -70%, еритроміцину -91,1%, що ускладнює обрання ефективних антибактеріальних препаратів [1][2][3]5,9,11,12,14,15,18,20,24]. ...
... Тому застосування методів сорбційної терапії, механізм дії яких у рані складається з капілярного дренажу, стимуляції процесів регенерації, сорбції мікробів та їхніх токсинів, ексудату, медіаторів запалення, ферментів, ендотоксинів, обумовлює швидку ліквідацію вогнища інфекції. А наявність імунодепресивного стану макроорганізму при інфікованих ранах є показанням для цілеспрямованого застосування в комплексній терапії гнійних ран у породілей методів імунопрофілактики та імунотерапії [6,9,13,15,19,20]. ...
Aim - based on the study of microbiological factors of the wound process, determine the effectiveness of treatment of obstetric surgical wound infection in women in labor when using drugs with sorption-detoxification and immunomodulatory properties. Materials and methods. Іn the work, microbiological studies were used to control the course of the wound process in 115 parturients with purulent wounds of the anterior abdominal wall after caesarean section and perineum after episiotomy, perineotomy, which, depending on the treatment method, were divided into groups: the Group I - 42 parturients with purulent wounds, which treated with organosilicon sorbent gentaxan; the Group II - 45 women in labor with purulent wounds, who were treated with organosilicon sorbent Gentaxan and immunomodulator Laferon; the Group III - 28 women in labor with purulent wounds, who were treated with traditional methods. The obtained results were processed by methods of statistical analysis. Results. Based on the analysis of microbiological studies, it was determined that the causative agent of purulent wounds in obstetric practice is opportunistic flora, among which S. epidermis. In 28.7%, inflammatory processes in the tissues of postoperative wounds arise under the influence of the symbiotic relationship of aerobic and anaerobic microorganisms. Complex treatment with gentaxan and laferon had an advantage over monotherapy with gentaxan and traditional methods, due to a more pronounced suppression of the pathogenic microflora of the wound and an increase in the number of microbes in its tissues in a shorter period of time, which accelerates the elimination of swelling and inflammation in the wound, the manifestation of symptoms that indicate complete healing biological cleaning of the wound, which, in turn, prevents contamination by hospital infection of the wounds of women in labor and further spread of the inflammatory process. Conclusions. The factor of wound infection is opportunistically pathogenic flora, which in 64.0% is isolated in aerobic and aerobic-anaerobic associations. Complex therapy of purulent wounds with drugs with sorption-detoxification and immunomodulatory properties increases the effectiveness of the treatment, due to the suppression of the pathogenic microflora of the wound and the increase of the number of microbes in its tissues in a shorter period of time, which prevents contamination by hospital infection of the wounds of women in labor and the further spread of the inflammatory process. The research was carried out in accordance with the principles of the Declaration of Helsinki. Research protocol approved by the Local Ethics Committee of the institution mentioned in the work. For conducting research informed consent of the parents was obtained from the women in labor. The authors declare no conflict of interest.
... These corneal healing properties explain its use in oculoplastic surgeries. It is assumed that scar healing is more related to the moist environment provided by petroleum jelly [33], which is present in all ointments used in this study. Carotenoids are precursors of vitamin A and act as antimicrobial agents. ...
... Patients in the LATB free groups were also more likely to experience wound dehiscence. These antibiotic ointments are in an oily form with liquid paraffin which could promote healing [33]. In all cases, statistical differences could be attributed to a too small sample size. ...
Purpose
To assess whether oculoplastic surgeries can be performed without any topical and systemic antibiotics, in a “100% antibiotic free” fashion.
Method
We conducted a multicenter retrospective study between November 2017 and December 2022. Patients who underwent an oculoplastic procedure were screened. Patients who received preoperative or postoperative systemic antibiotics were excluded. Intraoperative IV antibiotics were allowed. Patients were divided into two groups: those who were treated with local antibiotics ointments (LATB group) and those who were treated without local antibiotics ointments (LATB free group) postoperatively. The primary outcome was the incidence of surgical site infections (SSI). The relationship between the use of local antibiotics and the occurrence of SSI was assessed using Fisher’s exact test. The alpha risk was set to 5% and two-tailed tests were used.
Results
Among the 947 procedures included, 617 were included in the LATB group and 330 in the LATB free group. 853 and 80 procedures were classified Altemeier class 1 (clean) and class 2 (clean-contaminated) surgeries, respectively. Overall, 310 (32.73%) procedures were performed without any systemic nor topical antibiotics (100% antibiotic free fashion). SSI occured in four (4/617; 0.65%) and five (5/330; 1.52%) procedures in the LATB and LATB free group respectively, without any statistical difference between the groups (p = 0.290). A subgroup analysis was carried out by excluding the procedures performed under prophylactic intraoperative intravenous antibiotics and did not reveal any statistical difference between the two groups (p = 0.144). All SSI patients were treated with systemic antibiotics with favorable outcomes. Postoperative wound dehiscence was the only risk factor associated with postoperative SSI (p = 0.002).
Conclusion
This study suggests that performing a “100% antibiotic free” oculoplastic surgery without systemic and topical antibiotics is reasonable in Altemeier class 1 and class 2 procedures.
... The results showed that the increasing amount of STO added to the PVA matrix caused the higher water content in material. It suggests that it helps in moisturizing the wound and protecting it from drying out [38]. ...
... The results showed that the increasing amount of STO added to the PVA matrix caused the higher water content in material. It suggests that it helps in moisturizing the wound and protecting it from drying out [38]. Table 4. ...
Bioactive materials may be applied in tissue regeneration, and an example of such materials are wound dressings, which are used to accelerate skin healing, especially after trauma. Here, we proposed a novel dressing enriched by a bioactive component. The aim of our study was to prepare and characterize poly(vinyl alcohol) films modified with strontium titanate nanoparticles. The physicochemical properties of films were studied, such as surface free energy and surface roughness, as well as the mechanical properties of materials. Moreover, different biological studies were carried out, like in vitro hemo- and cyto-compatibility, biocidal activity, and anti-biofilm formation. Also, the degradation of the materials’ utilization possibilities and enzymatic activity in compost were checked.
The decrease of surface free energy, increase of roughness, and improvement of mechanical strength were found after the addition of nanoparticles. All developed films were cyto-compatible, and did not induce a hemolytic effect on the human erythrocytes. The PVA films containing the highest concentration of STO (20%) reduced the proliferation of Eschericha coli, Pseudomonas aeruginosa, and
Staphylococcus aureus significantly. Also, all films were characterized by surface anti-biofilm activity, as they significantly lowered the bacterial biofilm abundance and its dehydrogenase activity. The films were degraded by the compost microorganism. However, PVA with the addition of 20%STO was more difficult to degrade. Based on our results, for wound dressing application, we suggest
using bioactive films based on PVA + 20%STO, as they were characterized by high antibacterial properties, favorable physicochemical characteristics, and good biocompatibility with human cells.
... Слід зазначити, шо отримані нами результати в довоєнний період збігаються з результатами досліджень інших науковців [3,6,8,15,16,18]. ...
Мета - на підставі вивчення мікробіологічних факторів розвитку ранової інфекції в породілей в умовах війни розробити ефективніший метод лікування гнійних ран в акушерській практиці. Матеріали та методи. Вивчено якісний та кількісний склад ранової мікрофлори в 66 породілей із гнійними ранами передньої черевної стінки після кесаревого розтину та промежини після епізіо-, перінеотомії в умовах воєнного стану; проведено порівняння з показниками бактеріологічних досліджень у 76 породілей із гнійними ранами передньої черевної стінки після кесаревого розтину та промежини після епізіо-, перінеотомії в мирний час. Статистичну обробку даних виконано з використанням пакету прикладних програм «Microsoft Exсel 5.0» та за допомогою стандартної версії «Statistica 8.0». Статистично достовірною прийнято різницю показників р<0,05. Результати та висновки. На основі аналізу мікробіологічних досліджень визначено, що збудником гнійних ран в акушерській практиці під час війни на тлі стресу та більшого пригнічення як загального, так і місцевого імунітету є умовно-патогенна флора, серед якої домінує як грампозитивна, так і грамнегативна, а в мирний час найчастішим збудником гнійних ран у породілей є грампозитивна флора, виділена і в монокультурі, і в асоціації з грамнегативними та анаеробними мікроорганізмами. Перше місце серед грампозитивної флори посідає S . еpidermidis, а грамнегативної - Acinetobacter. У 37,9% запальні процеси в тканинах післяопераційних ран виникають під впливом симбіотичного взаємозв’язку аеробно-анаеробних мікроорганізмів, а у 57,6% - асоціації аеробних мікроорганізмів. Дослідження виконано відповідно до принципів Гельсінської декларації. Протокол дослідження ухвалено Локальним етичним комітетом зазначеної в роботі установи. На проведення досліджень отримано інформовану згоду пацієнтів. Автори заявляють про відсутність конфлікту інтересів.
... They help the injured tissue's structural and functional recovery and may also offer defense against external pathogens. A few important points Biocompatibility, fluid (super)absorption, oxygen and water partial permeability, nonimmunogenicity, and easy, nontraumatic removal are all factors that need to be taken into account for a successful wound dressing [69,70]. The current trend in wound care management, despite the large range of commercially available dressings, is to produce customized and performance-enhanced dressings that offer appropriate compositional, structural, and biofunctional properties for a proper wound healing process [71,72]. ...
Nanomaterials, particularly nanoparticles (NPs), have emerged as forefront materials of the 21st century due to their unique properties and potential applications. Silver nanoparticles (AgNPs) are among the most attractive inorganic nanomaterials, widely used due to their significant antibacterial properties, broad-spectrum activity, and potential applications across various fields, including health, food storage, textiles, and environmental solutions. AgNPs exhibit a large surface-area-to-volume ratio, enabling enhanced interaction with bacterial cells, making them effective in medical and industrial applications. Despite concerns over their toxicity, AgNP-based products have been approved by multiple regulatory bodies. Nanoparticle synthesis methods are generally divided into physical, chemical, and biological approaches. Although physical and chemical methods are efficient, they involve toxic chemicals and energy-intensive processes. Biosynthesis, particularly plant-based, offers an eco-friendly alternative, reducing the environmental and health risks associated with chemical agents. The review also explores the therapeutic potential of AgNPs in drug delivery systems, especially in topical formulations like nanoemulsions, solid lipid nanoparticles (SLNs), and nanostructured lipid carriers (NLCs). These nanocarriers enhance drug stability, skin penetration, and controlled release, making them ideal for dermal and transdermal delivery. Moreover, the use of AgNPs in dentistry is highlighted for their bactericidal properties, which help prevent infections and implant failure, with the potential for enhancing therapeutic outcomes without common drawbacks like tooth staining. Overall, AgNPs exhibit promising applications in biomedical, pharmaceutical, and dental fields, and their novel functionalities continue to advance the development of nanotechnology-driven solutions.
... The reconstructed nipple will be covered with a layer of Vaseline sterile gauze before bandaging to promote wet healing. (24)(25)(26) The drain from the mastectomy area was removed when there was less than 30 mL of discharge for 3 consecutive days and no bleeding (2, 27, 28). ...
Background
The current surgical methods for managing incisions after nipple excision in breast reconstruction patients are limited. However, double purse-string suture (DPS) shows promise in the treatment of nipple excision. This study aimed to investigate the safety and aesthetic outcomes of DPS nipple reconstruction in early breast cancer patients who underwent endoscopic skin-sparing mastectomy (E-SSM) and breast reconstruction.
Methods
We retrospectively analyzed the clinical data of 87 early breast cancer patients with nipple excision who underwent E-SSM with breast reconstruction. According to the suture methods of nipple incision, all patients were divided into the spindle suture (SS) group, single purse-string suture (SPS) group, and DPS group, with SS and SPS groups combined as the traditional suture (TS) group. Then, we compared the groups’ differences in aesthetic outcomes, surgical safety, and oncological safety.
Results
A total of 87 patients with 88 breasts were enrolled in this study (SS n=17, SPS n=21, DPS n=50). Patients in the DPS group had significantly better nipple reconstruction satisfaction, Harris scale and any complications incidence than the TS group (all p <0.05). For nipple reconstruction satisfaction and any complication, the adjusted OR (95%CI) of the DPS group were 6.314(1.095-36.415) (p=0.039) and 0.124(0.018-0.863) (p=0.035) compared with the SS group. One patient in the SS group had vertebral metastases, and no recurrence, metastasis, or death has been observed in the other two groups during the follow-up period.
Conclusions
DPS is an effective and safe nipple reconstruction procedure for patients undergoing E-SSM with breast reconstruction, delivering excellent aesthetic outcomes.
... Hydration status is considered a key factor for optimal healing [10]. Dry skin delays wound healing, resulting in poor cosmetic results [11]. ...
Background
Radiofrequency (RF) microneedling produces patient discomfort which deters patients from completing the recommended treatment series.
Objective
The primary objective was to determine the tolerability, safety, and efficacy of a neurocosmetic postprocedure cream post‐RF microneedling in reducing patient discomfort and enhancing recovery across the length of the study and, secondarily, to evaluate against a leading comparator. The third objective was to evaluate the efficacy of the neurocosmetic on self‐perceived improvement and objective grading.
Materials and Methods
An Institutional Review Board (IRB) approved, fourteen‐day, randomized, single‐center, double‐blind, controlled clinical case study was conducted with 11 healthy female subjects, 6 randomized to the neurocosmetic and 5 to the comparator cell. Following a 7‐day washout period, subjects received RF microneedling (face and neck) and applied the postprocedure cream twice daily for 7 days. Objective and subjective tolerability, self‐assessments, and clinical photography were performed immediately postprocedure, 24 h, three and seven days following the procedure.
Results
The neurocosmetic was tolerable and safe. Erythema and stinging immediately decreased postprocedure, postneurocosmetic application. After 24 h, 83% favorably agreed the neurocosmetic “reduced irritation on the skin post‐procedure,” and after 7 days, 100% favorably agreed “experience with the product was positive and I would be interested in returning for a second treatment.” The neurocosmetic reduced skin tone redness in the face and neck faster and to a greater degree when measured against a comparator.
Conclusion
The neurocosmetic postprocedure cream improved patient discomfort and enhanced recovery when used immediately post‐RF microneedling and after 7 days.
IRB Protocol Number
Pro00064211
... Cells need water to function properly, and proper hydration allows them to move into the wound bed to repair tissue. Excess moisture creates a breeding ground for bacteria and can damage surrounding tissue, while dryness slows cellular activity and makes it difficult for new tissue to form [47][48][49]. Maintaining physiological body temperature is also essential. A wound temperature close to body temperature (around 37 • C or 98.6 • F) is ideal for optimal cell function and enzyme activity necessary for healing. ...
Polyphenol is a versatile green phytochemical vital in several biomedical applications with fascinating inherent biocompatible, bioadhesive, antioxidant, and antibacterial properties. The emergence of novel nanotechnology techniques, such as electrospinning, has proven to be an excellent option for applications in nanotechnology, ensuring an effective drug delivery system for recognised medicinal plant extracts containing polyphenols as electrospun nanofibers can provide the necessary environment for encapsulation. Together, electrospun nanofibers and polyphenols have shown promising usage in wound healing. When polyphenols are incorporated into nanofibrous scaffolds, their combined properties enhance cell attachment, proliferation, and differentiation. This review explores the potential of polyphenol-loaded nanofibers for wound therapy, highlighting the importance of efficient drug delivery systems for electrospun polyphenols. It provides a brief assessment of specific polyphenols (resveratrol, curcumin, thymol, quercetin, tannic acid, ferulic acid, hesperidin, gallic acid, kaempferol, chlorogenic acid) that have been successfully encapsulated in electrospun nanofibers and applied in wound treatment. Despite ongoing research, certain polyphenols such as carvacrol, oleuropein, chlorogenic acid, gallic acid, and kaempferol in electrospun nanofibers remain less explored. This review underscores the need for continued investigation into these promising systems while recognising the growing application of polyphenol-loaded nanofibers in wound healing and their potential for more extensive therapeutic use.
... This fact paves the way for the development of new therapies that are more effective in managing burn wounds, especially in accelerating healing and reducing the risk of postinjury complications. 5 Therefore, this study was designed to systematically explore the effect of topical administration of Physeter Macrocephalus ambergris on the epithelialization of second-degree burn wounds in a rat animal model. Through an experimental approach, this research aims to provide scientific evidence that can support the use of Physeter Macrocephalus ambergris as an alternative treatment for burns, with the hope of improving clinical outcomes and quality of life for patients who experience burns. ...
... Their ability to retain moisture and promote hydration is crucial in creating a conducive environment for cell proliferation and tissue repair. By enhancing moisture uptake into the skin, these hydrotropes may facilitate the hydration of damaged or dry tissues, supporting the regeneration process [25]. As for the broader spectrum of tissue regeneration applications involving non-natural amino acids, the modification of sodium montmorillonite (Na-MMT) clay with unnatural amino acids emerges as a promising strategy for crafting intercalated clay structures with potential applications in bone biomaterials. ...
This study presents the chemical synthesis, purification, and characterization of a novel non-natural synthetic amino acid. The compound was synthesized in solution, purified, and characterized using NMR spectroscopy, polarimetry, and melting point determination. Dynamic Light Scattering (DLS) analysis demonstrated its ability to form aggregates with an average size of 391 nm, extending to the low micrometric size range. Furthermore, cellular biological assays revealed its ability to enhance fibroblast cell growth, highlighting its potential for tissue regenerative applications. Circular dichroism (CD) spectroscopy showed the ability of the synthetic amino acid to bind serum albumins (using bovine serum albumin (BSA) as a model), and CD deconvolution provided insights into the changes in the secondary structures of BSA upon interaction with the amino acid ligand. Additionally, molecular docking using HDOCK software elucidated the most likely binding mode of the ligand inside the BSA structure. We also performed in silico oligomerization of the synthetic compound in order to obtain a model of aggregate to investigate computationally. In more detail, the dimer formation achieved by molecular self-docking showed two distinct poses, corresponding to the lowest and comparable energies, with one pose exhibiting a quasi-coplanar arrangement characterized by a close alignment of two aromatic rings from the synthetic amino acids within the dimer, suggesting the presence of π-π stacking interactions. In contrast, the second pose displayed a non-coplanar configuration, with the aromatic rings oriented in a staggered arrangement, indicating distinct modes of interaction. Both poses were further utilized in the self-docking procedure. Notably, iterative molecular docking of amino acid structures resulted in the formation of higher-order aggregates, with a model of a 512-mer aggregate obtained through self-docking procedures. This model of aggregate presented a cavity capable of hosting therapeutic cargoes and biomolecules, rendering it a potential scaffold for cell adhesion and growth in tissue regenerative applications. Overall, our findings highlight the potential of this synthetic amino acid for tissue regenerative therapeutics and provide valuable insights into its molecular interactions and aggregation behavior.
... Their ability to retain moisture and promote hydration is crucial in creating a conducive environment for cell proliferation and tissue repair. By enhancing moisture uptake into the skin, these hydrotropes may facilitate the hydration of damaged or dry tissues, supporting the regeneration process [25]. As for the broader spectrum of tissue regeneration applications involving non-natural amino acids, the modification of sodium montmorillonite (Na-MMT) clay with unnatural amino acids emerges as a promising strategy for crafting intercalated clay structures with potential applications in bone biomaterials. ...
This study presents the chemical synthesis, purification, and characterization of a novel non-natural synthetic amino acid. The compound was synthesized in solution, purified, and characterized using NMR spectroscopy, polarimetry, and melting point determination. Dynamic Light 22 Scattering (DLS) analysis demonstrated its ability to form aggregates with an average size of 391 nm, extending to low micrometric sizes. Furthermore, cellular biological assays revealed its ability to enhance fibroblast cell growth, highlighting its potential for tissue regenerative applications. Circular dichroism (CD) spectroscopy showed the ability of the synthetic amino acid to bind serum albumins (using bovine serum albumin (BSA) as a model), and CD deconvolution provided insights into the changes in secondary structures of BSA upon interaction with the amino acid ligand. Additionally, molecular docking using HDOCK software elucidated the most likely binding mode of the ligand inside the BSA structure. We also performed in silico oligomerization of the synthetic compound in order to obtain a model of aggregate to investigate computationally. More in detail, in the dimer formation achieved by molecular self-docking, two distinct poses were observed, corresponding to the lowest and comparable energies, with one pose exhibiting a quasi-coplanar arrangement characterized by a close alignment of two aromatic rings from the synthetic amino acids within the dimer, suggesting the presence of π-π stacking interactions. In contrast, the second pose displayed a non-coplanar configuration, with the aromatic rings oriented in a staggered arrangement, indicating distinct modes of interaction. Both poses were further utilized in the self-docking procedure. Notably, iterative molecular docking of amino acid structures resulted in the formation of higher-order aggregates, with a model of a 512-mer aggregate obtained through self-docking procedures. This model of aggregate presented a cavity capable of hosting therapeutic cargoes and biomolecules, rendering it a potential scaffold for cell adhesion and growth in tissue regenerative applications. Overall, our findings highlight the potential of this synthetic amino acid for tissue regenerative therapeutics and provide valuable insights into its molecular interactions and aggregation behavior.
... As a result, more effective re-vascularization and re-epithelialization of the wounds are mitigated. However, excessive fluid retention at the wound site can lead to poorer healing and maceration of the surrounding tissue [30,31]. This is particularly important as chronic wounds are associated with higher levels of exudate production through the persistent inflammatory environment [32]. ...
A new ceramic dressing, free from active antimicrobial or pharmaceutical agents, uses physical binding mechanisms for its absorption capacities and bacterial-binding properties. The purpose of this study was to evaluate wound healing, bacterial-related retention, and diagnostic properties of ceramic dressings in patients with stagnated chronic wounds. Methods: In this monocentric, intra-individually controlled, prospective study, patients with conservatively treated refractory chronic wounds were enrolled. One week before the start of the application with ceramic dressing, it was ensured during a screening phase that chronic wounds showed less than a 10% reduction in wound size. During the 4-week ceramic dressing treatment wound size measurements, wound scoring, measurement of wound exudate amount, wound swabs, and ceramic dressing sonication (low-intensity ultrasound) were carried out. The sonication fluid of the removed ceramic dressing was used for analysis of bacterial retention and compared to wound swabs. Results: A total of 20 patients with a mean age of 64.6 years (±26.2) and 21 chronic wounds were included in this study. After a 4-week treatment, a significant reduction of median wound size from 1178 mm2 (range 104–6300) to 751.5 mm2 (range 16–4819) and better total wound scores were observed (p < 0.001). The sensitivity of bacteria detection was 90.7% in the sonication fluid from the ceramic dressings, while only 76.9% in the conventional wound swabs. Conclusion: The new ceramic dressing seems to have a positive impact on wound healing in chronic wounds. Bacteria-binding characteristics of the investigated ceramic dressing, in combination with its debridement, absorption, and detoxification properties, could contribute to its healing abilities. Based on those results, the investigated ceramic dressing seems to be a promising new treatment option for chronic wounds without the use of any active antimicrobial or pharmacological agents. Moreover, ceramic dressings can also be considered for microbiological diagnostic purposes.
... Following the manufacturer's recommendations on the application and intended use of each wound dressing represent crucial steps when choosing the proper dressing. Both basic and advanced wound dressings should protect from external influences, reduce the risk of contamination (e.g., by acting as a mechanical barrier), prevent mechanical trauma to the wound and the surrounding tissue, absorb associated secretions, not stick to the wound (reducing pain and trauma upon removal of the dressing), and improve patient comfort [67][68][69]. The mechanical barrier function offered by wound dressings represents an important aspect: by providing a barrier against germs, foreign bodies, and dirt particles, the wound dressing takes on critical protective functions of the skin and is, therefore, crucial in enabling an undisturbed wound healing process [70]. ...
The development of innovative products for treating acute and chronic wounds has become a significant topic in healthcare, resulting in numerous products and innovations over time. The growing number of patients with comorbidities and chronic diseases, which may significantly alter, delay, or inhibit normal wound healing, has introduced considerable new challenges into the wound management scenario. Researchers in academia have quickly identified promising solutions, and many advanced wound healing materials have recently been designed; however, their successful translation to the market remains highly complex and unlikely without the contribution of industry experts. This review article condenses the main aspects of wound healing applications that will serve as a practical guide for researchers working in academia and industry devoted to designing, evaluating, validating, and translating polymer wound care materials to the market. The article highlights the current challenges in wound management, describes the state-of-the-art products already on the market and trending polymer materials, describes the regulation pathways for approval, discusses current wound healing models, and offers a perspective on new technologies that could soon reach consumers. We envision that this comprehensive review will significantly contribute to highlighting the importance of networking and exchanges between academia and healthcare companies. Only through the joint of these two actors, where innovation, manufacturing, regulatory insights, and financial resources act in harmony, can wound care products be developed efficiently to reach patients quickly and affordably.
... The overall strategy for preparing HA-DA@rhCol hydrogels for wound healing is illustrated in Fig. 1. The selection of HA as the primary constituent of the hydrogels was based on its exceptional water-binding properties, which facilitate the creation of a moist wound environment and contribute to enhanced tissue regeneration and accelerated wound closure [23]. To confer HA with enhanced adhesiveness and antioxidant properties, the conjugation of DA to HA was achieved through EDC/NHS chemical crosslinking (Fig. 1). ...
The management of chronic wounds in diabetes remains challenging due to the complexity of impaired wound healing, delayed healing, susceptibility to infection, and elevated risk of reopening, highlighting the need for effective chronic wound management with innovative approaches such as multifunctional hydrogels. Here, we have produced HA-DA@rhCol hydrogels consisting of dopamine-modified hyaluronic acid and recombinant human collagen type-III (rhCol) by oxidative coupling of the catechol group using the H2O2/HRP catalytic system. The post-reactive hydrogel has a good porous structure, swelling rate, reasonable degradation, rheological and mechanical properties, and the catechol group and dopamine impart to the hydrogel tissue adhesiveness, antioxidant capacity, and excellent photothermal effects leading to superior in vitro antimicrobial activity. In addition, the ability of rhCol to confer hydrogels to promote angiogenesis and wound repair has also been investigated. Cytotoxicity and hemolysis tests demonstrated the good biocompatibility of the hydrogel. Wound closure, collagen deposition and immunohistochemical examination confirmed the ability of the hydrogel to promote diabetic wound healing. In summary, the adhesive hemostatic antioxidative hydrogel with rhCol to promote wound healing in diabetic rat is an excellent chronic wound dressing.
... Encapsulation of a PS in a wound dressing,nano-formulations like carbon dots, nanoparticles are expected to provide means to control the quantity of PS molecules to be delivered to the target site while preventing spillage of the PS molecules to surrounding tissue, which in turn minimize the chances of off-site tissue damage upon light exposure [10][11][12][13][14]. In addition, dressings can act as barriers to external contaminants, promote absorption of ulcer exudate, maintain moisture balance and prevent desiccation during light exposure [15,16]. ...
Antimicrobial wound dressings play a crucial role in treatment of wound infections. However, existing commercial options fall short due to antibiotic resistance and the limited spectrum of activity of newly emerging antimicrobials against bacteria that are frequently encountered in wound infections. Antimicrobial photodynamic therapy (aPDT) is very promising alternative therapeutic approach against antibiotic resistant microbes such as methicillin resistant Staphylococcus aureus (MRSA). However, delivery of the photosensitizer (PS) homogeneously to the wound site is a challenge. Though polymeric wound dressings based on synthetic and biopolymers are being explored for aPDT, there is paucity of data regarding their in vivo efficacy. Moreover, there are no studies on use of PS loaded, pluoronic (PL) and pectin (PC) based films for aPDT. We report development of a polymeric film for potential use in aPDT. The film was prepared using PL and PC via solvent casting approach and impregnated with Methylene blue (MB) for photodynamic inactivation of MRSA in vitro and in vivo. AFM imaging of the films yielded vivid pictures of surface topography, with rough surfaces, pores, and furrows. The PL:PC ratio (2:3) was optimized that would result in an intact film but exhibit rapid release of MB in time scale suitable for aPDT. The film showed good antibacterial activity against planktonic suspension, biofilm of MRSA upon exposure to red light. Investigations on MRSA infected excisional wounds of mice reveal that topical application of MB loaded film for 30 min followed by red light exposure for 5 min (fluence; ~30 J/cm2) or 10 min (fluence; ~60 J/cm2) reduces ~80 or ∼92% of bioburden, respectively. Importantly, the film elicits no significant cytotoxicity against keratinocytes and human adipose derived mesenchymal stem cells. Taken together, our data demonstrate that PS-loaded PL-PC based films are a promising new tool for treatment of MRSA infected wounds.
... Wound dressing is crucial in the wound healing process because it is a temporary physical barrier to prevent further injury and infection, which can exacerbate the wound 53 . The condition of a wound environment that is moist and clean will support wound healing, and the hydrogel is a platform for wound dressings that are currently widely used to support these conditions 54,55 . Hydrogel has properties that can provide suitable environmental conditions for wound healing, especially chronic wounds, and several other benefits 56 . ...
Diabetes mellitus (DM) is a metabolic disease characterized by increased blood sugar levels (hyperglycemia) and is associated with impaired function of β cells. The uncontrolled and prolonged hyperglycemia in DM can cause complications. One of the most common is diabetic non-healing wounds, the leading cause of disability in people with diabetes, therefore adjuvant therapy is needed. Compounds from natural ingredients are currently getting the spotlight in recent studies conducted to prove their effect on non-healing wounds, such as Resveratrol (RSV). This review aims to discuss the potential of RSV as a novel adjuvant therapy and its delivery system strategy in the case of diabetic non-healing wounds. We conducted an extensive search from three online scientific databases such as ScienceDirect, ResearchGate, and PubMed on February-March 2023. Keywords used are "resveratrol", "diabetic wound healing", and "diabetes mellitus". As a result, 86 studies were reviewed, and only 79 selected studies met all inclusion criteria. The formulation of RSV nanoparticles in oral drug delivery systems and topical administration has shown promise to overcome the limitations of RSV as adjuvant therapy in diabetic non-healing wounds. The best option that we found through this literature review is the nano-oral drug delivery system as it could minimize drug metabolism in the gastrointestinal tract, therefore the drug bioavailability and drug concentration on the target site could be maximized, even though the systemic side effects might occur.
... The silk threads provide adequate drainage to allow for the timely drainage of large amounts of exudate and pus during the inflammatory secretion phase, providing a relatively moist yet not overly wet environment for the patient's trauma to heal. [13][14][15] Control group: using traditional debridement dressing change method Steps: (1) Remove the dressing from the wound: Ask the patient to take a lateral position, the surgeon removes the adhesive tape and outer gauze by hand and slowly withdraws the old vaseline oil gauze along the long axis of the wound with forceps. Do not pull forcefully, if there is any adhesion, use saline cotton ball to soak it and then remove it to avoid injury and bleeding so as not to injure the wound surface and cause bleeding. ...
Background
Dressing change is the most important part of postoperative wound care. The aim of this study was to evaluate whether a more effective, simple and less painful method of dressing change for anal fistulas could be found without the need for debridement and packing. Data related to postoperative recovery were recorded at postoperative days 3, 7, 14, 21 and 180.
Methods
In this experiment, 76 subjects diagnosed with high anal fistula were randomly divided into a simplified dressing change (SDC) group and a traditional debridement dressing change(TDDC) group according to a ratio of 1:1.
Results
The SDC group had significantly fewer pain scores, bleeding rates, dressing change times, inpatient days and lower average inpatient costs than the TDDC group. There were no significant differences in wound healing time, area and depth and Wexner score between the two groups.
Conclusions
Studies have shown that the use of simplified dressing changes does not affect cure or recurrence rates, but significantly reduces dressing change times and pain during changes, reducing patient inpatient length of stay and costs.
... As already known, hydration status is an important factor in wound healing [26][27][28]. This study revealed a coherence between the hydration status and the wound healing process, especially the coagulation pathway, which is one of the main processes in wound healing [29]. ...
Due to multifactorial reasons, such as decreased thirst and decreased total body water, elderly patients are vulnerable to dehydration. The study aims to investigate whether moderate dehydration or hyperhydration affects the blood proteome. Blood samples, medication, and bioelectrical impedance analysis (BIA) details were collected from 131 geriatric patients (77 women and 54 men aged 81.1 ± 7.2 years). Based on an evaluation by Bioelectrical Impedance Vector Analyses (BIVAs) of this cohort, for each hydration status (dehydrated, hyperhydrated, and control), five appropriate blood plasma samples for both males and females were analyzed by liquid chromatography–mass spectrometry (LC-MS). Overall, 262 proteins for female patients and 293 proteins for male patients could be quantified. A total of 38 proteins had significantly different abundance, showing that hydration status does indeed affect the plasma proteome. Protein enrichment analysis of the affected proteins revealed “Wound Healing” and “Keratinization” as the two main biological processes being dysregulated. Proteins involved in clot formation are especially affected by hydration status.
... Traditional wound dressings made from cotton or synthetic fibers can help to keep wounds dry but have a limited effect on the acceleration of wound healing. Additionally, dry healing is not conducive to epithelial tissue growth; yet notably, wounds are more prone to mechanical re-injury during dressing changes [6]. Current wound dressings involve various polymer-based systems with multi-functions that have shown promising potential to speed up wound healing [7]. ...
The treatment of skin wounds caused by trauma and pathophysiological disorders has been a growing healthcare challenge, posing a great economic burden worldwide. The use of appropriate wound dressings can help to facilitate the repair and healing rate of defective skin. Natural polymer biomaterials such as collagen and hyaluronic acid with excellent biocompatibility have been shown to promote wound healing and the restoration of skin. However, the low mechanical properties and fast degradation rate have limited their applications. Skin wound dressings based on biodegradable and biocompatible synthetic polymers can not only overcome the shortcomings of natural polymer biomaterials but also possess favorable properties for applications in the treatment of skin wounds. Herein, we listed several biodegradable and biocompatible synthetic polymers used as wound dressing materials, such as PVA, PCL, PLA, PLGA, PU, and PEO/PEG, focusing on their composition, fabrication techniques, and functions promoting wound healing. Additionally, the future development prospects of synthetic biodegradable polymer-based wound dressings are put forward. Our review aims to provide new insights for the further development of wound dressings using synthetic biodegradable polymers.
... Additionally, the antibacterial effect of these nanoparticles is associated with oxidative stress, as evidenced by increased reactive oxygen species and lipid peroxidation. Other studies indicate that silver nanoparticles increase cell membrane permeability, inactivate enzymes, interfere with intracellular ATP levels, cause DNA damage, and induce the formation of reactive oxygen species [45][46][47][48][49]. ...
Wound infections are feared complications due to their potential to increase healthcare costs and cause mortality since multidrug-resistant bacteria reduce treatment options. This study reports the development of a carbomer hydrogel containing biogenic silver nanoparticles (bioAgNPs) and its effectiveness in wound treatment. This hydrogel showed in vitro bactericidal activity after 2 h, according to the time-kill assay. It also reduced bacterial contamination in rat wounds without impairing their healing since the hydrogel hydrophilic groups provided hydration for the injured skin. The high number of inflammatory cells in the first days of the skin lesion and the greater degree of neovascularization one week after wound onset showed that the healing process occurred normally. Furthermore, the hydrogel-containing bioAgNPs did not cause toxic silver accumulation in the organs and blood of the rats. This study developed a bioAgNP hydrogel for the treatment of wounds; it has a potent antimicrobial action without interfering with cicatrization or causing silver bioaccumulation. This formulation is effective against bacteria that commonly cause wound infections, such as Pseudomonas aeruginosa and Staphylococcus aureus, and for which new antimicrobials are urgently needed, according to the World Health Organization's warning.
... Dehydration disturbs cell metabolism and wound healing. Moreover, adequate fluid intake is necessary to support blood flow to wounded tissues and prevent breakdown of skin components such as the stratum corenum [42,43]. The therapeutic potential of cannabinoids for integumentary wound healing [44] and the isoflavonoid, equol has estrogenic actions such as skin hydration, cellular/tissue repair and wound healing [23,27] have been reported elsewhere. ...
Background
While cannabidiol (CBD) and 4’,7-isoflavandiol (Equol) have been examined individually in various skin studies, the present investigation tested whether topically applied CBD with Equol may yield enhanced effects on human skin biomarkers.
Methods
After 24 hours exposure human skin gene expression was measured by quantitative polymerase chain reaction-messenger ribonucleic acid (qPCR-mRNA) analysis across 9 functional skin categories covering 97 biomarkers.
Results
In general, among the biomarkers analyzed the CBD with Equol treatment displayed greater efficacy compared to CBD only or the Equol treatment alone (e.g., 4 out 5 for anti-acne, 15 out of 17 for anti-aging [e.g., collagen, elastin, calcium binding protein A7, tissue inhibitor of matrix metalloproteinase 1 (TIMP 1), etc.], 19 out of 21 for anti-inflammatory (pain), 10 out of 11 for antioxidants to protect against oxidative stress, 6 out of 6 for circadian rhythm regulation for cell repair/restoration, 10 out of 15 for anti-pigmentation properties, 4 out of 5 for skin hydration, 6 out of 6 for tissue integrity, and 11 out of 12 for wound healing properties).
Conclusions
CBD with Equol displayed synergistic effects that may be an effective topical treatment for dermatology and cosmetic applications to improve human skin health and reduce photo-aging.
... Hydrogels combined with honey have multiple benefits and are considered ideal wound dressings to promote healing [20,78,79] (Figure 5). Hydrogels are 3D structures crosslinked with hydrophilic characteristics that can hold abundant volumes of water and other liquids [11,80]. Thus, it is applicable for wound healing due to its high porosity, excessive water content, ability to release therapeutic agents, excellent biocompatibility, biodegradability, and it can accelerate the wound healing process [5,19,81]. ...
Excellent wound dressings should have crucial components, including high porosity, non-toxicity, high water absorption, and the ability to retain a humid environment in the wound area and facilitate wound healing. Unfortunately, current wound dressings hamper the healing process, with poor antibacterial, anti-inflammatory, and antioxidant activity, frequent dressing changes, low biodegradability, and poor mechanical properties. Hydrogels are crosslinked polymer chains with three-dimensional (3D) networks that have been applicable as wound dressings. They could retain a humid environment on the wound site, provide a protective barrier against pathogenic infections, and provide pain relief. Hydrogel can be obtained from natural, synthetic, or hybrid polymers. Honey is a natural substance that has demonstrated several therapeutic efficacies, including anti-inflammatory, antibacterial, and antioxidant activity, which makes it beneficial for wound treatment. Honey-based hydrogel wound dressings demonstrated excellent characteristics, including good biodegradability and biocompatibility, stimulated cell proliferation and reepithelization, inhibited bacterial growth, and accelerated wound healing. This review aimed to demonstrate the potential of honey-based hydrogel in wound healing applications and complement the studies accessible regarding implementing honey-based hydrogel dressing for wound healing.
... There are numerous local and systemic elements that delay wound healing. Examples of local factors include tissue hypoxia [22][23][24] , infection [25][26][27] , and hydration [28][29][30] . Systemic factors include ageing [31,32] , smoking [33][34][35] , stress [36,37] , diabetes [38] , and obesity [39] . ...
Wounds represent various significant health concerns for patients and also contribute major costs to healthcare systems. Wound healing comprises of overlapped and various coordinated steps such as homeostasis, inflammation, proliferation, and remodelling. In response to the failure of many strategies in delivering intended results including wound closure, fluid loss control, and exhibiting properties such as durability, targeted delivery, accelerated action, along with histocompatibility, numerous nanotechnological advances have been introduced. To understand the magnitude of wound therapy, this systematic and updated review discussing the effectiveness of nanoemulsions has been undertaken. This review portrays mechanisms associated with wound healing, factors for delayed wound healing and various technologies utilized to treat wounds effectively. While many strategies are available, nanoemulsions have attracted tremendous attention of scientists globally for the research in wound therapy due to their long-term thermodynamic stability and bioavailability. Nanoemulsions not only aid in tissue repair, but also considered as an excellent delivery system for various synthetic and natural actives. Nanotechnology provides several pivotal benefits in wound healing, including improved skin permeation, controlled release and stimulation of fibroblast cell proliferation. Significant role of nanoemulsions in improved wound healing along with their preparation techniques has also been highlighted with special emphasis on mechanistic insights. This article illustrates recent research advancements for the utilization of nanoemulsions in wound treatment. Adequate literature search has been conducted using keywords "Nanoemulsions in wound healing", "Wound therapy and nanoemulsions", "Herbal actives in wound therapy", Natural oils and wounds treatment" etc. from PubMed, Science Direct and Google Scholar databases. Referred and original publications in the English language accessed till April 2022 has been included, whereas non-English language papers, unpublished data and non-original papers were excluded from the study.
... Chronic skin wounds impose a significant medical burden on patients, particularly those with burns [1][2][3][4]. A good skin wound dressing must satisfy the following criteria [5]: good tissue compatibility, which avoids toxicity or inflammation [6,7], and good moisture retention, which keeps the wound moist and increases cell hydration [8], as well as suitable physical and mechanical durability, which ensures the dressing's integrity and prevents external bacterial infection caused by material damage [9]. For many years, N-acryloylmorpholine (ACMO) and its high molecular weight polymers have been researched [10]. ...
In this study, poly(AA-co-ACMO) and polyurethane-based nanofibers were prepared in a ratio of 1:1 (NF11) and 2:1 (NF21) as antimicrobial carriers for chronic wound management. Different techniques were used to characterize the nanofibers, and poly(AA-co-ACMO) was mostly found on the surface of PU. With an increase in poly(AA-co-ACMO) dose from 0 (PU) and 1:1 (NF11) to 2:1 (NF21) in the casting solution, the contact angle (CA) was reduced from 137 and 95 to 24, respectively, and hydrophilicity was significantly increased. As most medications inhibit biological processes by binding to a specific protein, in vitro protein binding was investigated mechanistically using a stopped-flow technique. Both NF11 and NF21 bind to BSA via two reversible steps: a fast second-order binding followed by a slow first-order one. The overall parameters for NF11 (K a = 1.1 × 10 4 M −1 , K d = 89.0 × 10 −6 , ∆G 0 = −23.1 kJ mol −1) and NF21 (K a = 189.0 × 10 4 M −1 , K d = 5.3 × 10 −6 M, ∆G 0 = −27.5 kJ mol −1) were determined and showed that the affinity for BSA is approximately (NF11)/(NF21) = 1/180. This indicates that NF21 has much higher BSA affinity than NF11, although BSA interacts with NF11 much faster. NF21 with higher hydrophilicity showed effective antibacterial properties compared to NF11, in agreement with kinetic data. The study provided an approach to manage chronic wounds and treating protein-containing wastewater.
... Reports in the literature acknowledge the difficulty in determining the "optimum" moisture/dryness to be achieved for wound healing. (71) In general, it is necessary to provide moisture to the wound, as moisture enables cell migration, cell signaling, re-epithelialization, and robust ECM formation, to increase the rate of healing and reduce scar formation. (72)(73)(74) The unaffected skin surrounding a wound can become damaged (ie, macerated) (75) (76)(77) if the wound treatment inadvertently increases the moisture in those areas. ...
Extremely low-birthweight (ELBW) infants are at increased risk for infection because the innate immune function of their skin is underdeveloped as they lack a competent epidermal barrier. Thus, neonatal clinicians need to pay careful attention to skin care practices, particularly for periviable infants. In this review, we describe the challenges of skin care in ELBW infants and summarize strategies to prevent skin injury, minimize damage when it occurs, and enhance cutaneous innate immunity.
Background
Skin water measurements are used to investigate skin physiology, clinically study dermatological issues, and for conditions like diabetes, oedema, and lymphedema with measurements done at various times of day (TOD). One method used is skin's tissue dielectric constant (TDC), often clinically measured to a single depth of 2.5 mm. This report characterizes intraday variations measured to multiple depths to guide expected TOD and depth dependence.
Materials and Methods
Twelve medical students self‐measured TDC on their forearm to depths of 0.5, 1.5, 2.5, and 5.0 mm every 2 h from 08:00 to 24:00 h on 2 consecutive days. All were trained in the procedure.
Results
TDC declined slightly from morning through evening, mostly at 0.5 mm for which TDC was reduced by 4%. TDC values were not related to participants' whole‐body fat or water percentages. The TDC decrease was less at 1.5 mm where the reduction was 2.7%. At depths of 2.5 or 5.0 mm, there was no significant decrease in TOD.
Conclusion
Skin TDC shows a minor decreasing trend with an effect greater for shallower depths. In part, the clinical relevance of the findings relates to the confidence level associated with skin water estimates, based on TDC measurements, when measured at different TOD and depths during normal clinic hours. Based on the present data the TOD change is at most 4% and insignificant for measurement depths of 2.5 mm.
Introduction:
Three interrelated skin water assessments include stratum corneum hydration (SCH) via electrical measurements, skin water using tissue dielectric constant (TDC) measurements, and transepidermal water loss (TEWL). These are differentially used for skin physiology research, clinical assessments of dermatological conditions and to assess skin water in diabetes and lymphedema. Often volar forearm skin is used for assessments done at various times of day (TOD). The present goal was to assess the extent of intraday variability in SCH, TDC, and TEWL.
Methods:
Twelve medical students self-measured SCH, TDC, and TEWL on their forearm every 2 h from 08:00 to 24:00 h on 2 consecutive days. All participants were well trained and pre-certified in all procedures. Tests for parameter differences among TOD were via the nonparametric Friedman test.
Results:
No significant differences in SCH or TEWL were found among TOD over the 16-h interval for either day or combined. Contrastingly, TDC decreased slightly but significantly from morning through evening. There was no evidence of a diurnal pattern. Interestingly, a significant nonlinear relationship between TEWL and SCH was detected.
Conclusion:
Findings indicate only minor intraday variations with TOD trend except for TDC which decreases slightly from morning through evening. The clinical relevance relates to the confidence now gained associated with the parameter estimates when measured at different TOD during normal clinic hours or beyond. This should help in estimating the potential importance of small differences if measured at a different TOD. From a physiological viewpoint, the findings uncover and describe an interesting nonlinear relationship between TEWL and SCH which may serve to propel further investigations that might better characterize this process.
Objective
Managing the gap between the dressing and the wound bed can facilitate the healing of exuding wounds. A silicone foam dressing (Biatain Silicone; Coloplast A/S, Denmark) was developed for application to exuding wounds. A sub-analysis of the real-world, prospective, observational VIPES (Observatoire en Ville des Plaies ExSudatives) study was conducted to investigate the use and performance of the silicone foam dressing in a community nursing setting in France.
Method
The sub-analysis included patients from the VIPES study who received the silicone foam dressing as a primary dressing for an acute or hard-to-heal (chronic) wound. Epidemiological and wound healing outcomes were reported via a smartphone application.
Results
Overall, 64 patients were included in the sub-analysis. At baseline, most wounds (n=33/40; 82.5%) were in treatment failure (i.e., were stagnant, non-healing or had poor exudate management). At the last follow-up visit, a median of 22.5 (range: 3–151) days post baseline, 48.4% of wounds had healed and 25.0% were progressing towards healing. From baseline to the last follow-up visit, significant reductions in exudate level (p<0.0001) and exudate pooling (p<0.0001), and significant improvements in wound edges (p≤0.0001) and periwound skin (p<0.01) were observed. A total of 62.3% of patients had re-epithelialising wounds at the last follow-up visit. The majority of nurses (88.3%) and patients (85.0%) reported that the wound had improved and, at most dressing removals (93.5%), nurses reported that the dressing conformed closely to the wound bed.
Conclusion
Overall, the data suggest that use of the silicone foam dressing in community practice supported the healing of wounds, illustrating the importance of exudate and gap management.
Background
Skin hydration (SKH) measurements are used for multiple purposes: to study skin physiology, to clinically investigate dermatological issues, and to assess localized skin water in pathologies like diabetes and lymphedema. Often the volar forearm is measured at various times of day (TOD). This report aims to characterize intra‐day variations in volar forearm SKH to provide guidance on expected TOD dependence.
Materials and methods
Forty medical students (20 male) self‐measured tissue dielectric constant (TDC) on their non‐dominant forearm in triplicate as an index of local skin tissue water every 2 h starting at 0800 and ending at 2400 h. All were trained and pre‐certified in the procedure and had whole‐body fat (FAT%) and water (H2O%) measured. Day average TDC (TDCAVG) was determined as the average of all time points expressed as mean ± SD.
Results
Males versus females had similar ages (25.1 ± 2.2 years vs. 25.1 ± 1.5 years), higher H2O% (56.6 ± 5.0 vs. 51.8 ± 5.7, p = 0.002), and higher TDCAVG (32.7 ± 4.1 vs. 28.5 ± 5.1, p = 0.008). TDC values were not significantly impacted by H2O% or FAT%. Female TDC exhibited a significant decreasing trend from morning to night (p = 0.004); male TDC showed no trend.
Conclusion
Skin water assessed by TDC shows some intra‐day variations for females and males but with quite different temporal patterns. Clinical relevance relates to the confidence level associated with skin hydration estimates when measured at different times of day during normal clinic hours which, based on the present data, is expected to be around 5% for both males and females.
Microneedles for skin regeneration are conventionally restricted by uncontrollable multi-drug release, limited types of drugs, and poor wound adhesion. Here, a novel core-shell microneedle patch is developed for scarless skin...
Minor and severe burn injuries are common and highly complicated pathology causing huge mortality and costly wound treatment protocols. In this work, an injectable microgel assembly was developed to accelerate burn wound healing rate and quality where the network formation occurred after injection of the precursor on the wound bed. Poly(hexamethylene biguanide) (PHMB), an amine-containing antibacterial polymer, was synthesized and functioned as a linker of microgels by the addition of a specific deep eutectic solvent (DES) as a catalyst for particles connection. The major function of the eutectic mixture was to assist in the cross-linking of the microgels; however, it could play as an antibacterial agent against Gram + bacteria. The THDES was prepared by the reaction of arginine with ascorbic acid (Asc), and glycerol ([DES]Arg/G,A), two of which are known as the components involved in the wound healing process. Depending on the PHMB concentration, the microgel assembly experienced a gel-to-sol transition under shear stresses ranging from 104 to 105 Pa and exhibited much stronger antibacterial activities as the fraction of PHMB increased. Application of the developed hydrogel promoted healing of the infected burned rat, enhanced re-epithelialization, and attenuated the formation of fibrotic scar tissue.
Introduction: Diabetic foot and complicated ulcers are relatively common occurrence in daily surgical topatient department for managing them various dressing materials and solutions are available. One of suchis acriflavine emulsion.Case Presentation: Both patients were diabetic having large ulcers over leg 2nd was Hepatitis B positivealso having large leg ulcer due to insect bite. In both Acriflavine emulsion was used as dressing material.STSG was performed in both and graft were accepted with uneventful post op courseDiscussion: Acriflavine made from acridine has a local antiseptic property with Antimicrobial and antiviralaction it does have a skin irritant 1 property but to neutralise that glycerine was used in 1:1000 emulsionConclusion: Acriflavine which was used in world war1 as antiseptic solution for war wounds can be usedfor dressing of complicated ulcers and wounds to gainbetter results.
Wounds in diabetes is a complex problem that requires effective treatment at a high cost. Adjuvant therapy from natural bioactive elements can be an alternative to overcome problems in diabetic wound healing disorders. Allicin and quercetin are natural bioactive substances contained in several fruit or vegetable plants that have various pharmacological effects. The purpose of this study was to determine the effect of allicin and quercetin in emulsion form as wound medicine in helping the wound healing process. Diabetic wistar rats with wounds on their backs measuring 1 × 1 cm were divided into four treatment groups which were given wound medicine once a day for seven days according to their distribution. The wound healing process was evaluated on the third and seventh day. Data were observed and analyzed using appropriate statistical tools. Measurement of wound healing indicators was carried out by examining wound contraction and histopathological examination showing that the treatment group given the allicin and quercetin formula experienced an improvement compared to the treatment group without allicin and quercetin. Allicin and quercetin increase the percentage of wound contraction, increase the density of blood vessels and the epithelialization process in the wound so that the wound healing process becomes faster. In conclusion, allicin and quercetin can be effective adjuvant therapies in helping wound healing in diabetes. Wound medication in the form of an emulsion is an effective choice, because it can maintain the stability of the allicin and quercetin content and can make the wound environment moist.
Chronic diabetic wounds have been an urgent clinical problem, and wound dressings play an important role in their management. Due to the design of traditional dressings, it is difficult to achieve adaptive adhesion and on-demand removal of complex diabetic wounds, real-time monitoring of wound status, and dynamic adjustment of drug release behavior according to the wound microenvironment. Smart hydrogels, as smart dressings, can respond to environmental stimuli and achieve more precise local treatment. Here, we review the latest progress of smart hydrogels in wound bandaging, dynamic monitoring, and drug delivery for treatment of diabetic wounds. It is worth noting that we have summarized the most important properties of smart hydrogels for diabetic wound healing. In addition, we discuss the unresolved challenges and future prospects in this field. We hope that this review will contribute to furthering progress on smart hydrogels as improved dressing for diabetic wound healing and practical clinical application.
Detailed knowledge of the anatomy of skin is important for the skillful planning and execution of all neurosurgical approaches, restoration of tissues, and avoidance of complications. Structure of skin varies greatly with respect to age, thickness, pigmentation, anatomical location and direction of relaxed skin tension lines, and hair distribution. An understanding of the microbiome of skin is important in the preparation of skin and hair for surgery, prevention of surgical site infections, and in the treatment of infections. The ability of skin to heal makes surgery possible. Minimization of infections and achievement of cosmetic healing require detailed understanding of the healing process and its optimization. The surgery of skin is a major component of plastic surgery, but receives little focused teaching in the course of neurosurgical training and only light attention in neurosurgical literature. The consequences of suboptimal surgical technique can lead to infection, excessive scarring, patient dissatisfaction, or poor outcomes.
The skin of an adult is the largest organ of the body, weighing about six pounds (approximately 15% of total adult body weight), having a surface area of approximately 2 square meters, and containing a third of the body’s blood volume (Wysocki, Anatomy and physiology of skin and soft tissue, In: Acute and chronic wounds: current management concepts, 4th ed, Minneapolis, Elsevier, pp 40–62, 2016). Skin consists of two primary layers, epidermis and dermis, and the latter contains skin appendages which include hair follicles, sebaceous glands, sweat glands, and nails.
Diabetic wounds (DWs) pose a major challenge for the public health system owing to their high incidence, complex pathogenesis, and long recovery time; thus, there is an urgent need to develop innovative therapies to accelerate the healing process of diabetic wounds. As natural nanovesicles, extracellular vesicles (EVs) are rich in sources with low immunogenicity and abundant nutritive molecules and exert potent therapeutic effects on diabetic wound healing. To avoid the rapid removal of EVs, a suitable delivery system is required for their controlled release. Owing to the advantages of high porosity, good biocompatibility, and adjustable physical and chemical properties of hydrogels, EV biopotentiated hydrogels can aid in achieving precise and favorable therapy against diabetic wounds. This review highlights the different design strategies, therapeutic effects, and mechanisms of EV biopotentiated hydrogels. We also discussed the future challenges and opportunities of using EV biopotentiated hydrogels for diabetic wound healing.
Objective: People have used traditional herbal medicines for wound care since the dawn of time. This study aimed to assess the cutaneous wound healing effects of wheat germ oil (WGO) and quince seed mucilage (QSM) in rats. Methods: Adult female Wistar albino rats were allocated to one of the three groups: rats treated with topical WGO (n=6); topical QSM (n=6); and topical saline (n=6) as the control group. Two circular, full-thickness wounds of 0.6 mm diameter were created on the dorsal thoracic region of each rat. Test and control solutions were applied twice daily for 14 days. Wound healing was assessed by measuring the wound contraction rate and the time needed for complete epithelialization. Results: When compared with the control group, rats in the WGO group had reduced wound closure rates in the first four days, but considerably greater rates in the 8th, 10th, and 12th days, as well as a shorter duration of time needed to complete epithelialization (11 days vs. 13 days). The wound closure rates of the rats in the QSM group were not substantially different from the control rats and the duration of time needed for complete epithelialization was not significantly different from the control group. Conclusion: WGO use has been shown to improve wound healing. It may be used as an alternative or complementary approach for wound treatment depending on the severity of the wounds. On the other hand, QSM was not found to improve wound healing.
Butyrate is a key bacterial metabolite that plays an important and complex role in modulation of immunity and maintenance of epithelial barriers. Its translation to clinic is limited by poor bioavailability, pungent smell, and the need for high doses, and effective delivery strategies have yet to realize clinical potential. Here, a novel polymeric delivery platform for tunable and sustainable release of butyrate consisting of a methacrylamide backbone with butyryl ester or phenyl ester side chains as well as mannosyl side chains, which is also applicable to other therapeutically relevant metabolites is reported. This platform's utility in the treatment of non‐healing diabetic wounds is explored. This butyrate‐containing material modulated immune cell activation in vitro and induced striking changes in the milieu of soluble cytokine and chemokine signals present within the diabetic wound microenvironment in vivo. This novel therapy shows efficacy in the treatment of non‐healing wounds through the modulation of the soluble signals present within the wound, and importantly accommodates the critical temporal regulation associated with the wound healing process. Currently, the few therapies to address non‐healing wounds demonstrate limited efficacy. This novel platform is positioned to address this large unmet clinical need and improve the closure of otherwise non‐healing wounds.
Significance: Matrix metalloproteinases (MMPs) are present in both acute and chronic wounds. They play a pivotal role, with their inhibitors, in regulating extracellular matrix degradation and deposition that is essential for wound reepithelialization. The excess protease activity can lead to a chronic nonhealing wound. The timed expression and activation of MMPs in response to wounding are vital for successful wound healing. MMPs are grouped into eight families and display extensive homology within these families. This homology leads in part to the initial failure of MMP inhibitors in clinical trials and the development of alternative methods for modulating the MMP activity. MMP-knockout mouse models display altered wound healing responses, but these are often subtle phenotypic changes indicating the overlapping MMP substrate specificity and inter-MMP compensation. Recent Advances: Recent research has identified several new MMP modulators, including photodynamic therapy, protease-absorbing dressing, microRNA regulation, signaling molecules, and peptides. Critical Issues: Wound healing requires the controlled activity of MMPs at all stages of the wound healing process. The loss of MMP regulation is a characteristic of chronic wounds and contributes to the failure to heal. Future Directions: Further research into how MMPs are regulated should allow the development of novel treatments for wound healing.
A growing body of literature supports use of negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) with positive clinical outcomes and potential cost savings. A retrospective analysis was performed to compare clinical outcomes of wounds treated with NPWTi-d versus NPWT and to estimate cost-differences between treatments based on clinical outcomes.
Data were extracted from records of patients with extremity or trunk wounds treated with NPWT (n = 34) or NPWTi-d using saline or polyhexanide (n = 48). On the basis of outcomes data, a hypothetical economic model using cost assumptions was created to calculate cost savings for NPWTi-d (related to) number of debridements and length of therapy. Operating room debridement cost was 194.80 (NPWTi-d) and 8143 for operating room debridements between NPWTi-d (14,929) patients. There was a 799/NPWTi-d vs $2217/NPWT).
In this study, NPWTi-d appeared to assist in wound cleansing and exudate removal, which may have allowed for earlier wound closure compared to NPWT. Hypothetical economic model findings illustrate potential cost-effectiveness of NPWTi-d compared to NPWT.
The TIME acronym (tissue, infection/inflammation, moisture balance and edge of wound) was first developed more than 10 years ago, by an international group of wound healing experts, to provide a framework for a structured approach to wound bed preparation; a basis for optimising the management of open chronic wounds healing by secondary intention. However, it should be recognised that the TIME principles are only a part of the systematic and holistic evaluation of each patient at every wound assessment. This review, prepared by the International Wound Infection Institute, examines how new data and evidence generated in the intervening decade affects the original concepts of TIME, and how it is translated into current best practice. Four developments stand out: recognition of the importance of biofilms (and the need for a simple diagnostic), use of negative pressure wound therapy (NPWT), evolution of topical antiseptic therapy as dressings and for wound lavage (notably, silver and polyhexamethylene biguanide) and expanded insight of the role of molecular biological processes in chronic wounds (with emerging diagnostics and theranostics). Tissue: a major advance has been the recognition of the value of repetitive and maintenance debridement and wound cleansing, both in time-honoured and novel methods (notably using NPWT and hydrosurgery). Infection/inflammation: clinical recognition of infection (and non infective causes of persisting inflammation) is critical. The concept of a bacterial continuum through contamination, colonisation and infection is now widely accepted, together with the understanding of biofilm presence. There has been a return to topical antiseptics to control bioburden in wounds, emphasised by the awareness of increasing antibiotic resistance. Moisture: the relevance of excessive or insufficient wound exudate and its molecular components has led to the development and use of a wide range of dressings to regulate moisture balance, and to protect peri-wound skin, and optimise healing. Edge of wound: several treatment modalities are being investigated and introduced to improve epithelial advancement, which can be regarded as the clearest sign of wound healing. The TIME principle remains relevant 10 years on, with continuing important developments that incorporate new evidence for wound care.
Sequestration of harmful proteases as human neutrophil elastase (HNE) from the chronic wound environment is an important goal of wound dressing design and function. Monosaccharides attached to cellulose conjugates as ester-appended aldohexoses and ketohexoses were prepared on cotton gauze as monosccharide-citrate-cellulose-esters for HNE sequestration. The monosaccharide-cellulose analogs demonstrated selective binding when the derivatized cotton dressings were measured for sequestration of HNE. Each monosaccharide-cellulose conjugate was prepared as a cellulose citrate-linked monosaccharide ester on the cotton wound dressing, and assayed under wound exudate-mimicked conditions for elastase sequestration activity. A series of three aldohexose and four ketohexose ester cellulose conjugates were prepared on cotton gauze through citric acid-cellulose cross linking esterification. The monosaccharide portion of the conjugate was characterized by hydrolysis of the citrate-monosaccharide ester bond, and subsequent analysis of the free monosaccharide with high performance anion exchange chromatography. The ketohexose and aldohexose conjugate levels on cotton were quantified on cotton using chromatography and found to be present in milligram/gram amounts. The citrate-cellulose ester bonds were characterized with FTIR. Ketohexose-citrate-cellulose conjugates sequestered more elastase activity than aldohexose-citrate-cellulose conjugates. The monosaccharide cellulose conjugate families each gave distinctive profiles in elastase-lowering effects. Possible mechanisms of elastase binding to the monosaccharide-cellulose conjugates are discussed.
The efficacy of NPWT in promoting wound healing has been largely accepted by clinicians, yet the number of high-level clinical studies demonstrating its effectiveness is small and much more can be learned about the mechanisms of action. In the future, hopefully we will have the data to assist clinicians in selecting optimal parameters for specific wounds including interface material, waveform of suction application, and the amount of suction to be applied. Further investigation into specific interface coatings and instillation therapy are also needed. We believe that advances in mechanobiology, the science of wound healing, the understanding of biofilms, and advances in cell therapy will lead to better care for our patients.
Significance: The increasing complexity of medical and surgical care provided to pediatric patients has resulted in a population at significant risk for complications such as pressure ulcers, nonhealing surgical wounds, and moisture-associated skin damage. Wound care practices for neonatal and pediatric patients, including the choice of specific dressings or other wound care products, are currently based on a combination of provider experience and preference and a small number of published clinical guidelines based on expert opinion; rigorous evidence-based clinical guidelines for wound management in these populations is lacking. Recent Advances: Advances in the understanding of the pathophysiology of wound healing have contributed to an ever-increasing number of specialized wound care products, most of which are predominantly marketed to adult patients and that have not been evaluated for safety and efficacy in the neonatal and pediatric populations. This review aims to discuss the available data on the use of both more traditional wound care products and newer wound care technologies in these populations, including medical-grade honey, nanocrystalline silver, and soft silicone-based adhesive technology. Critical Issues: Evidence-based wound care practices and demonstration of the safety, efficacy, and appropriate utilization of available wound care dressings and products in the neonatal and pediatric populations should be established to address specific concerns regarding wound management in these populations. Future Directions: The creation and implementation of evidence-based guidelines for the treatment of common wounds in the neonatal and pediatric populations is essential. In addition to an evaluation of currently marketed wound care dressings and products used in the adult population, newer wound care technologies should also be evaluated for use in neonates and children. In addition, further investigation of the specific pathophysiology of wound healing in neonates and children is indicated to promote the development of wound care dressings and products with specific applications in these populations.
Successful treatment of wounds relies on precise control and continuous monitoring of the wound-healing process. Wet or moist treatment of wounds has been shown to promote re-epithelialization and result in reduced scar formation, as compared to treatment in a dry environment.
By treating wounds in a controlled wet environment, delivery of antimicrobials, analgesics, other bioactive molecules such as growth factors, as well as cells and micrografts, is allowed. The addition of growth factors or transplantation of cells yields the possibility of creating a regenerative wound microenvironment that favors healing, as opposed to excessive scar formation.
Although several manufacturers have conceived products implementing the concept of moist wound healing, there remains a lack of commercial translation of wet wound-healing principles into clinically available products. This can only be mitigated by further research on the topic.
The strong evidence pointing to the favorable healing of wounds in a wet or moist environment compared to dry treatment will extend the clinical indications for this treatment. Further advances are required to elucidate by which means this microenvironment can be optimized to improve the healing outcome.
Neutrophils are one of the most abundant cells of the immune system and they are extremely active during the repair of cutaneous wounds. In general, the antimicrobial activity of neutrophils is effective and allows these cells to carry out their primary function of preventing wounds from becoming infected.
It is now known that in addition to sterilizing the wound, the weapons used by neutrophils to kill potential pathogens can also cause significant tissue damage to the host. This additional damage can lead to delayed healing and excessive scar formation.
Much of the host damage caused by neutrophils results from the activity of proteases secreted by these cells. The clinical significance of this problem is highlighted by numerous studies showing that high levels of neutrophil-derived proteases are associated with chronic, non-healing wounds.
Studies are currently being performed to evaluate new ways of counteracting protease activity in chronic wounds. Additional studies will have to be carried out to determine whether neutralizing neutrophil proteases can improve the healing of chronic wounds without sacrificing the ability of neutrophils to eliminate pathogens and risking infection.
The process of wound healing includes the regulated destruction of proteins via enzymes called proteinases. However, when the proteolytic process becomes excessive, pro-healing factors are destroyed and the wound healing process stalls. Matrix metalloproteinases (MMPs) are one key class of proteinases that have been observed to be elevated in many cases of failed wound healing.
Two key advances have been made in recent years. First is that, until recently, MMPs were only implicated in impaired healing of chronic wounds. Measurements of MMPs in wound fluids and serum from individuals with acute traumatic wounds have revealed that elevated MMPs are predictive of both impaired healing and of dehiscence of surgically closed wounds. The second advance is in the development of at least three clinically viable methods for measuring MMPs at the point of care.
At present there is no objective method of determining proteinase levels within a wound. Since elevated MMPs have now been shown to be predictive of dehiscence in surgically closed acute wounds, a new clinical utility for measuring MMPs has been established. With the advent of several new technologies to measure MMPs, the translation of this valuable molecular knowledge into improved therapeutic regimens is nearly complete.
The clinical utility of measuring MMPs continues to expand and be further validated with each new investigation. The tools that will enable clinicians to leverage this valuable information are nearing maturity and integration into the clinic.
The stratum corneum, the outer layer of mammalian skin, provides a remarkable barrier to the external environment, yet it has highly variable permeability properties where it actively mediates between inside and out. On prolonged exposure to water, swelling of the corneocytes (skin cells composed of keratin intermediate filaments) is the key process by which the stratum corneum controls permeability and mechanics. As for many biological systems with intricate function, the mesoscale geometry is optimized to provide functionality from basic physical principles. Here we show that a key mechanism of corneocyte swelling is the interplay of mesoscale geometry and thermodynamics: given helical tubes with woven geometry equivalent to the keratin intermediate filament arrangement, the balance of solvation free energy and elasticity induces swelling of the system, importantly with complete reversibility. Our result remarkably replicates macroscopic experimental data of native through to fully hydrated corneocytes. This finding not only highlights the importance of patterns and morphology in nature but also gives valuable insight into the functionality of skin.
Superabsorbent polymer (SAP)-containing wound dressings present a valuable and unique category of wound management products. An in vitro approach was used to assess the effects of a new SAP dressing in treatment of non-healing wounds. It was shown that the SAP dressing possesses a significant binding capacity for MMP-2 and MMP-9 in vitro (P < 0.001). The inclusion of the bound proteases was so strong that no MMP-2 and only marginal amounts of MMP-9 were released from the dressing samples in a subsequent elution step. In addition, the SAP dressing was able to take up collagenase and reduce its activity in vitro. However, collagenase was not completely inactivated upon binding and enzyme-mediated substrate turnover could be observed at the dressings. In conclusion, in vitro data confirm the positive effect of the SAP wound dressing observed in vivo. The findings suggest that it should be specifically useful for highly exuding wounds with an elevated proteolytic activity that needs to be reduced to support healing.
Unlabelled:
Acute and chronic wounds impact the lives of millions of patients. Since its introduction, negative pressure wound therapy using reticulated open cell foam (NPWT/ROCF) has significantly improved the healing outcome for many of these wounds.
Methods:
The effects of intermittent instillation of normal saline in conjunction with NPWT were investigated to determine if instillation therapy provides additional benefits in wound healing. Conventional NPWT/ROCF as delivered by V.A.C.® Therapy was compared to V.A.C. Instill® Therapy with normal saline in the treatment of porcine full-thickness excisional wounds. Wounds were treated with NPWT/ROCF or NPWT/ROCF with instillation therapy at approximately 4 cycles of normal saline instillation per day and dwell times of either 5 or 60 minutes for the instilled saline on the wound bed.
Results:
Instillation therapy with normal saline at either dwell time elicited a faster rate of wound filling with granulation tissue that contained an increase in total collagen content compared to continuous NPWT/ROCF alone. Analyses of wound contraction and the hydration state of the treated tissue exhibited no apparent differences between the experimental instillation therapy groups and the control NPWT/ROCF group.
Conclusion:
Collectively, these data suggest that instillation therapy with normal saline may lead to wound fill with higher quality granulation tissue composed of increased collagen following wounding of cutaneous tissue compared to the use of NPWT/ROCF alone. .
The problem of cutaneous scarring has conventionally been approached as a pathology of the dermis. Multiple lines of evidence from the clinic, in vitro experiments, and in vivo animal and human studies, however, increasingly suggest that the epidermis plays a major role in the control of underlying dermal scar. Building on the demonstrated efficacy of silicone gel occlusion, in this paper we review the evidence for epidermal regulation of scar, and propose the novel hypothesis that dermal fibrosis is exquisitely linked to the inflammatory state of the epidermis, which in turn is linked to hydration state as a function of epidermal barrier function. In the spectrum of factors contributing to dermal scar, the epidermis and its downstream effectors offer promising new targets for the development of antiscar therapies.
The oral mucosa is frequently exposed to mechanical forces, which may result in tissue damage. Saliva contributes to the repair of the oral mucosa in several ways. In the first place, it creates a humid environment to improve the function of inflammatory cells. During the last few years, it has been shown that saliva also contains a large number of proteins with a role in wound healing. Saliva contains growth factors, especially Epidermal Growth FACTOR, which promotes the proliferation of epithelial cells. Trefoil factor 3 and histatin promote the process of wound closure. The importance of Secretory Leucocyte Protease Inhibitor is demonstrated by the fact that in the absence of this salivary protein, oral wound healing is considerably delayed. Understanding these salivary proteins opens the way for the development of new wound healing medications.
Objective:
Patients with diabetes often present with pedal wounds resistant to standard wound healing modalities and become chronic in nature. These chronic wounds in diabetic patients have a high incidence of complications including infection and amputation. Negative pressure wound therapy has been found to facilitate healing of the stagnant pedal wound. This protocol was designed to determine wound closure rates using a unique negative pressure wound therapy system that delivers vacuum-assisted wound closure with a simultaneous irrigation feature (Svedman Wound Treatment System).
Methods:
A prospective single center study was conducted in adults with diabetic foot ulcers ≥cm(2) or more in size showing no signs of clinical infection, and having adequate blood flow. Patients received dressing changes and irrigation on a standard regimen with weekly wound assessments for a minimum of 6 weeks.
Results:
11 women and 8 men with a mean wound size of 2.4 cm × 2.2 cm were treated with the device. A total of 14 of /19 (74%) patients healed completely, with a median healing time of 34 days (range, 9-114). Eleven of 19 patients (58%) healed within the 6-week evaluation period. For the 5 patients who did not heal completely with the device, other treatments were utilized, including further wound debridement, muscle flaps, and skin grafting procedures.
Conclusions:
Negative pressure wound therapy with integrated irrigation was well tolerated by the patients without complications related to the device application or irrigation feature. The data clearly suggests that this technology may be a promising alternative for the chronic nonhealing diabetic wound.
In this review, I first provide relevant background information about normal epidermal barrier structure and function. I then update recent information about how inherited defects in either filaggrin and/or in the serine protease inhibitor, lymphoepithelial Kazal-type inhibitor 1, converge to stimulate the development of atopic dermatitis (AD). Next I explain the multiple mechanisms whereby a primary barrier abnormality in AD can lead to inflammation. Furthermore, I explore how certain acquired stressors, such as a reduced external humidity, high pH soaps/surfactants, psychological stress, as well as secondary Staphylococcus aureus infections initiate or further aggravate AD. Finally, and most importantly, I compare various therapeutic paradigms for AD, highlighting the risks and benefits of glucocorticoids and immunomodulators vs. corrective, lipid replacement therapy.
Negative pressure wound therapy (NPWT) is frequently employed in the treatment of complex wounds. A variety of wound chemotherapeutic agents such as insulin, which acts as a growth factor, may prove helpful in treatment as well. We present a case report in which insulin was used as a chemotherapeutic agent in continuous-instillation NPWT. To our knowledge, this is the first report in the literature describing this method of delivery.
Moist wound care has been established as standard therapy for chronic wounds with impaired healing. Healing in acute wounds, in particular in minor superficial acute wounds - which indeed are much more numerous than chronic wounds - is often taken for granted because it is assumed that in those wounds normal phases of wound healing should run per se without any problems. But minor wounds such as small cuts, scraps or abrasions also need proper care to prevent complications, in particular infections. Local wound care with minor wounds consists of thorough cleansing with potable tap water or normal saline followed by the application of an appropriate dressing corresponding to the principles of moist wound treatment. In the treatment of smaller superficial wounds, it appears advisable to limit the choice of dressing to just a few products that fulfil the principles of moist wound management and are easy to use. Hydroactive colloid gels combining the attributes of hydrocolloids and hydrogels thus being appropriate for dry and exuding wounds appear especially suitable for this purpose - although there is still a lack of data from systematic studies on the effectiveness of these preparations.
Winter's seminal work in the 1960s relating to providing an optimal level of moisture to aid wound healing (granulation and re-epithelialisation) has been the single most effective advance in wound care over many decades. As such the development of advanced wound dressings that manage the fluidic wound environment have provided significant benefits in terms of healing to both patient and clinician. Although moist wound healing provides the guiding management principle, confusion may arise between what is deemed to be an adequate level of tissue hydration and the risk of developing maceration. In addition, the counter-intuitive model 'hyper-hydration' of tissue appears to frustrate the moist wound healing approach and advocate a course of intervention whereby tissue is hydrated beyond what is a normally acceptable therapeutic level. This paper discusses tissue hydration, the cause and effect of maceration and distinguishes these from hyper-hydration of tissue. The rationale is to provide the clinician with a knowledge base that allows optimisation of treatment and outcomes and explains the reasoning behind wound healing using hyper-hydration.
Declaration of interest:
K. Cutting is a Clinical Research Consultant to the medical device and biotechnology industry. M. Rippon is Visiting Clinical Research Fellow, University of Huddersfield and K. Ousey provides consultancy for a range of companies through the University of Huddersfield including consultancy services for Paul Hartmann Ltd on HydroTherapy products.
It has long been recognized that the skin is responsible for preventing excessive loss of water from the body. In severe burns the fluids of the body are readily lost, and serious alterations in the electrolyte balance within the body result. Although the water-withholding function of the skin has long been generally recognized, there has not been, to our knowledge, any detailed study which attempted to determine which layer or layers of the skin are responsible for retarding loss of water through this structure. The following experiments were carried out to determine which layer of the skin is chiefly responsible for retention of water.
The terms diffusion water and sweat are used in these discussions as defined in a previous publication.¹ The term diffusion water indicates water that has passed through the skin to the atmosphere by the process of diffusion; it does not include water secreted onto the
Purpose:
To provide an overview of moisture management and its importance in wound care.
Target audience:
This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.
Objectives:
After participating in this educational activity, the participant should be better able to:1. Summarize causes and treatments for moisture balance issues of chronic wounds.2. Recognize the properties of dressings used for treatment for moisture management of chronic wounds and antiseptic agent cytotoxicity.3. Explain study findings of the effectiveness of dressing choices for treatment of chronic wounds.
Objective:
To provide an overview of moisture management and its importance in wound care. The authors evaluate the impact of moisture management for optimal wound care and assess current wound management strategies relating to antisepsis and moist wound healing utilizing the wound bed preparation paradigm 2015 update. The discussion distinguishes the form and function of wound care dressing classes available for optimal moisture management.
Conclusion:
Moisture management for chronic wounds is best achieved with modern moist interactive dressings if the wound has the ability to heal.
Management of severely infected wounds is a formidable challenge. The pilot prospective cohort study is to investigate the influence of continuous topical irrigation (CTI) on the outcomes of severely infected wounds.
This pilot study was performed on 17 patients with a single severely infected wound treated with CTI, compared with a control group of 15 patients treated with standard of care from January 2011-January 2013. Bates-Jensen wound assessment tool severity scores and the clinical outcomes were recorded. Profiles of cytokines and/or proteinase in wound fluid were quantified weekly.
Comparing with the control, the CTI-treated patients required fewer days for wound infection clearance (8 ± 2 versus 19 ± 5 d, P < 0.001), had wounds closed earlier (17 ± 4 versus 36 ± 7 d, P < 0.001), and had fewer inhospital stay days (23 ± 5 versus 42 ± 8 d, P < 0.001). Bates-Jensen wound assessment tool severity scorings, proinflammatory cytokines (tumor necrosis factor-α, interleukin 1β, and interleukin 6), and matrix metalloproteinase-8 were significantly decreased in response to CTI.
This pilot study demonstrates that CTI improves severely infected wound healing through partly inhibiting proinflammatory cytokines and improving tissue regeneration.
Copyright © 2015 Elsevier Inc. All rights reserved.
Complex wounds pose a considerable burden to patients and the health-care system. The development of negative pressure wound therapy (NPWT) has revolutionised the treatment of these wounds. NPWT helps create a favourable wound healing environment by removing infectious material, decreasing oedema and promoting perfusion and granulation tissue formation. Additionally, NPWT has been reported to help reduce time to wound closure and length of hospital stay. Modifications of this foundation of wound care have added intermittent instillation with a dwell time to NPWT (NPWTi-d). This new system offers more comprehensive wound care through automated wound irrigation, allowing more control over the wound environment and the opportunity to deliver topical wound solutions directly to the affected tissues. A comparison between the two therapies, NPWT and NPWTi-d, is described, and two real-world applications of NPWTi-d are presented.
• We prospectively studied 174 patients on whom 226 unsutured parallel incisional (shave) and 3-mm punch skin biopsies were performed. Two wound-care programs, occlusive dressing therapy and conventional therapy, were compared. The biopsy sites were evaluated after 1 or 2 weeks for healing, pain, and infection. We found that healing was unrelated to the indication for biopsy or the patients' age, gender, or race. Occlusive dressing therapy—treated shave biopsy sites were 3.83 times more likely to be healed than those treated with conventional therapy. Regardless of the treatment method, a facial shave biopsy site was 3.6 times more likely to be healed than a biopsy site in other locations. No punch biopsy site had healed after 1 week. At 2 weeks, only 7% and 36% of conventional therapy— and occlusive dressing therapy—treated punch biopsy sites, respectively, had healed. Pain at the biopsy site was six times more common in both shave and punch biopsy sites treated with conventional therapy. The absence of pain with occlusive dressing therapy was significant for both types of biopsy. One punch biopsy site treated with conventional therapy became infected, and one treated with occlusive dressing therapy was suspected of being infected. Forty patients, who had biopsy sites treated with both therapies, preferred occlusive dressing therapy over conventional therapy by a ratio of 3:1 because of ease of wound care and lack of pain. We conclude that occlusive dressing therapy may be the wound management of choice for shave biopsy sites. Since punch biopsy sites do not heal readily, it may be more appropriate to suture them, at least until therapies are developed that more effectively speed their healing.
(Arch Dermatol. 1991;127:1679-1683)
• Local wound environment under oxygen-permeable and oxygen-nonpermeable dressings in patients with chronic ulcers was investigated. The oxygen tensions under both these dressings were very low or zero. Wound fluid was more acidic under the nonpermeable hydrocolloid dressing than under the oxygen-permeable polyurethane dressing. Bacterial growth studied in vitro was retarded at the more acidic pH similar to that found under the hydrocolloid dressing. Viable and functioning neutrophils were found under both the polyurethane and hydrocolloid dressings, with a greater percentage of viable cells under the polyurethane film. Our data suggest that these synthetic dressings create hypoxic conditions in which wound healing occurs whether or not the dressing is permeable to oxygen. Furthermore the local wound environment can be modified by use of synthetic dressings.
(Arch Dermatol 1986;122:52-57)
This paper reviews the current state of thinking and evidence on moist wound healing, and presents a new wound dressing technology that enables the purported ‘optimum’ moist environment to be maintained without risk of desiccation or maceration
BACKGROUND Occlusive dressings have become increasingly popular in the management of wound care. Numerous types of occlusive dressings are presently available for the treatment of acute and chronic wounds. Occlusion enhances wound healing primarily by preventing wound dessication. As a result, epidermal necrosis and eschar formation do not occur, and wounds reepithelialize more quickly.
OBJECTIVE Choosing a dressing to meet the specific needs of the patient can often become confusing for the physician. We review the various types of occlusive dressings and their advantages and disadvantages in the practical management of acute and chronic wounds.
METHODS A literature review of the subject was performed.
RESULTS Occlusive dressings enhance reepithelialization by preventing wound dessication. Lower infection rates are generally achieved despite bacterial proliferation under some occlusive dressings.
CONCLUSION Occlusive dressings simplify wound care and are an excellent choice in the management of most acute and chronic wounds. This review should enable the clinician to choose the best dressing to meet the individual wound of the patient.
Combined use of adjunctive negative pressure wound therapy (NPWT) and instillation of topical wound solutions and suspensions (NPWTi) has proven to be an effective next-generation NPWT technique for wounds at risk for compromised healing. Fluid instillation has been shown to enhance exudate and debris removal, provide regular cleansing of the wound bed, and add moisture to the wound. Positive results have been demonstrated with NPWTi in assisting healing of stalled wounds and treating painful wounds as well as wounds at high risk for amputation. NPWTi has been used instead of conventional NPWT in wounds with thick exudate and slough content, acute traumatic wounds, wounds acutely debrided due to infected soft tissue, large areas of post-debrided exposed bone, and cases of critical bacterial colonization. Instilled solutions have included topical solutions such as saline, topical wound cleansers, and antiseptics. While various systems that combine instillation or irrigation with NPWT have been commercialized during the past decade, until very recently these have been relatively cumbersome to use and limited in their ability to regulate solution volume delivery. Recent advances in NPWTi technology (V.A.C. VeraFlo™ Therapy, KCI, San Antonio, TX) include automated volumetrically controlled delivery of fluids and upgraded foam dressing technology to provide better control and delivery of solutions to the wound bed. This article describes the latest NPWTi technology and provides recommendations for successful application of NPWTi in an effort to inform clinicians about product decision-making and practice.
Proteases and their inhibitors contribute to the balance between extracellular matrix (ECM) degradation and deposition, creating an equilibrium that is essential for the timely and coordinated healing of cutaneous wounds. However, when this balance is disrupted, wounds are led into a state of chronicity characterized by abundant levels of proteases and decreased levels of protease inhibitors.
Researchers have sought to investigate the roles of proteases within both acute and chronic wounds and how the manipulation of protease activity may aid healing. Indeed, numerous wound dressings have been developed that target such proteases in an attempt to promote wound healing.
The normal tissue response to injury involves a complex interaction between cells and cellular mediators. In particular, the inflammatory response is augmented in chronic wounds which are characterized by elevated levels of proinflammatory cytokines and proteases. While controlling levels of inflammation and protease expression is a critical part of normal wound healing, elevated and prolonged expression of proteases produced during the inflammatory phase of healing can lead to excessive ECM degradation associated with impaired healing.
It seems plausible that future research should aim to investigate the ways in which proteases may be targeted as an alternative therapeutic approach to wound management and to assess the benefits and draw-backs of utilizing wound fluids to assess wound progression in terms of proteolytic activity.
Wound dressings: ulcer dressings should create and maintain a moist environment on the ulcer surface. It has been shown that in an ulcer with a hard crust and desiccated bed, the healing process is significantly slowed and sometimes completely blocked so favouring infection, inflammation and pain. In contrast a moist environment promotes autolytic debridement, angiogenesis and the more rapid formation of granulation tissue, favours keratinocytes migration and accelerates healing of wounds. Apart from these common characteristics, wound dressings are completely different in other aspects and must be used according to the ulcer stage. In necrotic ulcers, autolytic debridement by means of hydrogel and hydrocolloids or with enzymatic paste is preferred. In case of largely exuding wounds alginate or hydrofibre are indicated. When bleeding occurs alginate is indicated due to its haemostatic power. Where ulcers are covered by granulation tissue, polyurethane foams are preferred. When infection coexists antiseptics are necessary: dressing containing silver or iodine with large antibacterial spectrum have proved to be very effective. In the epithelization stage polyurethane films or membranes, thin hydrocolloids or collagen based dressings are very useful to favour advancement of the healing wound edge. Despite these considerations, a Cochrane review failed to find advantages for any dressing type compared with low-adherent dressings applied beneath compression. Surgical debridement and grafting of wounds, negative wound pressure treatment: surgical and hydrosurgical debridement are indicated in large, necrotic and infected wounds as these treatments are able to get rid of necrotic, infected tissue very quickly in a single surgical session, thereby significantly accelerating wound bed preparation and healing time. Negative wound pressure treatment creating a negative pressure on ulcer bed is able to favour granulation tissue and shorten healing time. In case of hard-to-heal leg ulcers such as large, deep, infected and long-lasting venous ulcers, sharp debridement and skin grafting may favour and shorten ulcer healing.
Negative pressure wound therapy with instillation (NPWTi) is increasingly utilized as an adjunct therapy for a wide variety of wounds. Despite its growing popularity, there is a paucity of evidence and lack of guidance to provide effective use of this therapy.
A panel of experts was convened to provide guidance regarding the appropriate use of NPWTi. This included a face-to face meeting where the available evidence was discussed as well as individual clinical experience with this therapy was shared. Follow-up communication amongst the panelists continued until consensus was achieved. The final consensus recommendations were derived through >80% agreement amongst the panelists.
Nine consensus statements were generated that address the appropriate use of NPWTi. The question of clinical effectiveness of NPWTi was not directly addressed by this consensus panel.
This document serves as preliminary guidelines until more robust evidence emerges that will support or modify these consensus recommendations.
Therapeutic, V.
Transplantation of skin micrografts in a 1:100 ratio regenerate the epidermis of full-thickness wounds in pigs within 14 days in a wet environment. The aim of the current study was to combine micrografts and commercially available moist dressings. We hypothesized that micrografts regenerate the epidermis when covered with a moist dressing. 5cm×5cm and 10cm×10cm full-thickness wounds were created on the backs of pigs. Wounds were transplanted with 0.8mm×0.8mm micrografts created from a split-thickness skin graft in a 1:100 ratio. 5cm×5cm wounds were treated with wound chambers, moist dressings or dry gauze (non-transplanted control group). 10cm×10cm wounds were compared to non-transplanted wounds, both covered with moist dressings. Reepithelialization was assessed in biopsies from day 10, 14 and 18 post-transplantation. 5cm×5cm transplanted wounds covered with moist dressings showed 69.5±20.6% reepithelialization by day 14 and 90.5±10.4% by day 18, similar to wounds covered with a wound chamber (63.9±16.7 and 86.2±11.9%, respectively). 18 days post-transplantation, 10cm×10cm transplanted wounds covered with moist dressings showed 66.1±10.3% reepithelialization, whereas nontransplanted wounds covered with moist dressings were 40.6±6.6% reepithelialized. We conclude that micrografts combined with clinically available moist dressings regenerate the epidermis of full-thickness wounds.
The stratum corneum (SC) is an effective permeability barrier. One strategy to increase drug delivery across skin is to increase the hydration. A detailed description of how hydration affects skin permeability requires characterization of both macroscopic and molecular properties and how they respond to hydration. We explore this issue by performing impedance experiments on excised skin membranes in the frequency range 1 Hz to 0.2 MHz under the influence of a varying gradient in water activity (aw). Hydration/dehydration induces reversible changes of membrane resistance and effective capacitance. On average, the membrane resistance is 14 times lower and the effective capacitance is 1.5 times higher when the outermost SC membrane is exposed to hydrating conditions (aw = 0.992), as compared to the case of more dehydrating conditions (aw = 0.826). Molecular insight into the hydration effects on the SC components is provided by natural-abundance (13)C polarization transfer solid-state NMR and x-ray diffraction under similar hydration conditions. Hydration has a significant effect on the dynamics of the keratin filament terminals and increases the interchain spacing of the filaments. The SC lipids are organized into lamellar structures with ∼ 12.6 nm spacing and hexagonal hydrocarbon chain pa