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OBJECTIVE To describe the use of a novel wound dressing that delivers nitric oxide (NO) to naturally occurring traumatic wounds in dogs. ANIMALS 24 client-owned dogs with 30 wounds. METHODS Dogs were presented with acute traumatic wounds requiring open wound management. Wounds were bandaged with a novel NO wound dressing and reassessed as needed for continued open wound management until wounds healed by second intention or wound closure was recommended. Dogs could be removed from the study at any point at the clinician’s discretion. RESULTS All wounds had the novel NO wound dressing used during open wound management until wound closure was recommended. Median time to wound closure was 6 days (range, 2 to 42). There were no complications directly attributed to the use of the novel wound dressing that clinically affected the dogs. Three wounds dehisced following wound closure. Wound healing was confirmed in 19 dogs with 25 wounds, with 3 dogs lost to follow-up prior to suture removal. Only 7.1% of wounds had clinical signs consistent with wound infection following wound closure. CLINICAL RELEVANCE The novel NO wound dressing was easy to use and well tolerated in dogs with naturally occurring traumatic wounds. It can be used throughout all phases of wound healing, simplifying open wound management. [ABSTRACT FROM AUTHOR]

Introduction: Photodynamic Therapy has been an important ally in tissue repair, with positive effects in the treatment of wounds and infections. Objective: To analyze the effects of the Healing Acceleration Methodology (MAC®) using propolis and toluidine blue on lower limb ulcers. Methods: Single-center, experimental, randomized and controlled study. Carried out between April 2021 and May 2022 at the outpatient clinic of the school clinic in a Brazilian capital. Patients were randomly assigned in a 1:1 ratio to receive photodynamic therapy (experimental group) or conventional dressing alone (control group). Patients over 18 years of age diagnosed with lower limb ulcers were included. Ten patients comprised the experimental group and 10 the control group. Patients were seen three times a week and monitored for two months. The primary outcome was the assessment of healing progress and the secondary outcome was the microscopic analysis of wound smears for the presence of cells and microorganisms. Results: In the experimental group, two wounds did not heal completely while in the control group, none of the 10 wounds healed completely during the 60-day follow-up. In the experimental group, 90% of patients did not have bacteria and fungi at the end of 30 days versus 40% in the control group. Conclusion: The present study showed that photodynamic therapy is a potential effective treatment in the healing process of lower limb ulcers. This can impact cost reduction and quality of life. Larger, well-designed studies are needed to corroborate the findings of the present study. [ABSTRACT FROM AUTHOR]

From previous studies, we have shown that viable colony forming units of bacteria and bacterial biofilms are reduced after sequential treatment with a surfactant‐based dressing. Here, we sought to test the impact on visible bacterial pigments and the ultrastructural impact following the sequential treatment of the same surfactant‐based dressing. Mature Pseudomonas aeruginosa biofilms were grown on ex vivo porcine skin explants, and an imaging‐based analysis was used to compare the skin with and without a concentrated surfactant. In explants naturally tinted by bacterial chromophores, wiping alone had no effect, while the use of a surfactant‐based dressing reduced coloration. Similarly, daily wiping led to increased immunohistochemical staining for P. aeruginosa antigens, but not in the surfactant group. Confocal immunofluorescent imaging revealed limited bacterial penetration and coating of the dermis and loose pieces of sloughing material. Ultrastructural analysis confirmed that the biofilms were masking the extracellular matrix (ECM), but the surfactant could remove them, re‐exposing the ECM. The masking of the ECM may provide another non‐inflammatory explanation for delayed healing, as the ECM is no longer accessible for wound cell locomotion. The use of a poloxamer‐based surfactant appears to be an effective way to remove bacterial chromophores and the biofilm coating the ECM fibres. [ABSTRACT FROM AUTHOR]

Skin is constantly exposed to injury and infectious agents that can compromise its structural integrity and cause wounds. When this occurs, microorganisms from the skin microbiota and external bacteria and fungi can penetrate the wound and cause an infection, which complicates the healing process. Nowadays, there are several types of wound dressings available to treat wounds, some of which are incorporated with antimicrobial agents. However, the number of microorganisms resistant to these substances is rising. Therefore, the search for new, natural alternatives such as essential oils (EOs) and plant extracts (PEs) is on the rise. However, these substances present some limitations (poor bioavailability and poor target capacity), which limits their efficiency. Their incorporation in formulations in the form of films and hydrogels (HGs) can help to overcome these issues and may be a potential alternative to the current treatments. HGs and films incorporated with PEs and EOs have antimicrobial activity, promote the viability of skin cells and fibroblast migration, and are non-toxic and biocompatible. This review discusses the use of films and HGs for the topical delivery of EOs and PEs for wound treatment and their formulations as effective wound dressings, while debating some mechanisms and biological properties to elucidate their presumptive clinical relevance and possible applications. [ABSTRACT FROM AUTHOR]

Background: Burns are one of the most prevalent and mortifying forms of trauma. Patients burn with significant thermal injury require immediate intensive care unit (ICU) care to minimize morbidity and mortality. Burns patients are generally more predisposed to sepsis because of two main reasons, i.e., burn wound infection and catheter-related bloodstream infection (CRBSI). Due to extensive skin barrier disruption and an alteration in the cellular and humoral immune responses burn wounds has a much higher incidence of sepsis as compared to other forms of trauma. Aims and Objectives: The present study was undertaken to study the bacteriological profile and sources of sepsis in burns patients and their antimicrobial susceptibility pattern. Materials and Methods: It is a prospective observational study conducted in the Department of Burns, Plastic and Maxillofacial Surgery, ICU and Department of Microbiology of a tertiary care hospital, Uttar Pradesh, India, between January 2020 and June 2022. Adult patients with 30–70% of total body surface area burns with central venous catheter (CVC) inserted during ICU admission were enrolled in the study. The presence of clinical sepsis in the burn patients was evaluated using the American Burn Association Sepsis criteria. For all patients with suspected clinical sepsis, paired blood cultures were collected simultaneously; one from the CVC and another from a peripheral site and were sent for bacteriological culture. Blood culture samples were processed as per standard procedures. CRBSI was defined if the same organism was isolated in paired blood cultures. Burn wound biopsy was sent for quantitative culture and 105 organisms/g of tissue were considered significant. Results: In the present study, the overall incidence of clinical sepsis was 28.4% (39/137), out of which 48.7% of cases were found to be due to CRBSI and the most common organism involved was Klebsiella spp. (42.1%), 33.3% of cases were due to burn wound sepsis and the most common organism involved was Pseudomonas spp. (61.5%); and 18.0% of cases were those in which no known source could be found. Possible explanations for these cases could be sepsis without bacteremia due to endotoxins and Gram-negative endotoxemia. Conclusion: To find out microorganisms causing burn wound infection by culture and provide suitable antibiotics according to their antibiotic sensitivity patterns helping us in managing these infection and decreasing overall morbidity and mortality in burn patients. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to evaluate the antibacterial activity of bacteria associated with sea sponge Amphimedon sp. against multi-drug resistant (MDR) bacteria that cause wound infections. Methodology and results: The antibacterial activity was evaluated by the overlay method. Identification of active bacterial symbionts was carried out using the 16S rRNA gene sequence-based method of bacterial identification. The results suggest that one of nine isolates had antibacterial activity against MDR bacteria. Isolate Z9VIII was identified as Bacillus subtilis and demonstrated robust antibacterial activity against bacteria: MRSA (11 mm), MDR-AB (17 mm) and CRPA (12 mm). Conclusion, significance and impact of study: This study concludes that the one of the bacterial species associated with the sea sponge of Amphimedon sp. was B. subtilis, which has the potential as antibacterial agent against MDR bacteria. [ABSTRACT FROM AUTHOR]

Hazelnut shells, the main waste deriving from hazelnut processing, represent an interesting source of active molecules useful in pharmaceutics, although they have not yet been examined in depth. A hydrosoluble extract (hazelnut shell extract, HSE) was prepared by the maceration method using a hydroalcoholic solution and used as the active ingredient of patches (prepared by casting method) consisting of composites of highly deacetylated chitosan and green clay. In vitro studies showed that the formulation containing HSE is able to stimulate keratinocyte growth, which is useful for healing purposes, and to inhibit the growth of S. aureus (Log CFU/mL 0.95 vs. 8.85 of the control after 48 h); this bacterium is often responsible for wound infections and is difficult to treat by conventional antibiotics due to its antibiotic resistance. The produced patches showed suitable tensile properties that are necessary to withstand mechanical stress during both the removal from the packaging and application. The obtained results suggest that the developed patch could be a suitable product to treat wounds. [ABSTRACT FROM AUTHOR]

Aims and objectives: Surveillance of wound infection including signs of infection alongside antimicrobial usage (types, duration, frequency) can highlight knowledge gaps and inconsistencies. This manuscript aims to highlight these, identify and inform opportunities for practice improvement and to show impact of infection management practice may be having on the issue of antimicrobial resistance. Background: Infected wounds pose challenges to healthcare professionals. Balancing risk of wound deterioration and progression to systemic infection with appropriate use of antimicrobials is necessary to minimise development of resistance. Methods: Analysis consisted of a practice survey of 9661 wounds across 70 community sites over a period of one week. Data were collected from projects between 2017 and 2020. The form was available to providers within the UK, Ireland, Norway, Denmark, Sweden and Finland. EQUATOR research guidelines were followed; STROBE checklist for observational research reporting was completed. Results: Infection rates of 8.9% were reported from wounds assessed. These data indicate inconsistencies with diagnosis across practice with non‐specialists more likely to be unsure of wound infection. Greater confidence in infection identification was observed as number of signs increased. Inconsistencies were also observed in appropriate treatment; antimicrobials were used in 35% of wounds considered not infected and not used in 41% of wounds that were identified as infected. Conclusions: This investigation of infection management practice of over 9000 wounds provides an insight into diagnosis and treatment of infection. Inconsistencies in diagnosis and treatment of wound infections reported highlight the need for increased education, awareness of diagnosis and treatment of infection. Relevance to clinical practice: Variability in management of infected wounds highlights opportunities to aid more effective diagnosis and treatment of infected wounds. Incorporation of support tools or evidence‐based pathways into practice may enhance confidence in management of local infection, balanced with appropriate use, potentially minimising resistance and improving outcomes. [ABSTRACT FROM AUTHOR]

Objective: to evaluate management outcomes of post-sternotomy wounds. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2020 to Dec 2021. Methodology: We reviewed 35 patients who had developed sternal wound infections post-cardiothoracic surgery. Outcomes of the study were measured using the SF-36 Quality of Life questionnaire. Results: Our patients presented with either Pairolero Type-II 11(31.4%) or Type-III 19(54.2%) sternal wound infection. Pre-operatively patients scored 296.667±69.40 in physical functional, 100.00±30.51 in limitations due to physical health, 16.67±37.90 in role limitation due to emotional problems, energy/fatigue scored 43.53±23.70, emotional well-being 163.33±23.54, social functioning as 11.40±11.66, pain score 31.25±19.90 and general health 131.67±35.31. The improvement in scores was noted in all domains postoperatively. Physical functioning mean scored as 790.00±48.07, role limitations due to physical health scored as 310.34±67.32, role limitations due to emotional problems scored as 266.67±47.94, energy/fatigue 284.67±18.71, emotional wellbeing 448.67±18.71, social functioning 185.83±12.60, pain score 164.17±22.01 and general health 316.67±34.95. Thirty-four (97.1%) out of 35 patients recovered well postoperative, with a maximum follow-up of 4 years and a minimum follow-up of 1 year. One patient expired on the sixth day of muscle flap coverage of the wound due to cardiac arrest. Conclusion: A positive prognosis can be obtained by this treatment protocol. [ABSTRACT FROM AUTHOR]

Wound infection, especially the development of bacterial biofilms, delays wound healing and is a major public health concern. Bacteria in biofilms are more tolerant to antimicrobial agents, and new treatments to eradicate mature biofilms are needed. Combining antimicrobial molecules with different mechanisms of action is an attractive strategy to tackle the heterogeneous nature of microbial communities in biofilms. This study focused on three molecules of natural origin: gallic acid (G), carvacrol (K) and curcumin (Q). Their abilities, individually or in combination, to eradicate biofilms were quantified on mono- and dual-species mature biofilms of Pseudomonas aeruginosa and Staphylococcus aureus, the strains most commonly found in infected wounds. G presented biofilm eradicating activity on P. aeruginosa, whereas K had biofilm eradicating activity on S. aureus and P. aeruginosa. Q had no potent biofilm eradicating activity. The combination of G and K increased the effects previously observed on P. aeruginosa biofilm and led to complete eradication of S. aureus biofilm. This combination was also efficient in eradicating a dual-species biofilm of S. aureus and P. aeruginosa. This work demonstrates that K and G used in combination have a strong and synergistic eradicating activity on both mono- and dual-species mature biofilms of S. aureus and P. aeruginosa and may therefore represent an efficient alternative for the treatment of biofilms in wounds. [ABSTRACT FROM AUTHOR]

Wound infection is a complex pathology that may manifest either as a rapid onset acute condition, or as a prolonged chronic condition. Although systemic antibiotic therapy is often appropriate and necessary for acute wound infections, it is often used inappropriately, excessively and unsuccessfully in chronic wound infections. Overuse of antibiotics in chronic (hard-to-heal) wound management contributes to antibiotic resistance. This literature review confirms that acute and chronic wound infections are significantly differentiated by their cause (microbial phenotype), the subsequent host immune response and by the resulting clinical manifestations. Consequently, recognition of the type of wound infection followed by appropriate and timely therapy is required to improve wound healing outcomes while encouraging more judicious and responsible use of antibiotics. [ABSTRACT FROM AUTHOR]

Background: Health systems globally are facing unprecedented challenges in attempting to balance sharply rising demand against constraints on the availability of financial and other resources. These challenges have led to pressures to constrain expenditure growth through cost containment. But cost containment alone cannot be a sustainable solution if focus on short-term costs ignores the effect on long-term outcomes. Aim: The aim is to raise awareness of the concept of value-based healthcare (VBH) and to illustrate its application to the procurement of wound care products. VBH is about achieving the best possible health outcomes with available resources: either by producing better outcomes with the same resources or by producing the same outcomes with less. Minimising short-term costs is not consistent with the principles of VBH if it leads to higher costs on the long run or if the potential to improve patient outcomes is lost. Method: The impact of different dressing characteristics on the costs of nurse time, dressing spend, and the total annual costs of treating a cohort of patients is estimated. Conclusions: Dressing characteristics other than price are an important factor in determining the total cost of healing a wound. For example: fluid handling capacity impacts wear time that in turn impact the frequency of dressing change. Reducing dressing change frequency adds value by releasing nurse time for other uses and reducing annual dressing spend. Similar considerations apply to other dressing characteristics. The lowest cost dressing is not necessarily the one which adds most value. [ABSTRACT FROM AUTHOR]

Introduction: Acute bacterial skin and skin structure infections (ABSSSI) represent one of the most common reasons for emergency department visits, and are frequent complications of intravenous drug use in persons who inject drugs (PWID). This study examined the efficacy and safety of omadacycline, versus linezolid, in PWID and persons who do not inject drugs, in the Phase 3 Omadacycline in Acute Skin and Skin Structure Infection (OASIS-1, OASIS-2) studies. Methods: Eligible participants were aged ≥ 18 years with qualifying skin infections: wound infection, cellulitis, erysipelas, or major abscess. The primary efficacy endpoint was early clinical response (ECR) in the modified intent-to-treat (mITT) population, defined as survival with ≥ 20% reduction in lesion size at 48–72 h after the first dose of omadacycline or linezolid. Key secondary endpoints included investigator-assessed clinical response at the post-treatment evaluation (PTE) in the mITT and clinical per-protocol populations, and clinical response at PTE in the micro-mITT population. Safety was assessed based on adverse events (AEs) and standard clinical laboratory tests. Efficacy endpoints of clinical response at ECR and PTE were analyzed for the mITT and clinically evaluable (CE) PTE populations. Results: In total, 1380 patients (822 PWID, 558 non-PWID) were included in this secondary analysis. Wound infections were reported more frequently in the PWID subgroup (72.8%) at baseline; cellulitis or erysipelas (43.9%) and major abscess (37.4%) were the most frequently reported baseline infections in the non-PWID subgroup. Clinical success rates at ECR and PTE in the mITT population, and at PTE in the CE population, were high for patients receiving omadacycline or linezolid. Severe or serious treatment-emergent AEs (TEAEs), and TEAEs leading to discontinuation, were infrequent. Conclusion: This subgroup analysis showed that omadacycline was effective and well tolerated, regardless of PWID status. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of antiseptic solutions to that of non-antiseptic solutions in reducing wound infection rate, reducing bacterial load and improving wound healing. Method: We searched PubMed MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), ProQuest Medical Database and medRxiv for randomised controlled trials (RCTs) comparing antiseptic solutions with non-antiseptic solutions in simple, uncomplicated acute traumatic wounds. Qualitative data synthesis was employed. Risk of bias was assessed and GRADE assessment was used to evaluate quality of evidence. Results: In this systematic review, four studies with a total of 875 participants were included, of which two studies showed a significant reduction of wound infection rate using povidone-iodine (p=0.001 and p=0.03). The use of non-antiseptic solutions significantly increased bacterial load on acute traumatic wounds (p=0.0001). The quality of evidence was very low. No studies reported on wound healing outcome. Conclusion: No robust conclusions can be implemented in clinical practice. Future studies are needed to compare the use of antiseptic and non-antiseptic solutions in acute traumatic wounds. [ABSTRACT FROM AUTHOR]

Wound biofilms must be identified to target disruption and bacterial eradication but are challenging to detect with standard clinical assessment. This study tested whether bacterial fluorescence imaging could detect porphyrin‐producing bacteria within a biofilm using well‐established in vivo models. Mouse wounds were inoculated on Day 0 with planktonic bacteria (n = 39, porphyrin‐producing and non‐porphyrin‐producing species, 107 colony forming units (CFU)/wound) or with polymicrobial biofilms (n = 16, 3 biofilms per mouse, each with 1:1:1 parts Staphylococcus aureus/Escherichia coli/Enterobacter cloacae, 107 CFU/biofilm) that were grown in vitro. Mouse wounds inoculated with biofilm underwent fluorescence imaging up to Day 4 or 5. Wounds were then excised and sent for microbiological analysis. Bacteria‐matrix interaction was assessed with scanning electron microscopy (SEM) and histopathology. A total of 48 hours after inoculation with planktonic bacteria or biofilm, red fluorescence was readily detected in wounds; red fluorescence intensified up to Day 4. Red fluorescence from biofilms persisted in excised wound tissue post‐wash. SEM and histopathology confirmed bacteria‐matrix interaction. This pre‐clinical study is the first to demonstrate the fluorescence detection of bacterial biofilm in vivo using a point‐of‐care wound imaging device. These findings have implications for clinicians targeting biofilm and may facilitate improved visualisation and removal of biofilms. [ABSTRACT FROM AUTHOR]

Wound bed preparation is the management of a wound in order to optimise healing and/or facilitate other therapeutic measures. It is the most pivotal step in healing wounds. Early referral to a specialist wound clinic can markedly improve the wound healing process. This overview will discuss the techniques involved in the preparation of the wound bed that will effectively accelerate the healing process. The process begins with a correct diagnosis of the wound and optimising the patient's medical condition. The TIMERS framework is discussed. Wound dressings, including the use of negative-pressure wound therapy, are discussed, along with debridement techniques and agents. The timing of wound intervention and evaluating progress will also be discussed, and wound bed preparation strategies will be included. There has been an added challenge of wound care in the community as a result of the COVID-19 pandemic. The present article provides an overview of how to prepare a wound bed in the community. [ABSTRACT FROM AUTHOR]

Globally, multidrug-resistant bacteria affects wound infections, both hospital-acquired infections and community-acquired infections. The main isolates cultured from 607 subjects with wound infections were methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter spp. [multidrug resistant (MDR)]. Gram-negative bacteria caused most of the infections (67%) compared with gram-positive bacteria. Diabetic patients tend to have wound infections with mixed causative agents compared with non-diabetic patients. [ABSTRACT FROM AUTHOR]

Smart wound dressings aim to enable early diagnosis and treatment of wound infections to accelerate wound healing. This paper summarizes the latest research progress of smart wound dressings, including smart dressings for monitoring different parameters of wounds, smart dressings that can realize wound management, and advanced smart wound dressings that integrate monitoring and treatment into one, and systematically discusses and analyzes them. [Display omitted] • A comprehensive review of the latest developments in intelligent wound dressings. • Explored various wound dressing design concepts and developed applications. • Discussed the future prospects and challenges of intelligent wound dressings. Wound management has long been a significant concern within the healthcare industry. However, conventional passive wound dressings often fail to meet the requirements for effective wound management. As a result, there is a growing emergence of intelligent wound dressings that aim to address this issue. These smart wound dressings incorporate one or more electrochemical or optical sensors, enabling real-time monitoring of wound conditions. Furthermore, they also integrate various stimulation techniques, including photostimulation, electrostimulation, and pharmacological stimulation, in order to facilitate accelerated wound healing. This integration of sensing and stimulation capabilities holds immense potential for personalized wound care. This paper offers a comprehensive review of recent advancements in the field of wearable, novel dressings designed for the purpose of chronic wound monitoring and management. It examines various design concepts and applications that have been developed. Additionally, the paper discusses the future prospects and challenges associated with wearable bioelectronics in wound care, as well as their potential for clinical utilization. Furthermore, it explores the areas in which further development and research are needed, with a focus on establishing the priorities for the next generation of wound dressings. [ABSTRACT FROM AUTHOR]

Issues arising in wound healing are very common, and chronic wound infections affect approximately 1.5% of the population. The main substances used in wound washing, cleansing and treatment are antiseptics. Today, there are many compounds with a known antiseptic activity. Older antiseptics (e.g., boric acid, ethacridine lactate, potassium permanganate, hydrogen peroxide, iodoform, iodine and dyes) are not recommended for wound treatment due to a number of disadvantages. According to the newest guidelines of the Polish Society for Wound Treatment and the German Consensus on Wound Antisepsis, only the following antiseptics should be taken into account for wound treatment: octenidine (OCT), polihexanide (PHMB), povidone-iodine (PVP-I), sodium hypochlorite (NaOCl) and nanosilver. This article provides an overview of the five antiseptics mentioned above, their chemical properties, wound applications, side effects and safety. [ABSTRACT FROM AUTHOR]

Infection is one of the most serious complications that can occur in wounds. Biomarkers can be used as a tool directly related to infection. So, herein current methods and new approaches for the determination of wound infection, based on biomarkers, were compared and discussed. In this review, it is highlighted the different enzymatic biomarkers related to wound infection, and how they can be used for early detection of the same. It also aims to compile the different analytical methods and describe the potential of each one. The global and critical analysis research made it possible to perceive that of all the biomarkers studied, the enzymes demonstrated great potential, through the comparison with all biomarkers, since they allow the detection of infection in very early stages, and so a previous diagnostic and treatment. • Early infection detection in wounds prevents progressing to serious conditions. • There are biomarkers that are directly related to wounds infection. • Enzymes are potential biomarkers as they appear early in the wound. • Developing analytical methods for enzyme detection are in progress and presented. • The fluorimetry is a common method to all enzymes and lead in relation to the LOD. [ABSTRACT FROM AUTHOR]