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Significance: Wound healing is the largest medical market without an existing small molecule/drug treatment. Both “under-healing” (chronic wounds) and “over-healing” (scarring) cause a substantial ...

Uvod: Lecba pacientů s nehojicimi se ranami vyžaduje systematický přistup, který by měl zahrnovat kompletni posouzeni rany a objektivni popis hodnoceni rany. Metodika: Průřezova retrospektivni studie - obsahova analýza dokumentace z různých lokalit Ceske republiky. S využitim metody shlukove analýzy zjistit, jestli existuji různe skupiny, ktere se lisi svým přistupem k hodnoceni parametrů nehojicich se ran. Analyzovano bylo 331 dokumentaci od 16 poskytovatelů lůžkove a ambulantni pece a u poskytovatelů socialnich služeb. Cil: Cilem bylo posoudit, jakým způsobem jsou hodnoceny a dokumentovany nehojici se rany v klinicke praxi u vybraných poskytovatelů zdravotnich služeb a u poskytovatelů socialni pece v Ceske republice. Ověřit, zda je v klinicke praxi u vybraných poskytovatelů k dispozici klinický algoritmus pro hodnoceni nehojici se rany a zda je využivan. Výsledky: Výsledna data lze rozdělit do tři separovaných shluků. Jednotlive skupiny lze charakterizovat jako shluk 1 "smisena dokumentace", tento shluk obsahuje celkem 280 obsahových analýz, shluk 2 "osetřovatelska dokumentace konzultantek pro hojeni ran", který obsahuje 45 obsahových analýz, a shluk 3 "osetřovatelska dokumentace - předtistěný formulař", jenž obsahuje 6 obsahových analýz. Shluk 2 vykazuje castějsi použivani objektivizace při hodnoceni parametrů ran. Zavěr: Průzkum prokazal, že proces hodnoceni parametrů nehojici se rany je velmi nesourodý, že neni v klinicke praxi řadně dodržovan a akceptovan doporucený postup pro posuzovani stavu nehojicich se ran. Ověřili jsme, že přitomnost konzultantky pro hojeni ran souvisi s castějsim použivanim objektivnich skal k hodnoceni ran.

Chronic wounds are a major health problem that cause the medical infrastructure billions of dollars every year. Chronic wounds are often difficult to heal and cause significant discomfort. Although wound specialists have numerous therapeutic modalities at their disposal, tools that could 3D-map wound bed physiology and guide therapy do not exist. Visual cues are the current standard but are limited to surface assessment; clinicians rely on experience to predict response to therapy. Photoacoustic (PA) ultrasound (US) is a non-invasive, hybrid imaging modality that can solve these major limitations. PA relies on the contrast generated by hemoglobin in blood which allows it to map local angiogenesis, tissue perfusion and oxygen saturation—all critical parameters for wound healing. This work evaluates the use of PA-US to monitor angiogenesis and stratify patients responding vs. not-responding to therapy. We imaged 19 patients with 22 wounds once a week for at least three weeks. Our findings suggest that PA imaging directly visualizes angiogenesis. Patients responding to therapy showed clear signs of angiogenesis and an increased rate of PA increase (p = 0.002). These responders had a significant and negative correlation between PA intensity and wound size. Hypertension was correlated to impaired angiogenesis in non-responsive patients. The rate of PA increase and hence the rate of angiogenesis was able to predict healing times within 30 days from the start of monitoring (power = 88%, alpha = 0.05) This early response detection system could help inform management and treatment strategies while improving outcomes and reducing costs.

Summarization: Non-healing wounds are steadily becoming a global-health issue. Prolonged hypoxia propagates wound chronicity; yet, oxygenating treatments are considered inadequate to date. Dissolved oxygen (DO) in aqueous solutions introduces a novel approach to enhanced wound oxygenation, and is robustly evaluated for clinical applications. A systematic literature search was conducted, whereby experimental and clinical studies of DO technologies were categorized per engineering approach. Technical principles, methodology, endpoints and outcomes were analysed for both oxygenating and healing effects. Forty articles meeting our inclusion criteria were grouped as follows: DO solutions (17), oxygen (O2) dressings (9), O2 hydrogels (11) and O2 emulsions (3). All technologies improved wound oxygenation, each to a variable degree. They also achieved at least one statistically significant outcome related to wound healing, mainly in epithelialization, angiogenesis and collagen synthesis. Scarcity in clinical data and methodological variability precluded quantitative comparisons among the biotechnologies studied. DO technologies warrantee further evaluation for wound oxygenation in the clinical setting. Standardised methodologies and targeted research questions are pivotal to facilitate global integration in healthcare. Presented on

The treatment of long-term non-healing wounds in the conditions of purulent surgery departments, widely uses solutions of chemotherapeutic and antiseptic agents. The most common are the solutions of 3–6 % hydrogen peroxide and solutions of 2–10 % sodium chloride. As a rule, solutions of these drugs are used to treat non-healing, particularly, purulent wounds, bedsores and trophic ulcers. Therefore, solutions are injected into the wound area repeatedly in the form of course therapy. The findings show that the mechanism of action of these drugs and the effect of treating long-term non-healing wounds is largely determined by such physical and chemical factors of their local interaction as concentration of the main ingredients, osmotic, alkaline activity and local temperature. The findings point out the leading role of the local temperature and the dependence of the local effect on the concentration. They describe the essence of the innovative method of treatment.

Folk medicine uses decoctions of Vernonanthura patens (Kunth) H. Rob. leaves for healing wounds, and moderate pains. In this study, anti-inflammatory activity of decocted aqueous extract and its fractions is discussed. The fractions were obtained by liquid-liquid extraction in a separating funnel with solvents of increasing polarity: hexane, chloroform, and ethyl acetate. Antioxidant capacity, COX1, and COX2 cyclooxygenase inhibitory activities of aqueous extract (A1), aqueous (A2), and ethyl acetate (A3) fractions were assessed. A3 revealed the highest flavonoid content, and DPPH (2,2-diphenyl-1-picrylhydrazyl) scavenging activity. Nevertheless, no significance differences were observed between IC50 values of A1 and A2, and A1 showed anti-inflammatory activity with potential selectivity against COX2 enzyme, but intermediate COX1 inhibition. Further experiments are required to complement the remarkable anti-inflammatory effect of assessed aqueous extract. These results support the medicinal use of this plant species and indicate that A1 can be used as raw material for prospective nutraceutical products.

Background Chronic wounds resulting from a number of conditions do not heal properly and can pose serious health problems. Beyond clinician visual inspection, an objective evaluation of the wound is required to assess wound evolution and the effectiveness of therapies. Aim Our objective is to provide a methodology for the analysis of wound area vs. time for the early prediction of non-healing wounds evolution. Methods We propose a two-step approach consisting of: i) wound area quantification from planimetries and ii) classification of wound healing through the inference of characteristic parameters. For the first step, we describe a user-friendly software (Woundaries) to automatically calculate the wound area and other geometric parameters from hand-traced planimetries. For the second, we use a procedure for the objective classification of wound time evolution and the early assessment of treatment efficacy. The methodology was tested on simulations and retrospectively applied to data from 85 patients to compare the effect of a biological therapy with respect to general basic therapeutics. Results Woundaries provides measurements of wound surface equivalent to a validated device. The two-step methodology allows to determine if a wound is healing with high sensitivity, even with limited amount of data. Therefore, it allows the early assessment of the efficacy of a therapy. Conclusion The performance of this methodology for the quantification and the objective evaluation of wound area evolution suggest it as a useful toolkit to assist clinicians in the early assessment of the efficacy of treatments, leading to a timely change of therapy.

Arginase expression has been recently shown to increase in numerous disease states like neurodegeneration, inflammation, and malignancies. Although it has been found to be functionally important in various disease pathologies, little is known about its role in wound healing. Here, we look at the expression of arginase and its isoforms in chronic non-healing wounds and also study the expression of nitric oxide synthase (NOS) and oxidative stress enzymes in them. Wound tissues and blood samples were collected at the time of index presentation and follow-up from 61 chronic non-healing wound cases. The expression patterns of arginase isoenzymes, NOS, superoxide dismutases (SOD), lactic acid dehydrogenase (LDH), and catalase were examined by using enzyme-linked immunosorbent assay, immunohistochemistry, and western blot analysis at the transcript and protein level. We reported a significant decrease of serum arginase levels in chronic nonhealing wounds in the progress of wound healing. Interestingly, tissue arginase levels were found to be increased with improved wound condition at follow-up. Tissue NOS, LDH, and catalase activity were also found to be increased with the progress of healing, whereas SOD levels were downregulated. Our findings reported increased expression at the transcript level of arginase-I and arginase-II in chronic non-healing wounds for the first time. In conclusion, we observed decreased serum arginase levels in completely healed patients as compared to non-healed cases. Our study findings support the hypothesis that inhibition of the activity of arginase delays wound healing. Arginase and iNOS may also find their place in the future as possible biomarkers for wound healing.

Summary. The purpose of the study is — analysis of the sources of domestic and world literature with the study of modern approaches to the complex surgical treatment of purulent long-term non-healing wounds (PLTNHW). Research tasks — according to the literature, to determine the possibilities of surgical treatment at the present stage in patients with PLTNHW. Conclusions. Thus, to date, significant progress has been made in the surgical treatment of PLTNHW. Numerous diagnostic and therapeutic methods can significantly improve the results of surgical treatment of PLTNHW, but they are not without some disadvantages. In this regard, the development and implementation of new approaches and modern methods for diagnosing pathological changes and the effect on the wound process using modern developments and technologies is relevant.

Chronic non healing wounds represent a significant public health problem. A wound may be acute or chronic; the later could be defined as a wound that is not continuously progressing towards healing, which can be correlated with Dushtavrana. Various therapies are potentially conducive to wound healing, and according to T.I.M.E. principle of wound healing; E stands for edges of wound which is undermined due to chronicity and infection, corrected by debridement and Leech therapy is biological debridement therapy. It is a para-surgical procedure which serves debridement of the wounds by the blood sucking and oozing phenomenon. Jalaukavacharana possesses high efficacy in both Vrana Shodhana and Ropana, hence can be used for management of Dushta Vrana. Jalaukavacharana being a bio-purificatory method removes deep seated toxins, clearing Srotasa and pacifying vitiated Doṣha. Salivary gland secretions of leech have multiple actions like analgesic, anti-inflammatory and antibacterial which serve the purpose of wound healing. Keeping in mind, all the fundamentals & surgical applications of Leech therapy, a pilot study of 15 patients with chronic non healing wound was conducted. Observations were recorded on alternate days for 15 days. Within treatment analysis of the Chronic Non Healing Wound showed that T.I.M.E. principle reflected significant healing of wound after 7 days of leech therapy & supplementary protocol. The results of this pilot study in management of Chronic Non-Healing wound (Dushta Vrana) by Leech therapy (Jalauakavacharana) highlights the wound healing effects significantly.

Enteroatmospheric fistulae are challenging clinical conditions that require surgical expertise and that can result in chronic debilitating conditions placing the patient in a vicious cycle characterized by non healing wounds and malnutrition. They are a complex entity that presents great variability depending on the number, shape, and size of the fistulous orifices, their debit, and the dimensions of the wound. This means that, at present, there is no device that adapts to the anatomical characteristics of each patient and manages to control the spillage of intestinal effluvium from the wound. The aim of this study is to describe the manufacturing technique and to assess the preliminary results of a custom device designed through bioscanner imaging and manufactured using 3D printing for use with negative pressure wound therapy (NPWT) in the management of enteroatmospheric fistula. A proof of concept is given, and the design of the device is presented for the first time. After obtaining images of each fistula with a bioscanner, a personalised device was designed for each patient by 3D printing shape of a prism and a hollow base, taking into account the dimensions of the fistulous area in order to perform a floating ostomy to isolate the wound from the debit enteric. The polycaprolactone (PCL) device was placed including inside the fistulous surface and surrounding it with the NPWT system in order to accelerate wound healing.

Background: The management of chronic non- healing wounds has always been a cause of concern for the patients and treating team as well. There had been a marked increase in patients presenting with chronic non -healing wounds of varied etiology. The conventional methods of treatment have been in use traditionally include different medicated dressing application since the long-time yet desired results are not achievable always and some other applications like collagen are mostly not affordable to the poor local population. Vacuum-assisted closure using negative pressure being considered as a suitable alternative management for treating chronic non-healing wounds and the results are comparatively better in relatively lesser time than the conventional techniques. Objective: To assess the impact of (VAC) in the management of non-healing Ulcers To compare the advantage of VAC over conventional dressings in ulcer management Methods: Prospective controlled study of 60 patients aged between 40 and 60 were randomly divided into two groups (Wagner grade 2-5) VAC dressing was kept for over 2-5 weeks. Ulcers were treated until the wound closed spontaneously, surgically or until completion of the 50 days, whichever was earlier. Results: By the seventh week, discharge disappeared in 94 % in VAC and only 56 % in conventional dressing group. Granulation tissue appeared in 100 % of patients in the VAC group and only 63 % in the conventional dressing group. The patients treated with VAC dressing in our study showed comparable wound reduction capabilities with an average wound size reduction of 58 % in comparison to conventional dressing group which had an average wound size reduction of 26 %. Majority of wounds in the VAC group got closed in 7 weeks. Patient satisfaction was very good in the VAC group compared to those patients managed with conventional dressing group. Conclusion: The application of VAC is feasible, reliable and affordable with a better outcome in the management of chronic non-healing ulcers.

Aim: The aim of this study was to analyze published studies focusing on quality of life (QoL) in patients with non-healing wounds, with particular focus on assessment tools. Design: Type of study – literature review. Methods: Articles focusing on QoL in patients with non-healing wounds were searched for in various electronic databases using relevant terms. The search was limited to articles in English issued between January 2014 and April 2019, in the electronic databases Scopus, PubMed, and CINAHL. Results: In total, 24 studies were found which met the established criteria. Conclusion: Non-healing wounds significantly affect patients' QoL. Research is leading towards the creation of a standardized QoL tool in patients with chronic wounds, which could be included in the wound care standard care protocol. There are many generic and specific tools for evaluating QoL in patients with non-healing wounds, differing in length and complexity. The Wound-QoL was created by comparing and simplifying proven tools, and the follow-up research has proven it to be internally consistent, valid and reliable, and, due to its ease of use, suitable for re-measuring QoL.

Macrophages are prominent cells in normally healing adult skin wounds, yet their exact functions and functional significance to healing outcomes remain enigmatic. Many functional attributes are ascribed to wound macrophages, including host defense and support of the proliferation of new tissue to replace that lost by injury. Indeed, the depletion of macrophages is unmistakably detrimental to normal skin healing in adult mammals. Yet in certain systems, dermal wounds seem to heal well with limited or even no functional macrophages, creating an apparent paradox regarding the function of this cell in wounds. Recent advances in our understanding of wound macrophage phenotypes, along with new information about cellular plasticity in wounds, may provide some explanation for the apparently contradictory findings and suggest new paradigms regarding macrophage function in wounds. Continued study of this remarkable cell is needed to develop effective therapeutic options to improve healing outcomes.

Wound healing is a complex process that engages skin cells, the blood, the immune system and a number of circulating substances in the body. Infections, contamination of the wound or a vast area of damage complicate and delay the natural process of skin regeneration. The incidence of hard-to-heal wounds is an increasingly common problem, because they can significantly impair the quality of life of the patient. For this reason, it is extremely important to look for factors (drugs, dressings or other substances) that could accelerate and relieve wound healing. Among many compounds in the area of medical engineering interest, attention should be paid to natural polysaccharides, e.g. chitosan and alginate. This article is devoted to biomaterials that play an important role in the treatment of chronic wounds. These include the following: hydrogels, non-wovens, membranes and chitosan sponges as well as chitosan-alginate composites or chitosan composites combined with zinc oxide and nanosilver. The material, which has chitosan as a base, works on all stages of the healing process. Many in vitro, in vivo and clinical studies that provide the basis for using chitosan materials as a substitute for conventional bandages and dressings have been carried out. At the stage of hemostasis, it accelerates platelet aggregation and the formation of a fibrin clot. In the inflamed stage, they cause the proliferation of neutrophils and macrophages that cleanse the wound, releasing cytokines at the wound site. Studies have shown that chitosan mimics the native extracellular matrix, providing the optimal microenvironment for the wound.

WOS: 000504628000001 PubMed: 31884720 Wound healing is a complex cellular and biochemical process and can be affected by several systemic and local factors. In this study, we aimed to discuss the aetiologic factors of non-healing wounds and the management of this complicated process with current information. The medical data of the patients who were admitted to our clinic due to non-healing or chronic wounds were analysed retrospectively. A total of 27 patients were evaluated retrospectively during the 14 months of the study. The data of 6 patients who were followed up for chronic wound that developed after abdominal incisional hernia repair and pilonidal sinus surgery were not included in the study as their data could not be reached. A total of 21 patients were included in the study. Malignancy was diagnosed in two patients and granulomatous disease was found in four patients. The aetiology of the other cases included foreign body reaction, infection, and mechanical causes. Non-healing wounds are a serious social and economic problem for patients. Further studies on the pathophysiology of various aetiologies in non-healing wounds in both clinical settings and experimental animal models would be a useful step in treatment.

Kołodziejczyk Monika, Stasiak Elżbieta, Stasiak Karolina, Stasiak Łucja, Grzegorczyk Michał. The quality of life of people with slow-healing wounds is strengthened through the introduction of therapeutic and nursing activities administered in long-term homecare nursing, as based on case studies. Journal of Education, Health and Sport. 2019;9(12):49-66. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2019.09.12.006 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2019.09.12.006 https://zenodo.org/record/3579445 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2019; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 15.11.2019. Revised: 24.11.2019. Accepted: 16.12.2019. The quality of life of people with slow-healing wounds is strengthened through the introduction of therapeutic and nursing activities administered in long-term homecare nursing, as based on case studies Monika Kołodziejczyk1, Elżbieta Stasiak2, Karolina Stasiak3, Łucja Stasiak3, Michał Grzegorczyk4 Student of the Medical University of Lublin, Faculty of Health Sciences, Master's Degree, Nursing1 Medical University of Lublin Department of Oncology and Community Health Care, Department of Oncology2 STASIAK Medical Team II Elżbieta Stasiak3 Medical University of Lublin, Department of Rehabilitation and Physiotherapy4 Summary The quality of life of people with slow-healing wounds is a multi-faceted concept which focuses on the functioning of patients in many spheres of life. Two characteristics of patients qualified for long-term homecare nursing are multi-morbidities and senior age. The coexistence of several chronic diseases, including atherosclerosis, is associated with the presence of a number of healing and caring problems, for example, slow-healing wounds. The social security in Poland in the domain of long-term homecare nursing is at a very low level, as reported by the Central Statistical Office in 2015, with only 4 out of 1000 people using long-term nursing care in a home environment. Key words: quality of life of people with multi-morbidities, slow-healing wounds, long-term homecare nurse, senior age.

Reparative perineural hyperplasia is an incidental and probably underreported reactive histologic finding thus far only reported in the setting of healing wounds or adjacent to a dermatofibroma in cutaneous specimens. It is characterized by a focal concentric proliferation of cytologically bland spindled perineurial cells and is hence considered a benign histologic mimic of neoplastic perineural invasion. Thus, it may present a diagnostic pitfall and we therefore consider it as a valuable entity to be aware of. To the best of our knowledge, this brief case report is the first to convey that reparative perineural hyperplasia may also occur in the gastrointestinal tract. It may therefore be a ubiquitous reactive histological phenomenon relating to previous surgical or traumatic wounds in various sites, that is, outside the thus far established setting of skin reexcision specimens.

The gut–brain–skin axis is important in wound healing. The aim of this study was to investigate the association between experiencing irritable bowel syndrome (IBS) symptoms, perceived immune fitness, and impaired wound healing. N = 1942 Dutch students (mean (SD) age 21.3 (2.1), 83.6% women) completed an online survey. They were allocated to one of four groups: (1) control group (N = 1544), (2) wound infection (WI) group (N = 65), (3) slow healing wounds (SHW) group (N = 236), or (4) a combination group (COMBI), which experienced both WI and SHW (N = 87). Participants rated their perceived immune fitness on a scale ranging from very poor (0) to excellent (10), and the severity of IBS symptoms (constipation, diarrhea, and pain) was assessed with the Birmingham IBS Symptom Questionnaire. Compared to the control group, perceived immune fitness was significantly poorer for the SHW group (p &lt, 0.001) and COMBI group (p &lt, 0.001), but not for the WI group. Compared to the control group, constipation was reported significantly more frequently by the SHW group (p &lt, 0.001) and the WI group (p = 0.012), diarrhea was reported significantly more frequent by the SHW group (p = 0.038) and the COMBI group (p = 0.004), and pain was reported significantly more frequent by the SHW group (p = 0.020) and COMBI group (p = 0.001). Correlations between IBS complaints and perceived immune fitness were statistically significant (p &lt, 0.001), and also a highly significant and negative association was found between the percentage of participants that reported impaired wound healing and perceived immune fitness (r = −0.97, p &lt, 0.001). In conclusion, among participants with self-reported impaired wound healing, IBS complaints were significantly more severe, and accompanied by a significantly reduced perceived immune fitness.

The design and application of conductive biomaterials for wound healing are comprehensively reviewed, including versatile conductive agents, the various forms of conductive wound dressings, and different in vivo applications.Three main strategies of which conductive biomaterials realizing their applications in wound healing and skin tissue engineering are discussed.The challenges and perspectives in designing multifunctional conductive biomaterials and further clinical translation are proposed., Conductive biomaterials based on conductive polymers, carbon nanomaterials, or conductive inorganic nanomaterials demonstrate great potential in wound healing and skin tissue engineering, owing to the similar conductivity to human skin, good antioxidant and antibacterial activities, electrically controlled drug delivery, and photothermal effect. However, a review highlights the design and application of conductive biomaterials for wound healing and skin tissue engineering is lacking. In this review, the design and fabrication methods of conductive biomaterials with various structural forms including film, nanofiber, membrane, hydrogel, sponge, foam, and acellular dermal matrix for applications in wound healing and skin tissue engineering and the corresponding mechanism in promoting the healing process were summarized. The approaches that conductive biomaterials realize their great value in healing wounds via three main strategies (electrotherapy, wound dressing, and wound assessment) were reviewed. The application of conductive biomaterials as wound dressing when facing different wounds including acute wound and chronic wound (infected wound and diabetic wound) and for wound monitoring is discussed in detail. The challenges and perspectives in designing and developing multifunctional conductive biomaterials are proposed as well.

Non-healing wounds are usually colonised by various types of bacteria. An alternative to antibiotic treatment in patients with infected wounds with local signs of inflammation may be medical-grade honey (MGH), which favourably affects the healing process with its antimicrobial, antioxidant, anti-inflammatory, and immunomodulatory properties. The objective of this study was to evaluate the effect of MGH therapy on the healing process of non-healing wounds of various aetiologies and different wound colonisations. Prospective, observation–intervention case studies (n = 9) of patients with wounds of various aetiologies (venous leg ulcers, diabetic foot ulcers, surgical wound dehiscence) are presented. All wounds were treated with MGH and the healing trajectory was rigorously and objectively monitored. In all cases, pain, odour, and exudation were quickly resolved, which led to an improvement in the quality of life of patients. Despite the proven bacterial microflora in wounds, antibiotic treatment was not necessary. The effects of MGH alleviated the signs of local infection until their complete elimination. In eight out of nine cases, the non-healing wound was completely healed. MGH has antimicrobial, anti-inflammatory, and antioxidant effects in wounds of various aetiologies and forms an effective alternative for the use of antibiotics for treating locally infected wounds.

The induction of wound healing by insulin-like growth factor-I (IGF-I) has been demonstrated in several animal studies; however, there are disproportionately fewer studies assessing its value in humans. The aim of the present review is to provide a comprehensive summary of all the available evidence pertaining to the effects of IGF-I administration on the process of wound anaplasias, both in human tissues in vivo and in cells in vitro. A systematic search of Medline, Scopus and Google Scholar was performed for relevant studies published until May 2020. Overall, 11 studies were included. Of these, 2 studies were conducted in human subjects, whereas the rest of them were performed using in vitro models of human cell lines. All studies demonstrated a positive association between IGF-I and wound anaplasias; IGF-I promoted the migration of keratinocytes, thus playing an important role in wound epithelialization as well as enabling wound bed contraction, and it also stimulated hyaluronan synthesis. The wound healing-promoting effect of IGF-I may be a great asset in dealing with the healing of challenging wounds; thus, this type of treatment could be extremely useful in addressing patients with large burn wounds, chronic diabetic ulcers and patients with impaired wound healing. Nevertheless, the route of recombinant IGF-I administration, the recommended dosage, as well as the indications for clinical use of this growth factor remain to be determined and thus, additional clinical trials are required, with a focus on the medical use of recombinant IGF-I in wound anaplasias.

Persistent hyper-inflammation is a distinguishing pathophysiological characteristic of chronic wounds, and macrophage malfunction is considered as a major contributor thereof. In this review, we describe the origin and heterogeneity of macrophages during wound healing, and compare macrophage function in healing and non-healing wounds. We consider extrinsic and intrinsic factors driving wound macrophage dysregulation, and review systemic and topical therapeutic approaches for the restoration of macrophage response. Multidimensional analysis is highlighted through the integration of various high-throughput technologies, used to assess the diversity and activation states as well as cellular communication of macrophages in healing and non-healing wound. This research fills the gaps in current literature and provides the promising therapeutic interventions for chronic wounds.

Venous leg ulcers are complex, and their multifactorial etiology make successful treatment a difficult and long process. Nonhealing ulcers are the greatest challenge because they are resistant to standard therapies. In this study, we analyzed whether monitoring the temperature of the ulcered limb wound area could benefit the diagnosis of the wound's tendency to heal (estimating the presence of a healing or nonhealing wound) in patients with two-sided venous leg ulcers. This prospective, 12-week observational study included 57 adult individuals with chronic venous leg ulcers. The dynamics of wound healing was assessed by planimetry and infrared thermography every two weeks. We analyzed temperatures measured at three marked areas-the wound, the periwound skin, and the reference area. An initial wound area larger than 1 cm2 was associated with a temperature increase of 0.027 °C in the periwound skin. A 1-cm2 decrease in the wound area was associated with a 0.04 °C decrease in the temperature difference between the periwound skin and wound. A strong positive relationship was identified for both the bacteriology variables (the presence of bacteria: temperature increase in the periwound skin of 0.4 °C, p < 0.001; the number of bacterial species in a wound, temperature increase of 0.95 °C, p < 0.001). The temperature in the reference area was significantly correlated with the failure of the superficial and perforating veins (temperature increase of 0.69 °C, p = 0.04). This study reports that the assessment of the temperature a limb may be beneficial in predicting whether an ulcer is a healing or a nonhealing ulcer. The decrease in the temperature differences between the areas referred to as healing wounds was the only beneficial prognostic marker. Other temperature differences in the periwound skin were caused by disorders, such as multibacterial wound infections and superficial venous inflammation.

Early mobilization includes factors that can affect the process of wound healing after surgery. Immediate mobilization in stages is very useful for the process of healing wounds and preventing infection and venous thrombosis. The purpose of this study was to determine whether there is a relationship between early mobilization and the process of healing wound post operative sectio caesarea at Sinar Husni General Hospital Medan Helvetia. The research design used was analytic survey with cross sectional approach. The sample in this study used the Consecutive Sampling method of data collection using a checklist sheet conducted on a sample of 19 respondents. The results of the study in this study are the majority of respondents who did early mobilization and who experienced rapid wound healing process as many as 4 people (21%) while the minority of respondents who did early mobilization and who experienced slow wound healing process were 1 person (5.3%). The majority of respondents who did not mobilize early and who experienced a slow wound healing process were 11 people (57.9%) and a minority who did not mobilize early and who experienced rapid healing as many as 4 people (21.1%). Statistical test results obtained p value = 0.046

Objective: Venous leg ulcers (VLUs) comprise 80% of leg ulcers. One of the key parameters that can promote healing of VLUs is tissue oxygenation. To date, clinicians have employed visual inspection of the wound site to determine the healing progression of a wound. Clinicians measure the wound size and check for epithelialization. Imaging for tissue oxygenation changes surrounding the wounds can objectively complement the subjective visual inspection approach. Herein, a handheld noncontact near-infrared optical scanner (NIROS) was developed to measure tissue oxygenation of VLUs during weeks of treatment. Approach: Continuous-wave-based diffuse reflectance measurements were processed using Modified Beer-Lambert's law to obtain changes in tissue oxygenation (in terms of oxy-, deoxy-, total hemoglobin, and oxygen saturation). The tissue oxygenation contrast obtained between the wound and surrounding tissue was longitudinally mapped across weeks of treatment of four VLUs (healing and nonhealing cases). Results: It was observed that wound to background tissue oxygenation contrasts in healing wounds diminished and/or stabilized, whereas in the nonhealing wounds it did not. In addition, in a very slow-healing wound, wound to background tissue oxygenation contrasts fluctuated and did not converge. Innovation: Near-infrared imaging of wounds to assess healing or nonhealing of VLUs from tissue oxygenation changes using a noncontact, handheld, and low-cost imager has been demonstrated for the first time. Conclusion: The tissue oxygenation changes in wound with respect to the surrounding tissue can provide an objective subclinical physiological assessment of VLUs during their treatment, along with the gold-standard visual clinical assessment.

In this paper, the current state-of-art of extraction of alginates and the determination of their physico-chemical properties as well as their overall applications focussing on biomedical purposes has been presented. The quality and quantity of the alginate obtained with a variable yield prepared from brown seaweeds as a result of many factors, such as type of algae, extraction methods, chemical modification and others. Alginates are mainly extracted by using conventional alkaline extraction. However, novel extraction techniques such as microwave and ultrasound assisted extractions have gained a lot of interest. The extraction parameters (e.g., temperature and time of extraction) have critical impact on the alginate physiochemical and mechanical properties and thus, their potential applications. By controlling a chemical process makes it possible get various forms of alginates, such as fibres, films, hydrogels or foams. It is important to characterise the obtained alginates in order to their proper applications. This article presents several techniques used for the analysis of alginate properties. These natural polysaccharides are widely used in the commercial production, as a food ingredient, in the pharmaceutical industry due to their antibacterial, anticancer and probiotic properties. Their gelling characteristic and absorbable properties enable using alginates as a wound management material. Moreover, they are also biocompatible, non-toxic and biodegradable, therefore adequate in other biomedical applications.

Onosma dichroantha Boiss. (Boraginaceae), has been used in traditional medicine in Iran as anti-inflammatory for healing wounds and burns. This study aimed to investigate the wound healing potential of different extracts of roots of Onosma dichroantha. The roots were extracted successively with cyclohexane (CE), ethyl acetate (EtOAc), and methanol (MeOH). The extracts were tested for anti-inflammatory assay, and fibroblast proliferation. The most potent extract, CE, was further subjected to migration assay and angiogenic assay. Furthermore, LC–MS/MS analysis was used for identification of bioactive compounds present in CE extract. CE extract at 62.5 and 1000 μg/mL was the most effective in inhibiting LPS-induced inflammation assay and promoting Hs27 fibroblast proliferation, respectively. About 92% closing of the wound was observed after 24 h treatment of HMEC-1 cells with CE extract at concentration of 125 μg/mL in scratch test. Angiogenic effect of CE extract at the concentration of 0.5 μg/mL was also confirmed in vivo in transgenic zebrafish embryos by increasing the sprout number. LC–MS/MS studies revealed that compounds shikonin, β,β-dimethylacrylalkannin and β,β-dimethylacrylshikonin (arnebin-1) were present in the crude CE extract. These results provided scientific evidences to support the traditional use of O. dichroantha roots in treating wounds and ulcers.

Objective The study aimed to determine the clinical effectiveness of honey dressings in the management of non-healing wounds in elderly persons receiving home care. Material and methods Design: a prospective interventional study. The sample comprised 40 Czech home care clients (aged over 65 years) with non-healing wounds who were randomly assigned to two groups. Wounds were treated with honey (intervention group) or conventional (controls) dressings. Each wound was studied for three months. A detailed description of a wound (location, size, wound bed, edges, amount of exudate, odor, adjacent skin) were recorded. Wounds were assessed with the Wound Healing Continuum and pain intensity with the Visual Analog Scale. Results Over the 3-month period, 16 (80%) individuals in the intervention group had their wounds completely healed, as compared with only six (30%) controls. There was no statistically significant difference in wound size between the groups on Day 1 (p = 0.1801). Ninety days later, the difference in wound size between the groups was statistically significant (p = 0.0041). There was a statistically significant difference in pain intensity between the two groups (p = 0.0007), with higher pain scores being indicated by controls. Conclusion The study results showed that the application of honey dressings to non-healing wounds resulted in faster healing, wound size reduction and lower pain intensity.

This study aims at developing an effective, safe and economic hydrogel, with wound healing ability, by making use of polysaccharides. Bletilla striata polysaccharide (Bsp) and the bioactive natural polymers, carboxymethyl chitosan (CMC), were physically blended with Carbomer 940 (CBM940) in order to promote gel-forming and improve water retention. FT-IR displayed hydrogen bonding between CBM940 and CMC played a role in physical gel formation. XRD showed broad and weak intensity peak of Bsp/CMC/CBM940 hydrogel. SEM, rheological measurement and water loss test revealed that the best hydrogel with optimum characteristics in relation to porous structure, elastic property and water retention could be obtained by mixing Bsp, CMC and CBM940 in a ratio of 4:1:1. In vitro studies proved that the Bsp/CMC/CBM940 hydrogel possessed blood compatibility. M293T cells viability was over 85% via MTT assay which revealed non-cytotoxicity. Hydroxyl radical scavenging property highly improved while Bsp combined with CMC. The full-thickness wound experiment illustrated 71.64 ± 6.64% and 83.80 ± 5.56% wound healing rates for Bsp4:CMC1:CBM9401 hydrogel on Day 7 and Day 14, respectively, which showed no significant differences (p > 0.05) in comparison to the positive control. Histological observation expressed epithelization, dense collagen fiber and neovascular formation in hydrogel group on Day 14. Bsp/CMC/CBM940 hydrogel can, hence, serve as an attractive candidate for healing wounds.

Elizabethan collars (E-collars) are commonly used in various species to safeguard healing wounds. However, E-collars inadvertently restrict the expression of normal species-typical behaviors, including coprophagy, self-grooming, and social housing. To maintain social housing in accordance with recommendations in the 8th edition of the Guide for the Care and Use of Laboratory Animals, we implemented the use of human infant pants instead of E-collars for postsurgical protection. We retrospectively reviewed the medical records of 154 intact male New Zealand white rabbits (age, 2 to 3 mo) regarding the use of E-collars (group 1; n = 72) compared with human infant pants (group 2; n = 82) for postoperative protection after 308 femoral angioplasty procedures. Maintenance of social pairs throughout the postoperative phase, replacement rate of infant pants, and self-mutilation rates were measured. Our findings indicate that using infant pants for postoperative protection was most successful in maintaining social housing, offers a more cost-effective option to E-collars, and does not increase the rate of self-mutilation in intact male New Zealand white rabbits.

Ethnopharmacological relevance: The genus Curcuma, which is the most important source of curcumin, has been widely used in different traditional medicines. Various species of Curcuma have long been used for several purposes such as healing wounds, liver disorders, jaundice and also as a blood purifier. Aim of the study: This review focused on the ethnopharmacological uses and phytochemical aspects of Curcuma. Additionally, in this study, the different properties of two species of Curcuma in Islamic Traditional Medicine (ITM), C. longa and C. zedoaria, as well as their pharmacological aspects in modern medicine are reviewed. Materials and methods: ITM literatures were searched to find Curcuma’s applications. Also, electronic databases including PubMed and Scopus were searched to obtain studies giving any in vitro, in vivo or human evidence of the efficacy of C. longa and C. zedoaria in the treatment of different diseases. ChemOffice software was used to find chemical structures. Results: The analysis showed that ethno-medical uses of Curcuma have been recorded for centuries. Approximately, 427 chemical compounds have been isolated and identified from Curcuma spp. This genus is rich in flavonoids, tannins, anthocyanin, phenolic compounds, oil, organic acids and inorganic compounds. Curcumin is one of the main active ingredients in Curcuma which has strong anti-inflammatory and antioxidant effects. Besides, pharmacological studies have indicated wide range of Curcuma’s activities, such as hepato-protective, antifungal, antihypertensive and neuroprotective. Conclusions: In this study, we reviewed various studies conducted on ethno-medicinal, ITM properties and photochemistry of Curcuma spp. Also, pharmacological activities of two species, C. longa and C. zedoaria are summarized. Pre-clinical investigations have demonstrated some of the traditional aspects of Curcuma, such as wound healing, anti-arthritic, anti-tumor and liver protective activities. These could be related to antioxidant and anti-inflammatory properties of Curcuma which might be due to high amounts of phenolic compounds. Curcuma is mentioned to have neural tonic properties in ITM which have been confirmed by some animal studies. Considering various preclinical studies on C. longa and C. zedoaria and their active ingredient, curcumin, randomized controlled trials are warranted to confirm their promise as a clinically effective hepato and neuro-protective agents.

Telah dilakukan penelitian mengenai Uji Farmakologi Sediaan Patch Dari Limbah Kulit Pisang Kepok Untuk Penyembuhan Luka Bakar. Tujuan penelitain ini untuk melakukan uji efektivitas dengan menggunakan hewan coba kelinci, serta pembuatan plester patch untuk memberikan suatu kenyamanan dan kemudahan kepada konsumen dalam mengobati luka. Peneltian ini menggunakan metode kuantitatif dengan cara metode eksperimental laboratorium, cara kerjanya berupa pengambilan sampel, ektraksi kulit buah pisang kepok, membuat plester patch dari 3 macam formula kemudian membandingkan dengan kontrol positif dan negatif, evaluasi plester patch¸ dan setelah pengujian daya sembuh luka pada hewan kelinci. Dari hasil penelitian didapatkan Formula III yang memiliki efektifitas paling baik dalam menyembuhkan luka yaitu konsentrasi 30% kulit buah pisang kepok. ABSTRACT Research has been conducted on the Pharmacological Test of Patches Preparation from Kepok Banana Skin Waste to Heal Burns. The use of immature kepok banana peels to help speed up the duration of wound healing has already been done, but in previous studies, kepok banana peel was extracted, but made in gel form, whereas in patch plaster preparations had never been studied before. The purpose of this research is to make patch plaster preparations that have the best effectiveness in healing wounds, as well as making patch plasters to provide comfort and convenience to consumers in treating wounds. This research uses a quantitative method by means of laboratory experimental methods, how it works in the form of sampling, extraction of kepok banana peel, making patch plaster using active ingredients kepok banana peel extract (Musa acuminate), and other additives in the form of glycerin, chitosan, HPMC, Tween 80, then formulated into 3 types of formulas, then compared with positive and negative controls, evaluation of patch patches and after testing the healing power of wounds in rabbit animals. From the results of the study it was found that Formula III had the best effectiveness in healing wounds, namely the concentration of 30% kepok banana peels.

Introduction: The therapeutic use of oxygen under pressure is known as hyperbaric oxygen therapy (HBOT) and has been used to assist wound healing for almost 40 years. The purpose of the present study was to see the outcome of hyperbaric oxygen therapy following its use in non healing wounds. Methods: This prospective observational study was conducted in the Department of Plastic Surgery, Dhaka Medical College Hospital, Dhaka, from March 2016 to February 2017 for a period of 12 (twelve) months. The study was carried out on patients with non healing wounds. Patients were initially assessed with detailed history, clinical examination and investigations, and then treated with hyperbaric oxygen therapy for 90 minutes per session in 6 days a week for 25 cycles. Wound was assessed clinically, and with transcutaneous oximetry and laboratory investigations. Results: Eighty patients were included, where 52 (65.0%) patients had diabetic ulcer, followed by post traumatic wound (14) and venous ulcer (7). Fifty nine (73.75%) patients had initial wound size of < 50 cm2 with mean size 14.78 ± 12.5 cm2. Wound size reduction rate after 15 cycles of HBOT was 42.78%, and after 25 cycles of HBOT it was 61.21%. Among the 80 patients, 60 (75.0%) had moderate amount of discharge before HBOT; 19 (31.67%) & 25 (41.67%) reduced to small & no discharge after 25 cycles of HBOT respectively. 39 (48.75%) patients had serosanguineous discharge before HBOT, followed by 36 (45.0%) and 5 (6.25%) patients with purulent and serous discharge. Among the 39 patients with serosanguineous discharge, 15 (38.46%) & 20 (51.28%) patients had serous & no discharge after 25 cycles of HBOT respectively. Before starting HBOT, mean transcutaneous oximetry was 58.26 ± 3.84 mmHg, and it was 62.1 ± 6.27 mmHg and 66.92 7.52 mmHg after 15 and 25 cycles of HBOT respectively. Conclusion: So it can be stated that the hyperbaric oxygen therapy is a good option in treating different non healing wounds. J Bangladesh Coll Phys Surg 2019; 37(3): 109-118

The medicinal and dermo-cosmetic uses of clays date back to prehistory. Clays mixed with water and different types of mud were used by early humans for healing wounds and skin cleansing. Clays are naturally occurring ingredients in many natural health products, mentioned in many ancient Mediterranean and European medical texts, and currently used to prepare therapeutic hot-mud (peloid) baths at numerous spas in Mediterranean regions. We acquired eleven samples in five Tunisian town markets of green and brown clays traditionally used to prepare homemade mud-packs intended for topical application. These clays were partially characterized in a previous study regarding their mineralogical, chemical, textural and thermal properties. This study aims to evaluate the feasibility of these green and brown clay samples. We present data of pH, zeta potential and in vitro cation release from these inorganic gels. Other properties such as rheology and particle size distribution are also considered to be relevant given the clays' topical administration as cosmetic products., This research was supported by funding from the Spanish Group CTS-946 and projects CGL2016-80833-R, IRSES MEDYNA (PIRSES-GA-2013-612572) and PTQ-15-07625.

The ancestral knowledge regarding the use of the leaves and bark of the ceibo to heal wounds, sores, blisters and control the bleeding of wounds by cuts, is a practice that has been lost especially in the rural and marginal urban area of the Portoviejo canton, being this way we worked in the recovery of the ancestral knowledge regarding the use of the leaf and bark of the royal ceibo tree, using the experimental method to elaborate the remedy and the plaster, a qualitative research was applied through an interview 3 farmers who have ancestral knowledge about remedies based on royal ceibo. The results include the recovery of ancestral knowledge to develop a remedy healing wounds, sores, blisters, and bleeding controller, tested on 30 students who performed agricultural practices in the field, exposed to the sun and heavy work in the field, with cuts and minor injuries , in which the remedy was applied based on cooked leaves of ceibo, and in 2 cases of wounds with bleeding the remedy of leaves and a bark plaster was applied, managing to stop the bleeding with the washing and promoting the healing of the wounds.

In this autoethnographic response to Brexit, the author tries to make sense of feelings of profound loss following the UK referendum decision to leave the European Union. In exploring questions of what it is that has been lost, who ‘we’ are, and how we might recover, she traces key strands in her family, cultural, and professional life that highlight both points of division and points of connection with others (and with those doing ‘othering’), in our increasingly polarised and fragmented world. Stories she listened to in her professional capacity, told by politicians on the one hand and by those who had long felt excluded and ‘left behind’ on the other, take on a fresh significance in light of the decision to ‘leave’. In these uncertain and insecure times, one thing seems sure: Progress lies in connecting to others, reaching out, crossing borders, holding hands, healing wounds, re-creating community.

Chitosan has chemical properties that allow the formation of gels in acid media, which can be used as a dressing for wound treatment, since they are biocompatible and have activity against pathogenic microorganisms. Thus, a chitosan gel associated with chlorhexidine was developed and characterized for the study of antibacterial and healing activity. The gels were synthesized by the reaction of the acetic acid solution with chitosan, followed by the addition of 2 and 4% chlorhexidine to the amount of the acid solution being characterized by thermogravimetry, differential scanning calorimetry and infrared spectroscopy, which proved the presence of substances, in the gel. Tests of direct contact with the strain Staphylococcus aureus showed 100% inhibition of bacterial growth and formation of a halo for the associated gels. Histological examination revealed healing on 14th day when animals was treated with chitosan hydrogel containing 2% chlorhexidine, showing a greater contraction power of the wound when compared to the control groups. For the other products tested, healing was better after the 14th day, and except for saline and 4% chlorhexidine groups, all other lesions were closed on the 14th day. The results indicate that a promising material was obtained for use as a healing agent.

The use of antiseptics in wounds can cause long-term side effects. This study aims to determine the potential of mango leaves (Mangifera indica L) as a natural ingredient for healing wounds. This true experimental research used six treatment groups. This study used a completely randomized design of four repetitions using 24 samples of white rats (Rattus norvegicus) taken randomly. The results of the Anova statistical test showed that there was a difference in the effect of giving mango leaf extract to incisive wound healing. The results showed that a concentration of 20% showed a faster recovery time of 7.25 days with an average wound closure of 4.02 mm. This indicates that the extract of mango leaves has the potential to be used as a healing wound for the incision.

Tumbang Rungan Village is one of the villages located in Pahandut District, Palangka Raya City, Central Kalimantan. This village is one of the locations that have great potential for medicinal herbs (THBO). Many traditional medicines are marketed in the Central Kalimantan region made from THBO from the village of Tumbang Rungan. THBO from Tumbang Rungan Village is believed by the community to be able to treat various diseases including treating tonsillitis, coughing, asthma explosions, stamina enhancer in men, antidiabetic, diuretic, and healing wounds. But this is still empirical, and there is no scientific data. Therefore, this research was conducted to inventory THBO from Tumbang Rungan Village and do a literature study to look for experimental data on both active compounds and pharmacological effects compared to practical ones. The results of the survey obtained eleven THBO from Tumbang Rungan Village which is efficient as traditional medicines. Nine plants including scientific data have been collected regarding active compounds and their pharmacological effects. The results of this study can later become a reference for further research to develop the local potential of Central Kalimantan in traditional medicine.