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Diabetic foot ulcers (DFU) are chronic, refractory wounds caused by diabetic neuropathy, vascular disease, and bacterial infection, and have become one of the most serious and persistent complications of diabetes mellitus because of their high incidence and difficulty in healing. Its malignancy results from a complex microenvironment that includes a series of unfriendly physiological states secondary to hyperglycemia, such as recurrent infections, excessive oxidative stress, persistent inflammation, and ischemia and hypoxia. However, current common clinical treatments, such as antibiotic therapy, insulin therapy, surgical debridement, and conventional wound dressings all have drawbacks, and suboptimal outcomes exacerbate the financial and physical burdens of diabetic patients. Therefore, development of new, effective and affordable treatments for DFU represents a top priority to improve the quality of life of diabetic patients. In recent years, nanozymes-based diabetic wound therapy systems have been attracting extensive interest by integrating the unique advantages of nanomaterials and natural enzymes. Compared with natural enzymes, nanozymes possess more stable catalytic activity, lower production cost and greater maneuverability. Remarkably, many nanozymes possess multienzyme activities that can cascade multiple enzyme-catalyzed reactions simultaneously throughout the recovery process of DFU. Additionally, their favorable photothermal-acoustic properties can be exploited for further enhancement of the therapeutic effects. In this review we first describe the characteristic pathological microenvironment of DFU, then discuss the therapeutic mechanisms and applications of nanozymes in DFU healing, and finally, highlight the challenges and perspectives of nanozyme development for DFU treatment.

Purpose: In pediatric population, large soft tissue defects occur in avulsion injuries. In addition to the challenges of primary surgical therapy, elasticity, appearance and function of the scar in children are of crucial importance, especially in the context of body growth. So far various flaps, plasties, skin grafts and dermal substitutes have become established, although infections and skin shrinkage remain challenging. In 2020, a new skin substitute material—NovoSorb® Biodegradable Temporizing Matrix (BTM)—was introduced in Europe for temporary wound closure and tissue regeneration. The aim of this study was to evaluate the value of BTM in pediatric patients. Methods: The study included all children treated with BTM after traumatic soft tissue defects following limb avulsion injuries between June 2021 and June 2023 at a university hospital. Results: 7 patients with limb avulsion injuries were treated with BTM, 4 boys, 3 girls. Mean age was 6.5 years (2–11 years) at the time of BTM placement. 4/7 had concomitant fractures. BTM was used successfully in all cases, infection did not occur, skin shrinkage was seen in one case. Split thickness skin graft (STSG) after BTM application was performed in average after 33 days (26 to 39 days). Limitations of this study were highlighted. Conclusion: BTM is a promising alternative for reconstruction of complex trauma extremity wounds in children following avulsion injuries, even in cases of concomitant bone injuries. Interpretation may be limited by sample size. [ABSTRACT FROM AUTHOR]

Bacterial infection hampers wound repair by impeding the healing process. Concurrently, inflammation at the wound site triggers the production of reactive oxygen species (ROS), causing oxidative stress and damage to proteins and cells. This can lead to chronic wounds, posing severe risks. Therefore, eliminating bacterial infection and reducing ROS levels are crucial for effective wound healing. Nanozymes, possessing enzyme-like catalytic activity, can convert endogenous substances into highly toxic substances, such as ROS, to combat bacteria and biofilms without inducing drug resistance. However, the current nanozyme model with single enzyme activity falls short of meeting the complex requirements of antimicrobial therapy. Thus, developing nanozymes with multiple enzymatic activities is essential. Herein, we engineered a novel metalloenzyme called Ru-procyanidin nanoparticles (Ru-PC NPs) with diverse enzymatic activities to aid wound healing and combat bacterial infections. Under acidic conditions, due to their glutathione (GSH) depletion and peroxidase (POD)-like activity, Ru-PC NPs combined with H2O2 exhibit excellent antibacterial effects. However, in a neutral environment, the Ru-PC NPs, with catalase (CAT) activity, decompose H2O2 to O2, alleviating hypoxia and ensuring a sufficient oxygen supply. Furthermore, Ru-PC NPs possess exceptional antioxidant capacity through their superior superoxide dismutase (SOD) enzyme activity, effectively scavenging excess ROS and reactive nitrogen species (RNS) in a neutral environment. This maintains the balance of the antioxidant system and prevents inflammation. Ru-PC NPs also promote the polarization of macrophages from M1 to M2, facilitating wound healing. More importantly, Ru-PC NPs show good biosafety with negligible toxicity. In vivo wound infection models have confirmed the efficacy of Ru-PC NPs in inhibiting bacterial infection and promoting wound healing. The focus of this work highlights the quadruple enzymatic activity of Ru-PC NPs and its potential to reduce inflammation and promote bacteria-infected wound healing.

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

[Display omitted] • The catalytic activities of MIL-53 are enhanced by rational modification. • AgAu-modified quasi-MIL-53 hybrid nanozyme is successfully prepared. • The hybrid nanozyme shows satisfactory triple enzyme-like activities. • The hybrid nanozyme effectively promoted infected diabetic wound healing. Metal-organic frameworks (MOFs) have great potential for combating pathogenic bacterial infections and are expected to become an alternative to antibiotics. However, organic linkers obstruct and saturate the inorganic nodes of MOF structures, making it challenging to utilize the applied potential of metal centers. Here, we combined controlled ligand decarboxylation with noble metal nanoparticles to rationally remodel MIL-53, resulting in a hybrid nanozyme (AgAu@QMIL-53, AAQM) with excellent multiple enzyme-like activities that both eradicate bacteria and promote diabetic wound healing. Specifically, benefitting from oxidase (OXD)-like and peroxidase (POD)-like activities, AAQM converts oxygen (O 2) and hydrogen peroxide (H 2 O 2) into superoxide anion radicals (O 2 −) and hydroxyl radicals (OH) to eradicate bacteria. In in vitro antibacterial experiments, AAQM exhibited favorable killing efficacy against Pseudomonas aeruginosa (P. aeruginosa) and methicillin-resistant Staphylococcus aureus (MRSA) (>99 %). Notably, due to its superoxide (SOD)-like activity and outstanding reactive nitrogen species (RNS) elimination capacity, AAQM can produce adequate O 2 and alleviate oxidative stress in diabetic wounds. Benefiting from the rational modification of MIL-53, the synthesized hybrid nanozyme can effectively kill bacteria while alleviating oxidative stress and ultimately promote infected diabetic wound healing. Overall, this biomimetic enzyme-catalyzed strategy will bring enlightenment to the design of self-antibacterial agents for efficient disinfection and wound healing simultaneously. [ABSTRACT FROM AUTHOR]

Bacterial infection hampers wound repair by impeding the healing process. Concurrently, inflammation at the wound site triggers the production of reactive oxygen species (ROS), causing oxidative stress and damage to proteins and cells. This can lead to chronic wounds, posing severe risks. Therefore, eliminating bacterial infection and reducing ROS levels are crucial for effective wound healing. Nanozymes, possessing enzyme-like catalytic activity, can convert endogenous substances into highly toxic substances, such as ROS, to combat bacteria and biofilms without inducing drug resistance. However, the current nanozyme model with single enzyme activity falls short of meeting the complex requirements of antimicrobial therapy. Thus, developing nanozymes with multiple enzymatic activities is essential. Herein, we engineered a novel metalloenzyme called Ru-procyanidin nanoparticles (Ru-PC NPs) with diverse enzymatic activities to aid wound healing and combat bacterial infections. Under acidic conditions, due to their glutathione (GSH) depletion and peroxidase (POD)-like activity, Ru-PC NPs combined with H 2 O 2 exhibit excellent antibacterial effects. However, in a neutral environment, the Ru-PC NPs, with catalase (CAT) activity, decompose H 2 O 2 to O 2 , alleviating hypoxia and ensuring a sufficient oxygen supply. Furthermore, Ru-PC NPs possess exceptional antioxidant capacity through their superior superoxide dismutase (SOD) enzyme activity, effectively scavenging excess ROS and reactive nitrogen species (RNS) in a neutral environment. This maintains the balance of the antioxidant system and prevents inflammation. Ru-PC NPs also promote the polarization of macrophages from M1 to M2, facilitating wound healing. More importantly, Ru-PC NPs show good biosafety with negligible toxicity. In vivo wound infection models have confirmed the efficacy of Ru-PC NPs in inhibiting bacterial infection and promoting wound healing. The focus of this work highlights the quadruple enzymatic activity of Ru-PC NPs and its potential to reduce inflammation and promote bacteria-infected wound healing. Ru-PC NPs, a novel nanozyme with quadruple enzymatic activity, effectively treats infected wounds. They demonstrate strong antimicrobial effects, antioxidant capacity, and anti-inflammatory properties, promoting M2 macrophage conversion for enhanced healing. [Display omitted] [ABSTRACT FROM AUTHOR]

The effective management of bacterial infections that are resistant to multiple drugs remains a substantial clinical challenge. The eradication of drug-resistant bacteria and subsequent promotion of angiogenesis are imperative for the regeneration of the infected wounds. Here, a novel and facile peptide containing injectable hydrogel with sustained antibacterial and angiogenic capabilities is developed. The antibacterial peptide that consists of 11 residues (CM11, WKLFKKILKVL) is loaded onto acrylate-modified gelatin through charge interactions. A vascular endothelial growth factor mimetic peptide KLT (KLTWQELYQLKYKGI) with a GCG (Gly-Cys-Gly) modification at the N-terminal is covalently coupled through a visible light-induced thiol-ene reaction. In this reaction, the acrylate gelatin undergoes cross-linkage within seconds. Based on the physical/chemical double crosslinking strategy, the bioactive peptides achieve sustained and sequential release. The results show that the hydrogel significantly inhibits methicillin-resistant Staphylococcus aureus (MRSA) growth through the rapid release of CM11 peptides at early stage; it forms obvious growth inhibition zones against pathogenic bacterial strains. Moreover, cell counting kit-8 assay and scratch test confirm that the CM11/KLT-functionalized hydrogels promote cell proliferation and migration through the later release of KLT peptides. In a mouse skin wound infected with self-luminous MRSA, the CM11/KLT-functionalized hydrogels enhance wound healing, with rapidly bacterial infection reduction, lower expression of inflammatory factors, and neovascularization promotion. These results suggest that the rationally designed, sustained and sequential release CM11/KLT-functionalized hydrogels have huge potential in promoting the healing of multi-drug resistant bacterial infected wounds. [ABSTRACT FROM AUTHOR]

Objective: Severe soft tissue damage with destruction of the dermis requires plastic reconstructive treatment. For multimorbid patients or patients unable to undergo major reconstructive surgery, use of dermal substitutes, such as a collagen-elastin matrix (CEM) with a split-thickness skin graft (STSG), instead of local or free flap surgery, may be a valid and easy treatment option. We aimed to investigate and compare the outcomes and rate of successful defect reconstruction using CEM plus STSG, using either a one-step approach (simultaneous CEM and STSG) or a two-step approach (CEM and negative wound pressure therapy (NPWT), with secondary STSG transplantation). Method: A single-centre, retrospective follow-up study of patients who had received CEM was conducted. Wounds had been treated with an STSG transplantation covering a CEM (MatriDerm, MedSkin Solutions Dr. Suwelack AG, Germany). Previous attempts at wound closure with conventional methods had failed in the selected patient population, which would usually have resulted in flap surgery. Results: Overall, 46 patients were included (mean age 60.9±20.0 years), with a total of 49 wound sites. We analysed 38 patients with wounds that did not require flap coverage; 18 patients received the one-step approach and 20 patients received the two-step approach. The mean follow-up in these patients was 22±11.5 months, and one patient was lost to follow-up. Overall, 29 (78.4%) wounds remained closed. Wounds which did not successfully heal were related to comorbidities, such as diabetes, alcohol misuse and smoking. Using the one-step approach, long-term defect coverage was achieved in 13 (76.5%) wounds and 16 (80.0%) wounds were closed using the two-step approach. However, there was no statistically significant differences between the one- or two-step approaches regarding the rate of development of a wound healing disorder. Conclusion: Wound closure was achieved in 38 complex wounds using CEM plus STSG, while 11 wounds needed secondary flap coverage. In the flap-free wounds, there were no statistically significant differences between the one-step versus two-step approach. Using a simple defect reconstruction algorithm, we successfully used CEM plus STSG to treat complex wounds. [ABSTRACT FROM AUTHOR]

Aim: One of the technological advances in wound healing is negative pressure wound therapy (NPWT). NPWT is frequently used in acute and chronic wound care. However, few studies in the literature have investigated the effects of NPWT on the graft in patients with diabetic foot ulcers. In this study, we aimed to assess the effects of applying negative pressure wound closure on grafts and its influence on. The healing time indiabetic foot ulcers and thus contribute to the literature by sharing our experience. Materials and Methods: We retrospectively evaluated patients who had received treatment for diabetic foot ulcers in the chronic wound care unit of our hospital between February 2018 and October 2021 and underwent split-thickness skin grafting. The patients were categorized into two groups: those who did and did not receive NPWT to provide support for the graft. The patients were compared in terms of wound healing rates and healing times. Results: The study included 34 men (56.7%) and 26 women (43.3%) (n = 60). The mean age of the patients was 62.07 ± 11.5 years. Supportive NPWT was performed on the graft in 19 (31.7%) patients, whereas 41 (68.3%) patients were treated with grafting and conventional therapy. The treatment duration was shorter in the NPWT group (29.63 ± 19.6 days) than in the non-NPWT group (34.05 ± 17.5 days); however, this difference was not significant (p > 0.05). A significant weak positive correlation (r = 0.28) was observed between the Wagner stage and treatment duration. Conclusion: The treatment of diabetic foot ulcers is affected by several factors, including the presence of infection, vascularization status, wound size, and glycemic control. In this study, we examined a general patient population with diabetic foot ulcers and identified no significant difference in terms of treatment times and healing rates between NPWT and conventional methods as graft-supporting measures. Prospective studies investigating patient populations comprising subgroups may yield varying results, which emphasizes the need for further research in this direction. [ABSTRACT FROM AUTHOR]

We now commonly use Negative Pressure Therapy (NPWT) as an adjunct to care in a variety of circumstances. In the management of wounds, ulcers or sores of varying size and with such a degree of secretions, exudate, oozing that the correct use of common dressing devices is not possible. Over time, this therapeutic choice has seen an important evolution in clinical indications and technology aimed at achieving an effective and consistent result.

Necrotizing fasciitis is one of the most severe soft tissue infections, having substantial fatality rates even in facilities with the highest standards. Typically, it first affects the muscular fascia before spreading to the muscles and subcutaneous tissues. Thus, the therapy for this illness depends on early detection. In this report, we present the case of an 18-year-old male who developed severe necrotizing fasciitis in the right gluteal area following an intramuscular injection of diclofenac sodium. The patient received significant surgical debridement, negative pressure wound therapy (NPWT), and antibiotics as part of their care. A split-thickness skin graft was used for reconstruction. Our results were outstanding as the wound totally healed. Overall, our findings portrayed the importance of taking serious action against soft tissue infections. [ABSTRACT FROM AUTHOR]

Background: Zinc L-carnosine promotes the transition from the inflammatory to the proliferative phase of wound healing by reducing the expression of pro-inflammatory signals and enhancing the expression of anti-inflammatory signals. This prospective cohort study aims to test the effect of a zinc–L-carnosine mouthwash in promoting oral surgical wound healing. Methods: From October 2022 to February 2023, the authors enrolled healthy adult volunteers who needed the extraction of bilateral molars at the Unit of Dentistry of the University of Bari. The authors studied the baseline wound healing of each patient after the first extraction. Three months later, the patients underwent the second extraction and rinsed their mouths with zinc–L-carnosine mouthwash twice per day for the following 28 postoperative days. For a month after each extraction, the patients received weekly follow-up visits by an oral surgeon blinded about the study to record the modified healing index score of the wounds (range 0–6 points). For statistical analysis, we used the one-tailed t-test for paired samples with a significance level set at p < 0.05 to compare the baseline scores with those recorded during the exposure to the zinc–L-carnosine mouthwash. Results: The authors enrolled four women and six men (mean age = 44.60 ± 19.22 years). On the seventh and fourteenth postoperative days, the mean difference between the modified healing index scores obtained by using the zinc–L-carnosine mouthwash and the baseline was not significant. On the twenty-first postoperative day, the mean score obtained by using the mouthwash was 5.2 ± 1.3 points and was significantly higher than the 4.7 ± 1.8 points of the baseline (p = 0.026). On the twenty-eighth postoperative day, the mean difference was significant as well (5.9 ± 0.3 points and 5.4 ± 1.1 points, respectively). Conclusion: The preliminary results of this study showed that the zinc–L-carnosine mouthwash improved the quality of oral surgical wound healing. [ABSTRACT FROM AUTHOR]

Replantation is widely regarded as the first choice of treatment for finger amputations. However, if the fingertip of a traumatic finger amputation is missing after an injury, the following procedures are often performed to reconstruct this portion: flap surgery, stump surgery, or conservative treatment, including occlusive dressings. To our knowledge, no existing English literature reports using negative-pressure wound therapy (NPWT) to treat traumatic finger amputations. We postulated that NPWT may be applied as a conservative treatment for traumatic finger amputations, promoting the growth of granulation tissue and achieving early epithelialization of the fingertips. Among the case series of five patients, we included six injured fingers comprising two index, two middle, and two ring fingers. The fingertip of each traumatic finger amputation was either missing or highly crushed, making replantation impossible. To preserve finger length with conservative treatment, we adapted an NPWT device for finger amputations. It took an average of 22.7 days for the fingertips to epithelialize. Immediately after epithelialization, there was a slight decrease in sensory perception; however, all patients showed good recovery of sensory perception after 3 months. Range of motion remained unrestricted, with no reduction in grip strength. Patients were highly satisfied with their fingertip appearance. The regenerated nail exhibited slight deformation and shortening. No complications were observed. Our novel study regarding this new conservative treatment and its outcomes revealed that healing was achieved in a relatively short period; therefore, NPWT may serve as a new conservative treatment option in the future. [ABSTRACT FROM AUTHOR]

The rapidly expanding area of regenerative medicine may soon enter a new phase owing to developments in biomaterials and their application in generating new tissues. Chemicals and synthetic drugs are currently the subject of heated debate due to their effects on human health and the environment. Therefore, scientists seek out new products and procedures that are harmless to both the environment and human health concerns. Bio-based materials provide excellent functional qualities with a variety of applications. This study resulted in the development of a film with antimicrobial, hydrophilic, and anti-cancer properties, which is most beneficial in the medical sectors. In this study, we developed a blended biodegradable film containing agar and pectin (AP), with excellent surface functional properties framed through a casting technique. Additionally, the property can be changed by the addition of extract of hemigraphis alternata (HA) extract. The incorporation of extract in AP (APH) can be used for anti-cancer wound care therapy. The fabricated film is biodegradable, biocompatible, and non-toxic. This material is entirely based on a green methodology, and it was prepared in a concise manner without the use of any hazardous solvents. Based on the overall nature of biopolymer, the prepared material is a promising alternative to our society. [ABSTRACT FROM AUTHOR]

Complex and chronic wounds represent a highly prevalent condition worldwide that requires a multimodal and interdisciplinary treatment approach to achieve good functional and aesthetic outcomes. Due to increasing costs of health care, an aging population and an increase in difficult-to-treat microbial colonization of wounds, complex wounds will become a substantial clinical, social and economic challenge in the upcoming years. In plastic reconstructive surgery, a variety of dermal skin substitutes have been established for clinical use. Since its approval as a dermal skin substitute in Germany, NovoSorb® Biodegradable Temporising Matrix (BTM) has become a valuable therapeutic option for the treatment of full-thickness wound defects. The clinical data published to date are limited to case reports and small-scale case series with the main focus on single wounds. The aim of this single-center study was a retrospective analysis of our own patient collective that has received treatment with BTM for complex wounds. Overall, BTM showed to be a reliable and versatile reconstructive option, especially for patients with multiple co-morbidities and microbiologically colonized wounds. Although the preliminary findings have produced promising results, further investigation and research are warranted regarding long-term outcomes and additional clinical applications. [ABSTRACT FROM AUTHOR]

Diabetic wounds are the most critical complication in patients with diabetes, which often lead to hospitalization and limb amputations. Diabetic foot ulcers (DFU) is characterized by infections, prolonged inflammation, and a delayed wound healing process. Different types of medical procedures including surgical therapy, drug delivery, stem cell therapy, and wound dressings are used to manage DFU. Bioactive dressings such as hydrogels, nanofiber, and collagens are promising materials that can accelerate the healing process. The wound dressing materials can also be loaded with bioactive molecules like nucleic acids. MicroRNAs (miRNAs) are small non-coding RNA molecules that have recently emerged as regulators of impaired wound healing and could be a target for DFU treatment. miRNA therapeutics can be delivered to the wound region using different delivery systems such as exosomes and nanoparticles. These wound dressings have a high potential for treating diabetic wounds by topical delivery of certain miRNAs in a sustained release manner.

To overcome the challenges of poor wound diagnosis and limited clinical efficacy of current wound management, wound dressing materials with the aim of monitoring various biomarkers vital to the wound healing process such as temperature, pH, glucose concentration, and reactive oxygen species (ROS) and improving the therapeutic outcomes have been developed. These innovative theranostic dressings are smartly engineered using stimuli-responsive biomaterials to monitor and regulate local microenvironments and deliver cargos to the wound sites in a timely and effective manner. This review provides an overview of recent advances in novel theranostics for wound monitoring and therapy as well as giving insights into the future treatment of wounds via smart design of theranostic materials. [Display omitted] • This review discusses the management of wound healing and relevant strategies for improved skin regeneration. • This review describes point-of-care wound monitoring systems response to the stimulus of the pH, temperature, glucose concentration, ROS, etc. • This review provides a systematic summary of multifunctional wound theranostic materials and their therapeutic effects for the promotion of wound healing. • This review offers a prospective on application of stimuli responsive theranostic materials and the development of smart wound dressing materials. [ABSTRACT FROM AUTHOR]

Abstract Antibiotic‐resistant infections caused by bacterial pathogens pose a serious threat to public health, hampering wound healing and causing significant morbidities worldwide. A biomedical fiber‐device that functions as a drugless antiseptic is introduced as a solution to this problem. Through stitching, piercing, or topical application to the wound, this fiber slows down the proliferation of pathogenic bacteria, thereby reducing the risks associated with inflammation and inhibiting infections. The fiber's bacterial proliferation inhibition function is based on the galvanic effect, which disturbs bacterial quorum sensing. Detailed herein are the fiber design optimization, scalable fabrication approach, electrical function characterization, and antiseptic function verification in cultures of typical wound pathogens. Such a fiber—mechanically and environmentally resilient, insensitive to harsh storage conditions with nominally infinite shelf‐life, resulting from machining rather than pharmacochemical fabrication— provides a cost‐effective and widely available alternative to current antibiotic treatments of physical injury.

Disposal of the cow dung pollutants arising from cattle farming threatens the environment and public safety in diverse ways. To date, researchers have worked on developing new pathways to control and manage cattle farming wastes, but most do not involve the reuse of these wastes. Herein, a cow dung biochar-modulated photothermal N -halamine hydrogel (i.e., PAN/CA/CoBC/pMAG-Cl) was designed for converting cow dung into biochar (CoBC), which was then coupled with a 3D interpenetrating hydrogel network to treat infected wounds. The PAN/CA/CoBC/pMAG-Cl hydrogel exhibited excellent synergistic antibacterial performance against 10 6 CFU·mL -1 Escherichia coli ( E. coli ) and Staphylococcus aureus ( S. aureus ) within 60 min. The bactericidal effect was multimodal, involving CoBC-based photothermal killing (i.e., temperature as high as 80.5 °C) after 808 nm near-infrared light irradiation for 10 min, contact killing through the strong oxidative characteristic of N -halamine (pMAG-Cl), and release killing via active halogens (i.e., Cl + ) reinforced by the photothermal action of CoBC. The S. aureus -infected wound model in vivo demonstrated that the PAN/CA/CoBC/pMAG-Cl hydrogel worked as an ideal wound dressing, capable of resisting bacterial infection, accelerating the healing process, and promoting epithelial regeneration. This proposed strategy could indicate a new way for the disposal of cow dung pollutant and its reuse in antibacterial-associated applications.

Background and objective: To evaluate the effectiveness of vacuum-assisted closure (VAC) in the treatment of Fournier gangrene (FG). Material and methods: Forty-eight male patients treated for Fournier gangrene were included in the study. The patients were divided into two groups (Group I: conventional dressing, Group II: VAC therapy). Characteristics of the patients, laboratory parameters, number of debridement procedures, daily number of dressings, visual analogue scale (VAS) during dressing, analgesic requirement, colostomy requirement, time from the first debridement to wound closure, wound closure method, length of hospital stay, and mortality rates were compared. Results: Group I comprised 33 patients and Group II comprised 15 patients. The number of dressings, VAS score and daily analgesic requirement were statistically significantly lower in Group II (p < 0.05) than in Group I. The number of debridement procedures, colostomy requirement, orchiectomy rate, time from first debridement to wound closure, length of hospital stay, wound closure method and mortality rate were similar between these two groups (p > 0.05). Conclusion: The clinical results of conventional dressing and VAC therapy were similar for treating FG. VAC therapy is an effective postoperative wound care method that offers less requirement for dressing changes, less pain, less analgesic requirement and more patient satisfaction compared to conventional dressing.

Background: Zinc L-carnosine promotes the transition from the inflammatory to the proliferative phase of wound healing by reducing the expression of pro-inflammatory signals and enhancing the expression of anti-inflammatory signals. This prospective cohort study aims to test the effect of a zinc–L-carnosine mouthwash in promoting oral surgical wound healing. Methods: From October 2022 to February 2023, the authors enrolled healthy adult volunteers who needed the extraction of bilateral molars at the Unit of Dentistry of the University of Bari. The authors studied the baseline wound healing of each patient after the first extraction. Three months later, the patients underwent the second extraction and rinsed their mouths with zinc–L-carnosine mouthwash twice per day for the following 28 postoperative days. For a month after each extraction, the patients received weekly follow-up visits by an oral surgeon blinded about the study to record the modified healing index score of the wounds (range 0–6 points). For statistical analysis, we used the one-tailed t-test for paired samples with a significance level set at p < 0.05 to compare the baseline scores with those recorded during the exposure to the zinc–L-carnosine mouthwash. Results: The authors enrolled four women and six men (mean age = 44.60 ± 19.22 years). On the seventh and fourteenth postoperative days, the mean difference between the modified healing index scores obtained by using the zinc–L-carnosine mouthwash and the baseline was not significant. On the twenty-first postoperative day, the mean score obtained by using the mouthwash was 5.2 ± 1.3 points and was significantly higher than the 4.7 ± 1.8 points of the baseline (p = 0.026). On the twenty-eighth postoperative day, the mean difference was significant as well (5.9 ± 0.3 points and 5.4 ± 1.1 points, respectively). Conclusion: The preliminary results of this study showed that the zinc–L-carnosine mouthwash improved the quality of oral surgical wound healing.

Objective: To describe the effect of autologous blood patch (3CP, Reapplix, Denmark) treatments as a supplement to standard care among patients with hard-to-heal wounds in an outpatient multidisciplinary wound centre (MWC). Method: The 3CP is an autologous leukocyte- and platelet-rich fibrin patch, which is applied directly into the wound bed. Patients with a wound duration >6 weeks and an unsatisfactory outcome following standard care were considered. Weekly administration of the autologous blood patch was carried out and the wound size was measured using a picture-based area calculation program at three timepoints (first contact with the MWC, initiation of the autologous blood patch treatment and at the end of the autologous blood patch treatment). The effect was followed for one year or until healing. Results: From June 2016 to September 2019, 36 patients were included. The median age was 63.5 years (interquartile range (IQR): 58–70), and 14 patients were female (38.9%) and 22 were male (61.1%). Median wound duration pre-autologous blood patch was 21.5 weeks (IQR: 11.1–50.0) and median treatment time was 3.4 weeks (IQR: 1.6–5.3). Half of the patients (50%, 18/36) healed in <20 weeks, 30.6% (11/36) healed in 20–52 weeks and 19.4% (7/36) did not heal within a year. There was a significant difference between the mean wound area (±standard deviation) at the start of autologous blood patch treatment and the area at the end: 2.85±3.71cm2 versus 1.65±2.37cm2, respectively (p=0.0017). Treatment was stopped prematurely for 5/36 patients (reasons included wound infection, major amputation, procedure discomfort or withdrawal without reason). Conclusion: Among MWC patients with hard-to-heal wounds not responding to standard care, autologous blood patch treatment as a supplement to standard wound care expedited wound healing. [ABSTRACT FROM AUTHOR]

Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In bacterial cellulose (BC)-based living materials, the effective and permanent incorporation of bactericidal agents into BC remains a persistent challenge. In this study, midazole quaternary ammonium salt was grafted onto a dispersion of bacterial cellulose, which was subsequently directly added to the fermentation medium of BC-producing bacteria to obtain BC-based hydrogel materials (BC/BC-[PQVI]Br) with inherent antibacterial properties. The BC/BC-[PQVI]Br hydrogel prepared in this study exhibits favorable tensile properties, with a maximum tensile stress of 970 KPa and water retention for up to 6 h. Moreover, it demonstrates acceptable antibacterial activity against S. aureus (93 %) and E. coli (71 %), respectively. Additionally, the hydrogel displays a high cell survival rate of 98 % after contact with NIH 3T3 cells, indicating its non-cytotoxic nature. Furthermore, the mouse wound experiment confirms the excellent wound healing effect of the hydrogel. This research presents an innovative approach towards developing environmentally friendly active wound dressings with microbial-derived antibacterial functionality. [ABSTRACT FROM AUTHOR]

Dermal wound infections are a rising source of morbidity and mortality in patients worldwide as new and worsening complications reduce the efficacy of traditional treatments. These challenges in wound care are increasingly caused by comorbidities such as obesity and diabetes as well as surging rates of antibiotic resistance. As a result, there is an urgent need for alternative treatment options. Gaseous ozone has shown great promise as a potential new treatment for infected dermal wounds. In this brief review of current wound therapy techniques found in the literature, an in-depth discussion of the mechanisms, benefits, and results of topical ozone gas as a therapy for infected dermal wounds is presented. This includes studies of ozone applied to wounds performed in vitro, in vivo, and clinical settings, as well as the use of ozone as an adjunct therapy for increasing the efficacy of traditional treatments. The overwhelming evidence suggests that ozone exhibits significant antimicrobial properties and has been shown to promote wound healing factors, especially when applied between 5–60 ppm. As such, this promising alternative therapy warrants a significant investment of time and resources to fully utilize ozone as an effective treatment against antibiotic resistant bacteria and other rising challenges in wound treatment.

Aim: This study aimed to identify barriers and benefits of negative pressure wound therapy (NPWT) in patients at the Department of Surgery of the University Hospital Brno over a five year period (2017–2021). Methods: Retrospective, observational descriptive study of data from hospital records of patients at the Department of Surgery of the University Hospital Brno. Results: A total of 104 patients who were treated with NPWT were identified in the survey. The mean age of the patients was 66.7 years (Min. age 27, Max. age 93). The mean length of hospitalization was 30.2 days (Min. 6, Max. 145 days) and the mean length of NPWT was 20.6 days (Min. 4, Max. 76 days). In total, 31 patients (29.8%) had the same duration of hospitalization and NPWT application and 27 patients (26%) were simultaneously under a barrier regime. The etiology of the wounds was variable. A gastrointestinal disease in 63.4% (N = 66) of patients, vascular problems in 33.7% (N = 35) and pressure ulcers in 2.9% (N = 3). The frequency of wound swabbing was 4 to 6 days and wound dressing (NPWT) exchange was performed in intervals from 3 to 5 days. The VIVANOTec Pro® device was used in all patients. Conclusion: A retrospective analysis over a fi ve-year period showed that NPWT is routinely used in wounds of various etiologies, mostly in polymorbid patients of older age. No adverse eff ects associated with the use of NPWT were documented in the study group. [ABSTRACT FROM AUTHOR]

In this study, an environment‐friendly, energy‐saving, and useful synthesis of zinc oxide (ZnO) nanoparticles (NPs), titanium oxide (TiO2) NPs, and mixed Zn/TiOx‐NPs was achieved using underwater pulse discharge plasma. The obtained NPs were characterized by UV spectroscopy, X‐ray diffraction, scanning electron microscopy, and transmission electron microscopy. In the discharge cell, the viscose patch is impregnated with ZnO, TiO2, and mixed Zn/TiOx‐NPs in a one‐step process. The adhesive patch is effective against Escherichia coli, Staphylococcus albicans, and Bacillus subtilis. The viscose patch containing 0.22% Zn/TiOx‐NPs demonstrated the highest antimicrobial activity. These antimicrobial patches can be used to treat and cover wounds susceptible to infection. [ABSTRACT FROM AUTHOR]

Even today, not all wounds can be healed. Treatment, which often takes many years, is a burden for patients and is very cost-intensive. Therefore, additional procedures such as cold plasma are becoming increasingly popular. Active components of cold plasma include electromagnetic radiation and free radicals. The active principle is based on, among other things, damage to bacterial cells and positive interaction with epithelial and endothelial cells. Angiogenesis and cellular oxygen metabolism are stimulated. The evidence base is still limited and heterogeneous, as some results are contradictory and comparability is difficult. However, new, well-designed studies have confirmed previous findings. In order to create a solid database, further studies are needed., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Utilizing nanomaterials as an alternative to antibiotics, with a focus on maintaining high biosafety, has emerged as a promising strategy to combat antibiotic resistance. Nevertheless, the challenge lies in the indiscriminate attack of nanomaterials on both bacterial and mammalian cells, which limits their practicality. Herein, Cu 3 SbS 3 nanoparticles (NPs) capable of generating reactive oxygen species (ROS) are discovered to selectively adsorb and eliminate bacteria without causing obvious harm to mammalian cells, thanks to the interaction between O of N-acetylmuramic acid in bacterial cell walls and Cu of the NPs. Coupled with the short diffusion distance of ROS in the surrounding medium, a selective antibacterial effect is achieved. Additionally, the antibacterial mechanism is then identified: Cu 3 SbS 3 NPs catalyze the generation of O 2 •- , which has subsequently been conversed by superoxide dismutase to H 2 O 2 . The latter is secondary catalyzed by the NPs to form •OH and 1 O 2 , initiating an in situ attack on bacteria. This process depletes bacterial glutathione in conjunction with the disruption of the antioxidant defense system of bacteria. Notably, Cu 3 SbS 3 NPs are demonstrated to efficiently impede biofilm formation; thus, a healing of MRSA-infected wounds was promoted. The bacterial cell wall-binding nanoantibacterial agents can be widely expanded through diversified design.

The rapidly expanding area of regenerative medicine may soon enter a new phase owing to developments in biomaterials and their application in generating new tissues. Chemicals and synthetic drugs are currently the subject of heated debate due to their effects on human health and the environment. Therefore, scientists seek out new products and procedures that are harmless to both the environment and human health concerns. Bio-based materials provide excellent functional qualities with a variety of applications. This study resulted in the development of a film with antimicrobial, hydrophilic, and anti-cancer properties, which is most beneficial in the medical sectors. In this study, we developed a blended biodegradable film containing agar and pectin (AP), with excellent surface functional properties framed through a casting technique. Additionally, the property can be changed by the addition of extract of hemigraphis alternata (HA) extract. The incorporation of extract in AP (APH) can be used for anti-cancer wound care therapy. The fabricated film is biodegradable, biocompatible, and non-toxic. This material is entirely based on a green methodology, and it was prepared in a concise manner without the use of any hazardous solvents. Based on the overall nature of biopolymer, the prepared material is a promising alternative to our society.

Diabetic wounds are the most critical complication in patients with diabetes, which often lead to hospitalization and limb amputations. Diabetic foot ulcers (DFU) is characterized by infections, prolonged inflammation, and a delayed wound healing process. Different types of medical procedures including surgical therapy, drug delivery, stem cell therapy, and wound dressings are used to manage DFU. Bioactive dressings such as hydrogels, nanofiber, and collagens are promising materials that can accelerate the healing process. The wound dressing materials can also be loaded with bioactive molecules like nucleic acids. MicroRNAs (miRNAs) are small non-coding RNA molecules that have recently emerged as regulators of impaired wound healing and could be a target for DFU treatment. miRNA therapeutics can be delivered to the wound region using different delivery systems such as exosomes and nanoparticles. These wound dressings have a high potential for treating diabetic wounds by topical delivery of certain miRNAs in a sustained release manner. [ABSTRACT FROM AUTHOR]

Purpose: To explore the role of vacuum assisted closure (VAC) therapy versus conventional dressings in the Fournier's gangrene wound therapy. Patients and Methods: This is a retrospective multi-institutional cohort study. Data of 92 patients from nine centers between 2007 and 2018 were retrospectively analyzed. After surgery, patient having a local or a disseminated FG were managed with VAC therapy or with conventional dressings. The 10-weeks wound closure cumulative rate and OS were analyzed. Results: Of the 92 patients, 62 (67.4%) showed local and 30 (32.6%) a disseminated FG. After surgery, 19 patients (20.7%) with local and 14 (15.2%) with disseminated FG underwent to VAC therapy; 43 (46.7%) with local and 16 (17.4%) with disseminated FG were treated using conventional dressings. The multivariable logistic regression analysis demonstrated that the VAC in patients with disseminated FG led to a higher cumulative rate of wound closure than patients treated with no-VAC (OR = 6.5; 95% CI 1.1–37.4, p = 0.036). The Kaplan–Meier survival curves for the OS showed a significant difference between no-VAC patients with local and disseminated FG (OS rate at 90 days 0.90, 95% CI 0.71–0.97 vs 0.55, 95% CI 0.24–0.78, respectively; p = 0.039). Cox regression confirmed that no-VAC patients with disseminated FG showed the lowest OS (hazard ratio adjusted for sex and age HR = 3.4, 95% CI 1.1–10.4; p = 0.033). Conclusions: In this large cohort study, VAC therapy in patients with disseminated FG may offer an advantage in terms of 10-weeks wound closure cumulative rate and OS at 90 days after initial surgery. [ABSTRACT FROM AUTHOR]

Effective treatment of drug-resistant bacteria infected wound has been a longstanding challenge for healthcare systems. In particular, the development of novel strategies for controllable delivery and smart release of antimicrobial agents is greatly demanded. Herein, the design of biodegradable microcapsules carrying bactericidal gold nanoclusters (AuNCs) as an attractive platform for the effective treatment of drug-resistant bacteria infective wounds is reported. AuNC capsules are fabricated via the well-controlled layer-by-layer strategy, which possess intrinsic near-infrared fluorescence and good biocompatibility. Importantly, these AuNC capsules exhibit strong, specific antibacterial activity toward both S. aureus and methicillin-resistant S. aureus (MRSA). Further mechanistic studies by fluorescence confocal imaging and inductively coupled plasma mass spectrometry reveal that these AuNC capsules will be degraded in the S. aureus environment rather than E. coli, which then controllably release the loaded cationic AuNCs to exert antibacterial effect. Consequently, these AuNC capsules show remarkable therapeutic effect for the MRSA infected wound on a mouse model, and intrinsic fluorescence property of AuNC capsules enables in situ visualization of wound dressings. This study suggests the great potential of microcapsule-based platform as smart carriers of bactericidal agents for the effective treatment of drug-resistant bacterial infection as well as other therapeutic purposes., (© 2024 Wiley‐VCH GmbH.)

Objective: A score to identify local wound infections was developed by a panel of experts from seven European countries. The Therapeutic Index for Local Infections (TILI) score was designed for health professionals who are not specialised in wound care. This study was carried out to test the validity of the TILI score in everyday practice. Method: Content validity was analysed by means of evaluation by a panel of experts, individually and face-to-face, followed by a European multicentred, retrospective, observational study. Participating clinicians sent anonymised copies of completed TILI scores for patients with leg ulcers along with a photograph of the wound for analysis by two blinded reviewers. Concordance (Kappa index) and convergent criterion validity (sensitivity, specificity, accuracy, Youden's J Index and receiver operator characteristic (ROC) or area under the curve (AUC) curve) were calculated to construct validity and reliability. Results: A total of 307 patients with leg ulcers from seven institutions in five European countries were included in this retrospective analysis. It was shown that the diagnosis of local wound infection could be documented well with five of the six clinical criteria included in the TILI score. By summing up these facultative criteria in comparison with any direct criteria that may be present, there would have been an indication for local antiseptic wound therapy in 22% of patients examined. Conclusions: The results show that the TILI score is concordant with the expert assessment of patients and with good diagnostic characteristics. Thus, the easy-to-use TILI score can now be used in the daily routine practice of health professionals to diagnose local wound infections. Declaration of interest: JD has received financial support for lectures, consultations and/or studies from 4M, Coloplast, Convatec, Draco, Engelhardt, Paul Hartmann, KCI, Lohmann&Rauscher, Mölnlycke, SastoMed and Urgo. JVS has received lecture fees and travel-cost reimbursements from Mundipharma, Histocell, Quesper and Urgo. [ABSTRACT FROM AUTHOR]

Wound-associated infections are a significant and rising health concern throughout the world owing to aging population, prevalence of diabetes, and obesity. In addition, the rapid increase of life-threatening antibiotic resistant infections has resulted in challenging wound complications with limited choices of effective therapeutics. Recently, topical ozone therapy has shown to be a promising alternative approach for treatment of non-healing and infected wounds by providing strong antibacterial properties while stimulating the local tissue repair and regeneration. However, utilization of ozone as a treatment for infected wounds has been challenging thus far due to the need for large equipment usable only in contained, clinical settings. This work reports on the development of a portable topical ozone therapy system comprised of a flexible and disposable semipermeable dressing connected to a portable and reusable ozone-generating unit via a flexible tube. The dressing consists of a multilayered structure with gradient porosities to achieve uniform ozone distribution. The effective bactericidal properties of the ozone delivery platform were confirmed with two of the most commonly pathogenic bacteria found in wound infections, Pseudomonas aeruginosa and Staphylococcus epidermidis. Furthermore, cytotoxicity tests with human fibroblasts cells indicated no adverse effects on human cells.

Hyaluronan is a natural polymer that was introduced to wound therapy. Formulations based on synthetic polymers such as methylcellulose (MC) and polyacrylic acid (PA) containing hyaluronan (HA) were proposed for the development of prospective wound-healing preparations. The formulations of different carrier concentrations containing a fixed amount of HA were prepared, and their viscosity was measured. The HA release was evaluated by employing the apparatus paddle over a disc. The hydrogels were introduced to the donor chamber, and HA was released to the pH = 7.4 buffer. The amount of HA released was obtained using the ELISA test. The release was analyzed on the basis of different kinetic models: zero-, first-, and second-order kinetics, as well as Higuchi and Korsmeyer–Peppas equations. The release rate constants and the half release time were calculated from these equations. According to the value of the coefficient of the determination, the best model describing the observed process was selected. The comparison between the dissolution profiles was carried out by calculating the difference factor f1 and the similarity factor f2. The interaction between the hydrogel components was investigated by Fourier-transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC) measurements. The study revealed that the zero-order equation best described the release of HA from the formulations studied. The FTIR research and the DSC study showed the intermolecular interaction between HA chains in MC-based compositions, as well as between HA and the synthetic polymer in the PA-based formulations. The study revealed that the formulation with a higher concentration of synthetic polymer may prolong the release of HA. The obtained results indicated that the proposed hydrogels have potential for wound healing and may accelerate skin regeneration.

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• Hydrogels exhibited excellent stretchability and low hysteresis. • Hydrogels have adhesion, conductivity and strong antibacterial activity. • This hydrogel was design for wound dressing and skin bioelectronics. • The hydrogel sensor could realize wireless real-time monitoring and remote alarm. With the increasing utilization of therapeutic materials in wound care and skin bioelectronics, there is growing requirements for multifunctional hydrogels for personal therapy and health management. However, the limited functionality, mechanical incompatibility, and impracticality of traditional dressings and skin bioelectronics greatly restrict their widespread use in clinical settings. Herein, we fabricate a cellulose nanofibers (CNFs)-reinforced poly(Ionic Liquids) (PILs) composite hydrogel (PAC x V y) which can be used as infected wound therapy and real-time reliable bioelectronic. The hydrogel showed an orderly interconnected cellular architecture with excellent stretchability, outstanding elasticity and low hysteresis. As a wound dressing, the hydrogel could provide the adhesion to seal wounds, biocompatibility and outstanding antibacterial activity, enabling the wound dressing to effectively inhibit bacterial growth and accelerate infected wound healing. ILs enables the hydrogel to have high conductivity, outstanding sensing performance and impressive temperature response. Therefore, the hydrogel may also work as novel flexible bioelectronics, which could accurately capture motion signals ranging from large strain to minute physiological signal, such as body movement, heart rate, pulse, and body temperature. Notably, a dual-channel remote clinical alarm system was fabricated by combining the hydrogel with tailor-made single-chip to wireless real-time monitoring of finger joint movement and temperature changes, which could establish a communication channel between patient and wounded and provide effective medical intervention timely. This line of research work sheds light on the hydrogel has significant implications for improving personal therapy and health management. [ABSTRACT FROM AUTHOR]

Introduction: With growing prevalence of lower extremity ulcers (LEU) and shortage of wound specialists, gaps in access to care may occur, particularly in remote areas. This gap can be mitigated with high-quality telemedicine (TM). This study aims to explore the effectiveness of synchronous video TM compared to the conventional face-to-face treatment (FTF).Methods: The study was conducted at Maccabi Healthcare Services, a 2.2-million-member sick fund in Israel. We reviewed all consecutive visits of LEU patients to wound care specialists between Jan 2013 and Jun 2017. Both TM and FTF modalities were implemented using identical treatment settings with the same nurse at each location. Study endpoint was ulcer healing as assessed by the treating specialist.Results: The study population included 650 LEU cases (nTM = 277, nFTF = 373) and contained 5203 visits. Comparable (P = 0.475) proportions of healed ulcers (52% in TM vs. 55% in FTF) were detected. Survival analyses found a non-significant advantage of TM (0.887; 0.650-1.212) compared to FTF. The non-inferiority of TM was demonstrated within the Δ = 0.15 range limits and 80% statistical power. Trial replication probability is 0.93.Conclusions: Synchronous video-conferencing based telemedicine may be a feasible and efficient method of LEU management. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Wound Management / Leczenie Ran is the property of Evereth Publishing Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Wound infection arising from pathogenic bacteria brought serious trouble to the patient and medical system. Among various wound dressings that are effective in killing pathogenic bacteria, antimicrobial composites based on bacterial cellulose (BC) are becoming the most popular materials due to their success in eliminating pathogenic bacteria, preventing wound infection, and promoting wound healing. However, as an extracellular natural polymer, BC is not inherently antimicrobial, which means that it must be combined with other antimicrobials to be effective against pathogens. BC has many advantages over other polymers, including nano-structure, significant moisture retention, non-adhesion to the wound surface, which has made it superior to other biopolymers. This review introduces the recent advances in BC-based composites for the treatment of wound infection, including the classification and preparation methods of composites, the mechanism of wound treatment, and commercial application. Moreover, their wound therapy applications include hydrogel dressing, surgical sutures, wound healing bandages, and patches are summarized in detail. Finally, the challenges and future prospects of BC-based antibacterial composites for the treatment of infected wounds are discussed. [Display omitted] [ABSTRACT FROM AUTHOR]