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ObjectiveDiabetic foot ulcers (DFUs) present a significant global health challenge, resulting in high morbidity and economic costs. Current available treatments often fail to achieve satisfactory healing rates, highlighting the need for novel therapies. This study evaluated the safety and efficacy of a novel autologous whole blood clot (AWBC)-a blood-based, biodegradable provisional matrix-in conjunction with standard of care (SoC) when compared to SoC alone in the treatment of hard-to-heal DFUs.MethodA multicentre, prospective, blinded assessor, randomised controlled trial was conducted at 16 sites across the US, South Africa and Turkey. A cohort of patients with hard-to-heal DFUs was enrolled and randomised to either the AWBC group or the control group. The primary endpoint was complete wound closure at 12 weeks, while secondary endpoints included time to heal and percentage area reduction (PAR) at four and eight weeks. Data were analysed using both intention-to-treat (ITT) and per-protocol (PP) populations.ResultsThe cohort included 119 patients. AWBC treatment resulted in a significantly higher healing rate compared to the control in both ITT (41% versus 15%, respectively; p=0.002) and PP populations (51% versus 18%, respectively; p=0.0075). AWBC treatment also resulted in a shorter mean time to heal and higher durability of wound closure. Safety analysis showed a similar incidence of adverse events (AEs) between groups, with no device-related AEs.ConclusionThe AWBC system, by modulating the wound microenvironment and providing a functional extracellular matrix, offered a promising new approach to treating hard-to-heal DFUs, demonstrating superior healing outcomes compared to SoC alone in this study.

Surgical excision remains the principal treatment for melanoma, while tumor recurrence and delayed wound healing often occur due to the residual tumor cells and hypoxic microenvironment in the postoperative skin wounds. Herein, we present a living photosynthetic microneedle (MN) patch (namely MA/CM@MN) loaded with microalgae (MA) and cuttlefish melanin (CM) for postsurgical melanoma therapy and skin wound healing. Benefiting from the oxygenic photosynthesis of the alive MA in the MN base, the MA/CM@MN can generate oxygen under light exposure, thus facilitating skin cell proliferation and protecting cells against hypoxia-induced cell death. In addition, with CM nanoparticles embedded in the MN tips, the MA/CM@MN can be effectively heated up under near-infrared (NIR) irradiation, contributing to a strong tumor killing efficacy on melanoma cells in vitro. Further experiments demonstrate that the NIR-irradiated MA/CM@MN effectively prevents local tumor recurrence and simultaneously promotes the healing of tumor-induced wounds after incomplete tumor resection in melanoma-bearing mice, probably because the MA/CM@MN can inhibit tumor cell proliferation, stimulate tumor cell apoptosis, and mitigate tissue hypoxia in light. These results indicate that the living photosynthetic MN patch offers an effective therapeutic strategy for postoperative cancer therapy and wound healing applications. [ABSTRACT FROM AUTHOR]

Wound dressing changes are essential procedures for wound management. However, ~50% of patients experience severe pain during these procedures despite the availability of analgesic medications, indicating a need for novel therapeutics that address underlying causes of pain. Along with other clinical factors, wound pathogens and inflammatory immune responses have previously been implicated in wound pain. To test whether these factors could contribute to severe pain during wound dressing changes, we conducted an exploratory, cross‐sectional analysis of patient‐reported pain, inflammatory immune responses, and wound microbiome composition in 445 wounds at the time of a study dressing change. We profiled the bacterial composition of 406 wounds using 16S ribosomal RNA amplicon sequencing and quantified gene expression of 13 inflammatory markers in wound fluid using quantitative real‐time polymerase chain reaction (qPCR). Neither inflammatory gene expression nor clinically observed inflammation were associated with severe pain, but Corynebacterium and Streptococcus were of lower relative abundance in wounds of patients reporting severe pain than those reporting little or no pain. Wound microbiome composition differed by wound location, and correlated with six of the inflammatory markers, including complement receptor C5AR1, pro‐inflammatory cytokine interleukin (IL)1β, chemokine IL‐8, matrix metalloproteinase MMP2, and the antimicrobial peptide encoding cathelicidin antimicrobial peptide. Interestingly, we found a relationship between the wound microbiome and vacuum‐assisted wound closure (VAC). These findings identify preliminary, associative relationships between wound microbiota and host factors which motivate future investigation into the directional relationships between wound care pain, wound closure technologies, and the wound microbiome. [ABSTRACT FROM AUTHOR]

Background: The modern wound dressing is produced to absorb fluid and protect against external contamination. The choice of which wound dressing to apply after surgery is usually based on local tradition. There are various impervious dressings on the market. Even if the wound is sterile before application, there will be subsequent recolonisation of skin microbiota. Previous studies suggest that a high bacterial load on the skin hampers wound healing and might be a risk for SSI. Aim: The aim was to compare bacterial recolonisation on the shoulder under three different wound dressings, 48 h after sterile preparation of the skin as in preparation for surgery. Method: In 25 healthy volunteers, a standard pre-surgical skin disinfection for a deltopectoral incision was made on the left shoulder with 0.5% chlorhexidine solution in 70% ethanol. Three different wound dressings were then placed on the shoulder, and 48 h later the skin beneath each dressing was swabbed, subsequently cultured and bacterial density analysed using viable count. Results: The bacterial recolonisation under air-dry (gauze) dressing was significantly lower (p =.0001) compared to semipermeable and occlusive wound dressings. Conclusion: Choosing a less permeable wound dressing may lead to an increased bacterial load on the skin during the first 48 h after surgery. [ABSTRACT FROM AUTHOR]

Severe cutaneous injuries may not heal spontaneously and may necessitate the use of supplementary therapeutic methods. Electrospun nanofibers possess high porosity and specific surface area, which provide the necessary microenvironment for wound healing. Here in, the nanofibers of Soluplus-soy protein isolate (Sol-SPI) containing mupirocin (Mp) were fabricated via electrospinning for wound treatment. The fabricated nanofibers exhibited water absorption capacities of about 300.83 ± 29.72% and water vapor permeability values of about 821.8 ± 49.12 g/m2 day. The Sol/SPI/Mp nanofibers showed an in vitro degradability of 33.73 ± 3.55% after 5 days. The ultimate tensile strength, elastic modulus, and elongation of the Sol/SPI/Mp nanofibers were measured as 3.61 ± 0.29 MPa, 39.15 ± 5.08 MPa, and 59.11 ± 1.94%, respectively. Additionally, 85.90 ± 6.02% of Mp loaded in the nanofibers was released in 5 days in vitro, and by applying the Mp-loaded nanofibers, 93.06 ± 5.40% and 90.40 ± 5.66% of S. aureus and E. coli bacteria were killed, respectively. Human keratinocyte cells (HaCat) demonstrated notable biocompatibility with the prepared nanofibers. Furthermore, compare to other groups, Sol-SPI-Mp nanofibers caused the fastest re-epithelialization and wound healing in a rat model. The findings of this study present a novel nanofiber-based wound dressing that accelerates the healing of severe skin wounds with the risk of infection. [ABSTRACT FROM AUTHOR]

Multifunctional wound dressings have been applied for burn injuries to avoid complications and promote tissue regeneration. In the present study, we fabricated a natural alginate-chitosan hydrogel comprising silymarin and green-synthesized zinc ‎oxide ‎nanoparticles (ZnO NPs). Then, the physicochemical attributes of ZnO NPs and loaded hydrogels were analyzed. Afterward, wound healing efficacy was evaluated in a rat model of full-thickness dermal burn wounds. The findings indicated that ZnO NPs were synthesized via reduction with phytochemicals from Elettaria cardamomum seeds extract. The microscopic images exhibited fairly spherical ZnO NPs (35–45 nm), and elemental analysis verified the relevant composition. The hydrogel, containing silymarin and biosynthesized ZnO NPs, displayed a uniform appearance, smooth surfaces, and a porous structure. Moreover, infrared spectroscopy ‎identified functional groups, confirming the successful loading without adverse interactions. The obtained hydrogel exhibited great water absorption, high porosity, sustainable degradation for several days, and enhanced antioxidant capability of the combined loaded component. In vivo studies revealed faster and superior wound healing, achieving nearly complete closure by day 21. Histopathology confirmed improved cell growth, tissue regeneration, collagen deposition, and neovascularization. It is believed that this multifunctional hydrogel-based wound dressing can be applied for effective burn wound treatment. • Green-synthesized ZnO NPs displayed nano-scale diameters with spherical morphology. • Silymarin/ZnO NPs-loaded hydrogel exhibits uniformity, porous structure, and great water absorption. • In vivo studies demonstrate faster, superior burn wound healing with improved tissue regeneration and neovascularization. [ABSTRACT FROM AUTHOR]

The goal of this study is to investigate the antibacterial activity and sustained release of Centella Asiatica (CA) extract loaded in gelatin-based hydrogels, reinforced with MIL-53(Fe) (Fe-MOF) for the potential use as wound dressing. To induce antibacterial activity to the designed wound dressing, CA-extract was incorporated within the nanocomposite hydrogels. FT-IR analysis showed the distinctive peaks related to the Fe-MOF and CA-extract, with little shift, for hydrogel samples, which confirm the successful synthesis of nanocomposite hydrogels containing Fe-MOF and CA-extract. GC-mass analysis showed the antibacterial potential for CA-extract because of the presence of phenol, caryophyllene, and propanoic acid. SEM micrograph demonstrates the presence of Fe-MOF enhancing the porous of hydrogels. The antibacterial activity of prepared nanocomposite hydrogels was investigated by disk diffusion method revealing the significant inhibition zone growth for Basillus, Staphylococcus, and Streptococcus, as gram-positive and E. coli, Klebsiella, and P. aeruginosa as gram-negative bacteria and the "Candida albicans as fungi. Also, the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined by the micro-broth dilution method. The results showed that the nanocomposite hydrogel has a MIC values of 3.125 mg/ml and 6.25 mg/ml against both groups of bacteria. Cytotoxicity results obtained from MTT tests showed that the prepared hydrogels are biocompatible. The immunohistochemistry-stained hydrogel images revealed that the growth of cells on the CA-extract containing hydrogels was significantly increased in comparison to neat hydrogels. [ABSTRACT FROM AUTHOR]

Considering the special effect of wound treatment in the field of medicine, antibacterial wound dressings preparation is one of the main challenges in successful wound healing. In this research, a starch (St)/polyvinyl alcohol (PVA) nanofiberous mat modified with graphene oxide (GO)-silver nanowire (AgNW) hybrid was fabricated. Initially, silver nanowires were synthesized by the polyol method, then GO-AgNW nanoparticle was prepared as a biocompatible and antibacterial biofilm. Reducing the diameter of nanofibers due to the addition of starch and GO-AgNW nanoparticles leads to fibroblast proliferation, increased collagen secretion, reduced inflammation and wound closure. Nanofibrous mats showed significant antibacterial activity against Staphylococcus aureus and Escherichia coli microorganisms. The largest zone of bacterial inhibition was obtained for Starch/PVA nanofibers containing 8% GO-AgNWs hybrid (27.11 and 24.62 mm). The use of GO-AgNW nanoparticles without drugs is an important point due to the strong antibacterial property of silver nanowire. The measured contact angle of nanofibrous mats was in the range of 57.8° as a desirable level of hydrophilicity for wound dressings. The degree of swelling obtained about 491.12%, and the water vapor transmission rate of 2549 ± 36 (g/m2.day) as a proof for accelerating wound healing. Finally, the results indicated that St/PVA/GO-AgNWs composite electrospun fibers could be a suitable candidate for the treatment of infectious wounds, surgical wounds, minor burns, etc. [ABSTRACT FROM AUTHOR]

Patients are often advised to keep the initial postoperative dressings dry and undisturbed for 24 to 72 hours. However, these requirements may result in significant disruption of patients' activities of daily living, such as bathing, leisure, and exercise. Compare standard management of keeping wounds dry and covered (48 hours) with early (6 hours) postoperative water exposure. Investigator-blinded, randomized (1:1), controlled trial evaluating rate of infection and additional outcomes of interest. Overall, 437 patients were randomized to either the early (6-hour) water exposure (n = 218) intervention group or the standard cohort (n = 219). The incidence of culture-proven infection in the intervention group (1.8%) was similar to the standard group (1.4%) (P >.99). There was also no difference in rates of bleeding or bruising. Scar assessment using the Patient and Observer Scar Assessment Scale revealed similar scar outcomes. Single site, academic center. Surgical wounds can be allowed to get wet in the immediate postoperative period with no increased incidence of infection or other complications and with similar cosmesis. [ABSTRACT FROM AUTHOR]

In this research, a biomonomer based on hydroxyethyl methacrylate, citric acid, and polyethylene glycol (HEMA‐CA‐PEG) was synthesized. After confirming the reaction through 1H‐NMR and FT‐IR tests and obtaining the intended monomer, a flexible hydrogel was synthesized as a wound dressing, and its mechanical properties were evaluated using tensile strength, DMTA, and rheometry tests. This synthesized hydrogel exhibited sufficient mechanical properties. To enhance the efficiency of this hydrogel wound dressing and its effectiveness in facilitating wound healing, tannic acid (TA), as an antibacterial and antioxidant substance, was incorporated into it. In the second phase, antibacterial activity and animal studies were conducted. The comparison of the CA–based hydrogel with and without TA demonstrated that the TA–containing hydrogel achieved more than 99.9% inhibition and elimination of bacteria. The use of CA–based hydrogel with TA shown in treating burns on the backs of rats caused the wound to close after 17 days, and hair growth was observed by the 21st day. This synthesized flexible hydrogel wound dressing, along with suitable mechanical properties, exceptional antibacterial activity, increased granulation tissue formation, re‐epithelialization, angiogenesis, and collagen deposition, showed good performance in wound healing. [ABSTRACT FROM AUTHOR]

Background: Pressure injuries (PIs) are among the most common skin and soft tissue wounds occurring in patients who are bedbound and/or immobile. PI management hinges on their prevention; however, reoccurrence poses a challenge to their management and requires a multidisciplinary approach. Here, the authors describe a lumbosacral rotation flap (LSRF) for the coverage of sacral PIs. Method: A single-centre, retrospective analysis of prospectively collected data was carried out. All patients undergoing LSRF for sacral PIs were included. Patients with active systemic sepsis, immune compromise, hepatic or renal dysfunction were excluded. All patients underwent preoperative optimisation and wound cultures to direct antibiotic therapy after surgery. Results: A total of nine patients underwent the procedure (seven male and two female). Mean age was 47.6 years with a mean ulcer size of 92.9 cm2. Bone biopsy indicated the presence of osteomyelitis in three patients. Of the LSRFs, two flaps showed minimal local complications in the form of marginal flap necrosis which was managed conservatively. All flaps healed well with no cases of flap loss or the need for secondary procedures. Conclusion: The results of this analysis showed that LSRF can be considered a first line of treatment of sacral PIs. They can be used to cover large defects. Due to their large base and flap size, readvancement in cases of recurrence is also possible. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to observe the surgical wound healing process in patients with multiple myeloma who had undergone surgery. Method: We collected clinical data on patients with multiple myeloma and observed wound healing following surgical therapy. Additionally, we compared the expression of angiogenesis markers in patients with and without multiple myeloma (undergoing surgical excision of other tumour tissues). In patients who had multiple myeloma bone disease, we examined several clinical features: haemoglobin levels; albumin levels; blood glucose levels; and surgery programme. We then compared expression levels of the angiogenesis markers CD31, CD34 and vascular endothelial growth factor (VEGF) in samples scraped from the skin margin of the surgical incision in 12 patients without multiple myeloma (control) and nine patients with multiple myeloma. Results: All 61 patients with multiple myeloma observed showed no disunion, no delayed union and no infection in their wound healing. CD31 and VEGF expression was higher in the nine patients with multiple myeloma compared with the 12 control patients without. We observed no difference in CD34 expression between control and experimental groups. Conclusion: The results of this study suggest that patients with multiple myeloma who have undergone surgery recover well and produce higher quantities of new vessels compared with patients without multiple myeloma. This occurs through increased expression of CD31 and VEGF, angiogenic factors which promote wound healing. We did not observe higher expression of these factors contributing to increased incisional implantation metastasis. [ABSTRACT FROM AUTHOR]

Objective: Currently there is limited real-world research on the adhesion qualities, pain and clinical performance of specific silicone adhesives products, and their role in maintaining skin integrity and preventing medical adhesive-related skin injuries (MARSI). This paper presents a clinical evaluation of performance and safety parameters of two silicone adhesive dressings on lacerations or surgical wounds and the surrounding skin in daily practice on fragile skin. Method: An observational, prospective, multicentre, uncontrolled post-market clinical observational study with Leukomed T skin sensitive and Leukomed T plus skin sensitive (both BSN medical GmbH, Essity Group) was undertaken at three sites across Germany between June 2021 to November 2022. Inclusion parameters were acute wounds (surgical or laceration) in patients with at least one fragile skin condition. Endpoints included: the percentage of adhered dressing area seven days after application of the dressings; and evaluation of any signs of skin damage and erythema following dressing removal. Furthermore, self-reported patient pain, comfort during dressing wear, and the health professionals' ease of dressing handling with gloves were assessed. Results: A total of 42 patients with fragile skin and surgical wounds (35 patients) or lacerations (7 patients) were recruited. Mean age was 78 years. There were no signs of erythema following dressing removal and no MARSI (skin stripping, blister, skin tears, maceration, irritant contact dermatitis or allergic dermatitis) occurred at removal after seven days of wear time. Data demonstrated a reliable wound coverage with sufficient adhesion without negatively affecting the periwound skin and wound improvement was observed in 94% of patients. The vast majority of patients reported minimal pain at removal, reduced wound pain and high satisfaction with wearing comfort. Health professionals found the dressings easy to apply and remove, even with gloved hands. Conclusion: The results of this real-world evidence showed effective and well-tolerated use of transparent dressings with silicone adhesive in patients with fragile skin. The dressings may reduce the risk of skin damage including MARSI, while providing patients a high wearing comfort and allowing an almost pain-free dressing change. [ABSTRACT FROM AUTHOR]

Objective: Diabetic foot ulcers (DFUs) are a common downstream consequence of diabetes and pose significant concern to the health of affected individuals. There are currently limited data available that detail the epidemiology and inpatient burden of DFUs in Canada. This study aims to provide updated data on the epidemiological and economic burden of DFUs in Canada between 2015 and 2019. Method: Using the Canadian Institute for Health Information Patient Cost Estimator the authors estimated, as the primary outcome, the number of DFU inpatient cases in Canada, the associated financial burden of these admissions on the Canadian healthcare system, physician compensation, and average patient length of hospitalisation. This analysis covered 12 Canadian jurisdictions and was stratified by age, sex, province and geographical region. The secondary outcome was to highlight temporal trends in the public health burden of DFUs by computing the average annual percentage change (AAPC; the weighted average of several annual percentage changes over multiple years) using Joinpoint (Surveillance Research Program National Cancer Institute, US) regression analysis. Results: The total number of cases, average length of hospitalisation and physician costs across Canada were highest for patients over ≥60 years of age. By region, the total number of cases and standardised physician costs were highest in Central Canada, followed by Western Canada, and subsequently Eastern and Northern Canada. In 2019, there were >1800 patients with DFUs admitted to Canadian acute care hospitals. Despite having the lowest number of inpatient admissions, Northern Canada had the highest associated inpatient costs, followed by Central, then Western and, lastly, Eastern Canada. Overall, mean inpatient costs remained stable over time across all age groups (AAPC 0.61; 95% confidence interval: –1.87–3.15), with an average cost of >$10,000 CAD per case. Average physician cost across all jurisdictions was approximately $1000 CAD per case, with the mean hospitalisation time being nine days. Conclusion: The findings of this study emphasise the dynamic nature of the economic and epidemiological DFU burden in Canada, underscoring the need for targeted interventions, multidisciplinary care and evidence-based resource allocation for the optimal management of diabetes and DFUs. [ABSTRACT FROM AUTHOR]

Objective: Venous leg ulcers (VLUs) are often large and complicated wounds that, despite combinations of advanced wound care techniques and systemic treatment of underlying vascular issues, take many months to heal and have high rates of recurrence. In this study, we investigated the efficacy of a novel wound care solution—human keratin matrix (HKM). Method: A case series of VLUs were treated with HKM in conjunction with indicated vascular intervention and standard of care (SoC) procedures. For analysis, these wounds were divided into very large (>200 cm2) and smaller (<35 cm2) wounds. Results: The cohort comprised 16 VLUs (very large=7; smaller=9). Very large VLUs were reduced in size by an average of 71% within 10 weeks, and showed a 50% size reduction within four applications of HKM. Smaller VLUs reduced by 50% in size within the first three weeks of treatment, and 88.9% of these wounds healed completely with an average of 4.5 HKM applications over an average of 6.5 weeks. Conclusion: The results of this series highlight the potential of HKM, in combination with indicated systemic interventions and SoC, as an effective treatment for hard-to-heal (chronic) VLUs, even in very large wounds. [ABSTRACT FROM AUTHOR]

Objective: Wound care is an important component of nursing care, consuming a significant amount of working hours. Literature reports the existence of many barriers to evidence-based wound care and that nursing students have an increasing need for education in this field. While blended learning activities have shown some benefits in learning outcomes, dedicated wound care modules within baccalaureate nursing courses occur infrequently. The aim of this study was to facilitate an increase in confidence and knowledge of evidence-based wound care in third-year baccalaureate nursing students. Method: In this descriptive pre–post research design, a dedicated wound care module within a baccalaureate nursing course (using a constructivist learning approach) was offered to students in a university in Australia. Pre- and post-implementation surveys were completed (2018–2020). Due to a small number of matching participants, only descriptive statistics were calculated for all variables. Results: A total of 276 students were invited to respond to the survey and 41 responded initially, 35 responded post the wound care module, and 26 responded to the survey after six months. Positive outcomes were noted in increased levels of confidence in the student nurses' ability to assess, manage and prevent wounds; as well as to apply evidence-based practice and change management following the educational wound care module within the baccalaureate nursing course. Conclusion: Implementation of a dedicated wound care module within a baccalaureate nursing course in this sample of third-year students fostered a positive change in the knowledge of evidence-based wound management, assessment and prevention. Education of the next generation of registered nurses in this valuable area of practice is an important part of baccalaureate nursing education. [ABSTRACT FROM AUTHOR]

Caring for patients with hard-to-heal (chronic) wounds requires a multifaceted approach that addresses their diverse needs, which can contribute to the complexity of care. Wound care providers must have a comprehensive understanding of the patient's comorbid conditions and psychosocial issues to provide personalised and effective treatment. Key quality indicators for effective wound care involves not only selecting appropriate local wound care products, such as foam dressings, but also addressing individual patient experiences of wound-related pain, odour, itch, excessive wound drainage, and self-care needs. The purpose of this review is to inculcate the wound care practice community, research scientists and healthcare industry with a sense of accountability in order to work collaboratively in addressing these unmet care needs. [ABSTRACT FROM AUTHOR]

Objective: Closed surgical incision sites at high risk of complications, and with exudate or leakage, are increasingly being managed with closed incision negative pressure wound therapy (ciNPWT) to reduce tissue stress and increase the force necessary to disrupt the incision. This study was undertaken to investigate the performance and safety of a canister-based, single-use NPWT (suNPWT) system when used on closed surgical incision sites. Method: The investigation was designed as a prospective, open, non-comparative, multicentre study aimed at confirming the safety and performance attributes of the suNPWT system when applied to low-to-moderately exuding closed surgical incisions. The primary performance measure was the wound remaining closed from baseline to the last follow-up visit on day 14. Secondary performance measures included: wound and periwound condition; wear time of the system; product consumption; adherence to therapy; and patients' pain progress. Details of adverse events were also collected. Results: Some 35 patients were recruited. The closed surgical incisions responded well to treatment with the tested suNPWT system. All wounds remained closed throughout the investigation. Consistent with other studies of ciNPWT reporting low infection rates, the current study observed either no or low exudation in 90.4% of wounds at the final visit, together with absence of surgical site infection. Pain severity levels were low, both at dressing change and during delivery of negative pressure. No serious adverse device events were reported. Conclusion: In this study, the suNPWT system supported the healing of closed surgical incisions with no safety concerns relating to its use. [ABSTRACT FROM AUTHOR]

Objective: Complications from diabetic foot wounds, including bacterial infection, ulceration and gangrene, are major causes of hospitalisation and are responsible for 85% of amputations in patients with diabetes. Given that orally administered investigational therapeutic Cytoreg (Cytorex de Venezuela SA, Venezuela), a defined aqueous mixture of hydrofluoric, hydrochloric, sulfuric, phosphoric, citric and oxalic acids, has been shown to increase levels of arterial blood oxygen in a Wistar rat model, oral and oral+topical Cytoreg were tested on patients with diabetic foot ulcers (DFUs) under a humanitarian, compassionate-use protocol. Method: All patients received oral Cytoreg (5.0 ml concentrate in fruit juice) for 30 days; half also received weekly wound washing with Cytoreg concentrate in isotonic saline (1:50 volume/volume) (oral+topical group). In addition to standard clinical observations, wounds were monitored against the Saint Elian checklist system for the diabetic foot. Results: A total of 10 patients took part in the study. Complete wound closure was observed in 4/5 patients in the oral+topical group; in the remaining patient, necrotic and fibrin tissues on the wound edges were eliminated. Half (2/4) of the patients receiving oral-only Cytoreg experienced complete wound closure; one patient in this group was removed prematurely because of an unrelated illness and was not replaced. During the study, no significant differences were observed between groups in either the oxygen saturation of the affected tissues or in insulin and glycaemia levels (p<0.05). Significant increases in arterial haemoglobin and arterial oxygen partial pressure (p<0.05) were observed, and significant decreases were measured in the levels of glycosylated haemoglobin, aspartate aminotransferase, glutamic-pyruvic transaminase, creatine and urea (p<0.05). Conclusion: The results of this study justify an expanded clinical study for the treatment of DFUs with Cytoreg. [ABSTRACT FROM AUTHOR]

In the biomedical field, hydrogels are extensively utilized due to their ability to provide mechanical support and create a moist environment for wounds. In this study, nanocomposite hydrogels containing carboxymethyl chitosan (CsMe), polyvinyl alcohol (PVA), and zinc oxide nanoparticles (ZnO-NPs) in different weight ratios (0, 0.5, 0.8, and 1.2%) were prepared for wound healing. The prepared hydrogels were analyzed using Fourier transform infrared spectroscopy (FTIR), field-emission scanning electron microscopy (FE-SEM), and X-ray diffraction (XRD). Additionally, the mechanical properties, swelling ratio, MTT assay, antibacterial efficacy, and in vivo wound healing were assessed. MTT assays indicated no toxicity after incorporating ZnO-NPs into the hydrogel, and the maximum antibacterial efficiencies of CsMe/PVA/ZnO-NPs (0.5%) hydrogels against E. coli and S. aureus were 91.85 ± 1.2% and 52.7 ± 0.84%, respectively. In vivo studies demonstrated that the hydrogel containing 0.5% ZnO-NPs significantly accelerated wound healing, with 96 ± 2.41% wound closure after 14 days, compared to 83.5 ± 6.76% for the group treated with commercial ZnO ointment. The results suggest that ZnO-NPs in hydrogels enhance antibacterial activity and promote better wound healing than traditional ZnO ointments, offering a promising material for advanced wound care applications. [ABSTRACT FROM AUTHOR]

Endogenous electric field (EEF) is weakened in wounds due to electrolyte loss, hindering wound repair. Reshaping and repairing EEF play important roles in accelerating wound healing. The design of antibacterial dressings coupled with an EEF recovery ability to promote wound healing is urgent and significant. Herein, a self‐powered wearable thermoelectric dressing with antibacterial, antioxidant, and EEF reshaping activities for methicillin‐resistant Staphylococcus aureus‐infected wound therapy is fabricated. The dressing is based on a wearable thermoelectric device constructed of a polyanionic thermoelectric hydrogel loaded with tannic acid (TA). By taking advantage of the natural temperature difference between infected wounds and the external environment, the dressing is activated to convert thermal energy into electricity, producing a continuous and compensating electric field to reshape damaged EEF and stimulate tissue regeneration. Combined with the antibacterial and antioxidant properties of the TA released from the thermoelectric hydrogel, the self‐powered dressing can accelerate wound healing in vivo by topical targeted sterilization, reducing inflammation and reshaping the EEF of the wounds. Thus, this dressing provides a promising and facile self‐powered therapeutic strategy without the need for external stimuli to treat infected wounds. [ABSTRACT FROM AUTHOR]

Articulus wound infection is a threat to human health. Existing medical materials have poor biocompatibility and may contain harmful chemicals, causing allergies and secondary infections. Therefore, there is an urgent need to develop innovative medical materials. Materials made of artificial spider silk proteins have been widely used in wound healing because of their good biocompatibility, biodegradability, cell adhesion and bioelectronic properties. [ABSTRACT FROM AUTHOR]

Burn wounds are associated with infections, drug resistance, allergic reactions, odour, bleeding, excess exudates, and scars, requiring prolonged hospital stay. It is crucial to develop wound dressings that can effectively combat allergic reactions and drug resistance, inhibit infections, and absorb excess exudates to accelerate wound healing. To overcome the above-mentioned problems associated with burn wounds, SA/PVA/PLGA/Capparis sepiaria and SA/PVA/Capparis sepiaria nanofibers incorporated with Capparis sepiaria plant extract were prepared using an electrospinning technique. Fourier-transform infrared spectroscopy confirmed the successful incorporation of the extract into the nanofibers without any interaction between the extract and the polymers. The nanofibers displayed porous morphology and a rough surface suitable for cellular adhesion and proliferation. SA/PVA/PLGA/Capparis sepiaria and SA/PVA/Capparis sepiaria nanofibers demonstrated significant antibacterial effects against wound infection-associated bacterial strains: Pseudomonas aeruginosa, Enterococcus faecalis, Mycobaterium smegmatis, Escherichia coli, Enterobacter cloacae, Proteus vulgaris, and Staphylococcus aureus. Cytocompatibility studies using HaCaT cells revealed the non-toxicity of the nanofibers. SA/PVA/PLGA/Capparis sepiaria and SA/PVA/Capparis sepiaria nanofibers exhibited hemostatic properties, resulting from the synergistic effect of the plant extract and polymers. The in vitro scratch wound healing assay showed that the SA/PVA/Capparis sepiaria nanofiber wound-healing capability is more than the plant extract and a commercially available wound dressing. The wound-healing potential of SA/PVA/Capparis sepiaria nanofiber is attributed to the synergistic effect of the phytochemicals present in the extract, their porosity, and the ECM-mimicking structure of the nanofibers. The findings suggest that the electrospun nanofibers loaded with Capparis sepiaria extract are promising wound dressings that should be explored for burn wounds. [ABSTRACT FROM AUTHOR]

Diabetic wound healing remains a challenging issue, necessitating advanced dressings with active therapeutic agents to reduce inflammation and promote healing. Ecklonia cava phlorotannin (ECP) possesses therapeutic potential for wound healing including anti‐microbial, antioxidant, and anti‐inflammatory properties. Our previous study demonstrates the therapeutic efficacy of ECP‐loaded nanofibers in an in vitro hyperglycemic wound model. The present paper focuses on the detailed characterization of the polyvinyl alcohol (PVA)/polyvinylpyrrolidone (PVP) blend nanofiber incorporated with ECP. The ideal ratio, PVA80:PVP20, is selected to incorporate with ECP via the blend electrospinning method. To confirm the successful loading of ECP (0.5% and 1%), physicochemical characterization is conducted using scanning electron microscopy, Fourier‐transform infrared spectroscopy, and thermal analysis. Functionality assays are performed to evaluate their applicability as dressing biomaterials. Physicochemical analyses confirm the successful loading of ECP into the nanofibers. Overall, the ECP‐loaded PVA/PVP nanofiber membranes exhibit favorable wound dressing criteria, which attributed to high water absorption capacity (200%–400%), sufficient water vapor transmission rate (1550–1650 g/m2/d), high loading efficiency and slow release. Bioactivity tests indicate that the ECP's effectiveness is unaffected by the electrospinning process. Importantly, these membranes exhibit biocompatibility and nontoxicity to human dermal fibroblasts, indicating their potential as good diabetic wound dressings. [ABSTRACT FROM AUTHOR]

Hydrogel have been widely used to promote skin tissue regeneration and accelerate wound healing. The development of injectable hydrogels with multi‐functional integration is a priority, especially with antibacterial properties and cytocompatibility. Here, we reported a simple, and versatile method to fabricate a functional hydrogel with potential for wound dressing applications. The dopamine‐grafted gelatin (GT‐DA) and oxidized dextran (oxyglucan, ODex) were synthesized, and dipotassium glycyrrhizinate (DG) was in situ incorporated to fabricate the composite hydrogels (GDO) through the Schiff base reaction. SEM images revealed that hydrogel has a porous structure. By increasing the ratio of GT‐DA to ODex from 1 to 4, the storage modulus (G') and hydrogel network stability nearly doubled, reaching 900 Pa and 220% strain, respectively. The enhancement in mechanical properties could be attributed to the higher cross‐linking density resulting from increased Schiff base bonds in the GDO hydrogels. Furthermore, the GDO hydrogel exhibited antioxidant activity and antibacterial effects on Escherichia coli and Staphylococcus aureus. Moreover, the hydrogel demonstrated cytocompatibility after culturing with human umbilical vein endothelial cells (HUVECs). The results proved that the fabricated GDO hydrogels have the potential to be used as wound dressings. [ABSTRACT FROM AUTHOR]

Nanofibrous membranes were developed by combining chitosan (CS), polyvinyl alcohol (PVA), and calcium chloride (CC) to incorporate curcumin (CCM) through a co‐axial electro‐spinning method to improve CCM bioavailability. The optimal parameters were PVA/CS ratio of 7:3 v/v, PVA/CCM ratio of 8:2 v/v, CC amount of 0.5 g, fiber collection distance of 15 cm, voltage value of 18 kV, and injection flow of 0.1 mL/h (both core and shell layer). The prepared PVA/CCM@CS/PVA/CC nanofiber showed smooth surfaces and uniform bead‐free morphology with core‐shell structure. The average fiber diameter was 301.55 ± 76.77 nm with a narrow distribution. Using the Korsmeyer‐Peppas kinetic release model, the nanofiber membrane effectively released ∼85% CCM at pH 7.4 over 96 h via Fickian diffusion transport mechanism. In vitro antibacterial tests demonstrated that the membrane was efficient against both Gram‐positive (Staphylococcus aureus) and Gram‐negative (Pseudomonas aeruginosa) bacteria. When compared to free CCM, the membrane improved cell survival due to its nontoxic and cytobiocompatible features. In vivo tests found that the membrane significantly improved healing in incised‐wound rats, reducing inflammation, fibroblast proliferation, and collagen deposition. These findings indicate that the novel PVA/CCM@CS/PVA/CC nanofiber membrane, which has numerous biological functions, could be a promising candidate for wound dressing therapeutic applications. [ABSTRACT FROM AUTHOR]

Objective(s): This study uses the blend-electrospinning method to explore the development of apigenin) APG(-loaded PCL nanofibers as a promising wound dressing material. Materials and Methods: The approach combines APG's anti-inflammatory and antioxidant properties with the advantages of nanofibers for wound healing. The research investigates the electrospinning process for optimal parameters and characterizes the resulting nanofibers using FE-SEM, FTIR, and contact angle measurements. Results: The findings demonstrate successful APG incorporation into PCL nanofibers at concentrations up to 0.5 wt%. The APG release profile indicates a sustained release over 48 hours. Biocompatibility and cytotoxicity assessments using the Alamar Blue assay reveal excellent biocompatibility of APG-loaded PCL nanofibers (over 90% viability). Additionally, the nanofibers exhibit a porous, bead-free structure with improved hydrophilicity due to APG incorporation. Conclusion: Overall, this study highlights the development of APG/PCL nanofibers with promising characteristics for wound dressing applications. The combination of APG's therapeutic properties, sustained release profile, and biocompatible nanofiber structure suggests their potential for effective wound healing. [ABSTRACT FROM AUTHOR]

Background: Effective wound dressing is the key solution to combating the increased death rate and prolonged hospital stay common to patients with wounds. Methods: Sodium alginate-based single- and double-layer membranes incorporated with Capparis sepiaria root extract were designed using the solvent-casting method from a combination of polyvinyl alcohol (PVA), Pluronic F127 (PF127), and gum acacia. Results: The successful preparation of the membranes and loading of the extract were confirmed using Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD). The prepared membranes were biodegradable and non-toxic to human skin cells (HaCaT), with high biocompatibility of 92 to 112% cell viability and good hemocompatibility with absorbance ranging from 0.17 to 0.30. The membrane's highest water vapor transmission rate was 1654.7333 ± 0.736 g/m2/day and the highest % porosity was 76%. The membranes supported cellular adhesion and migration, with the highest closure being 68% after 4 days compared with the commercial wound dressings. This membrane exhibited enhanced antimicrobial activity against the pathogens responsible for wound infections. Conclusions: The distinct features of the membranes make them promising wound dressings for treating infected wounds. [ABSTRACT FROM AUTHOR]

The release of antibiotics or anions by traditional bacteriostatic agents led to the development of bacterial drug resistance and environmental pollution. Ionic liquids (ILs) have become important choices for antibacterial agents because of their excellent physical, chemical and biological properties. In this paper, the bioactivities of 1-vinyl-3-butylimidazolium chloride ([VBIM]Cl, IL) and poly (1-vinyl-3-butylimidazolium chloride) (P[VBIM]Cl, PIL) were evaluated, and the potential antibacterial material was used to synthesize hydrogels. Using the colony formation assay and the Oxford cup method, antibacterial effect of IL and PIL were tested. Cell-Counting-Kit-8 (CCK-8) experiments were used to study the IC50 (half maximal inhibitory concentration) values of IL and showed 1.47 mg/mL, 0.35 mg/mL and 0.33 mg/mL at 24 h, 48 h and 72 h, respectively. The IC50 value of PIL were 12.15 μg/mL, 12.06 μg/mL and 11.76 μg/mL at 24 h, 48 h and 72 h, respectively. The PIL is further crosslinked with polyvinyl alcohol (PVA) to form a novel hydrogel through freeze-thaw cycles. The newly fabricated hydrogel exhibited a high water content, excellent water absorption properties and outstanding mechanical performance. Using the colony formation assay and the inhibition zone assay, the hydrogels exhibited favorable antibacterial effects (against E.coli and S.aureus) such that nearly 100% of the bacteria were killed in liquid medium while cultivating with H4 (synthesized by 0.5 g PIL and 1g PVA). In addition, the cytotoxicity of PIL was significantly reduced through hydrogen bond crosslinking. H4 showed the highest antibacterial activity and a good biocompatibility. The results indicated that the PVA&PIL hydrogels had great potential for wound dressing. [ABSTRACT FROM AUTHOR]

The skin injuries pose a substantial public health challenge, not only due to their physical trauma but also the accompanying pain and complexities in wound healing. In the current research, Inula helenium extract and lidocaine were loaded into electrospun PVA/calcium alginate nanofibers to promote skin wounds healing and alleviate the resulting pain. Various in vitro experiments were utilized to characterize these dressings. Wound healing potential of these constructs and their analgesic effects were studied in a rat model of skin wounds. Our developed scaffolds released the loaded drugs in a slow manner and showed antioxidative and anti-inflammatory activities. Fiber size measurement showed that drug-loaded and drug-free scaffolds had around 418.025 ± 140.11 nm and 505.51 ± 93.29 nm mean fiber size, respectively. Bacterial penetration assay confirmed that drug-loaded scaffolds reduced bacterial infiltration through the matrices. Wound healing study showed that on day 14th, the dressings loaded with inula helenium extract and lidocaine could close the wounds up to 91.26 ± 5.93%. In addition, these scaffolds significantly reduced the animals pain sensitivity. ELISA assay results implied that these dressings modulated inflammation and reduced tissue's oxidative stress. [ABSTRACT FROM AUTHOR]

Hydrogels have several characteristics, including biocompatibility, physical similarity with the skin's extracellular matrix, and regeneration capacity. Cell migration and proliferation are facilitated by natural polymers such as gelatin (Gel) and carboxymethyl cellulose (CMC). Gelatin dressing acts as a structural framework for cell migration into the wound area, stimulating cell division and promoting granulation tissue formation. Omega-3 fatty acids from fish oil may prevent wound infection and improve the healing of wounds in the early stages. We studied the preparation of wound dressing containing Omega-3 and its ability to heal wounds. In this study, CMC-Gel hydrogels containing different concentrations of Omega-3 were investigated in full-thickness wounds. After the fabrication of the hydrogels by using surfactant (tween 20) and microemulsion method (oil in water), various tests such as SEM, Water uptake evaluation, weight loss, cell viability, blood compatibility, and in vivo study in rat cutaneous modeling during 14 days were performed to evaluate the properties of the fabricated hydrogels. The analysis of the hydrogels revealed that they possess porous structures with interconnected pores, with an average size of 83.23 ± 6.43 μm. The hydrogels exhibited a swelling capacity of up to 60% of their initial weight within 24 h, as indicated by the weight loss and swelling measurements. Cell viability study with the MTT technique showed that no cytotoxicity was observed at the recommended dosage, however, increasing the amount of omega-3 caused hemolysis, cell death, and inhibition of coagulation activity. An in vivo study in adult male rats with a full-thickness model showed greater than 91% improvement of the primary wound region after 2 weeks of treatment. Histological analysis demonstrated Omega-3 in hydrogels, which is a promising approach for topical skin treatment to prevent scar, and has shown efficacy as wound dressing by improving the repair process at the defect site. [ABSTRACT FROM AUTHOR]

[Display omitted] The skin has a multilayered structure, and deep-seated injuries are exposed to external microbial invasion and in vivo microenvironmental destabilization. Here, a bilayer bionic skin scaffold (Bilayer SF) was developed based on methacrylated sericin protein to mimic the skin's multilayered structure and corresponding functions. The outer layer (SF@TA), which mimics the epidermal layer, was endowed with the function of resisting external bacterial and microbial invasion using a small pore structure and bio-crosslinking with tannic acid (TA). The inner layer (SF@DA@Gel), which mimics the dermal layer, was used to promote cellular growth using a large pore structure and introducing dopamine (DA) to regulate the wound microenvironment. This Bilayer SF showed good mechanical properties and structural stability, satisfactory antioxidant and promote cell proliferation and migration abilities. In vitro studies confirmed the antimicrobial properties of the outer layer and the pro-angiogenic ability of the inner layer. In vivo animal studies demonstrated that the bilayer scaffolds promoted collagen deposition, neovascularization, and marginal hair follicle formation, which might be a promising new bionic skin scaffold. [ABSTRACT FROM AUTHOR]

In the present study, electrospinning of polyvinylpyrrolidone (PVP) and polydiacetylene (PDA) with pomegranate peel (PG) extract was investigated for the preparation of smart and antibacterial nanofibers. Briefly, PDA-PVP solutions were firstly prepared at two different ratios and electrospun under different conditions. Based on the SEM results, the 1:3 ratio of PDA:PVP nanofibers, with an average fiber diameter of 130 ± 40 nm, electrospun at a voltage of 15 kV, feeding rate of 0.5 ml/h and collector distance of 15 cm was selected as the optimal conditions. The addition of PG resulted in an increase in the diameter of the fibers. The color of the electrospun fibers was altered from blue to red due to changes in either temperature or pH or exposure to different solvents. The antibacterial test showed high antimicrobial activity of the fibers loaded with PG extract against both S. aureus and E. coli. MTT assay and cell attachment also validated the biocompatibility of the fabricated nanofibers. Thus, the prepared smart PG-loaded nanofibers had a high potential to be used in wound dressing applications. [ABSTRACT FROM AUTHOR]

Background: Hospital-acquired pressure ulcer (HAPU) is a significant problem in healthcare settings and is associated with negative impacts on patient health. Although monitoring of pressure ulcers (PUs) among hospitalised patients was started more than a decade ago in Oman, no previous studies have been completed to estimate the prevalence and risk factors of HAPUs among patients in the intensive care unit (ICU). The aim of this study was to estimate the prevalence and identify risk factors for HAPUs among adult ICU patients in selected tertiary hospitals in Oman. Method: A retrospective, cross-sectional, nested, case–control design was used to identify the prevalence rate of HAPUs and risk factors for a cohort of adult ICU patients over one calendar year (1 January–31 December 2019) in two tertiary hospitals in Oman. Results: The prevalence rate for HAPU among ICU patients in Oman was 36.4%. However, when excluding cases of stage 1 ulcer, the rate was 30.37%. The most prevalent location was the sacrum (64.1%), and the most common stage was stage 2 (73.1%). The risk factors for HAPU included male sex (odds ratio (OR): 0.37; p=0.023), organ failure (OR: 3.2; p=0.033), cancer (OR: 3.41; p=0.049), cerebrovascular accident (OR: 12.33; p=0.001), mechanical ventilator (OR: 9.64; p=0.025) and ICU length of stay (OR: 1.24; p<0.001). Conclusion: HAPUs among ICU patients constitute a significant problem associated with severe clinical consequences and result in substantial adverse healthcare outcomes worldwide, including in Oman. Identifying the risk factors and the impact on the healthcare system is the foundation for preventing and managing HAPUs. [ABSTRACT FROM AUTHOR]

Objective: Several national and international guidelines recommend lipidocolloid technology with a nano-oligosaccharide factor (TLC-NOSF) dressings (UrgoStart dressing range, Laboratoires Urgo, France) for treating patients with chronic wounds. However, these dressings are still often reported as second-line options, potentially leading to loss of opportunity for patients and additional costs for payers. This review aimed to explore the reported wound healing and patient outcomes as well as the related costs when the dressings were used as first-line treatment in patients with different types of chronic wounds. Method: A systematic review of the literature was conducted. Databases (MEDLINE, Embase, Emcare, and Google Scholar) were searched up to 1 February 2024, without any language or time period limitations. Studies were eligible if the evaluated dressings had been used as a first-line treatment for chronic wounds, that is, as an integral part of the standard of care (SoC) at the patient's first presentation and/or in recent wounds. The main evaluation criteria included: wound healing rate; time to reach wound closure; change in patients' quality of life (QoL); and associated costs. The quality of evidence of the included studies was appraised using well-recognised risk-of-bias tools suitable for different study designs. A narrative synthesis describes the findings in three sections depending on the type of comparison. This report followed the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: A total of 17 studies published between 2017 and 2024 met the eligibility criteria. A comparative analysis between TLC-NOSF dressings and standard dressings, both of which were used as first-line treatment, was reported in nine studies. A comparative analysis between the use of TLC-NOSF dressings as first-line and second-line treatments was reported in eight studies, and five studies reported a systematic use of the TLC-NOSF dressing as first-line treatment without a control group. Overall, the included studies had a relatively low risk of bias for the respective types of evidence. Data of 10,191 patients of both sexes and different age groups with a total of 10,203 wounds (diabetic foot ulcers, leg ulcers, pressure injuries, and other types of chronic wounds) were included in the analysis: 7775 treated with the evaluated dressing and 2428 treated with a comparator dressing. The data suggested that using TLC-NOSF as a first-line treatment for chronic wounds consistently resulted in significantly higher healing rates, shorter healing times, and cost savings compared with standard dressings used under similar conditions. Real-life evidence confirmed the results obtained in clinical trials and economic models, within similar ranges, regardless of the settings involved or of the characteristics of the patients and wounds treated. The wound healing rates ranged around 70-80% by week 20/24 and time-to-heal was reported on average around seven weeks, with slightly longer times reported in wounds with a more severe prognosis. Furthermore, the dressings were shown to improve patient QoL, and were well tolerated and accepted, supporting a wider adoption approach. Conclusion: The results of this review are aligned with the current guidelines recommending the use of TLC-NOSF dressings in the treatment of patients with chronic wounds. They support its wider implementation as a first-line treatment and as an integral part of SoC for these wounds in the daily practice of all centres involved in their management. [ABSTRACT FROM AUTHOR]

Objective: Delayed or stalled healing in open wounds can result from persisting chronic inflammation related to infection and/or persistent bacterial colonisation and biofilm. Treatment of hard-to-heal wounds focuses on debridement and exudate management, but also on infection prevention and control. Silver dressings have been evaluated in randomised clinical trials (RCTs); this meta-analysis evaluated the efficacy and safety of a silver ion-releasing foam dressing (Biatain Ag; Coloplast A/S, Denmark) to treat hard-to-heal wounds. Method: Literature databases (PubMed and Cochrane Library) were searched for studies on silver ion-releasing foam dressings in the treatment of hard-to-heal wounds. Individual patient data from four RCTs were obtained and included in the meta-analysis. Results: Findings showed that treatment with the silver ion-releasing foam dressing was associated with a significantly higher relative reduction in wound area after four (least squares-mean difference (LS-MD): -12.55%, 95% confidence interval (CI): (-15.95, -9.16); p<0.01) and six weeks of treatment (LS-MD: -11.94%, 95%CI: (-17.21, -6.68); p<0.01) compared with controls. Significant benefits were also observed for time to disappearance of odour (hazard ratio: 1.61, 95%CI: (1.31, 1.98); p<0.01), relative reduction of exudate (LS-MD: -5.15, 95%CI: (-7.36, -2.94); p<0.01), proportion of patients with periwound erythema (relative risk (RR): 0.81, 95%CI: (0.69; 0.94); p<0.01), and less pain at dressing removal (LS-MD: -0.35, 95%CI: (-0.63, -0.06); p=0.02). No differences regarding safety outcomes were identified. Conclusion: This meta-analysis has demonstrated beneficial outcomes and a good tolerability profile for silver ion-releasing foam dressings in the treatment of moderate-to-highly exuding wounds with delayed healing compared with control dressings. [ABSTRACT FROM AUTHOR]

Radiation-induced skin ulcer following cancer and/or tumour is well-documented in the literature. However, radiation-induced skin ulcer following the excision of keloid is yet to be reported. Here, we report the case of a 33-year-old female patient with a suprapubic skin ulcer of five months' duration following keloid treatment with electron beam therapy at recommended dosage. Various examinations, including a skin biopsy, metagenomic sequencing, magnetic resonance imaging and immunochemistry, indicated that the skin ulcer was induced by radiotherapy. While postoperative radiotherapy has been recommended immediately following keloid excision to reduce the risk of recurrence, the present case highlights the risk of skin refractory ulcer following keloid radiotherapy. [ABSTRACT FROM AUTHOR]

Objective: Person-centred care (PCC) is an important approach as it positively affects disease management. Guiding studies are needed on the use and development of PCC in hard-to-heal (chronic) wound management. This study aimed to determine attitudes and approaches of nurses and physicians working in hard-to-heal wound management towards PCC, and obtain their views and suggestions for its scope and improvement. Method: Participants of this descriptive survey study consisted of nurses and physicians responsible for hard-to-heal wound care and treatment in healthcare institutions at all levels in Turkey. Data were collected through a structured online survey shared with members of professional associations via social media platforms between March–November 2020. Descriptive statistics and qualitative inductive content analysis were used to analyse data. Results: Participants (n=418) included physicians (84.2%) and nurses (15.8%). Mean participant-graded their person-centred behaviour level was 8.18±1.80 (out of 10 points). The majority of participants reported that they informed patients about care, treatment processes and options (87.3%) as well as including them in the decision-making process (74.6%). Responses of the participants regarding the scope of PCC were classified into five main categories, the most prominent being: 'individual', 'care', 'professional development' and healthcare system'. Suggestions for the improvement of PCC were classified into seven main categories, with 'personalised care', 'disease-specific care', 'continued training of healthcare professionals should be ensured' and 'home care system should be developed for the continuity of care' among the prominent subcategories. Conclusion: The findings of this study suggests that education on PCC is an important approach. Institutional protocols and guidelines can support person-centred hard-to-heal wound management. In this study, the level of person-centred behaviour of the participants was determined to be good. Although the results of the study cannot be generalised to all health professionals—the majority of the participants were physicians—it is recommended to develop and disseminate the PCC model in hard-to-heal wound management using the findings. [ABSTRACT FROM AUTHOR]

Objective: To learn about the experiences of people who seek treatment for hard-to-heal wounds, we distributed a nationwide pilot survey, asking questions about the nature of their wound, how it shaped their daily lives, pathways to receiving care and experiences with treatment. The long-term objective is to quantify the journey of patients with hard-to-heal wounds to identify ideal intervention points that will lead to the best outcomes. This article summarises the findings, implications, limitations and suggestions for future research. Method: Qualitative data were self-reported from patients with hard-to-heal wounds (open for >4 weeks) in a pilot chatbot survey, (Wound Expert Survey (WES)) provided online in the US on Meta platforms (Facebook and Instagram) between 2021 and 2022. Results: The US national pilot survey attracted responses from 780 patients, 27 of whom provided a video testimonial. Some 57% of patients delayed treatment because they believed their wound would heal on its own, and only 4% saw a wound care specialist. Respondents reported the cost of care as the most frequent reason for not following all of a doctor's treatment recommendations. Queries regarding quality of life (QoL) revealed that more than half (65%) said they have negative thoughts associated with their wound at least every few days. Some 19% of respondents said their wound had an odour and, of them, 34% said odour had a major or severe negative impact on their self-confidence. Economically, nearly one-quarter of respondents said having a wound led to a drop in their total household income and 17% said their wound led to a change in their employment status. Conclusion: A national pilot survey of patients with hard-to-heal wounds revealed that many delay seeking professional assistance and only a small minority see a wound care specialist. Experiencing an ulcer, even for a few months, can have significant negative effects on a patient's QoL. Patients frequently had negative thoughts associated with their wound, and odour compounded these negative effects, leading to major or severe negative impacts on self-confidence. Households experienced a decline in income, due to both the direct reduction or loss of patient employment and the additional time spent by family members assisting in patient recovery. Thus, a variety of factors contribute to poor outcomes for patients with hard-to-heal wounds. To validate and extend these preliminary results, future surveys of patients with hard-to-heal wounds should focus on additional reasons patients do not seek professional help sooner. To improve health outcomes and QoL, assessment of patient socioeconomic variables should occur whenever wound closure stalls. [ABSTRACT FROM AUTHOR]

Objective: Hard-to-heal (chronic) wounds are treated differently at varying healing stages and often require long periods of time to heal completely. Therefore, it is often very difficult to achieve this primary endpoint in clinical trials with wound products which are used temporarily. Thus, it seems reasonable to use valid wound healing parameters determined at an early stage, such as the percentage (wound) area reduction (PAR), as surrogates for predicting complete wound healing. Method: To identify studies on the association between potential surrogate endpoints and complete wound healing, a systematic literature search in MEDLINE, Embase and the Cochrane Library databases was performed. The findings of the studies were summarised qualitatively. Results: A total of 23 publications with a focus on hard-to-heal wounds (n=10 diabetic foot ulcers (DFUs), n=10 venous leg ulcers (VLUs), n=3 other ulcers) and various wound care regimens were identified. All studies showed a high bias potential. The available clinical evidence confirmed that the PAR at week 4 showed a good discriminatory capacity to predict which wounds would eventually heal and which would not. The chance to achieve complete wound healing was significantly higher for wounds achieving a PAR of >40% (VLU) or ≥50% (DFU) at week 4. Conclusion: The PAR thresholds of 40% (VLU) and 50% (DFU) can be used to identify the proportion of the wounds that will heal, and those that will not heal, to compare the efficacy of different wound dressings as early as week 4 in the setting of clinical trials. The available evidence may be limited by a potential risk of bias. [ABSTRACT FROM AUTHOR]

Objective: This study examined the effectiveness of a combination of hyperbaric oxygen therapy (HBOT) and topical haemoglobin spray in treating hard-to-heal, sloughy diabetic foot ulcers (DFUs). Method: Patients with hard-to-heal DFUs at least 25% sloughy or necrotic were included in the study. We compared the results of patients who received standard of care and HBOT with topical haemoglobin spray (oxygen group) to an equal number of patients who only received standard personalised wound care (control group). The initial values of haemoglobin A1C and C-reactive protein, wound culture results and SINBAD (site, ischaemia, neuropathy, bacterial infection, area, depth) scores were documented. Wounds were considered healed when completely closed within 16 weeks. Results: The oxygen group (n=21) had a mean SINBAD score of 5.00±0.89, while the control group (n=21) had a mean score of 4.62±0.80 (p=0.155). After 16 weeks, 85.7% of wounds in the oxygen group showed complete recovery, compared with 52.4% in the control group (p=0.02). Conclusion: In this study, a greater number of wounds in the oxygen group healed. Combining HBOT with topical haemoglobin spray provides oxygenation to the wound for longer, primarily because patients can receive 90 minutes of HBOT daily. This ensures that patients benefit from both systemic and local oxygen. This combination therapy may effectively address the problem of hypoxia and promote healing in hard-to-heal wounds. [ABSTRACT FROM AUTHOR]

Objective: Innovation in wound healing, particularly regarding diabetic foot ulcers (DFUs), is needed to reverse the number of diabetes-related amputations. This study evaluated a novel approach and performance of a multimodal wound matrix in converting stalled DFUs into a healing trajectory. Method: Patients with either type 1 or 2 diabetes and with foot ulcers (Wagner grade 1 and 2), were screened to determine eligibility for treatment. Ulcers improving >30% in area during a two-week screening phase were not eligible for the study treatment phase. The study was an open-label trial conducted in three phases: screening, treatment and healing confirmation. Patients enrolled in the study received a treatment protocol that included application of a wound matrix to the ulcer and offloading. Results: A total of 19 patients (15 males, four females) with a median age of 60 years, and a median ulcer duration of 36 weeks took part in the study. Patients showed an average four-week percentage area reduction (PAR) of 62%, a 12-week PAR of 94%, and a 12-week healing rate of 57% (8/14). Conclusion: Results of this study support the viability and potential of a novel approach to treating DFUs that includes use of a multimodal wound matrix. [ABSTRACT FROM AUTHOR]

Objective: Maggot debridement therapy (MDT) is increasingly being used in clinical practice as an alternative treatment for hard-to-heal (chronic) wounds. Among the many benefits of using MDT is its antimicrobial effect. Maggots secrete substances that are known to have antibacterial properties against both Gram-negative and Gram-positive bacteria. Clinically, this results in the effective eradication of pathogenic species and consequently, a faster healing process. The aim of this study was to evaluate the effect MDT has on the bacterial flora of hard-to-heal ulcers. Method: Patients with venous, mixed arteriovenous, decubitus, diabetic and neuropathic wounds were treated with larvae of Lucilia sericata enclosed in bags. Dressings were applied to the wounds for 72 hours. Before and after the therapy, a swab was taken from the wound, and bacterial diversity and bacterial growth scores were assessed. While 16 patients were treated only once, the treatment had to be repeated in four cases until the wounds were fully debrided. Results: Bacteria of the species Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus and Enterococcus faecalis were the most common strains observed. Of the 20 patients treated, the total number of bacterial strains decreased in eight wounds, but increased in five wounds, while no difference was observed in nine wounds. The average number of bacterial strains in wounds decreased after MDT. A lower incidence of alarm pathogens was also reported. In cases where multiple applications of larvae were administered, greater decreases in bacterial growth scores were observed than in cases with a single application of dressing-(37.5% vs 18.1%, respectively). In 18 cases, after disinfection of the wound by larvae, it was reinfected by strains not detected before. Wounds healed completely after MDT in two patients. Conclusion: In this study, MDT changed the bacterial diversity of hard-to-heal wounds. The larvae reduced overall bacterial growth scores and acted on both Gram-positive and Gram-negative bacteria as well as on alarm pathogens. Cleaned wounds appeared to become vulnerable to infection by opportunistic bacteria. The bacterial burden decreased as the number of applications of biological dressings increased. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers are a serious complication of uncontrolled diabetes, emphasizing the need to develop wound healing strategies that are not only effective but also biocompatible, biodegradable, and safe. We aimed to create biomatrices composed of semi‐interpenetrated polymer networks of collagen, polyurethane, and dextran, to enhance the wound healing process. The hydrogels were extensively characterized by various analytical techniques, including analysis of their structure, crystallinity, thermal properties, gelation process, reticulation, degradation, cell proliferation, and healing properties, among others. Semi‐interpenetrated hydrogels containing dextran at levels of 10%, 20%, and 30% exhibited porous interconnections between collagen fibers and entrapped dextran granules, with a remarkable crosslinking index of up to 94% promoted by hydrogen bonds. These hydrogels showed significant improvements in mechanical properties, swelling, and resistance to proteolytic and hydrolytic degradation. After 24 h, there was a significant increase in the viability of several cell types, including RAW 264.7 cells, human peripheral blood mononuclear cells, and dermal fibroblasts. In addition, these hydrogels demonstrated an increased release of interleukin‐10 and transforming growth factor‐beta1 while inhibiting the release of monocyte chemotactic protein‐1 and tumor necrosis factor‐alpha after 72 h. Furthermore, these hydrogels accelerated the wound healing process in diabetic rats after topical application. Notably, the biomaterial with 20% dextran (D20) facilitated wound closure in only 21 days. These results highlight the potential of the D20 hydrogel, which exhibits physicochemical and biological properties that enhance wound healing by inhibiting inflammation and fibrillogenesis while remaining safe for application to the skin. [ABSTRACT FROM AUTHOR]

The development of new wound dressings made from biomaterials, which offer a better cost–benefit ratio and accelerate the healing process, is increasing nowadays. Various biopolymers can be electrospun to form functional membranes for wound healing. Therefore, in this study, chitosan and nanochitosan membranes with or without hyaluronic acid were prepared using the electrospinning technique, characterized and evaluated in the healing of skin wounds in rats. Chitosan and nanochitosan solutions, with or without hyaluronic acid, were prepared at concentrations of 1%–4% using PEO (polyethylene oxide) and subjected to the electrospinning process to obtain membranes characterized by scanning electron microscopy (SEM), mechanical tests, and antimicrobial activity. The healing effect of the membranes was evaluated by monitoring the area of the lesions, contraction of the wounds, histologic analysis, and induction of pro‐inflammatory cytokine (IL‐1 α and TNF‐α) production in rats. The nanochitosan and nanochitosan membranes with hyaluronic acid achieved greater fiber diameter and uniformity, resistance, elasticity, and thermal stability, in addition to good adhesion to the wound bed and permeation capacity. Despite not presenting antimicrobial activity in vitro, they contributed to the production of pro‐inflammatory interleukins in the animals tested, provided physical protection, reduced the wound area more markedly until the seventh day of the evaluation, with an acceleration of the healing process and especially when functionalized with hyaluronic acid. These results indicate that the membranes may be promising for accelerating the healing process of chronic wounds in humans. [ABSTRACT FROM AUTHOR]

Background/Objectives: The objective of this study was to assess the efficacy of a cell-containing wound dressing based on fibroblasts in hydroxyethylcellulose (HEC) gel for the local treatment of deep partial-thickness and/or full-thickness skin burns in an animal model. Methods: The rats (male Wistar, n = 100) were subjected to a full-thickness thermal burn (16 cm2). Radical necrectomy was performed one day after the burn. Three days later, the rats were randomly assigned to one of four groups: group 1 (no treatment), group 2 (chloramphenicol and methyluracil ointment, a routine clinical treatment), group 3 (a gel without cells, mock treatment), and group 4 (a dermal fibroblast-impregnated HEC gel). The treatment lasted for five days. The wound-healing process was evaluated by planimetric, cytologic, histologic, and immunohistochemical methods. Results: The differences in the rate of wound healing and the characteristics of wound cytology were identified. In the group 4, a regenerative type of cytogram was revealed, characterized by a significantly increased number of fibroblastic cells in comparison to samples from non-treated and mock-treated animals. Biopsy samples of burn wounds from animals in the group 4l demonstrated the presence of mature granulation tissue and a large number of microvessels. The repair process was stimulated, as evidenced by the increased thickness of newly formed granulation tissue and epidermis in the wound zone, elevated cellularity, and enhanced re-epithelialization activity. The number of Ki-67-positive proliferating cells was significantly higher in group 4 than in the control groups). A small number of non-proliferating donor fibroblasts was observed in the wound area 3 days after the end of treatment. Conclusions: The cell product is an effective agent for promoting wound healing during the regenerative phase. The experiments demonstrated that a gel populated by dermal fibroblasts can stimulate reparative regeneration processes in deep partial- and full-thickness burn wounds. [ABSTRACT FROM AUTHOR]

Designing a wound dressing with controlled uptake, antibacterial, and proper biocompatibility is crucial for the appropriate wound healing process. In this study, alginate/tetracycline (Alg/TC) beads were produced and embedded into chitosan/pluronic/agarose semi-interpenetrating polymer network hydrogel, which serves as a potential biocompatible dressing for treating skin wounds. The effect of pluronic content on the porosity, swelling, mechanical characteristics, and degradation of the hydrogel was investigated. Furthermore, the impact of Alg beads on TC release was subsequently examined. In the absence of Alg beads, faster release was observed. However, after incorporating beads into the hydrogels, the release was sustained. Particularly, the hydrogel containing Alg beads exhibited a nearly linear release, reaching 74% after 2 days in acidic media. The antimicrobial activity and biocompatibility of the hydrogel were also evaluated to assess the capability of the TC-loaded hydrogels for wound dressing applications. The hydrogel demonstrated efficient antibacterial features against Gram-positive and Gram-negative bacteria. Additionally, the sample behavior was evaluated against exposure to yeast. Furthermore, based on biocompatibility studies using HFF2 cells, the TC-loaded hydrogel exhibited remarkable biocompatibility. Overall, this novel composite hydrogel shows remarkable biocompatibility and antibacterial activities which can be used as a great potential wound dressing to prevent wound infections due to its effective inhibition of bacterial growth. [ABSTRACT FROM AUTHOR]

The aim of the study was to utilize kombucha-derived bacterial cellulosic sheet [KBC], formed as a by-product of fermented, sugared black tea (in the presence of a symbiotic culture of bacteria and yeast), for potential wound dressing applications. KBC was functionalized using aqueous and ethanolic extracts of different phytochemical agents using two ex-situ methods- casting and impregnation. It was observed that casted KBC functionalized with ethanolic extract of Turmeric (1.2% w/w) yielded a maximum zone of inhibition (24.37 ± 0.42 mm) against Pseudomonas aeruginosa. The hemocompatibility test confirmed the composite's biocompatible nature as the percentage hemocompatibility was found to be less than 5%. The MTT assay established its viability and anti-cancerous properties with Turmeric extract loaded KBC showing higher efficiency compared to Tulsi extract. FTIR analysis and SEM imaging confirmed the functionalization of cellulose sheets and the change in morphology. The contact angle analysis showed improved hydrophilic properties of the sheets for absorbing wound exudates, and the water absorption study revealed maximum absorptivity of up to 321.20 ± 6.23%. Thus, it can be concluded from the study that tea processing waste can be reused to produce a value-added product that can act as an efficient, cost-effective biomaterial for wound dressing applications. [ABSTRACT FROM AUTHOR]

Background: Wound healing is a natural but complex process that can be delayed by infection. Rosuvastatin calcium (RVS) is an anti-hyperlipidemic that was recently reported to have a wound healing capability. The study aimed to investigate the impact of combining RVS with Levofloxacin (LV) on wound healing. A physically crosslinked polyvinyl alcohol (PVA) film loaded with RVS and LV was formulated as wound dressing. Formulation optimization was carried out using Box–Behnken design. The effect of independent variables (PVA and propylene glycol concentrations and the number of freeze–thaw cycles) on tensile strength (TS), elongation to break (%EB) and in vitro drugs' release was studied. For simultaneous RVS and LV quantification in the formulations and pure form, three spectrophotometric methods: derivative of ratio spectrophotometry, first derivative and mean centering, were developed. Also, their greenness was evaluated by the Analytical Eco-Scale and the Green Analytical Procedure Index. Then, the wound healing effect of the optimized wound dressing was evaluated in rat models. Results: The optimized dressing had sufficient mechanical strength (9.45 ± 0.67 MPa), adequate flexibility (112.6 ± 3.8% EB) and suitable drug release (52.3 ± 1.4% for LV and 38.99 ± 1.6% for RVS after 12 h). The proposed methods were validated following ICH guidelines, and greenness assessment suggested their very low environmental effect. The wound healing evaluation showed a higher wound contraction percentage when RVS was combined to LV. A histopathological study confirmed marked improvement in animals treated with combined formula with lowest inflammatory infiltration and optimum epithelialization, compared to other groups. Conclusion: Study findings suggest that combined LV-RVS dressing would be a beneficial platform with potentiated wound healing capacity. [ABSTRACT FROM AUTHOR]

Objective: While most xenograft wound matrices are flat sheets not designed for deep or tunnelling wounds, three-dimensional acellular collagen matrices (3D-ACM) can fill deep wound beds and enable full wound wall apposition. This case series examines the use of 3D-ACM in treating diabetic foot ulcers (DFUs) that are deep, tunnelling, undermining, or irregularly shaped. We report outcomes of cases where 3D-ACM was applied to deep or tunnelling DFUs present for at least four weeks. Method: In this retrospective case series, 3D-ACM was applied, healing was monitored and measurements were collected. Additional 3D-ACM was applied as needed. Results: In total, 11 patients with 13 wounds were treated. Improved wound appearance and reduced size were observed at most follow-ups. Mean initial wound depth was 1.6cm, and several wounds showed significant depth reductions shortly after therapy initiation. In total, 62% of wounds (8/13) reached 50% closure by four weeks. Additionally, 54% (7/13) were fully closed by 12 weeks. The remaining 46% (6/13) took between 12–22.3 weeks to heal. Overall mean therapy time was 13.1 weeks (range: 2.0–22.3 weeks). Deeper wounds generally took longer to close. Conclusion: The findings of this case series showed that 3D-ACM could offer a protective microenvironment for wound management for deep or tunnelling DFUs. While some took >12 weeks to close, this may be attributable to large initial depths and volumes, rather than a failure to respond to the treatment modality. Other wounds that require a conforming 3D matrix, enabling full wound wall apposition, may benefit from 3D-ACM. Further investigations would be beneficial to understand the capabilities of this treatment modality. [ABSTRACT FROM AUTHOR]