Abstract
Wound healing involves a complex interaction between immunity and other natural host processes, and to succeed it requires a well-defined cascade of events. Chronic wound infections can be mono- or polymicrobial but their major characteristic is their ability to develop a biofilm. A biofilm reduces the effectiveness of treatment and increases resistance. A biofilm is an ecosystem on its own, enabling the bacteria and the host to establish different social interactions, such as competition or cooperation. With an increasing incidence of chronic wounds and, implicitly, of chronic biofilm infections, there is a need for alternative therapeutic agents. Nanotechnology shows promising openings, either by the intrinsic antimicrobial properties of nanoparticles or their function as drug carriers. Nanoparticles and nanostructured coatings can be active at low concentrations toward a large variety of infectious agents; thus, they are unlikely to elicit emergence of resistance. Nanoparticles might contribute to the modulation of microbial colonization and biofilm formation in wounds. This comprehensive review comprises the pathogenesis of chronic wounds, the role of chronic wound colonization and infection in the healing process, the conventional and alternative topical therapeutic approaches designed to combat infection and stimulate healing, as well as revolutionizing therapies such as nanotechnology-based wound healing approaches.
Highlights
Chronic wounds, such as venous or arterial ulcers, diabetic foot ulcers, pressure sores, and non-healing surgical wounds, have a significant impact on a patient’s quality of life, and are an important economic burden
Nitric oxide-releasing silica nanoparticles have been investigated in regards to wound healing and have shown that they play an important role in the deposition of extracellular matrix (ECM) proteins and cell proliferation [88]
With the increasing incidence of chronic biofilm infections, characterized by tolerance and resistance to antimicrobials, there is an imperative need for alternative therapeutic agents
Summary
Chronic wounds, such as venous or arterial ulcers, diabetic foot ulcers, pressure sores, and non-healing surgical wounds, have a significant impact on a patient’s quality of life, and are an important economic burden. Microbial species can establish relationships of cooperation and competition; evolving into an elaborate and functional adapted communities. Their interaction with the host’s immune system or with therapeutic agents contributes to the complexity of the wound ecosystem and modulates the healing potential. Wound debridement and the topical application of antibiotics or other antimicrobial substances are the conventional methods usually considered to eradicate wound infection. Nanoparticles are active at low concentrations toward a large variety of infectious agents. They are unlikely to provoke the emergence of resistance and have the ability to modulate microbial colonization and biofilm formation [2].
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