Advances In Wound Management Research Articles

Biocompatibility, antimicrobial efficacy, and therapeutic potential of cobalt carbonate nanoparticles in wound healing, sex hormones, and metabolic regulation in diabetic albino mice

Nanotechnology enables the manipulation of materials at the nanoscale, offering innovative solutions in various fields. Nanoparticles, with their small size and unique properties, have significant applications in the biomedical filed. The current study was designed to assess the biological applications of self-synthesized cobalt carbonate (CoCO3) nanoparticles. The crystalline structure and chemical composition of the CoCO3-NPs were confirmed by SEM, XRD, and FTIR techniques. We observed the 16.58 nm size of novelly synthesized CoCO3 NPS. The scanning electron microscope study confirmed a uniform cubic spinel structure. The biocompatibility and antimicrobial activity were checked in an invitro setup. We exposed albino mice to these synthesized NPs to study wound healing and metabolic effects. The results of biocompatibility analysis indicated hemolytic activity in a dose-dependent way, which showed no cytotoxic effect except at a higher concentration. Furthermore, the results showed enhanced wound healing processes in CoCO3-NP-treated albino mice as compared to the control group. CoCO3-NPs have considerable effect on the thyroid hormone and insulin levels in albino mice. The levels of T3, T4, and insulin were increased in a dose-dependent manner. Interactions between CoCO3-NPs and thyroxine and insulin were confirmed through molecular docking. We confirmed the antimicrobial efficiency of the nanoparticles using MIC values and zones of inhibition against Staphylococcus haemolyticus and Staphylococcus aureus. Despite their concentration-dependent biocompatibility concerns, the results are promising, as CoCO3-NPs hold potential for use in medical practice, particularly in advanced wound management and microbe inhibition.

Research trends and hot topics of wearable sensors in wound care over past 18 years: A bibliometric analysis

ObjectiveThis study determined the development trends, analyzed collaboration networks, and identified research hotspots in the field of wearable sensors for wound care from 2007 to 2024 using a rigorous bibliometric analysis approach. MethodsBibliometric and scientometric analyses were performed utilizing data sourced from the Web of Science Core Collection database. This study examined publication trends, contributions from various countries and institutions, author productivity, keyword prevalence, and citation patterns to discern research hotspots and potential future avenues in the application of wearable sensors for wound care. ResultsThis study included 1177 articles, which demonstrated a marked increase in publications since 2016 and underscores the burgeoning interest in wearable sensors for wound care. China and the United States have emerged as prominent contributors to the research field, exhibiting numerous international collaborations. An analysis of keywords and citation bursts highlighted wound healing, hydrogels, and sensors as the key research foci with recent trends shifting towards the integration of wearable technology with advanced materials and artificial intelligence for advanced wound management. The research landscape is characterized by a diverse network of international collaborations and an emphasis on interdisciplinary approaches that integrate materials science, sensor technology, and clinical applications. ConclusionThe utilization of wearable sensors in wound care constitutes a rapidly progressing area of research, garnering significant interest and promising avenues for future advances. The integration of wearable sensors with advanced materials and AI technologies presents a frontier of opportunity for innovating wound care methodologies, enhancing patient outcomes, and optimizing the allocation of healthcare resources.

Assessing polylactic acid nanofibers with cellulose and chitosan nanocapsules loaded with chamomile extract for treating gram-negative infections.

This study presents the development and characterization of a novel nanocomposite wound dressing material based on polylactic acid (PLA) nanofibers incorporating chitosan nanocapsules loaded with chamomile extract and cellulose nanoparticles. The nanofibers were fabricated using a three-step synthesis and electrospinning techniques, resulting in uniform, bead-free fibers with an average diameter of 186 ± 56nm. Fourier-transform infrared spectroscopy confirmed the successful incorporation of all components, while tensile strength tests demonstrated improved mechanical properties by adding nanoparticles. Water contact angle measurements revealed enhanced surface wettability of the PLA-Cellulose-Chitosan complex compared to pure PLA nanofibers. In vitro biocompatibility assessments using MTT assays showed excellent cell viability and proliferation, with the optimized composite exhibiting the best performance. Scanning electron microscopy imaging confirmed robust cell adhesion and interaction with the nanofibers. The nanocomposite demonstrated significant antimicrobial activity against Escherichia coli, with a 20mm inhibition zone observed for chamomile extract-loaded samples. Additionally, the material showed superior hemostatic ability compared to commercial gauze and high hemocompatibility. These comprehensive results indicate that the developed nanocomposite is a promising candidate for advanced wound management applications, offering a multifunctional approach to wound healing by combining antimicrobial activity, cell compatibility, and hemostatic properties.

3D Bilayered Hydrogel and Nanofiber Multifunctional Sponge Dressing: An Efficacious Healing Agent for Chronic Wound Healing.

Chronic wound management using biomaterial-based dressings has significantly impacted the standard and efficiency of wound healing. However, various available wound healing aids are ineffective in treating deep open injuries and chronic wounds such as diabetic wounds. Herein, we developed a 3D bilayered multifunctional sponge, which addresses the structural and functional issues faced by biomaterial dressings in treating deep and chronic wounds. The 3D bilayered sponge consists of a hydrogel base functionalized with wound healing peptide (Tylotoin)-carrying nanoparticles and topped with a nanofiber layer functionalized with an antimicrobial peptide (LLKKK18). The 3D bilayered sponge, with its highly porous, elastic, and enhanced fluid absorption ability, makes it a suitable wound treatment aid. The developed multifunctional 3D sponge shows antibacterial action and promotes a microenvironment similar to the extracellular matrix (ECM) in regulating dermal cell survival and migration. Study in a full-thickness skin defect diabetic mouse model has shown that the developed 3D bilayered sponge accelerated wound closure and promoted functional skin regeneration through reduced inflammation, faster granulation tissue formation, re-epithelialization, neovascularization, and skin appendage restoration, which make the developed 3D bilayered multifunctional sponge an efficient and advanced chronic wound management aid with potential for future clinical application.

An expanded focus in advanced wound care for geriatric emergency management nursing: a case study analysis.

Geriatric emergency management (GEM) nursing has emerged as a critical response to the increasing number of emergency department (ED) visits by older people, particularly in North America and specifically in Canada. This demographic often presents with complex medical conditions and atypical disease manifestations. The GEM programme, implemented in Ontario, Canada, aims to provide targeted assessment and establish community connections for frail older individuals, helping prevent their decline and loss of independence. There is a significant demand for specialised wound care services in EDs and frontline ED staff have a limited capacity to provide these. Advanced wound management was integrated into the GEM nursing scope of practice in an initiative. Patients who received wound care from GEM nurses and clinical nurse specialists had positive outcomes; those treated by GEM nurses had shorter wait times. Although the wound care role requires additional training and adds to the GEM nurse workload, the advantages appear substantial. Merging geriatric-focused care with specialist wound management may significantly benefit the care and satisfaction of older people attending the ED, as well as improve patient flow in the ED. This initiative requires further consideration by healthcare leaders and policymakers.

Study the effect of different concentrations of polydopamine as a secure and bioactive crosslinker on dual crosslinking of oxidized alginate and gelatin wound dressings

Alginate hydrogels are commonly used in wound care due to their ability to maintain a moist environment, absorb fluids, and aid wound healing. However, their stability and mechanical properties can sometimes limit their effectiveness. This study explores a new approach by creating a dual network system of oxidized alginate and gelatin hydrogel crosslinked with polydopamine in a single step, with the goal of improving the mechanical properties of these hydrogels. The unique aspect of this research is the comprehensive examination of different polydopamine concentrations in dual crosslinking systems. First, alginate was modified with sodium periodate to create additional active groups on its backbone, and various polydopamine concentrations were then tested to assess their impact on the dual crosslinking network and hydrogel properties. The study involved a range of tests, including FTIR, H-NMR, SEM, gelation time, rheology, adhesion, antioxidant activity, swelling ratio, weight loss, drug release, and cell viability. The addition of polydopamine was found to enhance the crosslinking density (0.859 × 109 mol.cm−3). Additionally, the results indicated improvements in properties such as reduced weight loss, enhanced antioxidant and adhesive qualities, and better mechanical properties (2240 kPa). However, the optimal concentration of polydopamine must be determined to achieve the best properties for a wound dressing. Excessive polydopamine can increase the space between polymer chains, leading to a reduction in crosslinking density and storage modulus. Nevertheless, it can also increase the swelling ratio, degradation rate, pore size, porosity, antioxidant activity, and dopamine release. Therefore, identifying the optimal concentration for a functional hydrogel is crucial. Notably, the hydrogel containing 0.5 mg.mL−1 polydopamine exhibited outstanding cell viability (108 % on the third day), swelling capacity (480 %), storage modulus (2240 kPa), gelation time (3 min), antioxidant activity (42.27 %), and skin adherence (11 kPa), making it an optimal choice for advanced wound management. According to the findings, it is emphasized that the application of this particular hydrogel expedites wound healing, as indicated by wound closure and histological studies. AbbreviationsUnlabelled TableOALoxidized alginateGELgelatinPDApolydopamineEDCsodium meta periodate 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide hydrochlorideNHSN-hydroxysuccinimide

A closed-loop patch based on bioinspired infection sensor for wound management

Pathogenic wound infections remain a major global health challenge. When skin tissue is wounded, some colonizing pathogenic bacteria secrete large amounts of hyaluronidase (HAase) to degrade the extracellular matrix (ECM), enabling their diffusion and proliferation. Current clinical techniques for detecting infection rely on basic visual cues or analysis of wound fluids, enabling only reactive treatment once severe signs manifest. Herein, we present the use of a closed-loop patch (CLP) for advanced wound management. The patch contains a bio-inspired sensor based on an engineered hyaluronic acid (HA) hydrogel that detects HAase secreted by invading pathogens. This detection triggers a quantifiable change in the capacitance of the interdigital electrode and achieving in-time detection of Staphylococcus aureus (S. aureus) infection in a murine wound model before obvious visual signs appear. In response, the release of titanium hydride (TiH1.924) nanodots from hydrogel decomposition can eradicate pathogens under ultrasound (US) irradiation. Concurrently, the product, HA fragments further promoted cell migration and angiogenesis to significantly improve wound healing by ∼14.6-fold rates in 12 days. Overall, the CLP provides a sensory act-treat effect according to the wound status, which facilitate the closed-loop integration of monitoring and rehabilitation. This strategy may provide additional possibilities for the design of future wound management systems.

Chitosan microflower-embedded gelatin sponges for advanced wound management and hemostatic applications

The study explored the antimicrobial, antibiofilm, and hemostatic properties of chitosan microflowers (CMF) in sponge form. The main objective was to enhance the preparation of CMF by employing varying quantities of calcium chloride (CaCl2) and tripolyphosphate (TPP). CMF was then combined with gelatin (GE) in different proportions to produce three sponge samples: CMF0@GE, CMF1@GE, and CMF2@GE. The CMF had a morphology like that of a flower and produced surfaces with a porous sponge-like structure. The antibacterial activity, as determined by the zone of inhibition (ZOI), increased with greater doses of CMF. Among the tested samples, CMF2@GE had the greatest activity against Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, and Enterococcus faecium. CMF2@GE successfully suppressed biofilm formation, decreased clotting time to an average of 212.67 s, and exhibited excellent biocompatibility by preserving over 90 % viability of human skin fibroblast cells at dosages below 100 μg/mL. The results indicated that gelatin sponges filled with CMF have considerable promise as flexible medical instruments for wound healing and infection control.

Development and Evaluation of a Novel Antibacterial Wound Dressing: A Powder Preparation Based on Cross-Linked Pullulan with Polyhexamethylene Biguanide for Hydrogel-Transition in Advanced Wound Management and Infection Control.

As antibiotic resistance increasingly undermines traditional infection management strategies, there is a critical demand for innovative wound care solutions that address these emerging challenges. This study introduces a novel antibacterial wound dressing based on Cross-Linked Pullulan (Pul) and Polyhexamethylene Biguanide (PHMB) for enhanced wound management and infection control. The dressing's adsorption rate reached 200% of its original weight within 30 min, exceeded 300% after 5 h, and exhibited significant non-Newtonian fluid properties. The dressings were able to release the loaded medication completely within 20 min; additionally, the dressing demonstrated significant antibacterial activity against a broad spectrum of bacteria. Significantly, the therapeutic effects of the Pul-PHMB/GP dressing were evaluated in a mouse model. Compared to untreated wounds, wounds treated with Pul-PHMB/GP exhibited a significant gelation process within 5 min post-treatment and showed a significant increase in wound healing rate within 12 days. This powder preparation overcomes the limitations associated with liquid and gel dressings, notably in storage and precise application, preventing the premature expansion or dissolution often caused by PHMB in high-humidity environments. The powder form can transform into a gel upon contact with wound exudate, ensuring accurate coverage of irregular wounds, such as those from burns or pressure sores, and offers excellent chemical and physical stability in a dry state, which facilitates storage and transport. This makes the dressing particularly suitable for emergency medical care and precision therapy, significantly improving the efficiency and adaptability of wound treatment and providing robust support for clinical treatments and emergency responses.

Platelet-Rich Plasma/Chitosan/Chondroitin sulfate immunomodulatory hydrogel Co-Networks for diabetic wound Repair: Functions and molecular mechanisms

Diabetic wound healing encounters numerous challenges including bacterial infection, macrophage dysfunction, excessive inflammation, and oxidative stress, causing delays in the overlapping processes of inflammation, proliferation, and remodeling and thus imposing a high burden on patients. Platelet-rich plasma (PRP) has demonstrated significant potential for diabetic wound treatment by promoting granulation tissue formation, collagen deposition, re-epithelialization, and angiogenesis. However, the underlying molecular and cellular mechanisms remain unclear. Here, immunomodulatory hydrogel co-networks based on PRP, with strong hemostatic, antibacterial, and free radical scavenging effects, are developed for diabetic wound treatment. In vitro and in vivo, the hydrogels can reduce endothelial cell apoptosis and promote tube formation by regulating the oxidative stress microenvironment. For anti-inflammatory and tissue repair, the hydrogels can facilitate the M2 macrophage polarization by inhibiting phosphorylation of p-IκBα and p-P65 in the NF-κB signaling pathway. Through increasing the expression of key angiogenic factors (HIF-1α, VEGF, and FGF2), the hydrogels can significantly promote angiogenesis and the formation of endothelial cell tubular structures. These findings offer new insight into the synergistic regulatory contributions of the PRP-based therapy throughout multiple stages of healing, thereby establishing a biomolecular and cellular foundation for advanced diabetic wound management.

Patterned PCL/PGS Nanofibrous Hyaluronic Acid-Coated Scaffolds Promote Cellular Response and Modulate Gene Expression Profiles.

Chronic wounds impose a significant burden on individuals and healthcare systems, necessitating the development of advanced wound management strategies. Tissue engineering, with its ability to create scaffolds that mimic native tissue structures and promote cellular responses, offers a promising approach. Electrospinning, a widely used technique, can fabricate nanofibrous scaffolds for tissue regeneration. In this study, we developed patterned nanofibrous scaffolds using a blend of poly(ε-caprolactone) (PCL) and poly(glycerol sebacate) (PGS), known for their biocompatibility and biodegradability. By employing a mesh collector, we achieved a unique fiber orientation pattern that emulated the natural tissue architecture. The average fiber diameter of PGS/PCL collected on aluminum foil and on mesh was found to be 665.2 ± 4 and 404.8 ± 16 nm, respectively. To enhance the scaffolds' bioactivity and surface properties, it was coated with hyaluronic acid (HA), a key component of the extracellular matrix known for its wound-healing properties. The HA coating improved the scaffold hydrophilicity and surface wettability, facilitating cell attachment, spreading, and migration. Furthermore, the HA-coated scaffold exhibited enhanced biocompatibility, promoting cell viability and proliferation. High-throughput RNA sequencing was performed to analyze the influence of the fabricated scaffold on the gene expression levels of endothelial cells. The top-upregulated biological processes and pathways include cell cycle regulation and cell proliferation. The results revealed significant alterations in gene expression profiles, indicating the scaffold's ability to modulate cellular functions and promote wound healing processes. The developed scaffold holds great promise for advanced wound management and tissue regeneration applications. By harnessing the advantages of aligned nanofibers, biocompatible polymers, and HA coating, this scaffold represents a potential solution for improving wound healing outcomes and improving the quality of life for individuals suffering from chronic wounds.

Clinical study on the role of LncRNA STX17‐AS1 in wound healing and hypertrophic scar formation

AbstractWound healing is a complex process that can lead to hypertrophic scarring (HS) when dysregulated. The role of lncRNAs in this process is increasingly recognized, yet the specific contributions of lncRNA STX17‐AS1 require elucidation. This study investigated the expression of STX17‐AS1, its regulatory effects on miR‐145‐5p, and downstream targets, highlighting its impact on wound repair and HS development. In a cohort of 20 HS patients and 20 matched controls, we assessed the expression of STX17‐AS1, miR‐145‐5p and PDK1 via real‐time PCR and immunohistochemistry. We correlated these expressions with wound characteristics and analysed their regulatory impact on the PI3K/AKT pathway, crucial for cellular proliferation and migration in wound healing. Elevated levels of STX17‐AS1 and miR‐145‐5p in patient samples were correlated with larger wound areas and slower healing rates, suggesting the regulatory imbalance in scar formation. The negative correlation of PDK1 expression with age and its positive association with wound size underscored its relevance in wound repair mechanisms. Functional analysis confirmed the interaction between STX17‐AS1 and miR‐145‐5p and modulation of PDK1, indicating the potential disruption of the PI3K/AKT pathway in the wound healing process. The study identified lncRNA STX17‐AS1 as the significant mediator in wound healing, with aberrations in its pathway correlating with impaired healing and HS. The findings proposed lncRNA STX17‐AS1 and miR‐145‐5p as molecular targets to enhance wound healing and prevent pathological scarring, offering a new avenue for therapeutic advances in wound management and regenerative medicine.

2024 TSOC/TSPS Joint Consensus: Strategies for Advanced Vascular Wound Management in Arterial and Venous Diseases.

The Taiwan Society of Cardiology (TSOC) and Taiwan Society of Plastic Surgery (TSPS) have collaborated to develop a joint consensus for the management of patients with advanced vascular wounds. The taskforce comprises experts including preventive cardiologists, interventionists, and cardiovascular and plastic surgeons. The consensus focuses on addressing the challenges in diagnosing, treating, and managing complex wounds; incorporates the perfusion evaluation and the advanced vascular wound care team; and highlights the importance of cross-disciplinary teamwork. The aim of this joint consensus is to manage patients with advanced vascular wounds and encourage the adoption of these guidelines by healthcare professionals to improve patient care and outcomes. The guidelines encompass a range of topics, including the definition of advanced vascular wounds, increased awareness, team structure, epidemiology, clinical presentation, medical treatment, endovascular intervention, vascular surgery, infection control, advanced wound management, and evaluation of treatment results. It also outlines a detailed protocol for assessing patients with lower leg wounds, provides guidance on consultation and referral processes, and offers recommendations for various wound care devices, dressings, and products. The 2024 TSOC/TSPS consensus for the management of patients with advanced vascular wounds serves as a catalyst for international collaboration, promoting knowledge exchange and facilitating advancements in the field of advanced vascular wound management. By providing a comprehensive and evidence-based approach, this consensus aims to contribute to improved patient care and outcomes globally.

Bacterial Cellulose-Based Bandages with Integrated Antibacteria and Electrical Stimulation for Advanced Wound Management.

Bandages for daily wounds are the most common medical supplies, but there are still ingrained defects in their appearance, comfort, functions, as well as environmental pollution. Here, novel bandages based on bacterial cellulose (BC) membrane for wound monitoring and advanced wound management are developed. The BC membrane is combined with silver nanowires (AgNWs) by using vacuum filtration method to achieve transparent, ultrathin (≈7 µm), breathable (389.98-547.79gm-2 d-1 ), and sandwich-structured BC/AgNWs bandages with superior mechanical properties (108.45-202.35 MPa), antibacterial activities against Escherichia coli and Staphylococcus aureus, biocompatibility, and conductivity (9.8 × 103 -2.0 × 105 Sm-1 ). Significantly, the BC/AgNWs bandage is used in the electrical stimulation (direct current, 600 microamperes for 1 h every other day) treatment of full-thickness skin defect in rats, which obviously promotes wound healing by increasing the secretion of vascular endothelial growth factor (VEGF). The BC bandage is used for monitoring wounds and achieve a high accuracy of 94.7% in classifying wound healing stages of hemostasis, inflammation, proliferation, and remodeling, by using a convolutional neural network. The outcomes of this study not only provide two BC-based bandages as multifunctional wound management, but also demonstrate a new strategy for the development of the next generation of smart bandage.

Wound Management Using Negative Pressure Therapy

Advanced wound management using Negative Pressure Therapy (NPT) has emerged as a revolutionary approach in the care of complex and chronic wounds. NPT, also known as Negative Pressure Wound Therapy (NPWT), employs subatmospheric pressure to promote wound healing. This review explores the epidemiology and significance of advanced wound management, provides a theoretical framework for understanding NPT, discusses its application in different clinical scenarios, outlines potential complications, and highlights its management strategies. The evidence suggests that NPT is a valuable tool in modern wound care, but its application should be guided by a comprehensive understanding of patient needs and the wound's characteristics. Ultimately, NPT offers promising results for wound management, provided it is integrated into a holistic care approach.

Advanced wound management approaches in Hidradenitis Suppurativa postsurgical lesions.

The most appropriate management of recurrent Hidradenitis Suppurativa (HS) lesions consists of wide surgical removal of the lesions with subsequent healing by second intention. Successful wound healing depends on the choice of an adequate wound dressing, targeted to the features of the wound.We enrolled 25 patients randomized into three groups according to the advanced dressing used in second intention healing of postsurgical wounds (standard therapy, an oxygen-enriched oil-based medical device with prolonged release of reactive oxygen species [ROS], ultra-portable negative pressure therapy). Data on wound size, clinical appearance of the wound bed, and pain experienced by the patient were collected twice a week for 4 weeksNo statistically significant differences were observed between the different groups evaluated. Oxygen-enriched oil-based medical device with prolonged release of ROS can be included in the principle of HS-tissue, inflammation, moisture, and epithelium (TIME).

Chronic Wound Management: From Gauze to Homologous Cellular Matrix.

Chronic wounds are a significant health problem with devastating consequences for patients' physical, social, and mental health, increasing healthcare systems' costs. Their prolonged healing times, economic burden, diminished quality of life, increased infection risk, and impact on patients' mobility and functionality make them a major concern for healthcare professionals. This review offers a multi-perspective analysis of the medical literature focusing on chronic wound management. We evaluated 48 articles from the last 21 years registered in the MEDLINE and Global Health databases. The articles included in our study had a minimum of 20 citations, patients > 18 years old, and focused on chronic, complex, and hard-to-heal wounds. Extracted data were summarized into a narrative synthesis using the same health-related quality of life instrument. We evaluated the efficacy of existing wound care therapies from classical methods to modern concepts, and wound care products to regenerative medicine that uses a patient's pluripotent stem cells and growth factors. Regenerative medicine and stem cell therapies, biologic dressings and scaffolds, negative pressure wound therapy (NPWT), electrical stimulation, topical growth factors and cytokines, hyperbaric oxygen therapy (HBOT), advanced wound dressings, artificial intelligence (AI), and digital wound management are all part of the new arsenal of wound healing. Periodic medical evaluation and proper use of modern wound care therapies, including the use of plasma-derived products [such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF)] combined with proper systemic support (adequate protein levels, blood sugar, vitamins involved in tissue regeneration, etc.) are the key to a faster wound healing, and, with the help of AI, can reach the fastest healing rate possible.

Smart wound dressing for advanced wound management: Real-time monitoring and on-demand treatment

Timely and accurate assessment of wounds during the wound healing process is key for correct diagnosis and treatment decisions for wound repair. However, traditional wound management strategies often fail to provide timely and accurate information on wound status, thereby delaying or misleading treatments. Smart wound dressings that enable the in situ real-time monitoring of wound-related biomarkers, early diagnosis and on-demand treatment of adverse wound healing events, such as bacterial infection and inflammation, by integrating wearable sensors, advanced drug delivery systems and wireless communication technology have recently been developed and could improve wound management. In this review, we provided an overview of biomarkers, including temperature, pH, uric acid, glucose, reactive oxygen (ROS), oxygen and enzymes, related to adverse wound healing events and exiting sensors for detecting these biomarkers based on colorimetric, fluorimetric and electrochemical approaches. Examples of smart wound dressings that integrate controllable drug delivery functions triggered by both endogenous and exogenous stimuli, the all-in-one wound dressing systems capable of real-time monitoring and on-demand treatment, and the major challenges and exciting opportunities of such smart wound dressings in wound management are presented and comprehensively discussed.

Updates in Traumatic Lower Extremity Free Flap Reconstruction.

Lower extremity reconstruction, particularly in the setting of trauma, remains one of the most challenging tasks for the plastic surgeon. Advances in wound management and microsurgical techniques in conjunction with long-term outcomes studies have expanded possibilities for limb salvage, but many aspects of management have continued to rely on principles set forth by Gustilo and Godina in the 1980s. The purpose of this article is to provide a comprehensive update on the various management aspects of traumatic lower extremity microvascular reconstruction based on the latest evidence, with an examination of recent publications.

Biomaterials-Based Regenerative Strategies for Skin Tissue Wound Healing.

Skin tissue wound healing proceeds through four major stages, including hematoma formation, inflammation, and neo-tissue formation, and culminates with tissue remodeling. These four steps significantly overlap with each other and are aided by various factors such as cells, cytokines (both anti- and pro-inflammatory), and growth factors that aid in the neo-tissue formation. In all these stages, advanced biomaterials provide several functional advantages, such as removing wound exudates, providing cover, transporting oxygen to the wound site, and preventing infection from microbes. In addition, advanced biomaterials serve as vehicles to carry proteins/drug molecules/growth factors and/or antimicrobial agents to the target wound site. In this review, we report recent advancements in biomaterials-based regenerative strategies that augment the skin tissue wound healing process. In conjunction with other medical sciences, designing nanoengineered biomaterials is gaining significant attention for providing numerous functionalities to trigger wound repair. In this regard, we highlight the advent of nanomaterial-based constructs for wound healing, especially those that are being evaluated in clinical settings. Herein, we also emphasize the competence and versatility of the three-dimensional (3D) bioprinting technique for advanced wound management. Finally, we discuss the challenges and clinical perspective of various biomaterial-based wound dressings, along with prospective future directions. With regenerative strategies that utilize a cocktail of cell sources, antimicrobial agents, drugs, and/or growth factors, it is expected that significant patient-specific strategies will be developed in the near future, resulting in complete wound healing with no scar tissue formation.