Chitosan Dressings Research Articles

Bioactive Curcuma aromatica-stabilized silver nanoparticles embedded chitosan dressing with improved antibacterial, anti-inflammatory, and wound healing properties

Chronic wounds, particularly those infected with multidrug-resistant (MDR) pathogens, present significant challenges for effective healing. Silver nanoparticles (CAAgNPs) were synthsized using aqueous rhizome extract of Curcuma aromatica (CA), known for its wound-healing properties. CAAgNPs were incorporated in a chitosan (CS) dressing (CAAgNPs/CS) and tested for their wound healing potential, expecting synergistic action of AgNPs and phytochemicals capped on it. The porous nature of the CAAgNPs was confirmed using Field emission scanning electron microscopy. Fourier-transform infrared spectroscopy demonstrated a shift in peak intensity from 1589.06 to 1575.54 cm-1 for CAAgNPs/CS dressing confirming crosslinking with glutaraldehyde. Antibacterial activity of the dressings was cofirmed against isolates of Pseudomonas aeruginosa and Staphylococcus aureus. Wound healing studies were carried out using Wistar rats (six groups)- wound control, CS, CAAgNPs256/CS, CAAgNPs512/CS, CAAgNPs1024/CS, and commercial dressings. Histological examination and direct red-80 staining demonstrated maximum epithelization and collagen deposition (58.02%) within CAAgNPs1024/CS groups on day 10. Increased hydroxyproline levels (76.51 µg/mL) on day 7 for CAAgNPs1024/CS indicated maximum collagen formation. Reduced levels of inflammatory cytokines IL-6 (17.38 pg/mL) and TNF-α (80.38 pg/mL) on day 10 indicated quick wound healing without scar formation and damaging effects. The present study highlights the antibacterial and anti-inflammatory properties of CAAgNPs1024/CS dressings with a potential for wound healing applications.

Evaluation of Chitosan Activity Produced Via Biotransformation of Chitin Against Some Pathogens Associated with Burn Infection in Vitro and in Vivo

Burn infections are a serious concern for patients with burn injuries, as they can lead to significant morbidity and mortality. The present study was designed to evaluate the chitosan activity against five pathogens collected from burn infections (Escherichia coli ZE15, Acinetobacter bummani ZA2, Klebsiella pneumonia ZK3 and Pseudomonas aeruginosa ZP17, Staphylococcus aureus ZS2). Chitosan was produced in solid-state fermentation using corn meal supplemented with 2% of shrimp shell chitin. The degree of deacetylation of chitosan was 79.5% and the FT-IR spectrum (4000 to 400) cm-1 gave IR spectra similar to that of the commercial chitosan. The produced chitosan showed a significant inhibitory ability from the concentration of 10 mg/ml to 2 mg/ml. The M.I.C. and S.I.C were varied between the isolates; for P. aeruginosa ZP17 and Staph. aureus ZS2, the M.I.C and S.I.C were 1.6 mg/ml and of 1.4 mg/ml respectively, while for E. coli ZE15, Kl. pneumonia ZK3 and A. bumannii ZA2 were 1.4 mg/ml and 1.2 mg/ml. Furthermore, this study showed an the important role of the produced chitosan as an antibiofilm agent to reduce the biofilm formation for the tested isolates. However, the strongest antibiofilm activity was against E. coli Z.E15 with 55.2%. Moreover, four potential formulas containing chitosan with concentration of 1.6 mg/ml were tested. A formula containing polyvinyl alcohol, vaseline and chitosan to create a cream showed the best results in comparison with the four-formula used in this study. This formula was added to pads of thick cellulosic filter paper to treat a mouse model with full thickness cutaneous burn to assess the benefits of treating with a chitosan dressing. The healing process was examined and results showed a signs of remodeling stage by day four and a scar tissue formation by day nine.

Development of collagen–chitosan dressing gel functionalized with propolis–zinc oxide nanoarchitectonics to accelerate wound healing

Using an in situ sol-gel technique, new nanoarchitectonics of propolis loaded zinc oxide nanoarchitectonics (PP/ZnO–NPs) were developed in order to improve the in vivo outcomes of collagen–chitosan gel in wounded rats. The obtained nanoarchitectonics were fully characterized. The XRD results indicate the presence of a Zincite phase for ZnO–NPs and Zincite accompanied by a minor amount of zinc hydroxide for PP/ZnO–NPs samples. While the TEM findings illustrate the transfer of the ZnO–NPs from agglomerated spheres with an average particle size of 230 ± 29 nm to needle–like NPs of 323 ± 173 nm length (PP1/ZnO–NPs) and to a sheet–like NPs of 500 ± 173 nm diameter (PP2/ZnO–NPs). In addition, the incorporation of PP results in an increase in the surface negativity of ZnO–NPs to −31.4 ± 6.4 mV for PP2/ZnO–NPs. The antimicrobial activities of the nanocomposite gel loaded with 10%PP1/ZnO–NPs (G6) revealed the highest inhibition zone against E. coli (26 ± 2.31 mm). Remarkably, the in vivo outcomes showed that the nanocomposite gel (G6) has exceptional collagen deposition, quick wound closure rates, and re-epithelization. The outcomes demonstrate the nanocomposite gel encouraging biological properties for the treatment of damaged and infected wounds.

3-Diethylaminopropyl isothiocyanate modified glycol chitosan for constructing mild-acid sensitive electrospinning antibacterial nanofiber membrane

Bacterial infections would cause pathological inflammation and even generate chronic wound. Herein, a ciprofloxacin (Cip)-loaded mild acid-responsive electrospinning nanofiber membrane (NFM) containing 3-diethylaminopropyl isothiocyanate material grafted glycol chitosan (GC-DEAP) was fabricated to prevent bacterial infection against hemostatic and inflammatory phases of wounds. The presence of Cip and GC-DEAP in the objective NFM (PCL/GC-DEAP/Cip) was confirmed through XRD and FTIR. Meanwhile, PCL/GC-DEAP/Cip NFM exhibited high mechanical profiles, suitable water absorption and water vapour transmission ratio. The non-protonated amphiphilic GC-DEAP under pH 7.4 facilitated the formation of uniform and smooth nanofibers with polycaprolactone (PCL) and Cip. However, the GC-DEAP was demonstrated to sharply respond to the mild-acid environment of the wound and effectively be protonated, and thus improved the swelling ability of NFM and triggered burst release of Cip. Due to the combination between protonated GC-DEAP and Cip, PCL/GC-DEAP/Cip NFM achieved attractive antibacterial activity in the mild-acid environment in vitro, and induced more efficient prevention of wound infection and faster wound healing compared with the commercial chitosan dressing. The designed NFM is expected to be a potential smart wound dressing against hemostatic and inflammatory phases with mild-acid specifically strengthened antibacterial features and satisfactory biocompatibility.

Current status and progress in research on dressing management for diabetic foot ulcer.

Diabetic foot ulcer (DFU) is a major complication of diabetes and is associated with a high risk of lower limb amputation and mortality. During their lifetime, 19%-34% of patients with diabetes can develop DFU. It is estimated that 61% of DFU become infected and 15% of those with DFU require amputation. Furthermore, developing a DFU increases the risk of mortality by 50%-68% at 5 years, higher than some cancers. Current standard management of DFU includes surgical debridement, the use of topical dressings and wound decompression, vascular assessment, and glycemic control. Among these methods, local treatment with dressings builds a protective physical barrier, maintains a moist environment, and drains the exudate from DFU wounds. This review summarizes the development, pathophysiology, and healing mechanisms of DFU. The latest research progress and the main application of dressings in laboratory and clinical stage are also summarized. The dressings discussed in this review include traditional dressings (gauze, oil yarn, traditional Chinese medicine, and others), basic dressings (hydrogel, hydrocolloid, sponge, foam, film agents, and others), bacteriostatic dressings, composite dressings (collagen, nanomaterials, chitosan dressings, and others), bioactive dressings (scaffold dressings with stem cells, decellularized wound matrix, autologous platelet enrichment plasma, and others), and dressings that use modern technology (3D bioprinting, photothermal effects, bioelectric dressings, microneedle dressings, smart bandages, orthopedic prosthetics and regenerative medicine). The dressing management challenges and limitations are also summarized. The purpose of this review is to help readers understand the pathogenesis and healing mechanism of DFU, help physicians select dressings correctly, provide an updated overview of the potential of biomaterials and devices and their application in DFU management, and provide ideas for further exploration and development of dressings. Proper use of dressings can promote DFU healing, reduce the cost of treating DFU, and reduce patient pain.

Evaluation of a chitosan dressing in the management of hard-to-heal wounds

Following Isle of Wight NHS Foundation Trust guidelines and with patient consent, 11 patients with chronic wounds of various aetiologies and wound durations were enrolled in a multicentre, clinical 4-week evaluation. Over a 4-week evaluation period, all patients showed a significant improvement in wound healing parameters including average tissue type, condition of periwound skin, patient comfort, exudate levels. The assessments demonstrated a significant decrease in necrotic and sloughy tissue (from >75% at the start of treatment), replaced with healthy granulation and epithelial tissue (>80% by week 4). Significant reduction in pain score was also reported in all patients, with average pain score at the start of the evaluation reducing from 5.8 ± 2.7 to a score of 2.5 ± 1.9 within 3 weeks. The complicated wounds seen in this study were previously non-healing and MaxioCel, with BMG technology, demonstrated both significant clinical improvement and a positive impact on patient quality of life within just 4 weeks, resulting in its addition to the team's woundcare formulary.

The beneficial effects of chitosan dressing in third-degree swine burn model

The beneficial effects of chitosan dressing in third-degree swine burn model

Is Chitosan Dental Dressing Better Than Cotton Gauze in Achieving Hemostasis in Patients on Antithrombotics?

Tooth extraction leads to bleeding which may be longer in patients on antithrombotics. This study was aimed to evaluate the hemostatic and wound healing efficacy of chitosan-based dressing in comparison to the cotton pressure pack after tooth extraction in patients receiving single or dual antithrombotics. This is a prospective, randomized split mouth study. Patients undergoing tooth extractions taking either single or dual antithrombotics, with an international normalized ratio (INR) value≤3 were enrolled at JSS Dental College & Hospital, Mysuru, India during February 2020 to January 2022. The study compared the efficiency of chitosan dressing in achieving quicker hemostasis in comparison to cotton pressure pack. The primary outcome was time to achieve hemostasis and the secondary outcomes were alveolar clinical healing index and alveolar osteitis. The covariates were gender, age, reason for extraction, INR, type of antithrombotic therapy, and the disease condition. Of the 54 enrolled subjects, 39 were males and 15 were females, aged between 33 and 86years. Thirty six patients were on single antithrombotics, whereas 18 patients were on dual antithrombotics. The reason for extraction was periodontitis in 37 patients and dental caries in 17 patients. The time to achieve hemostasis was lesser with chitosan dental dressing when compared to cotton pressure packs (96±4 and 797±23seconds; P<.001). In the chitosan group, the time to hemostasis was similar irrespective of single or dual antithrombotic therapy (90±6 and 109±8seconds, respectively). On the contrary, in the cotton pressure pack group, patients on dual antithrombotics had longer time to achieve hemostasis compared to those on single antithrombotics (940±20 and 726±26seconds; P<.001). The time to achieve hemostasis was dependent on INR only in cotton pressure pack group (r2=0.7756). The alveolar clinical healing index was better in 88.9% with chitosan and only 3.7% with cotton pressure packs. None of the patients treated with chitosan presented with alveolar osteitis, as opposed to 3.7% of patients with cotton pressure packs. When compared to cotton pressure packs, chitosan-based dressing was more effective in controlling postoperative bleeding in patients treated with single and dual antithrombotic therapy.

A Net Meta-Analysis of the Effectiveness of Different Types of Dressings in the Treatment of Diabetic Foot.

Objective This is an analysis of the impact of a new dressing commonly used to treat diabetic foot (DFU). Methods Chinese and English databases were searched to collect clinical randomized controlled studies (RCTs) of various types of dressings for the treatment of DFU, and the healing rates of the different dressings were combined by reticulation meta-analysis. Results The aggregate of the 36 RCTs included in this study analysed the healing rates of nine dressings: conventional dressing, alginate dressing, chitosan dressing, hyaluronic acid dressing, platelet-rich plasma dressing, amniotic membrane dressing, honey dressing, human recombinant growth factor dressing, and silver ionomer dressing. Conclusion Hyaluronic acid dressing, amniotic membrane dressing, honey dressing, and platelet-rich plasma dressing are the ideal materials for topical treatment of DFU.

Hemostasis and Anti-Inflammatory Abilities of AuNPs-Coated Chitosan Dressing for Burn Wounds.

Burn injuries are a common hazard in the military, as fire is likely to be weaponized. Thus, it is important to find an effective substance to accelerate burn wound healing. This study used chitosan and gold nanoparticles (AuNPs) as wound dressings and investigated their effectiveness in femoral artery hemorrhage swine and rat burn models. Chitosan dressing has significant hemostatic properties compared with gauze. Histological results showed that burn wounds treated with chitosan or AuNP-coated chitosan dressings exhibited more cells and a continuous structure of the epidermis and dermis than those of the control and untreated lesion groups. Furthermore, both chitosan dressings have been shown to positively regulate the expression of genes- and cytokines/chemokines-related to the wound healing process; AuNP-coated chitosan significantly lessened severe sepsis and inflammation, balanced the activities of pro-fibrotic and anti-fibrotic ligands for tissue homeostasis, regulated angiogenesis, and inhibited apoptosis activity, thereby being beneficial for the burn microenvironment. Hence, chitosan alone or in combination with AuNPs represents a prospective therapeutic substance as a burn dressing which might be helpful for burn wound care. This study provides a novel hemostasis dressing for modern warfare that is simple to use by most medical and paramedical personnel handling for burn treatment.

Acceleration of Healing in Full-Thickness Wound by Chitosan-Binding bFGF and Antimicrobial Peptide Modification Chitosan Membrane.

Skin wound healing is an important clinical challenge, and the main treatment points are accelerating epidermal regeneration and preventing infection. Therefore, it is necessary to develop a wound dressing that can simultaneously cure bacterial infections and accelerate wound healing. Here, we report a multifunctional composite wound dressing loaded with chitosan (CS)-binding bFGF (CSBD-bFGF) and antimicrobial peptides (P5S9K). First, CS was used as the dressing matrix material, and P5S9K was encapsulated in CS. Then, CSBD-bFGF was designed by combining recombinant DNA technology and tyrosinase treatment and modified on the dressing material surface. The results show that the binding ability of CSBD-bFGF and CS was significantly improved compared with that of commercial bFGF, and CSBD-bFGF could be controllably released from the CS dressing. More importantly, the prepared dressing material showed excellent antibacterial activity in vivo and in vitro and could effectively inhibit the growth of E. coli and S. aureus. Using NIH3T3 cells as cellular models, the results showed that the CSBD-bFGF@CS/P5S9K composite dressing was a friendly material for cell growth. After cells were seeded on the composite dressing surface, collagen-1 (COL-1) and vascular endothelial growth factor (VEGF) genes expression in cells were significantly upregulated. Finally, the full-thickness wound of the rat dorsal model was applied to analyse the tissue repair ability of the composite dressing. The results showed that the composite dressing containing CSBD-bFGF and P5S9K had the strongest ability to repair skin wounds. Therefore, the CSBD-bFGF@CS/P5S9K composite dressing has good antibacterial and accelerated wound healing abilities and has good application prospects in the treatment of skin wounds.

A hydrophobic cationic polyphenol coating for versatile antibacterial and hemostatic devices

Flexible coating materials have attracted much attention for the surface functionalization of biomedical devices. In this work, one cationic coating material (AQTA) is constructed with the co-substitution of tannic acid with alkyl and quaternary ammonium groups, and then employed to functionalize versatile medical devices for antibacterial and hemostatic applications. Stable AQTA coatings with tunable contents are realized by facile one-step soaking process, owing to the well-designed molecular structure of AQTA (elaborate combination of long-chain alkyl, phenolic hydroxyl and quaternary ammonium groups). The high content of AQTA is coated on polyurethane (as the model substrate of medical catheters), which achieves high blood compatibility and in vitro/in vivo antibacterial ability. The feasibility of AQTA for hemostatic uses is confirmed by the improved properties of functionalized alginate dressing and gauze with one moderate content of AQTA. Together with the negative role of AQTA on the hemostatic performance of chitosan dressing, the underlying hemostatic mechanism of AQTA for negatively charged dressings was revealed as the optimized surface-activated platelet adhesion. Two typical rat-hemorrhage models further confirm the high hemostatic performance of AQTA-coated dressing. This work sheds light on the design and flexible management of cationic coating materials for biomedical applications.

A self-crosslinking, double-functional group modified bacterial cellulose gel used for antibacterial and healing of infected wound

Cellulose/chitosan composite, as a mature commercial antibacterial dressing, is an important type of wound repair material. However, how to achieve the perfect compound of two components and improve antibacterial activity is a major, lingering issue. In this study, a bifunctional group modified bacterial cellulose (DCBC) was prepared by carboxymethylation and selective oxidation. Further, the chitosan (CS) was compounded in the network of DCBC by self-crosslinking to form dialdehyde carboxymethyl bacterial cellulose/chitosan composites (S-DCBC/CS). The aldehyde group can react with amino of CS by Schiff base reaction. The carboxyl group of DCBC and the amorphous distribution of CS molecular chains increase the antimicrobial properties of composites. The bacteriostatic rate of composites could be higher than 95%. Bacteria can be attracted onto the surface of composites, what we call it “directional adhesion antibacterial effects”. In particular, a kind of large animal wound model, deep Ⅱ degree infected scald of Bama miniature pig, was used to research the antimicrobial and healing properties of materials. The S-DCBC/CS can effectively inhibit bacterial proliferation of wound and kill the bacteria. The wound healing rate of S-DCBC/CS was up to 80% after three weeks. The composites show better antibacterial and promoting concrescence effects than traditional chitosan dressings.

To Evaluate Aloe Vera- Chitosan Based Surgical Dressing to Chitosan Dressing Alone on the Healing of Palatal Donor Sites - A Pilot Study

The present study was undertaken to clinically assess the synergistic effect of topically applied Aloe vera Chitosan to Chitosan alone on the healing of palatal donor sites in free gingival graft surgical procedures. 20 subjects (10 per group) were enrolled into this triple blinded randomized clinical trial, designed to evaluate the efficacy of Aloe vera Chitosan to Chitosan on free gingival graft surgical wounds. Subjects were assigned to either Group A (aloe vera + Chitosan) or Group B (Chitosan alone). Visual Analog Scale(VAS) and Wound healing index were recorded at 7th day, 14th day and 21 days postoperative. Results showed no statistical significance when considering VAS. However there was a statistical significance in wound healing (p=0.04) in group A when compared to group B from 14- 21st day postoperative. It is the first human trial and was a pilot study to assess the synergistic effect of Aloe vera and Chitosan on wound healing. The study has shown that a combination of both acts synergistically in accelerating healing especially in areas where faster healing is necessary to provide overall comfort to the patient. It is therefore a futuristic and a promising material as a surgical dressing with further longitudinal trials.

The Hemostatic and Wound Healing Effect of Chitosan Following Debridement of Chronic Ulcers

Chitosan has been proven to be helpful in wound care as a hemostatic agent. The hemostatic effect is due to the positively charged chitosan interacting with negatively charged red blood cell membranes, initiating the agglutination of red blood cells and platelets. This promotes the activation of thrombin, which activates the clotting pathway, leading to thrombus formation. Based on the properties of chitosan as a rapidly acting hemostatic agent, the authors sought to determine if a chitosan gelling fiber wound dressing could control bleeding of freshly debrided wounds. The effect of the chitosan dressing on overall healing and patient and provider satisfaction was also evaluated. Wounds of any etiology requiring sharp debridement in patients older than 18 years who were capable of consent were eligible. Wounds were sharply debrided by curettage, scalpel, electrosurgery, or a combination of methods. A chitosan dressing was applied to the freshly debrided wound with gentle pressure. The time from application to hemostasis as assessed by non-progression of blood pattern was measured. Other outcome measures also included digital photography, wound surface area, numerical pain scores, and Photographic Wound Assessment Tool (PWAT) scores. Patient and provider satisfaction were measured. Twenty patients with a variety of etiologies and ulcer types were evaluated. After debridement, wound bleeding was rated as mild (n=9), moderate (n=9), or severe (n=2). The mean time to hemostasis was 75 seconds ± 41 SD (range, 28-221 seconds). In 1 week, the mean wound area decreased from 6.9 cm2 ± 7.8 to 6.2 cm2 ± 7.9 and mean PWAT scores decreased from 17.7 ± 4.9 to 11.4 ± 5.0 (lower score indicates wound healing). Pain scores associated with wound debridement were reduced in all but 1 patient evaluated at week 1. Overall, the rating scores from the Patient Reported Acceptance Questionnaire (PRAQ) and Provider Acceptance Questionnaire (PAQ) developed by this research group were high. The mean total PRAQ score was 30.5 ± 3.9 out of 35 (35 being most satisfied). The PAQ score was 15 out of 15 for all but 1 patient (15 being most satisfied). The chitosan gelling fiber wound dressing was simple to use and rapidly promoted hemostasis in fresh sharply debrided wounds. It was safe and easy to use in an outpatient setting and was highly rated by the patients.

Effect of Chitosan and Aloe Vera Extract Concentrations on the Physicochemical Properties of Chitosan Biofilms.

Chitosan films have been extensively studied as dressings in formulations for the treatment of chronic wounds. The incorporation of aloe vera (Aloe barbadensis Miller) into chitosan dressings could potentialize the healing process since aloe vera shows several pharmacological activities. This work aimed to evaluate the effect of aloe vera and chitosan concentrations on the physicochemical properties of the developed films. The films were obtained by casting technique and characterized with respect to their color parameters, morphology, barrier and mechanical properties, and thermal analysis. Results showed that the presence of aloe vera modified the films′ color parameters, changed barrier properties, increased fluid handling capacity (FHC), and decreased water-vapor permeability (WVP). The reduced elongation at break resulted in more rigid films. Aloe vera concentration did not significantly change film properties, but the presence of this gel increased the films’ stability at temperatures below 200 °C, showing similar behavior as chitosan films above 400 °C. The results suggest a crosslinking/complexation between chitosan and aloe vera, which combine appropriate physicochemical properties for application as wound dressing materials.

Novel multifunctional adenine-modified chitosan dressings for promoting wound healing

Wound healing is a dynamic and intricate process, and newly dressings are urgently needed to promote wound healing over the multiple stages. Herein, two water-soluble adenine-modified chitosan (CS-A) derivatives were synthesized in aqueous solutions and freeze-dried to obtain porous sponge-like dressings. The novel derivatives displayed antibacterial activities against S. aureus and E. coli. Moreover, CS-A derivatives demonstrated excellent hemocompatibility and cytocompatibility, as well as promoted the proliferation of the wound cells by shortening the G1 phase and improving DNA duplication efficiency. The ability of CS-A sponges to promote wound healing was studied in a full-thickness skin defect model. The histological analysis and immunohistochemical staining showed that the wounds treated with CS-A sponges displayed fewer inflammatory cells, and faster regeneration of epithelial tissue, collagen deposition and neovascularization. Therefore, CS-A derivatives have potential application in wound dressings and provide new ideas for the design of multifunctional biomaterials.

Degradable tough chitosan dressing for skin wound recovery

AbstractThe performance of wound dressing determines the effect of wound closure and recovery. Water absorption and bacteriostasis of wound dressings play an important role in wound recovery and healing. In this study, an optimized chitosan wound dressing-tough chitosan dressing (TCS) with high water absorption, high bacteriostasis, and degradability was developed. The chemical structure of chitosan remained stable during the process of optimized treatment, and an increase in mechanical properties was obtained for the dressing. After optimization, the water absorption and antibacterial properties of the chitosan dressing were greatly improved, which is significantly better than sodium alginate dressing. The authors believe that TCS dressing with high hygroscopicity and high bacteriostasis has great potential application value in the field of wound recovery and healing.

The Effect of Chitosan in Wound Healing: A Systematic Review.

To systematically review the effectiveness of chitosan in wound healing. References were retrieved from PubMed, EMBASE, the Cochrane library, and Web of Science based on Medical Subject Headings and keywords ("chitosan" OR "chitin" OR "poliglusam" AND "wound healing"). Eligible articles were randomized controlled trials (RCTs) that required interventions for chitosan and its derivative dressings and included endpoints associated with wound healing. In summary, five RCTs (N = 319) were included in the final analysis. Only two RCTS (40%) reported significant beneficial effects of chitosan on wound healing compared with conventional gauze dressings (eg, tulle gras, petroleum jelly). The remaining three studies reported that chitosan had no significant effect on clinical wound healing compared with other biologic dressings (eg, alginate, hydrocolloid). Although the number of trials of new chitosan dressings has been increasing, studies on the relationship between chitosan and wound healing have been limited. Current data suggest that chitosan does not slow wound healing. However, the small number of available trials restricted adequate interpretation of the existing results. Future research needs to be rigorously designed to confirm any clinically relevant effect of chitosan in wound healing.

Fabrication of Chitosan-Reinforced Multifunctional Graphene Nanocomposite as Antibacterial Scaffolds for Hemorrhage Control and Wound-Healing Application.

Accidents on battlefields and roads often lead to hemorrhage and uncontrolled bleeding. Hence, immediate hemorrhage control remains of great importance to reduce mortality and socioeconomic loss. Herein, nanobiocomposite scaffolds (film and sponge) have been fabricated for the first time through the incorporation of a graphene-silver-polycationic peptide (GAP) nanocomposite into chitosan (Cs). Ten different scaffolds viz. Cs, Cs-GAP25, Cs-GAP50, Cs-GAP75, and Cs-GAP100 were prepared in the form of films and sponges. Cs-GAP100 nanobiocomposite sponge exhibited excellent porosity, fluid absorption, and blood clotting capacity, whereas Cs-GAP100 nanobiocomposite film showed excellent mechanical strength and poor degradation property. The presence of graphene in GAP provided a unique mechanical property and prevented the natural degradation, whereas silver nanoparticles and polycationic peptide provided an efficient antimicrobial property to the scaffolds. The high surface area of graphene and the hydrophilic nature of the polycationic peptide also imparted high fluid and blood absorption capacity to Cs-GAP nanobiocomposite scaffolds. The in vitro whole blood clotting assay demonstrated that clotting efficacy improved with the concentration of GAP nanocomposite and Cs-GAP100 nanobiocomposite sponge significantly (p value <0.003) reduced the clotting time to 60 s, as compared to the pristine chitosan dressings. On the other side, the Cs-GAP100 nanobiocomposite film showed an excellent wound-healing property. The Cs-GAP100 nanobiocomposite demonstrated profound antibacterial activity against Escherichia coli and Staphylococcus aureus. The intracellular reactive oxygen species (ROS) assay explained the interfacial interaction of Cs-GAP100 nanobiocomposite and bacterial cells, resulting in cell damage and finally cell death. The obtained information thus provided a novel safe-by-design concept for fabrication of Cs-GAP100 nanobiocomposite scaffolds and demonstrated potential development of antibacterial hemostatic and wound dressing in traumacare management.