Clinical Wound Healing Research Articles

Age-Related Palatal Wound Healing: An Experimental In Vivo Study.

We assessed age-related excisional palatal mucoperiosteal wound closure in rats. A 4.2 mm diameter punch was used to create a secondary healing defect in the palate of Wistar rats. Study group—21, 18-month-old vs. control 21, 2-month-old males. The 2-dimensional area, maximum length and width of the soft tissue defect served as clinical outcome parameters. The dynamics of the initial three healing weeks were assessed. Semi-quantitative histomorphometric analysis of inflammation and myofibroblasts served for the evaluation of the inflammatory and proliferative wound healing phases. Complete wound closure was faster in the old rats. A dimensional related wound closure was observed in the young rats versus a symmetrical wound closure in the old rats. Inflammatory response was significantly delayed and of lower intensity in the old rats. Myofibroblastic response, representing the proliferative stage, was delayed and of lower intensity in the old rats, albeit not statistically significant. Reduced initial tissue damage due to decreased and delayed inflammatory response in the old rats ultimately led to faster clinical wound healing compared to the young rats, despite a statistically non-significant lower proliferative response in the old rats.

Characterizing reduced scattering coefficient of normal human skin across different anatomic locations and Fitzpatrick skin types using spatial frequency domain imaging.

.Significance: Spatial frequency domain imaging (SFDI), a noncontact wide-field imaging technique using patterned illumination with multiple wavelengths, has been used to quantitatively measure structural and functional parameters of in vivo tissue. Using SFDI in a porcine model, we previously found that scattering changes in skin could potentially be used to noninvasively assess burn severity and monitor wound healing. Translating these findings to human subjects necessitates a better understanding of the variation in “baseline” human skin scattering properties across skin types and anatomical locations.Aim: Using SFDI, we aim to characterize the variation in the reduced scattering coefficient () for skin across a range of pigmentation and anatomic sites (including common burn locations) for normal human subjects. These measurements are expected to characterize baseline human skin properties to inform our use of SFDI for clinical burn severity and wound healing assessments.Approach: SFDI was used to measure in the visible- and near-infrared regime (471 to 851 nm) in 15 subjects at 10 anatomical locations. Subjects varied in age, gender, and Fitzpatrick skin type.Results: For all anatomical locations, the coefficient of variation in measured decreased with increasing wavelength. High intersubject variation in at visible wavelengths coincided with large values of the melanin extinction coefficient at those wavelengths. At 851 nm, where intersubject variation in was smallest for all anatomical locations and absorption from melanin is minimal, significant intrasubject differences in were observed at the different anatomical locations.Conclusions: Our study is the first report of wide-field mapping of human skin scattering properties across multiple skin types and anatomical locations using SFDI. Measured values varied notably between skin types at wavelengths where absorption from melanin was prominent. Additionally, varied considerably across different anatomical locations at 851 nm, where the confounding effects from melanin absorption are minimized.

Optimizing microenvironment by integrating negative pressure and exogenous electric fields via a flexible porous conductive dressing to accelerate wound healing.

Wound healing is a complex and sequential biological process that involves multiple stages. Current treatments for nonhealing or chronic wounds are unsatisfactory as they exert a single effect on one specific activity. Herein, we constructed a silver nanowire (AgNW)-based, three-dimensional (3D), porous foam dressing that is flexible and conductive. This conductive foam dressing was composed of AgNWs modified with a stable hydrophobic coating and porous polyurethane (PU), providing a skeleton to support the 3D conductive networks. The AgNWs-PU foam dressing exhibited favorable biocompatibility, outstanding electrical properties, excellent bending-compression durability, and long-term stability under wet conditions, making it suitable for wound treatment. Via the conductive foam dressing, negative pressure and exogenous wound directional electric fields (EFs) could be integrated for simultaneous implementation, and the artificial jointly constructed microenvironment promoted wound healing in a system. This novel "all-in-one" device presented intrinsic multifunctionality, including the drainage of pus and necrotic tissue, mitigation of inflammation, promotion of cell proliferation, direction of keratinocyte migration, and induction of angiogenesis. An immunohistochemical assay and western blot analysis illustrated that the angiogenesis and cell proliferation pathways in the tissue were significantly activated when this novel therapy was adopted. More importantly, the practical performance of this "all-in-one" device was demonstrated by assessment of full-thickness defect wounds in model pigs. Comparing the percentage of residual wound area after administration of traditional treatment (25.82 ± 3.52%) and the novel treatment (3.07 ± 1.23%) demonstrated the promising applications of this novel treatment in clinical wound healing.

Efficacy of Cryogun Versus Diode Laser Therapy in the Management of Oral Leukoplakia

Background and Aim: This study was aimed to clinically evaluate the effectiveness of 810 nm diode laser and cryosurgery in the management of oral leukoplakia (OL) in terms of healing outcomes. Materials and Methods: Thirty subjects clinically and histo-pathologically diagnosed as having OL were randomly allocated into two groups. Group-1 consisting of 15 subjects each treated with cryotherapy, Group-2 was treated with an 810 nm diode Laser. VAS scale was used for evaluating the postoperative discomfort due to pain and Bates- Jensen Wound Assessment Tool was used to evaluate clinical wound healing. Results: Data analysis was done by using one-way ANOVA for intragroup variations. For intergroup comparisons Paired t- test was used. A statistically significant number of recurrences was noticed in the cryo group compared to the LASER group. Conclusion: This study results suggest that both cryosurgery and laser therapy were effective in terms of patient comfort. However more number of recurrences and mild post operative edema in the cryo group make LASER therapy a better management option.

Machine Learning Analysis of Multispectral Imaging and Clinical Risk Factors to Predict Amputation Wound Healing

Machine Learning Analysis of Multispectral Imaging and Clinical Risk Factors to Predict Amputation Wound Healing

Multifunctional chitosan-copper-gallic acid based antibacterial nanocomposite wound dressing

Antibacterial wound dressings can effectively avoid the residual of antibacterial nanomaterials for injection in vivo, reduce their biological toxicity to normal cells and tissues, making them be widely applied in biomedical field. Herein, an approach of combining ion-crosslinking, in-situ reduction and microwave-assisted methods was employed to prepare chitosan-copper-gallic acid nanocomposites (CS-Cu-GA NCs) with dual-functional nano-enzyme characteristics (oxidase- and peroxidase-like functions). The oxidase-like activity of CS-Cu-GA NCs can facilitate the production of hydrogen peroxide (H2O2) when it contacted with physiologically relevant antioxidants (AH2) in bacteria. Subsequently, H2O2 was catalyzed to generate hydroxyl radicals (OH) under the peroxidase-like activity of CS-Cu-GA NCs. Furthermore, CS-Cu-GA NCs integrate the inherent antibacterial properties of chitosan, Cu NPs and Cu2+. Animal experiments revealed that the antibacterial dressing incorporating CS-Cu-GA NCs exhibited its effective promotion of S. aureus-infected wounds healing, as well as no damage to normal tissues. Besides, the antibacterial dressing was prepared to a band aid with excellent water swelling and antibacterial properties, which was further fixed in a medical tape to construct a portable antibacterial product that can be applied to the surface of human skin and showed excellent waterproof performance, providing a new insight for the construction of clinical antibacterial wound healing products.

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.

Species-Specific Immunoassay for Diagnosis and Tracking Treatment Response in Foot and Ankle Infection

Category:Basic Sciences/Biologics; DiabetesIntroduction/Purpose:Staphylococcus aureus is the major pathogen foot and ankle infections and osteomyelitis (>50%). There are currently no sensitive and specific diagnostic tools for monitoring a pathogen’s ongoing infection or providing prognostic measures. We have developed a novel immunoassay for S. aureus, and have applied this to diagnose and monitor its infectivity. We hypothesize that: 1) the species-specific immunoassay can serve as a reliable diagnostic tool for S. aureus foot and ankle infections and 2) the immunoassay provides a measure of treatment response and prognosis of clinical outcome to antibiotics therapy for S. aureus foot and ankle infections.Methods:From July 2015 to July 2019, 83 infected diabetic foot ulcer (DFU) patients undertaking surgical treatment were recruited. Blood were drawn from subjects at initial, 4-week, 8-week, and 12-week after surgery. Clinical wound healing status was determined by a fellowship-trained orthopaedic foot and ankle surgeon. Serum antibodies and plasmablast cultured antibodies (newly synthesized antibodies: NSA) were harvested. Eight unique S. aureusantigens from distinct functional classes were used for the immunoassay. All serum and NSA samples were run on a flow cytometer (Bio-Plex 200; Bio-Rad, Life Sciences Research) in duplicates and assessed for predictive ability in discriminating infection status and healing status using receiver operating characteristic (ROC) curve analysis, with accuracy summarized by the area under the ROC curve (AUC). Nonparametric estimates and 95% confidence intervals for the AUC were computed for each predictor along with p-values for testing the significance of each AUC.Results:Analysis of serum immunoassay showed significant difference in three anti-S. aureus antigens titers (IsdH (p = 0.037; AUC = 0.638), ClfB (p = 0.025; AUC = 0.644), and SCIN (p = 0.005; AUC = 0.677)) between S. aureus infected versus non- S. aureus infected DFU patients at initial presentation. NSA immunoassay showed elevation of two different S. aureus specific antigens, IsdH and LukS-PV, for S. aureus infected versus non- S. aureus infected DFU patients in ratios of approximately five and four, respectively. Changes of NSA based anti-S. aureus antibody titers over 12 weeks period, as single antigen or in combination, significantly correlated with clinical resolution of infection and wound healing status. Four anti-S. aureus antigen combinations achieved the highest AUC (Figure 1).Conclusion:Our results demonstrate that both the serum and NSA immunoassay can diagnose S. aureus infected DFUs. Furthermore, changes in NSA titers over a period of time against various S. aureus specific antigens significantly correlated with clinical representation of infection and wound healing status. The novel species-specific immunoassay can serve as a promising diagnostic system, tracking tool and prognostic potential in management of S. aureus associated foot and ankle infection.

The effect of closed-incision negative pressure wound therapy on clinical and ultrasonographic seroma formation and wound healing following forequarter amputation in large dogs - a randomized pilot trial

This pilot study aimed at evaluating whether closed-incision negative pressure wound therapy (ciNPWT) has an effect on seroma formation and wound healing following forequarter amputation in dogs above 20 kg. Twelve client-owned dogs weighing more than 20 kg, presented for forequarter amputation, were randomly assigned after surgery into two groups (six ciNPWT and six controls with soft-padded bandage, both bandages applied for three days). A clinical and ultrasonographic control (newly developed scoring system) was performed at bandage removal (three days postoperatively) and ten days, postoperatively. A postoperative seroma was present in 4/6 dogs in the ciNPWT group and in 5/6 dogs in the control group. There were no apparent differences in the ultrasonographic scores or subcutis measurements at three versus ten days, postoperatively. The results of this pilot trial do not support expansion to a larger-scale study evaluating ciNPWT after forequarter amputation in dogs.

The effect of form of carboxymethyl-chitosan dressings on biological properties in wound healing

Chitosan and its derivative have been widely used for wound healing applications, but the effect of the chitosan form on wound healing related properties has been less exploited. To this aim, water-soluble carboxymethyl-chitosan (CMCS) crosslinked by 10 wt.% genipin was fabricated in three different forms of dressings, i.e. hydrogel, membrane and sponge. The properties of dressing were evaluated and compared in terms of surface morphology, mechanical properties, water absorption rate, gas permeability, coagulation performance and biological responses in vitro and in vivo. The results showed that the prepared CMCS sponge dressing with porous structure exhibited the best water absorption, gas permeability, hemostatic performance and promoting effect on human skin fibroblast proliferation. The sponge sample overall had the highest expressions of α-smooth muscle actin (α-SMA) and transforming growth factor-β1 (TGF-β1), while the CMCS hydrogel was favorable for stimulating the expression of matrix metalloproteinase-1 (MMP-1). Furthermore, the CMCS sponge dressing demonstrated the best performance in wound closure and accelerating wound repair in-vivo, showing the fastest epithelization, and best healing performance with the well-structure of epidermis and well-arranged collagen in the dermis. On the other hand, the CMCS hydrogel and membrane also demonstrated good biocompatibility, hemostatic properties and the capability to promote wound healing. Overall, CMCS sponge dressing demonstrated the optimal biological performances and excellent potential for the clinical wound healing applications.

594-P: Human Nrf2-Active Multipotent Stromal Cell Exosomes Promote Tissue Repair in a Wound Model of Type 2 Diabetes

Exosomes, nanosized extracellular vesicles, may be key to translating multipotent stromal cell (MSC) therapy to the bedside. We previously found that nuclear factor erythroid 2-related factor 2 (Nrf2) regulates MSC promotion of tissue repair in diabetes. Here, we explore a novel role of Nrf2 in exosome biogenesis and investigate whether exosome treatment recapitulates the effects MSCs have on wound healing in mice with type 2 diabetes. Exosomes were harvested by differential ultracentrifugation of conditioned human bone marrow derived MSC media. For Nrf2-active exosomes, MSCs were incubated with potent Nrf2 activator, CDDO-Im. MSC characterization demonstrated robust tri-lineage differentiation, >95% expression of positive markers (CD44/CD73/CD90/CD105/CD106), and <5% expression of negative markers (CD45/CD31/CD14/CD19/HLA-DR). Immunoblotting of exosome isolates demonstrates enrichment for CD81, CD9 and TSG101. Nanoparticle tracking analysis demonstrates that Nrf2-active MSCs increase exosome secretion by 54%, compared to Nrf2-baseline MSCs (p<0.05). Exosomes were injected into the wound margin of full-thickness wounds on Leprdb/db (db/db) mice. Both Nrf2-baseline and Nrf2-active exosome treatment significantly reduced closure time to 15.5 and 14 days respectively, compared to 29.8 days for vehicle-treated wounds (p<0.05). This reduction eliminated the delay in closure time compared to wounds of C57/B6 mice. Nrf2-active exosome treatment of db/db wounds reduced closure time by a further 2.6 days compared to untreated C57/B6 wounds. At day 10, exosome treated db/db wounds have significant decreases in epithelial gap, expanded granulation tissue, and greater density of CD31+ vessels compared to vehicle-treated wounds. We conclude that activating Nrf2 in MSCs increases isolation efficiency by amplifying exosome yield and content. MSC exosome based therapies have potential for rapid translation to improve clinical wound healing outcomes. Disclosure J. Kuhn: None. A. Hassan: None. S. Sharma: None. J. Kwong: None. M. Rahman: None. S. Adam: None. J. Lee: None. A.P. Villarreal Ponce: None. P.S. Rabbani: None. Funding Plastic Surgery Foundation; Wound Healing Society; New York University Clinical and Translational Science Institute

Prediction of post-interventional physical function in diabetic foot ulcer patients using patient reported outcome measurement information system (PROMIS)

BackgroundInfected diabetic foot ulcer (DFU) patients present with an impaired baseline physical function (PF) that can be further compromised by surgical intervention to treat the infection. The impact of surgical interventions on Patient Reported Outcomes Measurement Information System (PROMIS) PF within the DFU population has not been investigated. We hypothesize that preoperative PROMIS scores (PF, Pain Interference (PI), Depression) in combination with relevant clinical factors can be utilized to predict postoperative PF in DFU patients. MethodsDFU patients from a single academic physician’s practice between February 2015 and November 2018 were identified (n = 240). Ninety-two patients met inclusion criteria with complete follow-up and PROMIS computer adaptive testing records. Demographic and clinical factors, procedure performed, and wound healing status were collected. Spearman's rank correlation coefficient, Chi-Squared tests and multidimensional modelling were applied to all variables’ pre- and postoperative values to assess patients’ postoperative PF. ResultsThe mean age was 60.5 (33–96) years and mean follow-up was 4.7 (3−12) months. Over 70 % of the patients’ initial PF were 2–3 standard deviations below the US population (n = 49; 28). Preoperative PF (p < 0.01), PI (p < 0.01), Depression (p < 0.01), CRF (p < 0.02) and amputation level (p < 0.04) showed significant univariate correlation with postoperative PF. Multivariate model (r = 0.55) showed that the initial PF (p = 0.004), amputation level (p = 0.008), and wound healing status (p = 0.001) predicted postoperative PF. ConclusionsMajority of DFU patients present with poor baseline PF. Preoperative PROMIS scores (PF, PI, Depression) are predictive of postoperative PROMIS PF in DFU patients. Postoperative patient’s physical function can be assessed by PFpostoperative = 29.42 + 0.34 (PFinitial) – 5.87 (Not Healed) – 2.63 (Amputation Category). This algorithm can serve as a valuable tool for predicting post-operative physical function and setting expectations.

Photo-responsive supramolecular hyaluronic acid hydrogels for accelerated wound healing

Supramolecular hydrogels confer control over structural properties in a reversible, dynamic, and biomimetic fashion. The design of supramolecular hydrogels with an improved structural and functional recapitulation of damaged organs is important for clinical applications. For wound healing management, in particular, an effective healing process, through the modulation of epidermal growth factor (EGF) delivery using supramolecular polysaccharide hydrogels, has yet to be developed. In this study, photo-responsive supramolecular polysaccharide hydrogels were formed through host-guest interactions between azobenzene and β-cyclodextrin groups conjugated to hyaluronic acid chains. By exploiting the photoisomerization properties of azobenzene under different wavelengths, a supramolecular hydrogel featuring a dynamic spatial network crosslink density through the application of a light stimulus was obtained. Under ultra violet (UV) light, the loosened hydrogel can rapidly release EGF, thereby enhancing EGF delivery at the wound site. Based on an in vivo assessment of the healing process through a full-thickness skin defect model, the controlled EGF release from a supramolecular hydrogel exhibited superior wound healing efficiency with respect to granulation tissue formation, growth factor levels, and angiogenesis. Therefore, the proposed supramolecular hydrogels are potentially valuable as controlled delivery systems for future clinical wound healing applications.

An injectable photopolymerized hydrogel with antimicrobial and biocompatible properties for infected skin regeneration

Currently, wound infection is an important health problem for the public. Wound infection can not only hinder healing but it can also lead to serious complications. Injectable wound dressings with biocompatible and antibacterial properties can promote wound healing during skin infections and reduce antibiotic use. Here, we used glycidyl methacrylate (GMA) to modify ε-polylysine (ε-PL) and γ-poly(glutamic acid) (γ-PGA) to produce ε-polylysine-glycidyl methacrylate (ε-PL-GMA) and γ-poly(glutamic acid)-glycidyl methacrylate (γ-PGA-GMA). Subsequently, ε-PL-GMA- and γ-PGA-GMA-based hydrogels were developed through photopolymerization using visible light. The hydrogels were injectable, could rapidly gelatinize, were biocompatible, and showed a wide spectrum of antibacterial activity. The hydrogels also promoted wound healing. The results show that these hydrogels inhibit bacterial infection and shorten the wound healing time of skin defects in Staphylococcus aureus models. This demonstrates that the hydrogels hold potential for clinical antimicrobial and wound healing therapy.

A liposome/gelatin methacrylate nanocomposite hydrogel system for delivery of stromal cell-derived factor-1α and stimulation of cell migration

Chronic, non-healing skin and soft tissue wounds are susceptible to infection, difficult to treat clinically, and can severely reduce a patient's quality of life. A key aspect of this issue is the impaired recruitment of mesenchymal stem cells (MSCs), which secrete regenerative cytokines and modulate the phenotypes of other effector cells that promote healing. We have engineered a therapeutic delivery system that can controllably release the pro-healing chemokine stromal cell derived factor-1α (SDF-1α) to induce the migration of MSCs. In order to protect the protein cargo from hydrolytic degradation and control its release, we have loaded SDF-1α in anionic liposomes (lipoSDF) and embedded them in gelatin methacrylate (GelMA) to form a nanocomposite hydrogel. In this study, we quantify the release of SDF-1α from our hydrogel system and measure the induced migration of MSCs in vitro via a transwell assay. Lastly, we evaluate the ability of this system to activate intracellular signaling in MSCs by using Western blots to probe for the phosphorylation of key proteins in the mTOR pathway. To our knowledge, this is the first study to report the delivery of liposomal SDF-1α using a nanocomposite approach. The results of this study expand on our current understanding of factors that can be modified to affect MSC behavior and phenotype. Furthermore, our findings contribute to the development of new hydrogel-based therapeutic delivery strategies for clinical wound healing applications. Statement of SignificanceChronic, non-healing wounds promote an inflammatory environment that inhibits the migration of mesenchymal stem cells (MSCs), which secrete pro-healing and regenerative cytokines. The goal of this project is to apply principles of tissue engineering to achieve controllable release of the pro-healing chemokine SDF-1α to modulate the intracellular signaling and migratory behavior of MSCs. In this work, we introduce a nanocomposite strategy to tailor the release of SDF-1α using a liposome/gelatin methacrylate hydrogel approach. We are the first group to report the delivery of liposomal SDF-1α using this strategy. Our findings aim to further elucidate the role of MSCs in directing wound healing and guide the development of immunomodulatory and therapeutic delivery strategies for clinical wound healing applications.

EFFECTS OF CANNABIDIOL, A CANNABIS SATIVA CONSTITUENT, ON ORAL WOUND HEALING

Objective To evaluate the effect of cannabidiol (CBD) on the healing of rats’ oral wounds. Study Design Traumatic ulcers were induced in 60 Wistar rats using a 5-mm biopsy punch on the midline of the ventral tongue. Animals received daily intraperitoneal (ip) injections of CBD at doses of 0 (control), 5 or 10 mg/kg. Rats were weighed daily and sacrificed after 3 and 7 days of treatment. Clinical (ulcer area and weight variation) and histopathologic (inflammation scores) analyses were performed. Data were analyzed statistically at the significance level of 5%. Results CBD was unable to clinically influence the size of ulcerative lesions. However, treatment with CBD in both tested concentrations decreased inflammatory scores after 3 days post-wounding (P < .05) compared to control. Conclusions Five and 10 mg/kg CBD exerted promising anti-inflammatory effect in oral ulcerative lesions, not being enough to accelerate clinical wound healing at 3 and 7 days. To evaluate the effect of cannabidiol (CBD) on the healing of rats’ oral wounds. Traumatic ulcers were induced in 60 Wistar rats using a 5-mm biopsy punch on the midline of the ventral tongue. Animals received daily intraperitoneal (ip) injections of CBD at doses of 0 (control), 5 or 10 mg/kg. Rats were weighed daily and sacrificed after 3 and 7 days of treatment. Clinical (ulcer area and weight variation) and histopathologic (inflammation scores) analyses were performed. Data were analyzed statistically at the significance level of 5%. CBD was unable to clinically influence the size of ulcerative lesions. However, treatment with CBD in both tested concentrations decreased inflammatory scores after 3 days post-wounding (P < .05) compared to control. Five and 10 mg/kg CBD exerted promising anti-inflammatory effect in oral ulcerative lesions, not being enough to accelerate clinical wound healing at 3 and 7 days.

The Effectiveness of Autologous Platelet-Rich Plasma vs Conventional Mechanical Suture Fixation in Skin Graft Transfer for Deep Burn Patients: An Intra-Patient Controlled Study

Background: Autologous platelet-rich plasma (PRP) is a patient-derived treatment containing fibrin and high concentrations of growth factors, often known for its adhesive and hemostatic abilities. PRP has been used for various types of wounds, including chronic and burn wounds. Autologous PRP is an affordable and practical modality that has been advocated by multiple publications due to its effect in improving clinical outcomes and wound healing time in regard to skin graft in burn patients. The aim of this study is to compare the effectiveness of PRP to conventional suture fixation in skin graft transfer for deep burn patients through objective “take” percentage analysis. Methods: This controlled prospective single center study included 15 deep burn patients with a total burn area of 5 – 30% on their extremities. Each patient received skin graft treatments using both methods: autologous PRP and conventional sutures. Pictures and analysis were taken on the third day after surgery to compare the open wound area between the two methods. Result: There was no significant “take” percentage difference between the autologous PRP and conventional suture group. The mean percentage of skin graft “take” for autologous PRP was 84.36% ± 13.82%, and the result for suture fixation was 84.16% ± 15.33%. Conclusion: The use of autologous PRP in this study did not improve the “take” percentage of skin grafts compared to conventional suture fixation. However, the use of autologous PRP did reduce the surgery duration and is still a treatment modality with high potential.

A Critical Review and Perspective of Honey in Tissue Engineering and Clinical Wound Healing.

Significance: Historically, honey has been regarded as a potent agent in bacterial inhibition and wound healing. An increased prevalence of antibiotic resistant pathogens spurred an initial resurgence in honey's clinical popularity, with it quickly finding a place in wound care and regenerative medicine. However, this renewed usage demanded a need for improved delivery and overall research of its bioactive properties. This review provides an overview of the antibacterial properties and clinical use of honey. Recent Advances: The past and present clinical use of honey is noted, focusing specifically on burns and ulcers, as these are the most common applications of the natural agent. While honey is often used without modification clinically, there are also commercially available products ranging from dressings to gels, which are discussed. Critical Issues: Despite these products growing in popularity, the need for improved delivery and a structure to support wound healing could improve the treatment method. Future Directions: Tissue engineering scaffolds can provide an alternative method of honey delivery with research focusing primarily on electrospun scaffolds, hydrogels, and cryogels. Current studies on these scaffolds are discussed with respect to their advantages and potential for future clinical work. Overall, this review provides a comprehensive overview of the properties of honey, its current use in wound healing, and the potential for future incorporation into tissue-engineered scaffolds to provide an innovative wound healing agent.

Inflammation Biomarkers and Correlation to Wound Status After Full-Thickness Skin Grafting.

Background: A surgical site infection (SSI) is believed to be the result of an exaggerated inflammatory response.Objective: Examine the relationship between clinical status and inflammation biomarkers in full-thickness skin grafting wounds.Methods: Twenty patients planned for facial full-thickness skin grafting were enrolled. A week after surgery, all graft wounds were clinically assessed using a 3-step scale for inflammation (low, moderate, high). All wounds were swabbed for routine microbiological analysis and assessment of numbers of aerobic bacteria. Tie-over dressings from all patients were collected and used for wound fluid extraction and subsequent analysis of MMPs, cytokines, and NF-κB inducing activity.Results: Wounds with a high degree of inflammation contained increased total MMP activity (P ≤ 0.05) in their corresponding fluids. Likewise, the level of the cytokines IL-1ß, IL-8, IL-6, TNF-α was analyzed, and particularly IL-1ß was discriminatory for highly inflamed wounds (P ≤ 0.01). Moreover, bacterial loads were increased in highly inflamed wounds compared to wounds with a low degree of inflammation (P ≤ 0.01). NF-κB activation in the monocytic cell line THP-1 was significantly higher when these cells were stimulated by wound fluids with a high degree of inflammation (P ≤ 0.01). Growth of S. aureus in wounds did not vary between wounds with different degrees of inflammation (chi-square 3.8, P = 0.144).Conclusion: Biomarkers analyzed from tie-over dressings correlated to clinical wound healing in full-thickness skin grafting.

Surface-structured bacterial cellulose loaded with hUSCs accelerate skin wound healing by promoting angiogenesis in rats

Promotion of wound healing is one of the most important fields in clinical medical research. This study aimed to evaluate the potential use of a new surface-structured bacterial cellulose(S-BC) biomaterial with human urine-derived stem cells (hUSCs) for wound healing. In vitro, EA.hy926 were inoculated on structured/non-structured bacterial cellulose, and the growth of EA.hy926 on bacterial cellulose in medium with/without conditioned medium of the hUSCs were observed to explore the effect of bacterial cellulose's surface structure and hUSCs-CM on vascular endothelial cell growth. In vivo, we covered wound surface with various BC materials and/or injected the hUSCs into the wound site on group BC, group S-BC, group hUSCs, group BC + hUSCs, group S-BC + hUSCs to evaluate the effect of S-BC and hUSCs on wound healing in rat full-thickness skin defect model. In vitro study, surface structure of S-BC could promote the growth and survival of EA.hy926, and the hUSCs-CM could further promote the proliferation of EA.hy926 on S-BC. In vivo study, wound healing rate of the group BC, group S-BC, group hUSCs was significantly accelerated, accompanied by faster re-epithelialization, collagen production and neovascularization than control group. It is note worthy that the effect of S-BC on wound healing was better than BC, the effect of S-BC + hUSCs on wound healing was better than BC + hUSCs. Moreover, the effect of S-BC combined with hUSCs on wound is better than treated with S-BC or hUSCs alone. All the findings suggest that the combination of S-BC and hUSCs could facilitate skin wound healing by promoting angiogenesis. This combination of the role of stem cells and biomaterial surface structures may provide a new way to address clinical wound healing problems.