Conventional Dressings Research Articles

Asymmetric adhesive SIS-based wound dressings for therapeutically targeting wound repair

Severe tissue injuries pose a significant risk to human health. Conventional wound dressings fall short in achieving effective tissue regeneration, resulting in suboptimal postoperative healing outcomes. In this study, an asymmetric adhesive wound dressing (marked as SIS/PAA/LAP) was developed, originating from acrylate acid (AA) solution with laponite (LAP) nanoparticles polymerization and photo-crosslinked on the decellularized extracellular matrix small intestinal submucosa (SIS) patch. Extensive studies demonstrated that the SIS/PAA/LAP exhibited higher tissue adhesion strength (~ 33 kPa) and burst strength (~ 22 kPa) compared to conventional wound dressings like Tegaderm and tissue adhesive products. Importantly, it maintained favorable cell viability and demonstrated robust angiogenic capacity. In animal models of full-thickness skin injuries in rats and skin injuries in Bama miniature pigs, the SIS/PAA/LAP could be precisely applied to wound sites. By accelerating the formation of tissue vascularization, it displayed superior tissue repair outcomes. This asymmetrically adhesive SIS-based patch would hold promising applications in the field of wound dressings.

Bioactive glass enhanced alginate / carboxymethyl cellulose funcional dressings Li2O–ZrO2–SiO2

The healing of skin injuries is crucial for the human body, but the presence of harmful bacteria can be detrimental. Conventional dressings provide protection but do not promote active healing. In contrast, functional dressings can enhance regeneration by regulating moisture, facilitating gas exchange, preventing infection, and may even contain therapeutic compounds. Li2O–ZrO2–SiO2 (LZS) bioactive glasses possess antibacterial and regenerative properties but have not yet been explored in wound dressings. Therefore, this work aims to evaluate the potential of LZS glass to be used as an antibacterial biomaterial to obtain functional dressings. The antibacterial activity against Staphylococcus aureus and Escherichia coli was considered for this purpose. In-vitro biological studies were assessed by MTT (3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide), and DNA damage. Alginate and carboxymethyl cellulose (CMC) dressings were prepared with the addition of LZS in a minimum bactericidal concentration (MBC). The dressings' bioactivity was assessed by exposing them to a simulated body fluid (SBF) and analyzing their structure and microstructure. The glass efficiently inhibited the tested microorganisms, with an MBC of 100 mg/mL. LZS glasses exhibited no cytotoxicity. The bioactive glass-incorporated dressings demonstrated appropriate thickness and fluid absorption capacity for application in wound treatment. The deposition of a calcium phosphate layer on the surface of the dressings proved its bioactivity. The optimized design exhibited a tensile strength of 0.28 MPa and an elongation of 15.63 %. The functional dressings obtained have potential for applications in tissue repair where bacterial proliferation is a concern.

An in situ dressing material containing a multi‐armed antibiotic for healing irregular wounds

AbstractAcute and infected wounds resulting from accidents, battlefield trauma, or surgical interventions have become a global healthcare burden due to the complex bacterial infection environment. However, conventional gauze dressings present insufficient contact with irregular wounds and lack antibacterial activity against multi‐drug‐resistant bacteria. In this study, we develop in situ nanofibrous dressings tailored to fit wounds of various shapes and sizes while providing nanoscale comfort and excellent antibacterial properties. Our approach involves the fabrication of these dressings using a handheld electrospinning device that allows for the direct deposition of nanofiber dressings onto specific irregular wound sites, resulting in perfect conformal wound closure without any mismatch in 2 min. The nanofibrous dressings are loaded with multi‐armed antibiotics that exhibit outstanding antibacterial activity against Staphylococcus aureus (S. aureus) and methicillin‐resistant S. aureus. Compared to conventional vancomycin, this in situ nanofibrous dressing shows great antibacterial performance against up to 98% of multi‐drug‐resistant bacteria. In vitro and in vivo experiments demonstrate the ability of in situ nanofibrous dressings to prevent multi‐drug‐resistant bacterial infection, greatly alleviate inflammation, and promote wound healing. Our findings highlight the potential of these personalized nanofibrous dressings for clinical applications, including emergency, accident, and surgical healthcare treatment.

Dual network composite hydrogels with robust antibacterial and antifouling capabilities for efficient wound healing.

Wound dressings play a critical role in the wound healing process; however, conventional dressings often address singular functions, lacking versatility in meeting diverse wound healing requirements. Herein, dual-network, multifunctional hydrogels (PSA/CS-GA) have been designed and synthesized through a one-pot approach. The in vitro and in vivo experiments demonstrate that the optimized hydrogels have exceptional antifouling properties, potent antibacterial effects and rapid hemostatic capabilities. Notably, in a full-thickness rat wound model, the hydrogel group displays a remarkable wound healing rate exceeding 95% on day 10, surpassing both the control group and the commercial 3M group. Furthermore, the hydrogels exert an anti-inflammatory effect by reducing inflammatory factors interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α), enhance the release of the vascular endothelial growth factor (VEGF) to promote blood vessel proliferation, and augment collagen deposition in the wound, thus effectively accelerating wound healing in vivo. These innovative hydrogels present a novel and highly effective approach to wound healing.

Advances in Chronic Wound Management: From Conventional Treatment to Novel Therapies and Biological Dressings.

Chronic wounds can be classified as diabetic foot ulcers, pressure ulcers, or venous leg ulcers. Chronic wound management has become a threat to clinicians and constitutes a major healthcare burden. The healing process of chronic wounds requires many factors to work in concert to achieve optimal healing. Various treatment options, ranging from hypoxia to infection, have evolved considerably to address the challenges associated with chronic wound healing. The conventional and accelerating treatments for chronic wounds still represent an unmet medical need due to the complex pathophysiology of the chronic wound microenvironment. In clinical settings, traditional chronic wound care practices rely on nonspecific topical treatment, which can reduce pain and alleviate disease progression with varying levels of success but fail to completely cure the wounds. Conventional wound dressings, such as hydrocolloids, gauze, foams, and films, have also shown limited success for the treatment of chronic wounds and only act as a physical barrier and absorb wound exudates. Emerging advances in treatment approaches, including novel therapies (stem cells, microRNAs, and nanocarrier-based delivery systems) and multifunctional biological dressings, have been reported for chronic wound repair. This review summarizes the challenges offered by chronic wounds and discusses recent advancements in chronic wound treatment.

Comparison of Negative Pressure Wound Therapy and Conventional Dressing of Fournier’s Gangrene

Comparison of Negative Pressure Wound Therapy and Conventional Dressing of Fournier’s Gangrene

Исследование эффективности использования желатин-танниновых гидрогелей для доставки биологически-активных веществ на примере куркумина

Wound healing is a complex process that requires a comprehensive approach to treatment. Hydrogel materials modified with bioactive substances (BAS) are currently under active development. Such materials represent an alternative to conventional dressings. The inclusion of BAS in their composition opens the way to providing the required properties (antiseptic, antioxidant, etc.). Curcumin is one of a number of polyflavonoids that are being intensively studied for such use. Objective: in the current work, the method of obtaining gelatin-tannin hydrogels with BAS (curcumin), as well as the efficiency of isolation of the injected substance in vitro and the characteristics of its binding to the polymer matrix are considered. Materials and methods. The object of the study is gelatin-tannin hydrogels with curcumin. The structure of the materials was studied by IR spectroscopy, the sorption parameters were determined gravimetrically, the release of curcumin was studied by visible spectroscopy and analyzed using conventional pharmacokinetic models. Results. In the course of the work, hydrogel materials based on gelatin and tannin with a curcumin content from 0.1 to 1.0% were synthesized. It was found that the incorporation of curcumin into the polymer mesh was successful and curcumin is not released from hydrogels when swelling in distilled water. The introduction of curcumin into the formulation reduced the sorption capacity of hydrogels in distilled water from 15 g/g to 7-9 g/g. The Higuchi model (R2>0.95) was determined to be the most optimal model describing the process of curcumin extraction from materials. Using the description of the release kinetics, it was determined that the maximum release (22%) was achieved with a minimum curcumin content in the hydrogel (0.1 wt.%) and the minimum release speed. Conclusion. A method for the synthesis of gelatin-tannin hydrogels with curcumin has been developed. The structure of materials, sorption capacity, and the ability to release BAS have been studied. Further prospects for the inclusion of other BAS of a hydrophobic nature in the composition of hydrogels are shown.

Development and biological evaluation of smart powder bandage for wound healing and dressing applications

Cutaneous wounds are one of the pressing concerns for healthcare systems globally. With large amounts of water, conventional hydrogels encounter obstacles in effectively delivering small molecules and peptides for wound healing. The surplus water content challenges the stability and sustained release of small molecules and peptides, diminishing their therapeutic efficacy. Our pioneering smart powder bandage, fabricated through freeze-drying, ensures a water content of <1 % during storage. Upon contact with wound exudate, it forms hydrogel layers, thereby optimizing the delivery of peptides. Tailored for thermosensitive peptides such as EGF, this strategy surmounts the limitations of conventional hydrogels, providing a robust platform for efficacious therapeutic delivery in wound healing applications. Developing multifunctional wound dressings with antibacterial, anti-inflammatory, hemostatic, and healing properties is essential to promote wound healing. Therefore, the current investigation reports the development of multifunctional EGF@Silnanom SPB with the above-mentioned properties to promote wound healing using silver nanomix (Silnanom) and bioactive epidermal growth factors (EGF) as active therapeutics. The characterization of smart powder bandage (SPB) revealed that Silnanom were homogeneously dispersed in the entangled polymer network. The multifunctional smart powder bandage exhibited high bacterial inhibition rates against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), and rigorous hemocompatibility, cell compatibility, and in vivo studies also confirmed its biocompatibility. Furthermore, multifunctional EGF@Silnanom SPB effectively reduced pro-inflammatory markers, enhanced collagen deposition, promoted angiogenesis, and accelerated wound healing in a full-thickness mouse wound model through the sustained release of Silnanom and EGF. Additionally, the results of hemostasis analysis on the tail amputation mouse model confirmed the hemostasis properties of the EGF@Silnanom SPB. Overall, the multifunctional EGF@Silnanom SPB shows promising potential for skin wound repair, offering a potent and effective solution to the challenges posed by conventional wound dressings.

Wound Microenvironment Self-Adjusting Hydrogels with Thermo-Sensitivity for Promoting Diabetic Wound Healing.

The hard-healing chronic wounds of diabetics are still one of the most intractable problems in clinical skin injury repair. Wound microenvironments directly affect wound healing speed, but conventional dressings exhibit limited efficacy in regulating the wound microenvironment and facilitating healing. To address this serious issue, we designed a thermo-sensitive drug-controlled hydrogel with wound self-adjusting effects, consisting of a sodium alginate (SA), Antheraeapernyi silk gland protein (ASGP) and poly(N-isopropylacrylamide) (PNIPAM) for a self-adjusting microenvironment, resulting in an intelligent releasing drug which promotes skin regeneration. PNIPAM has a benign temperature-sensitive effect. The contraction, drugs and water molecules expulsion of hydrogel were generated upon surpassing lower critical solution temperatures, which made the hydrogel system have smart drug release properties. The addition of ASGP further improves the biocompatibility and endows the thermo-sensitive drug-controlled hydrogel with adhesion. Additionally, in vitro assays demonstrate that the thermo-sensitive drug-controlled hydrogels have good biocompatibility, including the ability to promote the adhesion and proliferation of human skin fibroblast cells. This work proposes an approach for smart drug-controlled hydrogels with a thermo response to promote wound healing by self-adjusting the wound microenvironment.

Effectiveness of stingless bee (Kelulut) honey versus conventional gel dressing in diabetic wound bed preparation: A randomized controlled trial

PurposeKelulut honey contains trehalulose and has high antioxidant content, such as phenolic and flavonoid substances, which can promote wound healing. This study evaluated the effectiveness of Kelulut honey in diabetic wound healing compared to a commercially available conventional gel dressing (Intrasite gel). MethodsA prospective, randomized, single-blinded control trial was performed on eligible diabetic patients with full-thickness cavity wounds. Patients’ demographics, size and site of wounds, and baseline routine blood investigations were recorded. The wounds were dressed every other day with Kelulut honey for the intervention group or gel for the control group. The wound size reduction and granulation tissue formation percentage were calculated every 6 days for 1 month. ResultsSeventy-one patients were randomized. After 30 days of follow-up, 62 participants were available for analysis: 30 from the control group and 32 from the treatment group. The control group had increased granulation tissue at baseline and more wounds on the lower limb and posterior trunk. Both groups showed an increasing mean and median percentage of wound epithelialization and granulation tissue over time, with significantly higher values at every timepoint in the honey group (p < 0.05). However, repeated measures analysis of variance and analysis of covariance revealed no significant interaction effect between the different treatments and time, with F (2.02, 121.28) = 0.88, p = 0.417 and F (1.60, 93.95) = 0.79, p = 0.431, respectively. ConclusionThis study revealed that Kelulut honey was comparable to and as effective as the conventional gel in treating diabetic wounds in terms of promoting epithelialization and granulation tissue formation.

Incisional negative pressure wound therapy may not protect against post-operative surgical site complications in bicondylar tibial plateau fractures.

To determine if incisional negative pressure wound therapy is protective against post-operative surgical site complications following definitive fixation of bicondylar tibial plateau fractures. A retrospective analysis of patients diagnosed with an acute bicondylar tibial plateau fracture (AO/OTA 41-C) undergoing ORIF from 2010 to 2020 was performed. Patients received either a standard sterile dressing (SD) or incisional negative pressure wound therapy (iNPWT). Primary outcomes included surgical site infection, osteomyelitis, and wound dehiscence. Secondary outcomes included non-union and return to the operating room. Multivariate logistic regression analyses were performed. 180 patients were included and 22% received iNPWT (n = 40) and 78% received standard dressings (n = 140). iNPWT was more common in active smokers (24.7% vs. 19.3%, p = 0.002) and the SD group was more likely to be lost to follow up (3.6% vs. 0%, p = 0.025). iNPWT was not protective against infection or surgical site complications, and in fact, was associated with higher odds of post-operative infection (OR: 8.96, p = 0.005) and surgical site complications (OR:4.874, p = 0.009) overall. Alcohol abuse (OR: 19, p = 0.005), tobacco use (OR: 4.67, p = 0.009), and time to definitive surgery (OR = 1.21, p = 0.033) were all independent risk factors for post-operative infection. In this series of operatively treated bicondylar tibial plateau fractures, iNPWT did not protect against post-operative surgical site complications compared to conventional dressings. Tobacco use, alcohol abuse, and time to definitive surgery, were independent risk factors for post-operative infection. Further studies are needed to determine if iNPWT offers a protective benefit in exclusively high-risk patients with relevant medical and social history.

Characteristics of pressure injuries among geriatric patients at an Indonesian tertiary hospital: a cross-sectional study

BACKGROUND Pressure injury develops due to sustained pressure at the bony prominence of the skin and tissues. Geriatric patients often have multiple comorbidities, predisposing them to pressure injury. Data on the characteristics of the geriatric with pressure injuries are still limited. This study aimed to report the characteristics of geriatric patients with pressure injuries admitted at a tertiary hospital in Indonesia.&#x0D; METHODS This cross-sectional study used medical records of geriatric patients admitted with all stages of pressure injuries consulted to the Department of Dermatology and Venereology at a tertiary hospital in Indonesia between January 2017 and April 2021. Pressure injuries were classified based on the 2019 National Pressure Injury Advisory Panel guideline.&#x0D; RESULTS 39 patients presented with varied pressure injury characteristics. The sacral region was the most reported site (36%), with stage 2 pressure injury being the most commonly found stage in the patients (74%). Interestingly, 22% of the patients had pressure injuries found on the atypical sites due to prolonged surgery or the pressure of medical devices. More than half of the patients used conventional dressings (51.3%). Immobility was found in 35.9% of the patients due to being bedridden.&#x0D; CONCLUSIONS No characteristics were found as a significant risk factor for pressure injury formation during or outside the admission period. However, a history of surgery might be related to pressure injury formation during admission.

Comparison of Efficacy of Vacuum Dressing Versus Conventional Dressing Over Autologous Split Skin Grafts in Burn Wounds: A Single-Center Prospective Cohort Study.

This study was carried out to compare the efficacy of vacuum dressing and conventional dressing over split skin grafts in burn patients. It was a single-center prospective cohort study on patients, with less than 40% TBSA burn, undergoing skin grafting at 2 different sites simultaneously over the burn wounds. One site underwent conventional dressing following grafting, and the other underwent vacuum dressing. The primary objective was to compare the percentages of skin graft uptake on Day 5 and Day 14. The secondary objectives were to compare the duration of dressings, time for complete epithelization, need for regrafting, and wound swab culture positivity rates. Three independent examiners assessed the efficacy of dressings in terms of epithelization percentage, need for continued dressing, graft loss, wound swab culture positivity rate, and qualitative assessment of grafts. A total of 16 patients were included in the study. The graft loss, number of days of dressings, and complete epithelization time were statistically lower in the negative-pressure wound therapy (NPWT) group compared with the conventional group (P values .007, .006, and 0009, respectively). The percentage of epithelization was also found to be higher in the NPWT group (P = .006). The incidence of positive cultures and clinically significant graft loss was found to be lower in the NPWT group. However, this was not found to be statistically significant. NPWT dressings can be used in burn wounds following skin grafting and have been found to reduce the time for epithelization compared to conventional dressing.

Clay Therapy in Wound Healing: A Brief Review of the Literature

Clay is ubiquitous, and its hydrous phyllosilicate properties have promoted its use as a traditional wound healing agent in many cultures. Various types of natural clay have been utilized for skin diseases and wound treatments. Therefore, we aimed to study natural and synthetic clay minerals and summarize their applicability in medical settings. A review of prospective studies published since 2008 examining the properties of different forms of natural clay minerals and their therapeutic benefits in wound care was conducted. Studies were obtained using the databases of Google Scholar, PubMed, Web of Science, and HINARI (Health Inter-Network Access to Research Initiative) and searching related journals. The primary outcomes were assessed qualitatively and were categorized by the type of natural clay used. The included papers studied five available types of clay: Chamliyal clay, French green clay, Oregon Mineral Technologies blue clay, Kisameet clay, and various synthetic clays. The studies found how these forms of clay together demonstrate anti-inflammatory and antibacterial properties while promoting fibroblast regeneration and circulation while remaining biocompatible. Clay-based materials may be a potential alternative for conventional dressings for wound healing in resource-limited settings. This review opens doors to expanding clay-based therapies for wound healing.

Evaluation of Negative Pressure Wound Therapy in the Management of Fournier's Gangrene.

Introduction Necrotizing soft tissue infections (NSTIs), including Fournier's gangrene (FG), are severe polymicrobial bacterial infections characterized by rapidly spreading inflammation and tissue necrosis. This study aims to compare the clinical outcomes of vacuum-assisted closure (VAC) dressing and conventional dressing in patients with FG. Materials and methods A prospective study was conducted from December 2020 to May 2022, including patients with clinical features suggestive of FG. Patients were divided into two groups: conventional dressing and VAC dressing. Relevant clinical data, including age, duration of hospital stay, wound status, Fournier's gangrene severity index (FGSI) scores, sepsis markers (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio, and procalcitonin), and pain assessment, were recorded and compared between the two groups. Results A total of 84 patients were included in the study, with 42 patients in each group. The mean age was 57.48 ± 15.74 years in the conventional dressing group and 50.83 ± 13.95 years in the VAC dressing group. VAC dressing was associated with a significantly shorter duration of hospital stay (8.14 ± 3.13 days) compared to conventional dressing (11.36 ± 4.75 days). The average time taken for wound closure was significantly reduced in the VAC dressing group (63 ± 14.81 days) compared to the conventional dressing group (112.56 ± 13.82 days). FGSI scores showed significant improvement after debridement in both groups, with lower scores in the VAC dressing group at discharge. Sepsis markers such as CRP and serum procalcitonin exhibited a significant decrease after VAC application. Discussion The study demonstrates that VAC therapy is associated with better clinical outcomes in FG, including reduced duration of hospital stay, faster wound closure, improved FGSI scores, decreased sepsis markers, and reduced pain. These findings align with previous studies highlighting the advantages of VAC therapy over conventional dressing methods. Conclusion VAC therapy provides significant benefits in the management of FG, leading to improved clinical outcomes and patient quality of life. It offers advantages such as shorter hospital stays, faster wound closure, and reduced sepsis markers. The application of VAC dressing should be considered a valuable treatment modality for FG.

Probing the Onset of the Bacterial Membrane Photodamage in Time using a Raman Optical Tweezer

Laser-induced photo damage of the optically confined microorganism is known to affect the bacterial membrane. We record the Raman spectra of a live, optically trapped Bacillus subtilis at different trapping time lapses to determine the changes in the bacterial membrane, which in turn impacts the flagellar rotation. A 1064 nm tightly focused laser traps a single de-flagellated bacterium and Surface Enhanced Raman Scattering (SERS) signals are recorded with silver nanoparticles (AgNPs) inserted into bacteria via the internal colloid method. The internal colloid method, albeit resulting in a modest signal increase, is employed in preference here to prevent undesirable cell aggregation or instabilities in trapping or compromised cell integrity resulting from the conventional nanoparticle dressing of the cell membrane. The second derivative of the Raman spectrum reveals subtle changes in the molecular structure of the bacterial membrane manifested by shifts in the phospholipid peak (1462 cm−1), amide III peak (1245 cm−1) and cytosine peak (792 cm−1), with increased trapping duration. This is followed by a Principal Component Analysis (PCA) to examine the changes occurring in the Raman spectral range (600 cm−1–1800 cm−1). By comparing the spectral shifts at specific time lapses from the moment of trapping, with the diminishing frequency of rotation of the body and flagella of the trapped flagellated counterpart bacterium at these same time lapses, we establish a direct correlation between the changes in membrane structure and compromised rotation of the bacterium during photodamage. Our results confirm that the subtle changes that occur at the biomolecular level in a cell when subjected to photodamage can be identified with good sensitivity, and moreover, that the changes occurring at the biomembrane have a role to play in reduced rotation of the trapped bacterium during exposure to the laser.

Novel Method of Split-Thickness Skin Graft Donor Site Management Using Combined Fenestrated Polyurethane Film and Negative-Pressure Wound Therapy

Background: Split-thickness skin graft (STSG) is a fundamental and versatile technique used in reconstructive surgery. Despite numerous studies addressing the management of STSG donor sites, there is still little consensus on the optimal dressing method. This study aimed to analyze the effectiveness of a novel method that combines a fenestrated polyurethane film with negative-pressure wound therapy (NPWT) over conventional moist dressings.Methods: Between January 2021 and December 2022, 23 patients who received STSG were retrospectively reviewed. In group A, a polyurethane film punctured with a 20-gauge needle was applied to the skin graft donor site. A NPWT system (CuraSys) was subsequently applied over the film. The conventional NPWT was replaced with a portable NPWT (PICO system) on the day of discharge. On the 14th postoperative day, the NPWT and film were removed. In group B, patients were administered a traditional moist dressing until epithelization. Postoperative pain, reepithelization rate, and dressing cost per cm² were compared.Results: Group A exhibited a lower mean pain score on all the measured days. Furthermore, group A demonstrated a significantly shorter time required for complete reepithelization (18.07±8.43 days vs. 28.20±5.25 days, P=0.003) and a lower dressing cost per square centimeter (6,517±6,162 KRW [4.82±4.56 USD] vs. 23,036±27,157 KRW [17.05±20.11 USD], P=0.006).Conclusion: The combination of fenestrated polyurethane film and NPWT resulted in reduced pain caused by dressing, a faster reepithelization rate, and lower dressing cost than that of conventional moist dressing.

Next-generation of smart dressings: Integrating multiplexed sensors and theranostic functions

Non-healing wounds represent a significant burden for healthcare systems and society, giving rise to severe economic and human issues. Currently, the use of dressings and visual assessment represent the primary and standard care for wounds. Conventional dressings, like cotton gauze, provide only passive physical protection. Besides, they end up paradoxically hampering the wound-healing process by producing tissue damage and pain when removed during routine check-ups. In response to these limitations, researchers, engineers, and technologists are developing innovative dressings that incorporate advanced diagnostic and therapeutic functionalities, coined as “smart dressings”. Now, the maturation of smart dressing is bringing them closer to real-life applications, leading to an exciting new generation of these devices. The next generation of smart dressings is capable of monitoring in real-time multiple biomarkers while including pro-healing capabilities in a single platform. Such multiplexed and theranostic smart dressings are expected to offer a timely biomarker-directed diagnosis of non-healing wounds while enabling rapid, automated, and personalized treatments of infection and chronicity. Herein, we provide an insightful overview of these advantageous devices, delving into the diverse spectrum of possible engineering strategies. This encompasses the use of electrochemical and optical platforms with diverse multiplexing architectures, such as multi-zone sensing arrays and multi-layered devices. Open or closed-loop theranostic mechanisms using various stimuli-responsive materials that could be internally or externally controlled are also included. Finally, a critical discussion on the main challenges and future directions of smart dressings is also offered.

Closed incision negative pressure wound therapy following pancreaticoduodenectomy for prevention of surgical site infections in high-risk patients.

Surgical site infection (SSI) is one of the most common sources of morbidity after pancreaticoduodenectomy. Surgical site infections are associated with readmissions, prolonged length of stay, delayed initiation of adjuvant chemotherapy and negative effects on quality of life. Incisional vacuum-assisted closure (iVAC) devices applied on closed incisions may reduce SSI rates. The objective of this retrospective review is to evaluate the impact of iVAC on SSI rate after pancreaticoduodenectomy. A cohort of patients undergoing pancreaticoduodenectomy at a single institution who had at least 1 risk factor for SSI and who received an iVAC were compared with a historical cohort of high-risk patients who received conventional dressings after pancreaticoduodenectomy. The primary outcome was incidence of SSI within 30 days, abstracted from chart review. Secondary outcomes were 30-day readmission, 90-day mortality, rate of postoperative pancreatic fistula and rate of delayed gastric emptying. In total, 175 patients were included, of whom 61 received an iVAC. The incidence of SSI was 13% (8 of 61 patients) and 16% (18 of 114 patients) in the iVAC and conventional dressing groups, respectively (odds ratio 0.81, 95% confidence interval 0.33-1.98). Preoperative biliary drainage was the most frequent SSI risk factor. Binary logistic regression using SSI as the outcome demonstrated no significant association with iVAC use when adjusted for SSI risk factors. There were no differences in rates of postoperative pancreatic fistula, delayed gastric emptying or 90-day mortality. This report describes the outcomes of the integration of iVAC devices into routine clinical practice at a high-volume institution. Application of this device after pancreaticoduodenectomy for patients at elevated risk of SSI was not associated with a reduction in the rate of SSIs.

Negative pressure wound therapy for flap closed-incisions after 3D-printed prosthesis implantation in patients with chronic osteomyelitis with soft tissue defects

BackgroundThe flap closed-incisions healing after 3D-printed prosthesis implantation in Chronic Osteomyelitis with Soft Tissue Defects (COSTD) is critical. This study aimed to explore the safety and effectiveness of Negative Pressure Wound Therapy (NPWT) in promoting flap closed-incisions healing.MethodsRetrospective analysis of clinical data was performed, including baseline, surgical and hospitalization information. The efficacy of NPWT was assessed by comparing the ASEPSIS scores, Visual Analogue Scale (VAS), Activity of Daily Living Scale (ADLS), and Lower Extremity Functional Scale (LEFS), as well as the major postoperative complications.ResultsThe study included 20 patients, 13 received conventional dressing (Control group) and 7 received NPWT treatment (NPWT group). These two groups exhibited a notable disparity in the distribution of ASEPSIS scores, and the median scores were 24 in Control group and 9 in NPWT group (p = 0.001). Eight patients in the Control group experienced major incisional complications, including 7 cases of exudation, 3 cases of infection, 2 cases of non-healing, and 1 case of dehiscence, while none were observed in the NPWT group (p = 0.015). The VAS, ADLS, and LEFS scores were significantly improved in the NPWT group compared to the Control group (p = 0.003, 0.017, and 0.043, respectively).ConclusionsThe study findings suggest that NPWT applied to the healing process of flap closed-incisions after 3D prosthesis implantation in patients with COSTD can reduce the occurrence of postoperative major complications and promote the recovery of lower limb function and daily activities, which should be recommended for clinical practice.