Wound Granulation Research Articles

Hydrogen Peroxide: Its Use in an Extensive Acute Wound to Promote Wound Granulation and Infection Control - Is it Better Than Normal Saline?

Background: Hydrogen peroxide (H2O2) is used as a topical antiseptic in contaminated wounds caused by road traffic accidents. It kills bacteria by producing oxidation through local, nascent, free oxygen radicals. It also removes dirt from the wound due to its frothing action. H2O2 is synthesized by various cells as an active biochemical agent that affects cell biological behavior through complex chemical reactions. H2O2 has also been used as a wound cleaning agent, removing debris, preventing infection, and causing hemostasis due to its exothermic reaction with blood. Despite its widespread use, there is scanty literature on its use to promote granulation tissue formation. Objective: In the orthopaedics literature, studies on H2O2 use are very limited and its potential is underestimated. In the present study, we would like to report our protocol of use of H2O2 for its tremendous potential for stimulating granulation and early wound healing. Material and Methods: A total of 53 patients with large acute extensive lower limb contaminated wounds reported to the emergency department have been included with and without lower limb fracture. In group A (43 patients) wound management was done using 7% H2O2 and group B (10 patients) was treated by only saline dressing as a control group. Results: In the present study, daily dressing by 7% H2O2 solution and provide solution gives excellent results compared to the Saline group. Granulation tissue appeared much earlier with a mean SD 6.3 ± 6.8 days in the hydrogen peroxide group as compared to the Saline group where granulation tissue appeared in 9.3 ± 8.4 days. Conclusion: Spontaneous wound healing is a controlled balance between destructive and healing processes. It is mandatory to remove damaged tissue to promote healing by secondary intention and minimize infection. The dynamic effect of H2O2 promotes faster healing, stimulates granulation, and minimizes infection by oxidative stress.

Both fumigation and heating of moxibustion promote wound healing and tissue repair in rats with full-thickness skin incision

To investigate the effect of moxibustion on wound healing, new capillaries and tissue repair in rats with full thickness skin excision. SD rats were randomly divided into control, moxa-fumigating and moxa-heating groups, with 24 rats in each group. The full-thickness skin excision injury model was replicated according to Balaji's and colleague's methods. Rats in the moxa-fumigating group received fumigation of moxa-smog at the wound surface (25 min/time) immediately after modeling through a smoke-heat separation device, and those of the moxa-heating group received conventional thermal stimulation of the ignited moxa over the wound (25 min/time) without moxa smog, once a day for 10 consecutive days. The wound color, pus, carrion, granulation, and healing status of the rats were observed. H.E. staining and Masson staining were used to observe the local tissues and collagen fibers of the wound on the 3rd and 7th days. Newly born capillaries at the wound surface were observed on the 10th day. Following modeling, the wound area of the moxa-fumigating group on the 1st and 7th day, and those of both moxa-fumigating and moxa-heating groups on the 3rd and 5th day were significantly reduced compared with the model group (P<0.001), and the wound area of the moxa-fumigating group was obviously smaller than that of the moxa-hea-ting group (P<0.01，P<0.001). On the 3rd and 7th day after modeling, the re-epithelialization rates were significantly increased (P<0.001), and the amounts of inflammatory cells were significantly reduced in both moxa-fumigating and moxa-heating groups (P<0.001). At the same time, the re-epithelialization rate of the moxa-fumigating group was higher than that of the moxa-heating group (P<0.05，P<0.001), and the inflammatory cell count of the moxa-fumigating group was lower than that of the moxa-hea-ting group (P<0.001). On the 10th day after the modeling, the number of new capillaries and capillary density in the wound basal layer were significantly increased in both moxa-fumigating and moxa-heating groups (P<0.05, P<0.001, P<0.01), and were notably higher in the moxa-fumigating group than in the moxa-heating group (P<0.01, P<0.05). Both fumigation and heating of moxibustion can promote wound healing in rats with full-thickness skin excision injury，which may be related to their effects in controlling the inflammatory response and promoting the production of collagen fibers, granulation tissue and capillaries.

Antimicrobial loaded gum odina - gelatin based biomimetic spongy scaffold for accelerated wound healing with complete cutaneous texture

The main objective of this study was to assess the therapeutic activity of gum odina and gelatin based biomimetic scaffold which was previously established as an excellent wound dressing material. In the accelerated stability study, the changes in physicochemical properties were found to be negligible. The cytotoxicity studies were carried out in-vitro and the results showed that upto 90% of the cells remained viable in presence of the scaffold, confirming its biocompatibility. Moreover, results depicted the superior ability of the scaffold to promote cutaneous healing by increasing the rate of wound contraction (about 98%), granulation formation, collagen deposition and formation of an intact epidermis within 18 days. A satisfactory amount of hydroxyproline (240.2 ± 6.67 μg/100 mg tissue) in scaffold treated groups at 21 days ensured the significant deposition of collagen to re-epithelialization. Further it can be hypothesized that the controlled levels of antioxidant enzymes (SOD, CAT) to diminish the oxidative stress in the wounded sites were due to the innate antioxidant properties of both blank and drug loaded scaffold. These results strongly indicated that the prepared scaffolds have strong potential for biomedical applications and it may serve as promising candidate for the next generation of wound treatment systems.

Sustained Release of Insulin-Like Growth Factor-1 from Bombyx mori L. Silk Fibroin Delivery for Diabetic Wound Therapy.

The goals of this study are to develop a high purity patented silk fibroin (SF) film and test its suitability to be used as a slow-release delivery for insulin-like growth factor-1 (IGF-1). The release rate of the SF film delivering IGF-1 followed zero-order kinetics as determined via the Ritger and Peppas equation. The release rate constant was identified as 0.11, 0.23, and 0.09% h−1 at 37 °C for SF films loaded with 0.65, 6.5, and 65 pmol IGF-1, respectively. More importantly, the IGF-1 activity was preserved for more than 30 days when complexed with the SF film. We show that the IGF-1-loaded SF films significantly accelerated wound healing in vitro (BALB/3T3) and in vivo (diabetic mice), compared with wounds treated with free IGF-1 and an IGF-1-loaded hydrocolloid dressing. This was evidenced by a six-fold increase in the granulation tissue area in the IGF-1-loaded SF film treatment group compared to that of the PBS control group. Western blotting analysis also demonstrated that IGF-1 receptor (IGF1R) phosphorylation in diabetic wounds increased more significantly in the IGF-1-loaded SF films group than in other experimental groups. Our results suggest that IGF-1 sustained release from SF films promotes wound healing through continuously activating the IGF1R pathway, leading to the enhancement of both wound re-epithelialization and granulation tissue formation in diabetic mice. Collectively, these data indicate that SF films have considerable potential to be used as a wound dressing material for long-term IGF-1 delivery for diabetic wound therapy.

Development of a Method for Clinical Evaluation of Artificial Intelligence–Based Digital Wound Assessment Tools

Accurate assessment of wound area and percentage of granulation tissue (PGT) are important for optimizing wound care and healing outcomes. Artificial intelligence (AI)-based wound assessment tools have the potential to improve the accuracy and consistency of wound area and PGT measurement, while improving efficiency of wound care workflows. To develop a quantitative and qualitative method to evaluate AI-based wound assessment tools compared with expert human assessments. This diagnostic study was performed across 2 independent wound centers using deidentified wound photographs collected for routine care (site 1, 110 photographs taken between May 1 and 31, 2018; site 2, 89 photographs taken between January 1 and December 31, 2019). Digital wound photographs of patients were selected chronologically from the electronic medical records from the general population of patients visiting the wound centers. For inclusion in the study, the complete wound edge and a ruler were required to be visible; circumferential ulcers were specifically excluded. Four wound specialists (2 per site) and an AI-based wound assessment service independently traced wound area and granulation tissue. The quantitative performance of AI tracings was evaluated by statistically comparing error measure distributions between test AI traces and reference human traces (AI vs human) with error distributions between independent traces by 2 humans (human vs human). Quantitative outcomes included statistically significant differences in error measures of false-negative area (FNA), false-positive area (FPA), and absolute relative error (ARE) between AI vs human and human vs human comparisons of wound area and granulation tissue tracings. Six masked attending physician reviewers (3 per site) viewed randomized area tracings for AI and human annotators and qualitatively assessed them. Qualitative outcomes included statistically significant difference in the absolute difference between AI-based PGT measurements and mean reviewer visual PGT estimates compared with PGT estimate variability measures (ie, range, standard deviation) across reviewers. A total of 199 photographs were selected for the study across both sites; mean (SD) patient age was 64 (18) years (range, 17-95 years) and 127 (63.8%) were women. The comparisons of AI vs human with human vs human for FPA and ARE were not statistically significant. AI vs human FNA was slightly elevated compared with human vs human FNA (median [IQR], 7.7% [2.7%-21.2%] vs 5.7% [1.6%-14.9%]; P < .001), indicating that AI traces tended to slightly underestimate the human reference wound boundaries compared with human test traces. Two of 6 reviewers had a statistically higher frequency in agreement that human tracings met the standard area definition, but overall agreement was moderate (352 yes responses of 583 total responses [60.4%] for AI and 793 yes responses of 1166 total responses [68.0%] for human tracings). AI PGT measurements fell in the typical range of variation in interreviewer visual PGT estimates; however, visual PGT estimates varied considerably (mean range, 34.8%; mean SD, 19.6%). This study provides a framework for evaluating AI-based digital wound assessment tools that can be extended to automated measurements of other wound features or adapted to evaluate other AI-based digital image diagnostic tools. As AI-based wound assessment tools become more common across wound care settings, it will be important to rigorously validate their performance in helping clinicians obtain accurate wound assessments to guide clinical care.

Adjunctive Hyperbaric Oxygen Therapy in Refractory Crohn's Disease: An Observational Study.

Background and Aims Patients may experience complications of Crohn's disease (CD) even when treated with optimal medical therapy strategies. Previous data have shown the efficacy of hyperbaric oxygen therapy (HBOT) in the management of complicated CD. However, there is no consensus regarding the optimal number of sessions or duration of treatment regimens. The aim of the present study was to investigate the efficacy of HBOT in CD patients who were refractory to conventional medical management. Methods This study included patients who underwent HBOT for the treatment of the following complications: perianal fistulizing Crohn's disease (pCD), enterocutaneous fistulas (ECF), or pyoderma gangrenosum (PG). Complete healing was defined as the closure of external orifice and the absence of active draining (in pCD), complete wound healing (in PG), and granulation or complete wound epithelialization with no enteric draining (in ECF). The persistence of draining and the absence of wound granulation were defined as incomplete healing. Results Forty patients were included. The mean CD duration was 10.6 ± 5.8 years. pCD comprised most of the included patients (25/62.5%), followed by ECF (n = 13/32.5%) and PG (n = 6/15%). In two patients (5%), a combination of ECF and PG was diagnosed, and in one patient (2.5%), all three complications were observed. A total of 32 patients (82.5%) had complete healing. Patients with PG had the highest healing rates (100%), followed by those with ECF (84.6%) and pCD (80%). Conclusions Adjunctive HBO was associated with significant healing rates for CD-associated complications such as pCD, ECF, and PG.

Parameter-Dependency of Low-Intensity Vibration for Wound Healing in Diabetic Mice.

Chronic wounds in diabetic patients represent an escalating health problem, leading to significant morbidity and mortality. Our group previously reported that whole body low-intensity vibration (LIV) can improve angiogenesis and wound healing in diabetic mice. The purpose of the current study was to determine whether effects of LIV on wound healing are frequency and/or amplitude dependent. Wound healing was assessed in diabetic (db/db) mice exposed to one of four LIV protocols with different combinations of two acceleration magnitudes (0.3 and 0.6 g) and two frequencies (45 and 90 Hz) or in non-vibration sham controls. The low acceleration, low frequency protocol (0.3 g and 45 Hz) was the only one that improved wound healing, increasing angiogenesis and granulation tissue formation, leading to accelerated re-epithelialization and wound closure. Other protocols had little to no impact on healing with some evidence that 0.6 g accelerations negatively affected wound closure. The 0.3 g, 45 Hz protocol also increased levels of insulin-like growth factor-1 and tended to increase levels of vascular endothelial growth factor in wounds, but had no effect on levels of basic fibroblast growth factor or platelet derived growth factor-bb, indicating that this LIV protocol induces specific growth factors during wound healing. Our findings demonstrate parameter-dependent effects of LIV for improving wound healing that can be exploited for future mechanistic and therapeutic studies.

RETRACTED: Healing potential of Spirulina platensis for skin wounds by modulating bFGF, VEGF, TGF-ß1 and α-SMA genes expression targeting angiogenesis and scar tissue formation in the rat model

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief. The journal was alerted to an associated PubPeer post in which suspected duplicated features were identified within Figure 4 B1, and the histological image in Figure 3 A1 appears to have been previously published in another article, as detailed here: https://pubpeer.com/publications/E5658B7B735FF993AA795A5F14C086. The journal performed independent analysis and identified additional suspected image duplications between the images of mice in Figure 1 A+B and images of mice in Figure 6 A+B from Elbialy et al., BMC Veterinary Research (2020). The journal requested the authors provide an explanation to these concerns and associated raw data, but this request was not satisfactorily fulfilled. The Editor-in-Chief assessed the case and decided to retract the article.

Reconstituting the dynamics of endothelial cells and fibroblasts in wound closure.

The formation of healthy vascularized granulation tissue is essential for rapid wound closure and the prevention of chronic wounds in humans, yet how endothelial cells and fibroblasts coordinate during this process has been difficult to study. Here, we have developed an in vitro system that reveals how human endothelial and stromal cells in a 3D matrix respond during wound healing and granulation tissue formation. By creating incisions in engineered cultures composed of human umbilical vein endothelial cells and human lung fibroblasts embedded within a 3D matrix, we observed that these tissues are able to close the wound within approximately 4 days. Live tracking of cells during wound closure revealed that the process is mediated primarily by fibroblasts. The fibroblasts migrate circumferentially around the wound edge during early phases of healing, while contracting the wound. The fibroblast-derived matrix is, then, deposited into the void, facilitating fibroblast migration toward the wound center and filling of the void. Interestingly, the endothelial cells remain at the periphery of the wound rather than actively sprouting into the healing region to restore the vascular network. This study captures the dynamics of endothelial and fibroblast-mediated closure of three-dimensional wounds, which results in the repopulation of the wound with the cell-derived extracellular matrix representative of early granulation tissue, thus presenting a model for future studies to investigate factors regulating vascularized granulation tissue formation.

Mechanical Negative Pressure Wound Therapy: Real-World Effectiveness in Challenging Patient Presentations

Introduction. When used for wound management, negative pressure wound therapy (NPWT) delivers subatmospheric pressure at the wound site, exerting multiple beneficial effects, including microstrain, macrostrain, edema management, granulation tissue formation, drainage management, and wound stabilization. Comparative effectiveness research has demonstrated similar wound healing and adverse event outcomes between traditional NPWT (tNPWT) and mechanical NPWT (mNPWT). Therefore, considerations for patient selection for mNPWT vs tNPWT are in alignment with current recommendations, including therapeutic goals, wound-related factors, patient satisfaction, quality of life, care setting, economic-related factors, and product design. Case Reports. The 3 complex patient cases in the present report describe the routine use of mNPWT between December 18, 2020, and June 7, 2021, at a community hospital-based outpatient wound center within an academic health system, including 2 dehisced surgical incisions and 1 complicated venous leg ulcer. All patients received local standard of care, including surgical debridement, soap and water cleansing of the wound and extremity, hypochlorous acid 5-minute soak prior to dressing application, non-sting skin barrier periwound protection, smoking cessation and nutrition counseling, and chronic disease management. Case selections for mNPWT included: the need for frequent activity at work, minimal wound depth, lack of undermining, exudate, wound size, wound location allowing for the wound to fit comfortably beneath the mNPWT dressing, need for graft stabilization, protection of the site from repeated trauma, need for granulation tissue formation, and periwound inflammation. Conclusions. Mechanical NPWT is a convenient therapeutic option that appears to deliver healing outcomes comparable to those of tNPWT but with improved wound-related quality of life. These cases reveal the real-world effectiveness of mNPWT in challenging patient presentations and wounds that have stalled. The cases outline common endpoints for using advanced therapy in addition to wound closure, such as granulation tissue formation and quality of life.

The Vacuum-Assisted System as A Treatment of Deep Sternal Wound Infections Following Cardiac Surgery. Cairo University Hospitals Experience

Background: The vacuum-assisted system in wound closure (VAC) is a new modality, which is recently used widely as a treatment of severely infected wounds. It is a noninvasive way that improves healing of severely infected wounds that fail to respond to conventional ways of treatment. This type of treatment depends on applying air tight controlled negative pressure suction directly to the infected wounds. The mechanism of action of this treatment depends on allowing the growth of healthy granulation tissues of the infected wounds. Objective: To evaluate the effect of vacuum assisted suction in treatment of deep sternal wound infection after cardiac surgery. Patients and Methods: In Cairo University Hospitals, in the period between January 2018 and January 2019, 17 patients (6 men, 11 women) with a median age of 62.5 years (range 50 to 75 years) underwent open heart surgery, which was complicated by sternal dehiscence and deep sternal wound infection. All those patients were subjected to the VAC system before any surgical intervention. Results: All patients involved in this study had complete wound healing without need of any major surgical intervention (muscle or omental flaps) even without wound debridement. The VAC system was applied for a mean of 21.5 days (range 15 to 28 days), VAC system was removed when the wound became completely clean with healthy granulation tissues. After removal of the VAC system, 9 patients (52.9%) were subjected to closure of the skin and subcutaneous tissues by interrupted stitches while the remaining 8 patients (47.1%) the wound was completely closed in all layers up to the skin. Duration of hospital stay varied from 22 to 45 days (median 33.5 days). There were no mortalities among all the patients who were involved in this study. Conclusion: The VAC system is a noninvasive, safe and very effective as a treatment for deep sternal wound infections following cardiac surgery.

50Years of Myofibroblasts: How the Myofibroblast Concept Evolved.

Myofibroblasts are key cells in mediating normal wound contraction and promoting connective tissue deformations characteristic of fibrosis and scarring. Five decades ago, myofibroblasts were discovered in electron micrographs of wound granulation tissue as fibroblastic cells containing microfilaments that are organized in bundles like those present in smooth muscle. The contractile function of myofibroblasts was demonstrated by measuring the contraction of strips of granulation tissue in response to smooth muscle agonists and in cell culture. Although formation of contractile bundles already defines the myofibroblast, neo-expression of α-smooth muscle actin (α-SMA) in fibroblastic cells has become the most widely used myofibroblast marker. Because α-SMA incorporation into stress fibers mediates enhanced fibroblast contraction, it has been proposed and successfully tested as a drug target in therapeutic approaches to reduce tissue contractures. Other anti-fibrosis strategies target growth factor-, extracellular matrix-, and mechanical stress-induced pathways of myofibroblast activation from various precursors or aim to induce myofibroblast apoptosis. To understand the involved mechanisms of myofibroblast formation and function, critical experimental tools and animal models have been developed, which are made available in this collection of protocols by experts in the field.

Clinical outcome and cost analysis of negative pressure wound therapy in extremity wounds: a comparison to conventional wound management

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Open fractures and traumatic wounds constitute a major health problem. Amongst the armamentarium of wound care products available, negative pressure wound therapy (NPWT) is a modality that has transformed wound care and has been recommended for treating all kinds of acute and chronic wounds.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective randomised comparative study was conducted at a tertiary care hospital in Northeast India. 30 patients were included in this study over a period of 24 months commencing from January 2018. The patients consisted of two groups of 15 each, the first group comprised patients who underwent treatment using NPWT and the second group was treated using standard wound therapy (SWT). The endpoint taken was a granulated wound or a wound ready for split skin grafting (SSG).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean wound size difference between the NPWT group and the SWT group on day nine was 13±7.17 mm and 4.53±0.99 mm, respectively. Likewise, on day nine, 11 (73.3%) patients in the group treated using NPWT had no positive bacterial cultures compared to 8(53.3%) patients on SWT. The estimated cost of materials for each NPWT dressing change was roughly INR₹ 3446 (US$ 45.57).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; NPWT is not a magic bullet and will not replace the basic methods of wound treatment such as wound debridement, infection control and ensuring adequate blood supply. Nevertheless, NPWT remains an integral part of the current scenario in wound care management and is cost effective under the condition that it accelerates wound healing when compared to traditional treatment.&lt;/p&gt;

Knockdown of Dual Oxidase 1 (DUOX1) Promotes Wound Healing by Regulating Reactive Oxygen Species (ROS) by Activation of Nuclear Kactor kappa B (NF-κB) Signaling.

BackgroundThe aim of this study was to evaluate the potential role of dual oxidase 1 (DUOX1) in wound healing.Material/MethodsPrimary fibroblasts were isolated from wound granulation tissue. Fibroblasts cell lines were established using DUOX1 overexpression and interference. Cell proliferation and reactive oxygen species (ROS) production were measured and compared among the groups.ResultsDUOX1 expression was highest in the slow-healing tissues (P<0.05). Knockdown of DUOX1 significantly increased cell proliferation and inhibited ROS production and cell apoptosis (P<0.01). Moreover, expression of malondialdehyde (MDA) was significantly reduced, while expression of superoxide dismutase (SOD) expression was significantly increased (P<0.01). In addition, DUOX1 silencing significantly upregulated collagen I, collagen III, and NF-κB protein levels in the cytoplasm, and inhibited the protein levels of P21, P16, and NF-κB in the nucleus (P<0.01). Overexpression of DUOX1 caused a reverse reaction mediated by knockdown of DUOX1. When DUOX1-overexpressing cells were treated with the ROS inhibitor N-acetyl-L-cysteine (NAC), the protein levels that were increased by DUOX1 overexpression were reversed.ConclusionsThese results suggest that knockdown of DUOX1 significantly benefits wound healing, likely by the regulation of oxidative stress via NF-κB pathway activation.

Unna boot efficacy in dermatologic diseases

To the Editor: The Paul Gerson Unna boot (UB) is a compressive semisolid gauze casting saturated with a mixture of zinc oxide, gum acacia, glycerol, castor oil, and deionized water.1 In the setting of stasis ulcers, UB compression results in wound granulation and reepithelization.2,3 Evidence supporting UB efficacy in other dermatologic conditions is scant.3,4 The purpose of this study is to review outcomes in 19 conditions treated with UB.

THE EFFECTIVENESS OF THE ELECTROMAGNETIC FIELD MATRIX TO THE WOUND HEALING PROCESS IN PARTIAL – THICKNESS BURNS

Burns are one of the most serious injuries, affecting around 11 million people a year worldwide. About 200/100000 inhabitants in Lithuania. Treatment is com­plex: the priorities of specialized facilities focus on sta­bilizing the patient, preventing infection, and optimizing functional recovery; and requires a lot of resources, both human and financial. Therefore, more and more effective treatments for burns are constantly being sought in order to accelerate the healing itself and thus reduce the du­ration of hospitalization. Number of recent reports sug­gests that EMF has a positive impact at different stages of healing. Processes impacted by EMF include, but are not limited to, cell migration and proliferation, expres­sion of growth factors, nitric oxide signaling, cytokine modulation, and more. Objectives and methods. The objective of this work was to study the effect of electromagnetic matrix on wound healing in burns. We evaluated medical records of 18 patients who underwent treatment in the department of plastic and reconstructive surgery from 2018.01.01 to 2019.12.30. All patients had IIA-IIB degree burns affec­ting less than 10% of the body surface and underwent the standard general treatment. They were divided into two groups: control group 55,6% (n=10) – treated only with the standard treatment and research group 44,4% (n=8) – to whom the EMF matrix were applied. Statistical data analysis was carried out using the SPSS 23.0 software. Results. Pain assessment, wound granulation area, and epithelialization were chosen to evaluate the burn healing process. These indicators were assessed on day 0-1; 3(±1) days and 7(±1) days after hospitalization. There was a statistically significant increase in wound granulation 5 days after the start of treatment in patients treated with the applicator (p = 0.019). Pain and epithelialization ra­tes between standard and applicator treatment methods did not differ statistically significantly over the treatment period. The partial nonparametric Spearman correlation coefficient, eliminating potentially influencing factors such as time after injury, the area of burn showed that the treatment method had a direct effect on the area of wound granulation (r = 0.625; p = 0.04). Conclusion. During the period from 2018.01.01 to 2019.12.31 patients had IIA-IIB degree burns affecting less than 10% of the body surface. 55,6 % of patients were treated only with the standard treatment and 44,4% with EMF matrix. The analysis showed that the average hospitalization time of the control group was 8.5 (0.898) days, while in the research group it was 7.88 (1.493) days, no statistically significant difference (p&gt;0.05). There was a statistically significant increase in wound granulation 5 days after the start of treatment in patients treated with the applicator (p = 0.019). Pain and epitheli­alization rates between standard and applicator treatment methods did not differ statistically significantly over the treatment period.

Histamine augments collagen content via H1 receptor stimulation in cultures of myofibroblasts taken from wound granulation tissue

The inflammatory reaction influences the deposition of collagen within wound granulation tissue. The aim of the present study is to determine whether histamine acting directly on myofibroblasts derived from wound granulation tissue may influence collagen deposition. It also identifies the histamine receptor involved in this process. The experiments were carried out on cells isolated from the granulation tissue of a wound model (a polypropylene net inserted subcutaneously to rats) or intact rat skin. Collagen content was measured following the addition of different concentrations of histamine and treatment with histamine receptor antagonists (ketotifen – H1 inhibitor, ranitidine – H2 inhibitor) and a histamine receptor H1 agonist (2-pyridylethylamine dihydrochloride).The cells were identified as myofibroblasts: alpha-smooth muscle actin, vimentin, and desmin positive in all experimental conditions. Histamine increased the collagen level within both cell cultures, i.e., those isolated from granulation tissue or intact skin. It did not, however, influence the expression of either the collagen type I or III genes within the cultured myofibroblasts. Histamine activity was reduced by ketotifen (the H1 receptor inhibitor) and increased by the H1 receptor agonist, as demonstrated by changes in the levels of collagen in the myofibroblast culture. Histamine increased collagen content within the cultures, acting directly on myofibroblasts via H1 receptor stimulation.

Antioxidant, Antimicrobial and Wound Healing Potential of Jatropha variegata - An Interesting Plant Endemic to Yemen.

Jatropha variegata is traditionally used in Yemeni folk medicine for antiseptic and hemostatic purposes. In this study, the methanolic extract of the plant leaves was evaluated for its antioxidant, antibacterial and wound healing activity. The antioxidant activity was assessed using 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging assay. The antibacterial activity against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa was tested using disc diffusion and broth microdilution assays. In vivo, the ability of the extract to accelerate wound healing in rats was evaluated using both wound area measurements and histological analyses. The leaves extract exhibited strong antioxidant activity with an IC50 value of 16.7 μg mL-1. The extract exhibited moderate antibacterial activity against S. aureus with inhibition zones of 10.6 mm, and the Minimum Inhibitory Concentration (MIC) value was 5 mg mL-1. The extract significantly accelerated the rate of wound healing closure compared to those treated with the vehicle. In addition, histopathological analyses of wound granulation tissues showed significantly better healing signs after 14 days in the extract-treated groups, with denser collagen deposition at the injury site. The leaves of J. variegata appear to contain bioactive compounds that may be utilized clinically in combating oxidative stress and in wound management.

Collagen extract obtained from Nile tilapia (Oreochromis niloticus L.) skin accelerates wound healing in rat model via up regulating VEGF, bFGF, and \u03b1-SMA genes expression

BackgroundCollagen is the most abundant structural protein in the mammalian connective tissue and represents approximately 30% of animal protein. The current study evaluated the potential capacity of collagen extract derived from Nile tilapia skin in improving the cutaneous wound healing in rats and investigated the underlying possible mechanisms. A rat model was used, and the experimental design included a control group (CG) and the tilapia collagen treated group (TCG). Full-thickness wounds were conducted on the back of all the rats under general anesthesia, then the tilapia collagen extract was applied topically on the wound area of TCG. Wound areas of the two experimental groups were measured on days 0, 3, 6, 9, 12, and 15 post-wounding. The stages of the wound granulation tissues were detected by histopathologic examination and the expression of vascular endothelial growth factor (VEGF), and transforming growth factor (TGF-ß1) were investigated using immunohistochemistry. Moreover, relative gene expression analysis of transforming growth factor-beta (TGF-ß1), basic fibroblast growth factor (bFGF), and alpha-smooth muscle actin (α-SMA) were quantified by real-time qPCR.ResultsThe histopathological assessment showed noticeable signs of skin healing in TCG compared to CG. Immunohistochemistry results revealed remarkable enhancement in the expression levels of VEGF and TGF-β1 in TCG. Furthermore, TCG exhibited marked upregulation in the VEGF, bFGF, and α-SMA genes expression. These findings suggested that the topical application of Nile tilapia collagen extract can promote the cutaneous wound healing process in rats, which could be attributed to its stimulating effect on recruiting and activating macrophages to produce chemotactic growth factors, fibroblast proliferation, and angiogenesis.ConclusionsThe collagen extract could, therefore, be a potential biomaterial for cutaneous wound healing therapeutics.

Randomized controlled trial on application of negative pressure materials of polyvinyl alcohol and polyurethane in full-thickness burn wounds after escharotomy

Randomized controlled trial on application of negative pressure materials of polyvinyl alcohol and polyurethane in full-thickness burn wounds after escharotomy