Local Treatment Of Chronic Wounds Research Articles

PROGRESS OF KNOWLEDGE IN THE DEVELOPMENT OF CHITOSAN FORMULATIONS WITH INSULIN TO PROMOTE SKIN WOUND HEALING

The treatment of difficult-to-heal wounds is a major problem in modern medicine. The search for new materials and ways to treat wounds is important and timely. Insulin stimulates proliferation, differentiation and migration of skin fibroblasts and keratinocytes. Chitosan has beneficial biological properties and can be an effective carrier of insulin. This review discusses research into the development of chitosan formulations with insulin to aid local treatment of chronic wounds. The PubMed, Google Scholar, Scopus and Web of Science databases were searched for studies on chitosan preparations with insulin in terms of their efficacy in wound healing. Twelve original English-language articles published in peer-reviewed scientific journals were included in the analysis. Insulin preparations in a chitosan matrix in the form of gel, hydrogel, injection and non-woven dressing are highly effective at all stages of the wound-healing process. They show anti-inflammatory and antimicrobial effects. Insulin from the formulations is released in a prolonged or controlled manner. However, it seems necessary to learn more about the mechanisms of insulin action within lesions. Of note, the data are mainly from basic and preclinical studies. Only one clinical study has been conducted.

Pain Assessment in Patients Undergoing Maggot Debridement Therapy in the Process of Local Treatment of Chronic Wounds

(1) Background: Developing and implementing strategies for local wound care focused on improving the quality of life related to health status and reducing treatment costs for this patient group poses a challenge to contemporary healthcare systems. The utilization of Maggot Debridement Therapy (MDT) is one potential form of local therapy for preparing wounds for the healing process. The debridement of the wound bed with medical maggots is highly precise, and the defensins produced by the larvae eliminate bacteria and stimulate tissue regeneration. However, the presence of larvae in the wound may lead to the occurrence of pain symptoms. The aim of the study was to assess the intensity of pain during larval therapy in patients with chronic wounds treated in outpatient settings. (2) Patients and Methods: The study employed a diagnostic survey and estimation; the tool consisted of a research protocol comprising three parts (questionnaires). Inclusion criteria for the study were voluntary consent to participate (completion of the MDT acceptance questionnaire), chronic wounds of vascular etiology or pressure injuries, full-thickness skin or deep tissue damage, and pain intensity not exceeding four on the NRS (Numerical Rating Scale: 0—no pain, 10—the most severe pain) at the time of the study. Patient observation during the 3-day treatment was conducted by a wound care clinic nurse, assessing pain intensity once every 24 h during the larval dressing changes. (3) Results: Out of 348 individuals who qualified for MDT during the study period, 215 individuals participated in the study: 94 women (43.7%) and 121 men (56.3%). The age of the participants ranged from 28 to 97 years (mean 69.87 ± 12.95). Each participant experienced mild pain (2.26 ± 1.60 on the NRS) on the day of qualification for the study. An increase in pain intensity, according to subjective assessments, was reported by 29.3% of participants (n = 63). On the third day of MDT therapy, an increase in pain intensity was observed, reaching a mean value of 4.79 ± 2.12 (p < 0.0001). Participants with pressure injuries showed the lowest pain intensity, which increased in consecutive days for all types of wounds. Additionally, the increase in pain intensity in patients with vascular etiology wounds was greater compared to patients with pressure injuries (p < 0.001). (4) Conclusions: Local wound therapy with Lucilia sericata larvae increases pain intensity in the consecutive days of treatment. The wound area and the time since its occurrence may determine pain symptoms.

Local personalised treatment of long-term non-healing wounds

Introduction. A significant number of nosologies can result in long-term non-healing wounds that mostly have similar principles of local treatment. However, positive clinical outcomes are not always obtained in the management of such wounds. The authors have developed a personalized technology for local treatment of chronic wounds depending on their etiology. Aim. Was to investigate the effectiveness of the proposed methods and personalized approaches for local treatment of long-term nonhealing wounds. Materials and methods. Innovative methods of cleaning and stimulating regeneration of non-healing wounds have been developed in the study; their effectiveness was tested in 3 blocks of the study. The first block of the study included patients with long-term non-healing wounds of venous etiology, the second and third blocks included patients with long-term non-healing arterial and neurotrophic wounds, respectively. Each block involved two series of tests studying the developed methods of cryodestruction and stimulation of regeneration, respectively. In the 1st block, the 3rd series of tests was additionally conducted; it included patients with wounds larger than 20 cm2 in size. Results. The developed methods of cryodestruction accelerate the course of phase I of the wound process by 12% in patients with longterm non-healing wounds of venous etiology, by 27% in patients with critical ischemia of the lower extremities, by 70% in patients with neurotrophic etiology (p ≥ 0.05). The use of the proposed methods of stimulating regeneration significantly reduced the average area of wounds in the study blocks. The main components of treatment stimulating regeneration in long-term non-healing wounds have been identified considering wound etiology. Conclusion. The use of the developed algorithm for local personalized treatment of long-term non-healing wounds considering underlying disorders contributes to an earlier cleaning of the wound surface, elimination of inflammation and an increased activity of regeneration processes when compared with conventional approaches.

The use of histoequivalent-bioplastic material for chronic foot ulcers on patients with diabetes

The main goal of this study was to improve the results of therapy in patients with chronic wounds on the foot in diabetics (I-II degree according to Wagner's classification) using histoequivalent bioplastic material «G-derm».Materials and methods. The study included 72 patients. The comparison group included 35 patients who underwent standard treatment with hydrocolloid dressings. The main group consisted of 37 patients. For them, in addition to standard treatment, the histoequivalent-bioplastic material «G-derm» was used. The patients' condition was assessed in dynamics on the 1st, 10th, 30th days from the start of treatment.Results. By the 30th day, the complete epithelialization was registered in 12 (16.7%) patients. The main group included 8 (21.6%) cases, and the control group – 4 (11.4%). The unsatisfactory epithelialization (healing less than a quarter of the initial area) by the 30th day of treatment was in 14 (19.4%) patients: in the main group – in 4 (10.9%) patients, in the comparison group – in 10 (28.5%) of patients. The remaining 25 (67.6%) patients in the main group and 21 (60%) participants in the comparison group had satisfactory epithelialization results by the 30th day of treatment.Conclusion. The results of this study show the effectiveness of using histoequivalent bioplastic material G-derm in local treatment of chronic wounds in patients with neuropathic diabetes in combination with standard therapies.The use of histoequivalent-bioplastic material in patients with diabetes leads to faster regeneration of the wound as well as increases the cases of complete epithelialization.

Clinical evaluation of polyabsorbent TLC-NOSF dressings on chronic wounds: a prospective, observational, multicentre study of 1140 patients.

The superior wound healing properties and cost-effectiveness of TLC-NOSF dressings in the local treatment of chronic wounds have already been demonstrated by several randomised controlled trials (RCTs) at a high quality level. Therefore, this study aimed to evaluate the efficacy and safety of new TLC-NOSF dressings with polyabsorbent fibres in an unselected population of patients under real-life conditions. A large, prospective, multicentre, observational study with two polyabsorbent TLC-NOSF dressings (UrgoStart Plus Pad and UrgoStart Plus Border, Laboratoires Urgo, France) was conducted in Germany between July 2017 and December 2018. Main outcomes included wound healing rate, clinical assessment of wound healing progression, local tolerability and acceptance of dressings. A total of 1140 patients with chronic wounds of various aetiologies (leg ulcers, diabetic foot ulcers, pressure ulcers, etc.) were treated with the investigated dressings in 130 centres, for a mean duration of 56±34 days. By the final visit, 48.5% of wounds had healed and 44.8% had improved. Similar results were reported regardless of wound aetiology or regardless of proportions of sloughy and granulation tissue at the start of treatment. According to the subgroup analysis by wound duration, the sooner the TLC-NOSF treatment was initiated, the better the clinical outcomes for all types of wounds. The dressings were very well tolerated and accepted by the patients. These results are consistent with those from RCTs conducted on TLC-NOSF dressings. They complete the evidence on the good healing properties and safety profile of these dressings, especially in non-selected patients treated in current practice, and regardless of the characteristics of wounds and patients. They support the use of the dressings as a first-line intervention and until wound healing in the management of chronic wounds, in association with appropriate standard of care.

Glucocorticoid-loaded liposomes induce a pro-resolution phenotype in human primary macrophages to support chronic wound healing

Glucocorticoids are well established anti-inflammatory agents, however, their use to treat chronic inflammatory diseases is limited due to a number of serious side effects. For example, long-term local treatment of chronic wounds with glucocorticoids is prohibited by dysregulation of keratinocyte and fibroblast function, leading to skin thinning. Here, we developed and tested liposome formulations for local delivery of dexamethasone to primary human macrophages, to drive an anti-inflammatory/pro-resolution phenotype appropriate for tissue repair. The liposomes were loaded with the pro-drug dexamethasone-phosphate and surface-modified with either polyethylene glycol or phosphatidylserine. The latter was used to mimic phosphatidylserine-harboring apoptotic cells, which are substrates for efferocytosis, an essential pro-resolution function. Both formulations induced a dexamethasone-like gene expression signature in macrophages, decreased IL6 and TNFα release, increased secretion of thrombospondin 1 and increased efferocytosis activity. Phosphatidylserine-modified liposomes exhibited a faster uptake, a higher potency and a more robust phenotype induction than polyethylene glycol-modified liposomes. Fibroblast and keratinocyte cell cultures as well as a 3D skin equivalent model showed that liposomes applied locally to wounds are preferentially phagocytosed by macrophages. These findings indicate that liposomes, in particular upon shell modification with phosphatidylserine, promote dexamethasone delivery to macrophages and induce a phenotype suitable to support chronic wound healing.

Local treatment of chronic wounds

Lokaltherapie chronischer Wunden Phlebologie 2016; 45: 106–112 http://dx.doi.org/10.12687/phleb2297-2-2016 Received: November 29, 2015 Accepted: December 07 ,2016 A wide range of modern wound dressings are available in Germany today and it is difficult to keep track of them because new products are continuously appearing on the market. This article summarises the various options for the treatment of chronic wounds, based on problems of relevance to everyday practice. The use of modern dressings appropriate to the stage of the wound can really only be based on empirical observations, because comparative studies are lacking. This article therefore makes no claim to be an exhaustive review. Before deciding on the most suitable wound dressing, the cause of the wound must always be established first and appropriate causal treatment instituted (e.g. compression therapy for venous leg ulcers, revascularisation for arterial leg ulcers or immunosuppression in the case of pyoderma gangrenosum). When prescribing wound dressings, the sometimes considerable costs must generally be taken into account. In addition, they must be easy to apply and remove completely, must offer mechanical protection, absorb wound secretion in a reliable manner and be permeable to carbon dioxide, oxygen and water vapour. Further requirements on wound dressings include thermal insulation and the prevention of dehydration (principle of moist wound treatment). They should be made from hypoallergenic, non-toxic materials and be sterile-packed. (1) Dressing appropriate for phase of wound healing

Poly(vinyl alcohol)-hyaluronic Acid Membranes for Wound Dressing Applications: Synthesis andin vitroBio-Evaluations

Physically crosslinked poly(vinyl alcohol)-hyaluronic acid (PVA-HA) hydrogel membranes composed of different amounts of HA were prepared by freeze-thawing (F-T) method. F-T cycle was repeated for three consecutive cycles. HA was chosen and routinely utilized in the local treatment of chronic wounds, because of its advantages as, HA is endogenous and biodegradable polymer. Physicochemical properties of PVA-HA membranes such as, gel fraction (GF), swelling, mechanical properties, hydrolytic degradation and in vitro bio-evaluation tests were investigated. Results revealed that introducing HA into PVA structure affected significantly the physicochemical properties of membranes than the pristine PVA, because of its crosslinking interaction with PVA. With the increase of HA content in PVA hydrogel membranes, GF and mechanical stability of PVA-HA membranes decreased. However, the swelling behavior, mechanical flexibility, protein adsorption and hydrolytic degradation of PVA membrane increased. The HA content < 20% in PVA hydrogels showed high cell viability (%) and no toxicity was observed using microculture tetrazolium assay (MTT-assay). However, less cell viability was determined with high HA incorporation. PVA-HA-ampicillin free showed antimicrobial activity against Candida albicans as a result of HA presence. Thus, ampicillin-loaded wound dressing with PVA-HA membranes could be used as promising materials with easy forming and biologically evaluated for wound care.

Local Treatment of Chronic Wounds. In Patients With Peripheral Vascular Disease, Chronic Venous Insufficiency, and Diabetes

A chronic wound is defined as an area where the skin is not intact that fails to heal within eight weeks. Such wounds usually develop on the lower limbs as a complication of diabetes, venous insufficiency, or inadequate arterial perfusion. Most of the roughly 45,000 limb amputations performed in Germany each year are necessitated by non-healing chronic wounds. In the development of this S3 guideline, a systematic search was performed that yielded 4998 references including 38 randomized, controlled trials and 26 systematic reviews, which were used as the basis for the recommendations and statements made in the guideline. Twelve member societies of the umbrella Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF), as well as the German Association of Nursing Science (Deutsche Gesellschaft für Pflegewissenschaft, and patient representatives participated in the consensus rounds in which the guideline's recommendations and statements were agreed upon. This guideline contains seven evidence-based recommendations and 30 good clinical practice (GCP) recommendations. Evidence-based recommendations are given in favor of hydrogel, hyperbaric oxygenation, and integrated care, and against the use of medicinal honey and growth factors. Terms are defined precisely in order to ease communication and to specify what is meant by "wound debridement" (a procedure performed by a physician) as opposed to cleansing a wound. Under the premise of preventing pain, exudation, and maceration, local therapeutic agents can be chosen on the basis of the scientific evidence, the patient's preference, the physician's experience, and the wound situation. Costs should also be considered. Scant evidence is available to answer many of the relevant questions about chronic wounds. There are valid data in support of hyperbaric oxygen and integrated care. More research is needed.

Efficacy and safety of a gauze pad containing hyaluronic acid in treatment of leg ulcers of venous or mixed origin: a double‐blind, randomised, controlled trial

Topical hyaluronic acid (HA) is routinely used in the local treatment of chronic wounds, but few data have been reported to date. A 60-day double-blind, randomised, controlled superiority trial was designed to investigate the efficacy and safety of a gauze pad containing HA in local treatment of venous leg ulcers, compared with its neutral vehicle. The primary endpoint was the percentage of wound size reduction after 45 days. Totally 89 patients were included. At day 45, the percentage of ulcer surface reduction was significantly greater in the HA group (73 ± 4·6%) versus neutral vehicle group (46 ± 9·6%) (P = 0·011). The number of healed ulcers was significantly higher in the HA group at day 45 (31·1% versus 9·3% respectively) and day 60 (37·8% versus 16·3% respectively; P < 0·05). At day 30, pain intensity based on visual analogue scale was significantly lower in the HA group (12·4 mm ± 2·6 versus 22·8 mm ± 3·8; P = 0·026). Tolerance of both treatments was comparable in the two groups. HA gauze pad, in local treatment of venous leg ulcers, was significantly more effective than the neutral vehicle on wound size reduction, healed ulcers rate and pain management with a good safety profile.

The use of dressing materials based on the lipid-colloid technology for the local treatment of diabetic foot syndrome

Aim. Clinical assessment of the use of dressing materials based on the lipid-colloid technology for the local treatment of diabetic foot syndrome (DFS). Materials and methods. The study included 24 patients with DM1 and DM2 and neuropathic or neuroischemic forms of DFS in the absence of pronounced leg ischemia (ankle-brachial index &gt;0.7). Duration of the observation period was 8 weeks, the patients were examined once in 2 weeks. The dressing materials used in the study were based on the Cellosorb NA, Cellosorb Ag, Urgotul S Ag. technology (Laboratories Urgo). Efficacy and safety of the dressing materials were estimated from the wound size, degree of exudation, characteristics of the wound bed and the surrounding tissues. The data obtained were treated using Statistica v. 7.0 software (StatSoft Inc.). Results. Efficacy of local therapy was assessed based on the Pressure Ulcer Scale of Healing (PUSH). Neither local nor systemic adverse events related to the use of the above dressing materials were registered during the follow-up. Cellosorb NA and Cellosrb Ag hydrocellular dressings showed high absorption activity and atraumatic properties. Most patients especially those using Cellosorb Ag were free from local infection. Conclusion. Dressing materials based on the lipid-colloid technology are safe and meet all requirements for the means of local treatment of chronic wounds.