Prolonged Wound Healing Research Articles

Extension of the Human Fibrinogen Database with Detailed Clinical Information-The αC-Connector Segment.

Fibrinogen, an abundant plasma glycoprotein, is involved in the final stage of blood coagulation. Decreased fibrinogen levels, which may be caused by mutations, are manifested mainly in bleeding and thrombotic disorders. Clinically relevant mutations of fibrinogen are listed in the Human Fibrinogen Database. For the αC-connector (amino acids Aα240–410, nascent chain numbering), we have extended this database, with detailed descriptions of the clinical manifestations among members of reported families. This includes the specification of bleeding and thrombotic events and results of coagulation assays. Where available, the impact of a mutation on clotting and fibrinolysis is reported. The collected data show that the Human Fibrinogen Database reports considerably fewer missense and synonymous mutations than the general COSMIC and dbSNP databases. Homozygous nonsense or frameshift mutations in the αC-connector are responsible for most clinically relevant symptoms, while heterozygous mutations are often asymptomatic. Symptomatic subjects suffer from bleeding and, less frequently, from thrombotic events. Miscarriages within the first trimester and prolonged wound healing were reported in a few subjects. All mutations inducing thrombotic phenotypes are located at the identical positions within the consensus sequence of the tandem repeats.

Biomimetic immunomodulation strategies for effective tissue repair and restoration.

Inflammation plays a central role in wound healing following injury or disease and is mediated by a precise cascade of cellular and molecular events. Unresolved inflammatory processes lead to chronic inflammation and fibrosis, which can result in prolonged wound healing lasting months or years that hampers tissue function. Therapeutic interventions mediated by immunomodulatory drugs, cells, or biomaterials, are therefore most effective during the inflammatory phase of wound healing when a pro-regenerative environment is essential. In this review, we discuss the advantages of exploiting knowledge of the native tissue microenvironment to develop therapeutics capable of modulating the immune response and promoting functional tissue repair. In particular, we provide examples of the most recent biomimetic platforms proposed to accomplish this goal, with an emphasis on those able to induce macrophage polarization towards a pro-regenerative phenotype.

Postoperative morbidity differences between proximal and distal knee saphenous harvesting in coronary artery bypass graft surgery

Objectives. Coronary artery bypass grafting (CABG) is the most common procedure in cardiac surgery and the great saphenous vein (GSV) are the preferred conduits. The effects of saphenous vein incision (SVI) harvesting site choice on SVI wound complications, pretibial edema, and the need for compression stockings were evaluated retrospectively in patients undergoing CABG surgery. Materials and Methods. A total of 1900 patients operated for CABG between 2003 and 2021 in our clinic were included in this study, with GSV harvest performed at below-knee level (Group-A, n:841) and above-knee level (Group-B, n:1059). SVI was made 2 cm superior and 1 cm anterior to the medial malleolus in group-A; and 3 cm superior to medial epicondyle, extending to 3 cm inferior to the inguinal ligament in group-B. Examination for edema was made with 4-5 seconds of thumb pressure at the ankle level, then the depth of the pit was measured. Results. Ankle edema (Group-A n:132, Group-B n:25), the use of compression stockings (Group-A n:97, Group-B n:13), and paresthesia (Group-A n:51, Group-B n:10) were different between the two groups and the differences were statistically significant. However, prolonged wound healing (Group-A n:11, Group-B n:38), superficial wound infection (Group-A n:6, Group-B n:11), hematoma (Group-A n:4, Group-B n:9), and lymphorrhea (Group-A n:4, Group-B n:7) incidences were not statistically different between the two groups. Conclusions. Among patients with GSV extracted using the open conventional surgery technique, pretibial edema, paresthesia, and compression stocking use were observed less frequently in patients with preoperative doppler-ultrasonography evaluation and above-knee saphenous harvest.

Impact of radiotherapy on long-term treatment outcomes in patients with breast cancer who have undergone simultaneous one-stage and two-stage reconstructive surgeries. Literature review

The evolution in reconstructive breast surgery in the form of widespread use of implants allows you to abandon the “simple” mastectomy in most patients, provide faster rehabilitation and minimize the psychological trauma due to the absence of a breast. However, in most cases, radiation therapy and/or drug treatment are necessary, as they reduce the risk of relapse, disease progression and mortality. The combined or complex treatment increases the frequency of postoperative complications, such as prolonged wound healing, infection, protrusion/extrusion of the endoprosthesis, the development of capsular contracture, seroma, hematoma, etc. The greatest negative impact on the aesthetic result, both in the early and in the long-term period, is provided by remote radiation therapy. On the other hand, performing reconstructive plastic surgery may complicate radiation therapy. The issues of how long it is necessary to conduct radiation therapy, what type of reconstruction and how to conduct radiation therapy, how to minimize the frequency of complications without compromising the oncological and aesthetic results of treatment of breast cancer patients remain controversial.

Early Experience With a Novel Suture Device for Sternal Closure in Pediatric Cardiac Surgery

BackgroundSternal closure by absorbable suture material is an established method for chest closure in pediatric cardiac surgical procedures. However, the formation of granuloma around knotted suture material is frequently observed and has potential for prolonged wound healing and infection, particularly in newborns and infants. This retrospective study analyzed the suitability and reliability of a novel absorbable, self-locking, multianchor knotless suture with antibacterial technology for sternal closure in pediatric cardiac surgical procedures. MethodsThe applied material (STRATAFIX Symmetric PDS Plus, Ethicon) presents a polydioxanon (PD) suture with a self-locking, multianchor design that enables a sternal closure in a continuous knotless suture technique. All children undergoing knotless closure after standard median sternotomy were examined for the occurrence of sternal wound infection or sternal instability by applying the screening criteria of the Centers for Disease Control and Prevention at hospital discharge and at 30 and 60 days. ResultsThe new knotless sternal closure was used in 130 patients. Patients were a mean age of 19.0 ± 31.9 months (range, 0-142 months), and mean bodyweight was 7.8 ± 6.6 kg (range, 2.4-35 kg). Delayed sternal closure occurred in 23 patients, with a mean closure time after 2.9 ± 2.6 days. One superficial incisional sternal site infection occurred, but no cases of deep sternal site infection or sternal instability were observed. ConclusionsThe application of the absorbable, knotless suture technique provides excellent results regarding the rate of sternal wound infection and improved healing after median sternotomy in pediatric patients.

Comparison of the Keystone flap and the Limberg flap technique in the surgical treatment of pilonidal sinus disease.

Pilonidal sinus (PS) disease is a chronic inflammatory disease of the sacrococcygeal region. Although various methods have been described for surgical treatment, there is no consensus on the best surgical technique. The aim of this study was to present the results of a new advancement flap technique named the "Keystone flap (KSF)" and compared with the Limberg flap (LF) technique in pilonidal sinus surgery. A retrospective review was made of 124 consecutive patients surgically treated for PS disease with KSF and LF procedures. Baseline characteristics, operation time, volume of excised specimen, duration of hospitalization, duration of drainage, duration of healing, time to return to work, local complications and recurrence were evaluated and compared between the two procedures. Operation time, healing time, and time to return to work were significantly shorter in the KSF group. Partial wound dehiscense and prolonged wound healing were more common in the LF group. An additional intervention in the operating room was required by 21.1% of the LF group and was a significantly lower rate in the KSF group at 7.5%. There was no significant difference between the groups in terms of recurrence. The KSF procedure seems promising for treating pilonidal sinus disease, with the advantages of shorter operation, healing, and return to work times. It also provides lower partial wound dehiscence and necrosis rates.

An Integrated Smart Sensor Dressing for Real-Time Wound Microenvironment Monitoring and Promoting Angiogenesis and Wound Healing.

Prolonged chronic wound healing not only places great stress on patients but also increase the health care burden. Fortunately, the emergence of tissue-engineered dressings has provided a potential solution for these patients. Recently, the relationship between the wound microenvironment and wound healing has been gradually clarified. Therefore, the state of wounds can be roughly ascertained by monitoring the microenvironment in real time. Here, we designed a three-layer integrated smart dressing, including a biomimetic nanofibre membrane, microenvironment sensor and β-cyclodextrin-containing gelatine methacryloyl (GelMA + β-cd) UV-crosslinked hydrogel. The hydrogel helped increase the expression of vascular endothelial growth factor (VEGF) through hypoxia-inducible factor-1α (HIF-1α) to promote neovascularization and wound healing. The microenvironment sensor, combined with the biological dressings, exhibited satisfactory measurement accuracy, stability, durability and biocompatibility. A BLE4.0 antenna was used to receive, display and upload wound microenvironment data in real time. Such integrated smart dressings can not only achieve biological functions but also monitor changes in the wound microenvironment in real time. These dressings can overcome the challenge of not knowing the state of the wound during the healing process and provide support for clinical work.

Medication-Related Osteonecrosis of the Jaws Initiated by Zoledronic Acid and Potential Pathophysiology

The aim of this systematic review is to present an up-to-date review of available publications investigating the cellular mechanisms initiating the development of medication-related osteonecrosis of the jaw caused by zoledronic acid. Electronic searches of MEDLINE/PubMed and Scopus were conducted on the 3 June 2019. A total of 804 publications were identified, of which 11 met the inclusion criteria and were, therefore, included in this study. All the included studies were in vitro studies investigating various human cells. The current review found that zoledronic acid in various concentrations increased apoptosis and decreased migration and proliferation of epithelial cells, fibroblasts, osteoblasts, endothelial cells and dental pulp stem cells, which can affect local tissue homeostasis. The consequences of zoledronic acid were found to be both time- and dose-dependent. The pathophysiology of medication-related osteonecrosis of the jaw is likely a multifactorial process involving prolonged wound healing, chronic inflammation and altered bone remodelling following the administration of zoledronic acid. Further research is needed to identify the exact pathophysiology to optimise management and treatment.

Hyaluronic Acid-Based Scaffolds as Potential Bioactive Wound Dressings.

The negative factors that result in delayed and prolonged wound healing process include microbial pathogens, excess wound exudates, underlying conditions, smoking, obesity, etc. Most of the currently used wound dressings demonstrate an inadequate capacity to treat wounds resulting from the factors mentioned above. The commonly used wound dressings include hydrogels, films, hydrocolloids, foams, fibers, sponges, dermal patches, bandages, etc. These wound dressings can be loaded with various types of bioactive agents (e.g., antibiotics, nanoparticles, anti-inflammatory drugs, etc.) to improve their therapeutic outcomes. Biopolymers offer interesting properties suitable for the design of wound dressings. This review article will be based on hyaluronic-acid-based scaffolds loaded with therapeutic agents for the treatment of wounds.

Piezoelectric canalplasty for exostoses and osteoma

ObjectiveTo evaluate the safety profile and surgical technique for removal of symptomatic exostoses and osteoma of the external auditory canal with a micro-oscillating piezoelectric device. MethodA chart review was conducted on patients undergoing piezoelectric canalplasty between 2019 and 2021 at tertiary referral hospital. Surgery was performed by two surgeons with varying experience. Bone removal was achieved using both osteotomy and osteoplasty. Postoperative complications, operative time and hearing outcome were evaluated. ResultsThe study comprised 16 patients (16 ears). No major complications occurred. The skin of the auditory canal was completely preserved in all patients without injury to the tympanic membrane. Except for one patient with known noise-induced hearing loss, there was no postoperative deterioration of the bone-conduction threshold more than 10 dB HL at any frequency. The difference of the bone-conduction threshold in pure-tone audiometry (average for 0.5, 1, 2 and 4 kHz) three weeks postoperatively had a median of 0.6 dB ± 5.7. One patient complained of temporary new tinnitus. One patient had prolonged wound healing. Mean operative time was comparable with literature data. ConclusionThe atraumatic characteristics of the piezoelectric instrument enable low-risk removal of external auditory canal exostoses and osteoma. Through the combination of precise osteotomy and osteoplasty, this novel instrument has the potential to become established in routine canalplasty.

Impairment of corneal epithelial wound healing is association with increased neutrophil infiltration and reactive oxygen species activation in tenascin X-deficient mice

The purpose of the study was to uncover the role of tenascin X in modulation of healing in mouse corneas subjected to epithelium debridement. Healing in corneas with an epithelial defect was evaluated at the levels of gene and protein expression. Wound healing-related mediators and inflammatory cell infiltration were detected by histology, immunohistochemistry and real-time RT-PCR. Tenascin X protein was upregulated in the wounded wild-type (WT) corneal epithelium. The lack of tenascin X impaired closure of an epithelial defect and accelerated infiltration of neutrophils into the wound periphery as compared to the response in WT tissue. Expression of wound healing-related proinflammatory and reparative components, i.e., interleukin-6, transforming growth factor β, matrix metalloproteinases, were unaffected by the loss of tenascin X expression. Marked accumulation of malondialdehyde (a lipid peroxidation-derived product) was observed in KO healing epithelia as compared with its WT counterpart. Neutropenia induced by systemic administration of a specific antibody rescued the impairment of epithelial healing in KO corneas, with reduction of malondialdehyde levels in the epithelial cells. Finally, we showed that a chemical scavenging reactive oxygen species reversed the impairment of attenuation of epithelial repair with a reduction of tissue levels of malondialdehyde. In conclusion, loss of tenascin X prolonged corneal epithelial wound healing and increased neutrophilic inflammatory response to debridement in mice. Tenascin X contributes to the control of neutrophil infiltration needed to support the regenerative response to injury and prevent the oxidative stress mediators from rising to cytotoxic levels.

636 Factors associated with prolonged wound healing

636 Factors associated with prolonged wound healing

72 Parent Behavioral Responses to Children’s Itching following Unintentional Burns: Persevering Through Devastation. A Mixed-Methods Study

Abstract Introduction Postburn itch is one of the disturbing symptoms that persist throughout the burn wound healing period. Parents often assume the responsibility to respond to their child’s symptoms; consequently, their responses to their child’s symptoms contributed to the child’s symptom experience and long-term outcomes. To date, literature examining parental behaviors in response to symptoms has been limited to children with pain. This study examined parents’ behavioral responses to itching in young children with burns. Methods:: This analysis was part of a larger descriptive study that examined parental behavioral and psychological responses to children’s itch following the child’s unintentional burn injury. Parents of young children with deep second or third-degree burns were recruited. Semi-structured interviews were conducted with parents to learn about parental behavioral responses to the child’s itching. The Adult Responses to Children’s Symptoms (ARCS) scale was used to evaluate parental responses as part of the interview. The ARCS scale consists of 29 items that allow parents to self-report their responses to children’s itch. However, four items were excluded: three items were not appropriate to the study sample; one item related to sleep because children’s sleep pattern has been dramatically disturbed. We used the inductive content analysis that adapted from Grounded Theory to analyze the data. Results Twenty parents of children 34 (±11.5) months with moderate to severe burns 11.2% (±8.7%) total burn surface area (TBSA) participated in the interview. The mean length of time since burn injury was 6.4 (±3.1) months. Persevering through Devastation was the core construct that captured the lived experience of parental itching management. Parental behavioral responses to their child’s itch involved shifting their children’s attention, touching the scar, and tending to the itching scar. Data triangulation revealed that the ARCS scale captured parent behaviors in response to their child’s itch that was not reported in the interview. Conclusions Parents were devastated when they struggled on their own to relieve their child’s incessant itching during the prolonged wound healing stage. They cared for children with perseverance in the face of traumatic burn event; however, some parents responded to their child’s distress and call for comfort with anger or reactive behavior.

Predictors of post-operative outcomes in patients with peripheral arterial disease and critical limb ischaemia: a systematic review and meta-analysis.

A very small proportion (1%) of patients with peripheral artery disease (PAD) present with critical limb threatening ischaemia (CLTI) with poor prognosis. The present review showcased several pre-operative predictors and key post-operative outcomes. Identification of any modifiable predictors may impact positively on surgical outcomes. PubMed/Medline, Google scholar and Cochrane databases were searched using terms such as "peripheral arterial disease" AND "critical limb ischemia," "post-operative outcome," AND "predictors of post-operative outcomes". Search was for relevant English-language articles published between January 1997 and December 2007 Selected articles were screened first by title and abstract, and selection of full articles was based on relevance using our inclusion and exclusion criteria and quality ratings performed with the MINORS score. The included studies were published between 1997 and 2007. Only six (6) articles out of a total of 2,114 were deemed suitable for analysis. Ambulatory recovery was >70% at six months, 86.7% and 70.0% at one year and five years respectively. Rate of local wound complications was between 12% and 24%. Reported limb salvage rates were >90% at six months, >70% at one year and 70.0-90.0% at five years. Primary graft patency rate at one year ranged from 63% and 76.6%. Gangrene, diabetes and impaired pre-operative ambulatory function are associated with more wound complications, low limb salvage, reduced graft patency and poor functional outcome. Pre-operative ambulatory status was the most important predictor of post-operative ambulatory recovery. Diabetes mellitus was an important risk factor for prolonged wound healing, local wound complications and major amputation. None declared.

The Effect of Snakehead Fish (Channa striata) Extract on Inflammation Reaction of Skin Wound Tissue in Rattus novergicus Wistar Strain

Background: Snakehead fish has been associated with wound healing due to its high albumin content. Albumin can accelerate the inflammatory process so that tissue repair will be faster. Lack of albumin protein causes a person tend to experience prolonged wound healing. Purpose: This study aims to prove the effect of snakehead fish extract on the number of macrophages and blood vessels on the inflammatory reaction of skin wound tissue in rats. Methods: Laboratory experimental design with a total sample size of 27 male rats have undergone incisions, divided into 3 random groups: control group was given aquadest, treatment group 1was given aquadest and 50% extract of snakehead fish, and treatment group 2 was given 100% extract of snakehead fish. The rat’s skin wound tissues were taken on day 5 and observed under the microscope. The average number of macrophages and blood vessels on granulation tissue that formed at the base of the wound were counted and then performed data analysis. Result: In this study, we found a down wards trend in the average number of macrophages and blood vessels in treatment group 1 and treatment group 2. The control group and the treatment group 2 showed a significant difference, however, between the other groups did not show significant difference. Conclusion: There is a significant effect of giving 100% snakehead fish extract on decreased macrophages and blood vessels in the inflammatory reaction of skin wound tissue.

Tectonic Eccentric Penetrating Sclerokeratoplasty à chaud as Treatment for Peripheral Perforated or Predescemetal Corneal Ulceration.

Tectonic eccentric sclerokeratoplasty à chaud is a very complex corneal operation and aims to preserve the eyeball and possibly to improve visual acuity in patients with peripheral corneal ulcerations or perforating corneal trauma. 1650 eyes received corneal transplants in our clinic between 2006 and 2019. 14 of these 1650 eyes (0.8%) had a perforated or predescemetal peripheral corneal ulceration and these were treated between 2006 and 2019 with a tectonic eccentric sclerokeratoplasty à chaud. The mean age of the 8 women and 6 men included in this case series was 63years (22 - 91 years). In the postoperative follow-up period, most complications and reoperations occurred in the first 6 months. Re-ulceration was observed in 2 cases as well as early suture loosening in 12 patients. These 2 cases were treated with a partial conjunctival flap. Additionally, prolonged superficial wound healing process was shown in 12 patients. Therefore 27 amniotic membrane transplantations, 12 suture replacements, and 6 partial conjunctival flaps were performed in total. No re-keratoplasties were required in this case series. All eyes could be stabilised through the sclerokeratoplasty as well as subsequent operations and intensive local or even systemic treatment. After removal of the corneal suture, the best-corrected visual acuity improved only insignificantly to hand movement in 1 case, finger counting in 3 cases, 0.1 in 5 cases, 0.2 in 4 cases and 0.5 in 1 case. Preservation of the eyeball with pain relief was achieved in all 14 eyes. Eccentric sclerokeratoplasty is a very demanding surgical procedure and is extremely rarely performed. The goal is to preserve the eye.

Partial and Total Flap Failure after Fibula Free Flap in Head and Neck Reconstructive Surgery: Retrospective Analysis of 180 Flaps over 19 Years.

Simple SummaryMost data concerning fibula free flaps after cancer resection in the head and neck region are limited to small sample sizes and a short period of follow-up. This retrospective study aims to evaluate the flap success, failure, and complications at the recipient site in 180 cases over 19 years. The flap failure is classified as partial and total flap necrosis. A correlation between flap failure and patients’ medical status, age, sex, BMI, ASA-Score, planning type, and reconstruction time point was performed. Our findings help head and neck surgeons understand the factors that influence flap failure and assess risk factors. Our observations could optimize the treatment of cancer patients receiving a fibula free flap in the future.Fibula free flap (FFF) is widely used in head and neck reconstructive surgery and is considered as a standard and therapy of choice after ablative cancer surgery. The aim of this retrospective monocenter study was to determine the success rates of fibula free flaps for jaw reconstruction after ablative tumor surgery. The disease course of patients who underwent jaw reconstructive surgery with FFF from January 2002 to June 2020 was evaluated regarding the flap success rate. Flap failure was analyzed in detail and categorized into two groups: partial flap failure (PFF) and total flap failure (TFF). A total of 180 free fibular flaps were performed over the last 19 years and a total of 36 flap failures were recorded. TFF occurred in n = 20 (56.6%) and PFF in n = 16 cases (44.4%) cases. No statistically significant differences were found concerning patients’ age at flap transfer, sex, BMI, ASA-Score, preoperative non-virtual or virtual surgical planning (non-VSP vs. VSP), and time of reconstruction (immediately vs. delayed). Duration of hospitalization shows statistically significant differences between both groups (p = 0.038), but no differences concerning operating time and duration on Intensive Care Unit (ICU). Partial flap failure appears to be underreported in literature. Sub- and complete failure of the skin paddle leads to clinical complaints like uncovered bone segments and plate exposure. Partial or complete FFF failure lead to infections on the recipient site and prolonged wound healing and therefore may cause a delay of the beginning of adjuvant radiation therapy (RT). PFF of hard tissue can be induced by RT.

Complex Soft Tissue Defects in Operative Urology: Pedicled Perforator Flaps of the Anterior Lateral Thigh for Tissue Reconstruction of the Lower Trunk

Background: Complex soft tissue defects involving the lower abdomen, perineum, and groin (LAPG) represent reconstructive challenges following urologic surgery. Consequently, these often require an interdisciplinary approach involving plastic surgery. While pedicled flaps from the lower abdomen are a reliable option, previous placement of colostomies and urinary urostomies renders these flap types unavailable. Here, the pedicled anterolateral thigh perforator (ALT) flap represents a reliable pedicled alternative which can harvest from the thigh. Materials and Methods: A retrospective data analysis of pedicled perforator flaps harvested from the thigh to reconstruct soft tissue defects was conducted. Seven patients treated in the urology department with soft tissue defects following tumor resection, infection, and dehiscence were included. Results: In all patients, the ALT flap was utilized successfully to reconstruct soft tissue defects up to 450 cm² in size. All flaps survived. In 1 case, prolonged wound healing was observed. All defects were adequately addressed with no recurrence of dehiscence or fistula formation. Conclusions: Pedicled perforator flaps represent a valid option for the soft tissue reconstruction of the lower abdomen and perineum when a pedicled rectus abdominis flap is no longer available. This flap is, therefore, a good option in an interdisciplinary approach to soft tissue reconstruction, especially following urologic surgery, which is predominantly performed in the LAPG region.

Therapeutic potential of selected South African macrofungi in diabetic wound healing: An in vitro evaluation

Diabetic wounds frequently undergo impaired and prolonged wound healing due to cellular dysfunction. Treatment options, however, remain limited, non-specific, and generally unsuccessful. The potential of medicinal mushrooms in treating several diseases have been exploited by traditional folk medicines for centuries yet very little scientific evidence to support these practices exists. To explore natural products as potential therapeutics to treat diabetic wounds and encourage more research on this topic, this study sought out to screen the potential of four wild mushroom species (Pisolithus tinctorius, Russula capensis, Imleria badia and Pleurotus ostreatus) as suitable diabetic wound healing therapies. This was achieved using various in vitro models characteristic of the diabetic state including LPS and glycated gelatin to mimic bacterial infection and protein glycation, respectively. Activities screened include antioxidant (FRAP and DPPH), collagenase inhibition, immune modulatory capacity in RAW 264.7 macrophages (NO production, NO scavenging, COX-2, M1/M2 polarisation and phagocytosis) as well as MRHF fibroblast migration. In vitro toxicity screening revealed negligible toxicity for all of the tested aqueous and ethanolic extracts with a mildly cytostatic response recorded for P. tinctorius. P. tinctorius also demonstrated strong pro-inflammatory activity in RAW 264.7 macrophages (NO production and COX-2) however, in the presence of LPS the opposite effect was observed owing to strong NO scavenging capabilities while the pro-inflammatory nature of R. capensis aqueous extract was found to be due to the presence of bacterial endotoxins. Overall, different mushroom species presented divergent macrophage responses with the ethanol extract of R. capensis producing the most favourable effects with respect to established diabetic wounds due to its capacity to attenuate inflammation, promote macrophage transition from a pro-inflammatory to a wound healing phenotype, re-establish the phagocytic activity of macrophages and stimulate dermal fibroblast cell migration.

Alginate-gum acacia based sponges as potential wound dressings for exuding and bleeding wounds

The improper management of wound exudates can expose the wound to bacterial invasion, skin maceration etc. thereby resulting in prolonged wound healing. Biopolymers are characterized by hydrophilic functional groups which when employed for the development of wound dressings promote the wound dressings capability to absorb a high amount of wound exudates. Alginate-gum acacia sponges were prepared from a combination of biopolymers such as sodium alginate and gum acacia in varying amounts with carbopol via crosslinking with 1 and 2% CaCl2. The prepared sponges were loaded with a combination of ampicillin and norfloxacin. In vitro antibacterial analysis revealed that the antibacterial activity of the loaded antibiotics was retained and the sponges were effective against gram-positive and gram-negative bacteria. The sponges displayed rapid and high absorption capability in the range of 1022–2419% at pH 5.5 simulating wound exudates, and 2268–5042% at pH 7.4 simulating blood within a period of 1–3 h. Furthermore, the whole blood clotting studies further revealed low absorbance values when compared to the control revealing the good clotting capability of the sponges. The unique features of the sponges revealed their potential application for the management of infected, high exuding and bleeding wounds.