Wound Protection Research Articles

Gelatine methacrylamide-based multifunctional bilayer hydrogels for accelerating diabetic wound repair

Diabetic wounds are a common disease that plague many doctors in the clinic. Diabetic wounds are caused by increased blood sugar levels, which leads to microvascular disease and skin dystrophy. Additionally, their occurrence can be accompanied by inflammation and a variety of bacterial infections. Diabetic wounds are complex; therefore, achieving good results after a single treatment modality is often difficult. In this study, we used materials science engineering methods to integrate several factors required for diabetic wound treatment, which resulted in the development of a bilayer hydrogel. First, the upper layer of the hydrogel inhibits bacterial growth and promotes wound closing, which solves the problems of wound infection and protection. Additionally, the lower layer of the hydrogel has a porous structure, which promotes the adhesion and growth of wound healing-related cells. Moreover, the lower layer of the hydrogel can release cytokines that promote vascular endothelial cell and fibroblast migration and stimulate skin tissue regeneration. We evaluated the ability of this double-layer hydrogel to heal diabetic wounds in vivo and in vitro and found that it offered protection while promoting healing. We also determined that a combination of multiple factors can provide better reparative effects to treat chronic diabetic wounds.

Biocontrol Activity of Trichoderma Species Isolated from Grapevines in British Columbia against Botryosphaeria Dieback Fungal Pathogens.

Botryosphaeria dieback (BD) is a grapevine trunk disease (GTD) causing significant yield losses and limiting the lifespan of vineyards worldwide. Fungi responsible for BD infect grapevines primarily through pruning wounds, and thus pruning wound protection, using either synthetic chemicals or biological control agents (BCAs), is the main available management strategy. However, no products to control GTDs are currently registered in Canada. With a focus on more sustainable grapevine production, there is an increasing demand for alternatives to chemical products to manage GTDs. Accordingly, the objective of this study was to identify Trichoderma species from grapevines in British Columbia (BC) and evaluate their potential biocontrol activity against BD fungi Diplodia seriata and Neofusicoccum parvum. Phylogenetic analyses identified seven species, including T. asperelloides, T. atroviride, T. harzianum, T. koningii, T. tomentosum, and two novel species, T. canadense and T. viticola. In vitro dual culture antagonistic assays showed several isolates to inhibit fungal pathogen mycelial growth by up to 75%. In planta detached cane assays under controlled greenhouse conditions identified T. asperelloides, T. atroviride and T. canadense isolates from BC as providing 70% to 100% pruning wound protection against BD fungi for up to 21 days after treatment. In addition, these isolates were shown to provide similar or better control when compared against commercial chemical and biocontrol products. This study demonstrates the potential that locally sourced Trichoderma species can have for pruning wound protection against BD fungi, and further supports the evaluation of these isolates under natural field conditions.

Kill&Repel Coatings: The Marriage of Antifouling and Bactericidal Properties to Mitigate and Treat Wound Infections (Adv. Funct. Mater. 9/2022)

Wound Dressings In article number 2106656, Ulrich Schwaneberg, Cesar Rodriguez-Emmenegger, and co-workers present a novel antimicrobial coating for wound dressings, termed the Kill&Repel strategy. The bactericidal action of the coating, synergistically combined with antifouling properties and biocompatibility, enables wound protection and treatment against bacterial pathogens, far superior to that of commercial dressings. Moreover, the Kill&Repel coating is readily applicable without any strenuous procedures, holding promise for clinical application.

Efficacy of Ring Drape and Unused Sterile Instruments for Incisional SSI After Hepatectomy.

The aim of this study was to verify the efficacy of wound protection with a plastic ring wound protector (ring drape) and using new sterile instruments when closing the abdominal wall (wound closure set), both of which were used to prevent incisional surgical site infection (SSI) after hepatectomy. The incidence of incisional SSIs and the clinical courses of 572 patients who underwent hepatectomy between January 2010 and December 2015 were studied retrospectively. The patients were divided into three period groups according to the period when each infection countermeasure was started. Incisional SSI incidence decreased significantly with additional countermeasures: 1st period 10.1%; 2nd period 2.08% (p=0.0114); 3rd period, 1.63% (1st vs. 3rd period, p=0.0016). A multivariate analysis showed that postoperative bile leakage [odds ratio (OR)=4.12, p=0.012] and not using a ring drape (OR=0.176, p=0.003) were independent factors for incisional SSI. Incisional SSI incidence was significantly reduced by using ring drape after hepatectomy.

Evaluation of Biological and Chemical Pruning Wound Protectants to Control Grapevine Trunk Disease Pathogens Eutypa lata and Neofusicoccum parvum

Grapevine trunk diseases, caused by many different fungal pathogens, are among the most economically important diseases affecting the grapevine industry worldwide. Pruning wounds are the main point of entry for these fungal pathogens and, thus, disease control is focused on preventative pruning wound protection by chemical products or biological control agents (BCAs). In this study, we evaluated a broad variety of chemical products and BCAs already registered or at the experimental stage in greenhouse and in field trials for the protection of table- and wine-grape vines against infection by Eutypa lata and Neofusicoccum parvum, major pathogens responsible for Eutypa and Botryosphaeria dieback, respectively. Our study showed that Trichoderma asperellum and T. gamsii consistently provided pruning wound protection in greenhouse and field trials, with a mean percent disease control (MPDC) of 88 and 100% for E. lata and N. parvum, respectively, when compared with the water-treated inoculated positive control (P < 0.05). The chemical protectants thiophanate-methyl + myclobutanil, fluopyram, and trifloxystrobin were also able to effectively protect wounds, with a MPDC of up to 86% when compared with the water-treated inoculated positive control (P < 0.05). When biological treatments were evaluated for recovery from treated canes at the end of the growing season, Trichoderma-based treatments had a rate of recovery between 0 and 100%, Aureobasidium-based treatments had a recovery rate between 25 and 100%, and Bacillus-based treatments had a recovery rate between 0 and 25%.

Biological and chemical pruning wound protectants reduce infection of grapevine trunk disease pathogens

Grapevine trunk diseases (GTDs) are currently considered some of the most important challenges for viticulture, curtailing vineyard longevity and productivity in nearly every raisin, table and wine grape production region in California and worldwide. Pruning wounds provide the main entry point for fungal pathogens responsible for these diseases; pathogens enter the wounds following precipitation events. The aim of this study was to evaluate the efficacy of selected chemical and experimental biological fungicides for protection of pruning wounds against two of the most common and virulent fungal pathogens causing GTDs:Eutypa lataandNeofusicoccum parvum. This study was conducted on sauvignon blanc at the UC Davis Department of Plant Pathology Field Station. Results showed that several chemical and biological fungicides, notably the chemical fungicide Luna Sensation, the biofungicide Vintec and a combination of the biofungicides Bio-Tam and CrabLife Powder, provided significant protection against at least one of the two canker pathogens used in this study. However, the majority of products tested did not provide simultaneous control of bothE. lataandN. parvumpathogens, highlighting the continuing challenge of controlling GTDs.

In vitro evaluation of grapevine endophytes, epiphytes and sap micro-organisms for potential use to control grapevine trunk disease pathogens

Grapevine trunk diseases (GTDs) threaten the economic sustainability of viticulture, causing reductions of yield and quality of grapes. Biological control is a promising sustainable alternative to cultural and chemical methods to mitigate the effects of pathogens causing GTDs, including Botryosphaeria dieback, Eutypa dieback and Esca. This study aimed to identify naturally occurring potential biological control agents from grapevine sap, cane and pith tissues, and evaluate their in vitro antagonistic activity against selected fungal GTD pathogens. Bacterial and fungal isolates were preliminarily screened in dual culture assays to determine their antifungal activity against Neofusicoccum parvum and Eutypa lata. Among the fungal isolates, Trichoderma spp. inhibited mycelium growth of E. lata by up to 64% and of N. parvum by up to 73%, with overgrowth and growth cessation being the likely antagonistic mechanisms. Among the bacterial isolates, Bacillus spp. inhibited mycelium growth of E. lata by up to 20% and of N. parvum by up to 40%. Selected antagonistic isolates of Trichoderma, Bacillus and Aureobasidium spp. were subjected to further dual culture antifungal analyses against Diplodia seriata and Diaporthe ampelina, with Trichoderma isolates consistently causing the greatest inhibition. Volatile organic compound antifungal analyses showed that these Trichoderma isolates inhibited mycelium growth of N. parvum (20% inhibition), E. lata (61% inhibition) and Dia. ampelina (71% inhibition). Multilocus sequence analyses revealed that the Trichoderma isolates were most closely related to Trichoderma asperellum and Trichoderma hamatum. This study had identified grapevine sap as a novel source of potential biological control agents for control of GTDs. Further testing will be necessary to fully characterize modes of antagonism of these microorganisms, and assess their efficacy for pruning wound protection in planta.

Smart band-aid: Multifunctional and wearable electronic device for self-powered motion monitoring and human-machine interaction

Integrating multifunctionality into wearable electronics is becoming a tendency to meet the complexity of daily practical applications in the monitoring of human health and exercise. However, the types of multifunctional electronic devices are limited and the fabrication of the devices is usually complicated. Herein, we develop an electronic smart band-aid, which endows traditional band-aid new functionalities, by simply coating the traditional band-aid with silver nanowire network and polytetrafluoroethylene/polydimethylsiloxane mixture. The fabricated smart band-aid exhibits excellent triboelectric performances (VOC = 380 V, ISC = 23 μA, and power density = 1.13 W m−2) and high strain sensing performances (working strain range of ∼110%, and sensitivity as high as 7.71). It can be used not only for wound protection but also for self-powered sensing of movements and human-machine interaction. Our work provides a cheap, convenient, and effective approach for multifunctional sensing applications in the field of wearable and flexible electronics.

Application of functional materials to promote cutaneous wound healing

Cutaneous wound is one of the common clinical diseases. Functional materials can provide targeted wound protection and promote wound healing through the structural adjustment and functional integration. Currently, functional materials have been widely used in the field of wound repair, becoming one of the important tools for clinical wound treatment. This paper summarizes the application of functional materials of following categories including hemostasis, antibacterial, anti-inflammation, vascularization, and regulation of wound microenvironment in wound repair.

Combining an HA + Cu (II) Site-Targeted Copper-Based Product with a Pruning Wound Protection Program to Prevent Infection with Lasiodiplodia spp. in Grapevine.

The genus Lasiodiplodia has been reported from several grape growing regions and is considered as one of the fastest wood colonizers, causing Botryosphaeria dieback. The aim of this study was to (i) evaluate the efficacy of Esquive®, a biocontrol agent, on vineyard pruning wound protection, applied single or, in a combined protection strategy with a new site-targeted copper-based treatment (LC2017), and (ii) compare their efficacy with chemical protection provided by the commercially available product, Tessior®. For two seasons, protectants were applied onto pruning wounds, while LC2017 was applied throughout the season according to the manufacturer’s instructions. Pruning wounds of two different cultivars were inoculated with three isolates of Lasiodiplodia spp. Efficacy of the wound protectants, varied between both years of the assay and according to the cultivar studied but were able to control the pathogen to some extent. The application of LC2017 did not show clear evidence of improving the control obtained by the sole application of the other products tested. Nevertheless, LC2017 showed a fungistatic effect against Lasiodiplodia spp., in vitro, and has previously shown an elicitor effect against grapevine trunk diseases. Therefore, this combination of two protection strategies may constitute a promising long-term approach to mitigate the impact of Botryosphaeria dieback.

Undressing the choice of dressings.

There is a vast number of wound dressings to choose from, which can make selecting the most suitable dressing for a wound a daunting prospect. This article highlights how the wound can guide the doctor's decision. Although all wound dressings are intended to achieve optimal wound healing and protection from contamination, they do so to varying degrees depending on the qualities of the dressing and the wound itself. This article looks at a range of dressings, from traditional to newer dressings, and evaluates their benefits and contraindications to help determine where they are best suited for use in wound management.

Evaluation of Pruning Wound Protection Products for the Management of Almond Canker Diseases in California.

Almond trunk and branch canker diseases constitute a major cause of tree mortality in California. Numerous fungal pathogens have been associated with these canker diseases and pruning wounds act as major infection courts. Before this study, there were no products registered in California for the management of these diseases. In this study, fungicidal products including synthetic chemistries, biocontrols, paint, and a sealant were evaluated for preventing fungal pathogen infection via pruning wounds. In four field trials conducted over two dormant seasons, 16 pruning wound treatments were tested using handheld spray applications against five almond canker pathogens, namely Botryosphaeria dothidea, Neofusicoccum parvum, Cytospora sorbicola, Ceratocystis destructans, and Eutypa lata. The fungicide thiophanate-methyl (Topsin M; United Phosphorus, Bandra West, Mumbai, India) provided 82% overall disease prevention against four fungal pathogens. The biological control agent, Trichoderma atroviride SC1 (Vintec; Bi-PA, Londerzeel, Belgium), tested at three application rates, resulted in 90 to 93% protection of pruning wounds in field trials, and for individual pathogens ranged from 81 to 100% protection for the three rates. At the time of this publication, Vintec is being considered for registration as a biological control product for the prevention of almond canker diseases, while Topsin M is recommended to growers for the prevention of almond canker diseases. This research indicates that effective protection of pruning wounds from infection by almond canker pathogens can be achieved with a one-time spray application of thiophanate-methyl or the biocontrol T. atroviride SC1 (recommended 2 g/liter) after pruning.

Mechanical Properties of Human Concentrated Growth Factor (CGF) Membrane and the CGF Graft with Bone Morphogenetic Protein-2 (BMP-2) onto Periosteum of the Skull of Nude Mice.

Concentrated growth factor (CGF) is 100% blood-derived, cross-linked fibrin glue with platelets and growth factors. Human CGF clot is transformed into membrane by a compression device, which has been widely used clinically. However, the mechanical properties of the CGF membranes have not been well characterized. The aims of this study were to measure the tensile strength of human CGF membrane and observe its behavior as a scaffold of BMP-2 in ectopic site over the skull. The tensile test of the full length was performed at the speed of 2mm/min. The CGF membrane (5 × 5 × 2 mm3) or the CGF/BMP-2 (1.0 μg) membrane was grafted onto the skull periosteum of nude mice (5-week-old, male), and harvested at 14 days after the graft. The appearance and size of the CGF membranes were almost same for 7 days by soaking at 4 °C in saline. The average values of the tensile strength at 0 day and 7 days were 0.24 MPa and 0.26 MPa, respectively. No significant differences of both the tensile strength and the elastic modulus were found among 0, 1, 3, and 7 days. Supra-periosteal bone induction was found at 14 days in the CGF/BMP-2, while the CGF alone did not induce bone. These results demonstrated that human CGF membrane could become a short-term, sticky fibrin scaffold for BMP-2, and might be preserved as auto-membranes for wound protection after the surgery.

Challenges Related to Surgical Site Infection Prevention-Results after Standardized Bundle Implementation.

Aim: The aim of this study was to assess the implementation of an intraoperative standardized surgical site infection (SSI) prevention bundle. Methods: The multimodal, evidence-based care bundle included nine intraoperative items (antibiotic type, timing, and re-dosing; disinfection; induction temperature control > 36.5°; glove change; intra-cavity lavage; wound protection; and closure strategy). The bundle was applied to all consecutive patients undergoing colonic resections. The primary outcome, SSI, was independently assessed by the National Infection Surveillance Committee for up to 30 postoperative days. A historical, institutional pre-implementation control group (2012–2017) with an identical methodology was used for comparison. Findings: In total, 1516 patients were included, of which 1256 (82.8%) were in the control group and 260 (17.2%) were in the post-implementation group. After 2:1 propensity score matching, the groups were similar for all items (p > 0.05). Overall compliance with the care bundle was 77% (IQR 77–88). The lowest compliance rates were observed for temperature control (53% overall), intra-cavity lavage (64% overall), and wound protection and closure (68% and 63% in the SSI group, respectively). Surgical site infections were reported in 58 patients (22.2%) vs. 21.4% in the control group (p = 0.79). Infection rates were comparable throughout the Centers for Disease Control and Prevention (CDC) categories: superficial, 12 patients (4.5%) vs. 4.2%, p = 0.82; deep incisional, 10 patients (3.7%) vs. 5.1%, p = 0.34; organ space, 36 (14%) vs. 12.4%, p = 0.48. After propensity score matching, rates remained comparable throughout all comparisons (all p > 0.05). Conclusions: The implementation of an intraoperative standardized care bundle had no impact on SSI rates. This may be explained by insufficient compliance with the individual measures.

Drug-loaded PLCL/PEO-SA bilayer nanofibrous membrane for controlled release

The bilayer nanofibrous membrane fabricated via electrospinning technique can be considered as an ideal structure for the treatment of chronic skin diseases and exudative wound dressings. Wound exudate would affect healing and increases the likelihood of infection at the same time. Therefore, it is essential to produce a kind of wound dressing with relatively high hygroscopicity which could absorb wound exudate and provide a relatively dry healing environment. Bilayer nanofibrous membranes of poly(L-lactide-co-ε-caprolactone)/tetracycline hydrochloride- polyethylene oxide/sodium alginate-zinc oxide (PLCL/TCH-PEO/SA-ZnO) with drug delivery potential were prepared by electrospinning for wound healing. Then, a cross-linking which involved soaking the samples in an aqueous solution containing strontium ions for 4 h was conducted. SEM images showed that membranes still maintained the peculiar nanofibrous structure. The spinning aid (PEO) used was removed in the cross-linked alginate without affecting the PLCL/TCH outer layer gave the membrane good mechanical properties and manageability. The hydrophilicity of the mats was tested to evaluate the ability of the bilayer membrane to absorb exudate from the wound. In vitro drug release suggested that antibacterial agents TCH could release continuously more than 10 days. The cross-linked fibrous membrane has improved mechanical properties and fluid repellency, thus representing a barrier to the external environment and effective wound protection. Consequently, the bilayer fibrous scaffold with good hygroscopicity and drug release properties would have wide applications prospects for the treatment of chronic skin diseases and exudative wound dressings.

Orthopaedic surgical dressings

The choice of which surgical dressing to use is an important step in the postoperative care of orthopaedic patients. This decision is influenced in part by the patient's level of activity prior to surgery, medical history, wound classification, and cost. As orthopaedic wounds are inherently complex, often overlying bony prominences, it is imperative that orthopaedic providers are aware of the dressings available and how best to deploy them. Classified into three categories (passive, active, and interactive), orthopaedic surgical dressings can vary based upon their mechanism of action, absorptive capacity, and ability to provide wound protection. Through the activation or promotion of one of the four stages of wound healing, orthopaedic surgical dressings act to optimize postoperative wound care, leading to improved patient outcomes and a decrease in associated complications. The combined use of multiple dressings, with varying attributes, provides the ultimate method for obtaining the ideal orthopaedic surgical dressing . Choosing the appropriate dressing and subsequent care regimen can prevent unnecessary hospitalizations and additional costs associated with complex wound care. Future prospective trials aimed at evaluating specific dressings and their utility in orthopaedics is warranted. • Dressings can be classified into three categories: passive, active and interactive. • Dressings aid in activating or promoting steps within the stages of wound healing. • The ideal orthopaedic dressing is obtained using multiple varying dressings. • Patient specific factors and dressing characteristics can influence dressing choice.

Critical timing of fungicide application for pruning wound protection to control grapevine trunk diseases

Critical timing of fungicide application for pruning wound protection to control grapevine trunk diseases

Advance-Platelet Rich Fibrin and Hyaluronic Acid Combination Improves Interleukin-6 and Granulation Index in Diabetic Foot Ulcer Patients

BACKGROUND: Diabetic foot ulcer (DFU) is the most common and threatening complication of Diabetes Mellitus (DM). Ideal wound dressing for DFU management should relieve symptoms, provide wound protection, and encourage healing. Advanced-Platelet Rich Fibrin (A-PRF) and Hyaluronic Acid (HA) have been proven to improve wound healing process. This study was aimed to demonstrate the ability of combination of A-PRF and HA in reducing inflammation and improving DFU tissue healing.METHODS: Twenty DFU subjects were involved in this study, and divided into two groups based on the topical fibrin gel treatment: A-PRF + HA group and A-PRF only group. A-PRF was obtained by peripheral blood centrifugation. A-PRF + HA was prepared by homogening A-PRF and AH with a ratio of 1:0.6. Interleukin-6 (IL-6) level, granulation index (GI), numeric pain score (NPS), and inflammation clinical symptoms (ICS) were assessed on day-0, 3, 7 and 14.RESULTS: Wound swabs’ IL-6 level on day-7 was found to be significantly lower in A-PRF + HA compared to A-PRF alone (p=0.041). The IL-6 level reduction also found to be significant higher either in wound swabs (day 0-7, p=0.015) or fibrin gel (day 0-3, p=0.049; day 0-7, p=0.034). A-PRF + HA treatment significantly increased the GI even since day-3 (p=0.043), with lower NPS (p<0.001), and ICS score.CONCLUSION: The combination of A-PRF and HA increases the GI in DFU healing by reducing the inflammation state which will induce the angiogenesis process, as well as reducing pain in DFU subjects better than A-PRF alone.KEYWORDS: inflammation, interleukin-6, wound healing, angiogenesis, proliferation

In Vitro User Assessment of a Novel Wound Protection and Specimen Extraction System for Laparoscopic Procedures Involving Morcellation

Introduction: The risk of unknowingly disseminating leiomyosarcoma by morcellation in women undergoing laparoscopic hysterectomy has massively impacted gynaecological practice. Here, we present the results of an in vitro assessment of a novel protection system developed to mitigate this hazard. Methods: The Tissue Containment System for Manual Morcellation (Guardenia™, Advanced Surgical Concepts, Wicklow, Ireland) is an evolved wound protection/specimen extraction guarded bag system compatible with any 12mm trocar. Device use was assessed by device-naïve gynaecological and general surgeon volunteers (providing expert and inexpert morcellation cohorts, respectively) on a bench model consisting of biological tissue in a custom-built moulded rig with camera control after the operators were instructed in its use. Results: Twenty surgeons (10 gynaecologists/10 general surgeons, median duration of practice experience: 8 years, median annual number of laparoscopic operative procedures: 150 and 80, respectively) completed the user assessment. All subjects understood and correctly performed each step; i.e., (i) placement of the bag through the trocar, (ii) specimen bagging, (iii) incision extension (range 25-60 mm) after tethering the bag through the port, (iv) insertion of the device guard through the mouth of the bag after trocar removal, and (v) sufficient tissue morcellation within the bag to enable complete specimen removal (mean specimen weight 390g, range 201-1800g). There was 100% bag integrity by water-leak testing following use, despite scalpel contact with the guard in 14/20 cases (70%). Conclusion: Among first-time clinical users, this novel device enabled complete containment of morcellation debris and removal of a laparoscopic specimen, which would support further submission for regulatory approval.

Prospective surveillance after implementation of a colorectal surgical site infection prevention bundle

Abstract Objective Surgical site infections (SSI) are the most frequent complications after colorectal surgery. The aim of the present study was to evaluate the impact of a standardized SSI prevention bundle. Methods The multimodal, evidence-based care bundle included 9 intraoperative items (antibiotic type, timing and re-dosing, desinfection, induction temperature control >36.5°, glove change, intracavity lavage, wound protection and closure strategy). The bundle was implemented in November 2018 and applied to all consecutive patients undergoing colonic resections. Demographics, surgical specifics and overall compliance to the care bundle were prospectively assessed until October 2020. The primary outcome SSI was defined according to the definition of the Center for Disease Control (CDC) and independently assessed by the National Infection Surveillance Committee (Swissnoso) up to 30 postoperative days. A historical, institutional pre-implementation control group (2012-2017, DOI: 10.1016/j.jhin.2018.09.011) with identical methodology was used for comparison. Results In total, 243 patients were included. The control group included 1’263 patients. Both groups were comparable regarding main demographics (age, sex, body mass index, American Society of Anaesthesiologists class) and surgical characteristics (type and duration of surgery). Overall compliance to the care bundle was 77% (IQR 77-88). Lowest compliance was observed for temperature control (48%), intracavity lavage (59%) and predefined wound closure strategy (74%). Surgical site infections were reported in 54 patients (22.2%) vs. 21.4% in the control group, p = 0.79. Infection rates were comparable throughout the CDC categories: superficial: 11 patients (4.5%) vs. 4.2%, p = 0.82, deep incisional: 9 patients (3.7%) vs. 5.1%, p = 0.34, organ space: 34 (14%) vs. 12.4%, p = 0.48. Conclusion Implementation of a standardized surgical care bundle had no impact on SSI rates according to these preliminary results. Improved compliance to individual measures may help to achieve a clinical benefit.