Topical Wound Research Articles

Multifunctional Synthetic Amphiphile for Niche Therapeutic Applications: Mitigation of MRSA Biofilms and Potential in Wound Healing.

The relentless menace of implant- and skin wound-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA) biofilms demands the design of therapeutics that have an edge over conventional antibiotics. The present study reports the potential of pluri-active amphiphiles having a 12-carbon alkyl chain and a salicaldehyde head group (C1) or a napthaldehyde head group (C2) in mitigating wound site- and implant-associated MRSA biofilms and as a topical wound healing agent. The amphiphiles impeded S. aureus MRSA 100 biofilm formation on collagen both on extraneous addition and on impregnation into collagen and inflicted damage to MRSA cells embedded in collagen matrix infused with simulated wound fluid, with C1 being more potent than C2. Adhesion of the MRSA biofilm was hampered on C1-coated orthopedic stainless-steel wire, while eluates from C1-coated wires were non-toxic to HEK 293 cells, highlighting the prospect of C1 as an implant-associated antibacterial coating. Upon treatment with C1, expression of the adhesin fnbA gene was low in the MRSA biofilm and downregulated in non-adherent MRSA cells, while δ-toxin (hld) gene expression in the MRSA biofilm increased, implying that C1 hindered cell-cell adhesion and planktonic-biofilm transition and also reduced biofilm adhesion. Oral administration of C1 (300 and 1000 mg/kg) was non-toxic to BALB/c mice as evidenced in stable hematological parameters and normal histopathological features of vital organs. Topical application of C1 (50 and 100 mg/kg) on a skin excision wound in female BALB/c mice resulted in effective wound closure, fibrous tissue proliferation, and tissue reorganization. Confocal microscopy revealed that topical application of C1 in an ex vivo murine skin explant could alleviate invasion of skin by MRSA, while solution-based studies indicated subdued MRSA adhesion onto the skin explants. The pluri-active synthetic amphiphile C1 provides a framework for developing antibacterials that hold translational potential as a therapeutic for implant- and skin wound-associated MRSA infections.

Development of a Scar Removal Ointment Containing Natural Active Ingredients

Aims: The present study aimed to evaluate the healing effect of five new dermal ointments made with natural ingredients, derived from the Ficus microcarpa fruit, Pulicaria odora L. leaf powder, vaseline, lanolin, and sweet almond oil on thermal burns of New Zealand rabbits. Background: Many natural ingredients are used as alternatives in topical burn wound treatments. However, the effectiveness of an ointment is primarily assessed on the basis of the healing time. The latter depends on the synergetic effect resulting from the interaction of its different constituents. Hence there is the need to explore different formulations to find the most optimal one. Objectives: 1/ To evaluate some biochemical compositions, biological properties, and functional quality of F. microcarpa fruit and P. odora L. leaf powder., 2/ To identify the best combination between the F. microcarpa fruit, P. odora L. leaf powder, vaseline, lanolin, and sweet almond oil to obtain an ointment with high healing quality. Method: Ten (10) New Zealand rabbits (5 males and 5 females) received two thermal burns caused by a hot cylindrical metal on their backs. Each rabbit was treated immediately thereafter with one of the elaborated ointments and with a commercial skin ointment Madecassol (reference). All the ointments were applied topically every other day until a complete epithelialization takes place. Evaluation of the healing process was based on the healing time and diameter narrowing calculated every seven days. Results: The obtained results show that all the developed ointments used in the experiments lead to total recovery with fur growth. However, the healing time varies from one formula to another. Conclusion: The study concludes that the combination of the natural active ingredients used in this study promotes burn wound healing in the rabbit’s model.

Comparing the use of a novel antibiotic-free film-forming topical wound dressing versus a topical triple antibiotic in dermatologic surgical procedures including Mohs micrographic surgery.

BackgroundThere is no universally accepted protocol of topical wound care after cutaneous surgical procedures. The current practice is to use petrolatum‐based products, commonly containing topical antibiotics. The rise in antibiotic‐resistant bacteria and increased risk of allergic and contact dermatitis due to the use of topical antibiotics is well established.ObjectiveTo compare the prevalence of contact dermatitis, the infection rate and the subjective measures of healing of a novel, antibiotic‐free, film‐forming silicone‐based wound dressing to a topical triple antibiotic petrolatum‐based ointment in patients undergoing invasive dermatological interventions in two arms: (1) Mohs micrographic surgery (MMS) and (2) a combination of various routine dermatologic surgical procedures.DesignThe 231 patients were enrolled in this open‐label, randomized, single‐blinded study. Patients applied the products immediately after surgery and daily afterwards. Clinicians evaluated the surgical site for infection or contact dermatitis at all follow‐up visits. Acute wound healing progression was assessed using a rating scale against clinical experience and expected results from −4 (much worse) to +4 (much better).ResultsContact dermatitis was significantly decreased in the wound dressing group compared to the topical antibiotic group (0 vs 15.9%, P < 0.001). There was no difference between the study arms (Mohs vs. non‐Mohs, P = 0.242). Infection rate was not significantly different between the groups (P > 0.05) and between the study arms (P > 0.05). Assessor‐rated secondary outcomes like healing time, healing quality, erythema and new tissue quality were significantly better in the wound dressing group, while comfort and perceived overall satisfaction were better in the antibiotic group. Patient‐rated outcomes did not show any difference between groups and between study arms.ConclusionThe wound dressing used in this study is a topical silicone gel preparation and presents a viable alternative to topical antibiotics for postoperative wound care without enhancing the risk of infection.

Clinical Significance of Manuka and Medical-Grade Honey for Antibiotic-Resistant Infections: A Systematic Review.

Antimicrobial resistance is an ever-increasing global issue that has the potential to overtake cancer as the leading cause of death worldwide by 2050. With the passing of the “golden age” of antibiotic discovery, identifying alternative treatments to commonly used antimicrobials is more important than ever. Honey has been used as a topical wound treatment for millennia and more recently has been formulated into a series of medical-grade honeys for use primarily for wound and burn treatment. In this systematic review, we examined the effectiveness of differing honeys as an antimicrobial treatment against a variety of multidrug-resistant (MDR) bacterial species. We analysed 16 original research articles that included a total of 18 different types of honey against 32 different bacterial species, including numerous MDR strains. We identified that Surgihoney was the most effective honey, displaying minimum inhibitory concentrations as low as 0.1% (w/v); however, all honeys reviewed showed a high efficacy against most bacterial species analysed. Importantly, the MDR status of each bacterial strain had no impact on the susceptibility of the organism to honey. Hence, the use of honey as an antimicrobial therapy should be considered as an alternative approach for the treatment of antibiotic-resistant infections.

Topical Wound Healing Activity of Myricetin Isolated from Tecomaria capensis v. aurea.

Wounds and burn injury are major causes of death and disability worldwide. Myricetin is a common bioactive flavonoid isolated naturally from the plant kingdom. Herein, a topical application of naturally isolated myricetin from the shoots of Tecomaria capensis v. aurea on excisional wound healing that was performed in albino rats. The wounded rats were treated every day with 10 and 20% myricetin for 14 days. During the experiment, the wound closure percentage was estimated at days 0, 7, and 14. Effects of myricetin on the inflammatory cytokines (tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and cluster of differentiation 68 (CD68) in the serum were evaluated using immunosorbent assay kits. The percentage of wound closure and contraction was delayed in wounded rats (67.35%) and was remarkably increased after treatment of wounded rats with myricetin; the treatment with 20% myricetin was the most potent (98.76%). Histological findings exhibited that 10% myricetin caused the formation of a large area of scarring at the wound enclosure and stratified squamous epithelium without the formation of papillae as in the control group. Treatment with 20% myricetin exhibited less area of scarring at the wound enclosure as well as re-epithelialization with a high density of fibroblasts and blood capillaries in the wound. Level elevations of serum pro-inflammatory cytokines, IL-1β, and TNF-α and macrophage CD68 were decreased in wounded rats treated with myricetin. Thus, it can be suggested that the enhancements in inflammatory cytokines as well as systemic reorganization after myricetin treatment may be recommended to play a crucial part in the promotion of wound healing. The findings suggest that treatment with a higher dose of myricetin was better in improving wound curing in rats. It could serve as a potent anti-inflammatory agent and can be used as an adjunctive or alternative agent in the future.

Pediatric Treadmill Friction Burns to the Hand: Outcomes of an Initial Nonoperative Approach.

Treadmill burns that occur from friction mechanism are a common cause of hand burns in children. These burns are deeper and more likely to require surgical intervention compared to hand burns from other mechanisms. The purpose of this study was to identify the factors associated with healing time using an initial nonoperative approach. A retrospective chart review was performed examining children (<15 years) who were treated for treadmill burns to the hand between 2012 and 2019. Patient age, burn depth, total body surface area of the hand injury, and time to healing were recorded. Topical wound management strategies (silver sheet, silver cream, non-silver sheet, and non-silver cream) and associated treatment durations were determined. For patients with burns to bilateral hands, the features, treatment, and outcomes of each hand were assessed separately. Cox regression analysis was used to evaluate the association between time to healing and patient characteristics and treatment type. Seventy-seven patients with 86 hand burns (median age 3 years, range 1-11) had a median total body surface area per hand burn of 0.8% (range 0.1-1.5%). Full-thickness burns (n = 47, 54.7%) were associated with longer time to healing compared to partial-thickness burns (HR 0.28, CI 0.15-0.54, P < .001). Silver sheet treatment was also associated with more rapid time to healing compared to treatment with a silver cream (HR 2.64, CI 1.01-6.89, P = .047). Most pediatric treadmill burns can be managed successfully with a nonoperative approach. More research is needed to confirm the superiority of treatment with silver sheets compared to treatment with silver creams.

Graphene oxide crosslinked-zein nanofibrous scaffolds for prominent Cu-adsorption as tissue regeneration promoters in diabetic rats: Nanofibers optimization and in vivo assessment.

Diabetic ulcers are prone to bacterial contamination and can severely affect patient's quality of life. This study is first report to explore copper-grafted graphene oxide-crosslinked zein scaffolds (Cu-GZS) for promoting cutaneous excision wounds healing as a promising therapeutic modality in diabetic male-rats. Cu-GZS scaffolds were fabricated using electrospinning technique, where GO was employed as an echo-friendly crosslinker to meliorate mechanical stability and swellability of scaffolds. To circumvent risk of infection, copper ions were grafted into GZS as bactericidal agents and angiogenesis promoters, through soaking GZS nanofibers into Cu-solution or direct loading during electrospinning process. SEM images showed GO encapsulation by wrapping around/or trapping within nanofibrous. Interestingly, formation of chemical amide bond between zein and GO was proven by FTIR spectra. Crosslinking of zein nanofibers with GO increased tensile strength of nanofibrous by 3-folds compared to uncrosslinked zein nanofibers. Optimized Cu-GZS exhibited constant release rate of copper over a period of 8days (~53.42%). Cu-GZS immensely accelerated wound closure demonstrated by diminished infiltration of leukocytes, absence of α-SMA positive cells, presence of fully intact epithelium with normal keratinization and accelerated wound size reduction, compared to control. Cu-GZS scaffolds could serve as promising biomaterials for effective topical wound healing in diabetic rats.

Topical Zinc May Augment Post-Operative Wound Healing, Including Following Mohs Micrographic Surgery: A Review of the Literature

Background: Zinc, an essential mineral, has been extensively studied in the field of dermatology for the treatment of a plethora of skin conditions. However, minimal literature exists regarding its use for the enhanced healing of wounds after surgery, including following Mohs micrographic surgery (MMS).Objective: Evaluate the available literature regarding the utilization of zinc for enhanced healing of post-surgical wounds in humans.Methods: A systematic review of studies evaluating the use of zinc for post-surgical management was conducted via an electronic literature search of the PubMed database. Clinical trials were searched using ClinicalTrails.gov.Results: Topical zinc formulations may decrease healing time and post-operative infection rates, including following MMS of the lower extremity.Limitations: Currently, there are a limited number of studies available on this topic, with lack of a standard comparable outcome measure.Conclusion: Topical zinc oxide may be a beneficial treatment option for post-surgical wound healing, including after MMS. Further studies are needed to better define the efficacy of zinc for post-operative wound healing and the optimal treatment regimen.

A composite hydrogel loading natural polysaccharides derived from Periplaneta americana herbal residue for diabetic wound healing

In view of the long medicinal use history of Periplaneta americana for manifold ulcer or skin wounds treatment, the comprehensive utilization value of P. americana herbal residue was evaluated. In this study, we isolated a polysaccharide fraction from P. americana herbal residue with the potential wound healing effect, named as PAP faction, based on our previous study and provided the structural and monosaccharide composition characterization. To improve the topical wound dressing property, a novel composite hydrogel consisting of PAP, carbomer 940 (CBM), carboxymethyl cellulose (CMC) with different ratios were prepared and optimized. Mediated by the physical crosslinking effect among these polymers, the composite hydrogel exhibited good three-dimensional network structures, good swelling and water retention capacity, moderate mechanical property in rheological test. And then, the good cytocompatibility of hydrogel was corroborated by 3T3 fibroblast proliferation assay. Finally, the composite hydrogel loading PAP has been proved to accelerate wound healing in diabetic rat models, by promoting wound closure, collagen deposition, M2 macrophages polarization and angiogenesis. In summary, this study would provide an effective and promising wound dressing candidate for the prevention and treatment of diabetic wound, based on the ecological concept of the comprehensive utilization of natural herbal resources.

Definitions, survey methods, and findings of patient satisfaction studies in teledermatology: a systematic review.

Remote consultations likely will grow in importance if the COVID-19 pandemic continues. This review analyzes which methods of teledermatology patients prefer by categorizing how recent studies have defined satisfaction, conducted surveys and concluded patients respond to the different modalities of teledermatology. Using PubMed and Cochrane databases, we reviewed studies from April 5th, 2010 to April 5th, 2020 that included the search terms patient satisfaction and teledermatology. All studies that included patient satisfaction as an outcome were included, but studies not published in English were excluded. We examined domains of satisfaction, survey method, study characteristics (including patient population, country, age, study design and evidence score), findings and statistical comparisons. We thoroughly reviewed 23 studies. Definitions of satisfaction varied, but all concluded patients were satisfied with the live-interactive and store-and-forward modalities. The studies reveal that store-and-forward is appropriate for clinicians with established patients who require regular follow-up. Verified areas of care include treatment of chronic conditions, topical skin cancer therapy, wound monitoring, and post-procedural follow-up. Only four studies conducted statistical analyses. One of those studies compared patient preference for each modality of teledermatology with face-to-face dermatology. While this study reported high satisfaction with each mode of teledermatology, patients still preferred face-to-face. Favorable responses to remote diagnostic capabilities suggest that these offerings improve preference for teledermatology. With only one study evaluating preference between each modality and face-to-face dermatology, more studies should address the discrepancy. Surveys that cover all domains of satisfaction may improve assessments and identify where gaps in preference exist.

Impact of a Topical Anaesthesia Wound Management Formulation on Pain, Inflammation and Reduction of Secondary Infections after Tail Docking in Lambs.

Simple SummaryTail docking is routinely conducted in sheep husbandry around the world, often without anaesthesia or analgesia despite recognition that it is a painful process. Several methods are used, although the Council of Europe states that surgical methods with anaesthesia should be used to dock the tail, with these recommendations copied into national legislation by most European countries. However, no studies have been documented comparing the use of general anaesthesia and stitching. This study compared different surgical approaches with and without general anaesthesia, and with and without surgical stitching, plus examined the efficacy of applying a commercially available wound gel spray containing topical anaesthetics and an antiseptic, immediately on tail amputation. Results demonstrated that lambs display more pain when the surgery included stitching and these wounds became more readily infected, potentially requiring antibiotic therapy. As the generation of potential antimicrobial resistance and drug residues issues in food-producing animals from over-use of antibiotics is an emerging one health consideration, the availability of a topical anaesthetic formulation that provides pain relief and contains an antiseptic that reduces secondary infections and hasten wound healing, is of potential importance for improving husbandry procedures such as tail docking.We examined several procedures for surgical tail docking; with and without general anaesthesia (GA), including the use of a topical wound gel formulation to provide pain relief (PR) and improve healing after surgery, containing local anaesthetics lignocaine and bupivacaine, with cetrimide and adrenalin. Forty-four lambs were recruited into four equal cohorts: Groups A and C, the tail was excised with a scalpel without anaesthesia or stitches; Groups B and D, the tail was surgically excised and stitched under GA; Groups C and D wounds were immediately sprayed with PR. Behavioural observations identified that Groups A and C displayed significantly less pain-related behaviours than Groups B and D shortly after the procedure, especially if treated with PR. Similarly, the mean of days when animals showed no signs of wound infection was longer in the groups not undergoing stitching. Finally, treatment with PR appeared to reduce the cortisol response and avoided the elevation of serum amyloid A in lambs where the tail was excised without general anaesthesia. In conclusion, surgical tail-docking without GA but where wounds are immediately sprayed with PR, appears as an affordable and more welfare-appropriate method for conducting tail docking in lambs.

Innovations in Infection Prevention and Treatment.

Background: Patients with large, acute burn injuries are a major challenge for clinicians. The loss of skin barrier protection against micro-organisms combined with the induced immunosuppression after burn injury makes this population especially vulnerable to infection. For burn-injured patients who survive immediate management considerations and burn resuscitation after acute injury, sepsis remains the primary cause of death. The purpose of this article is to describe current strategies and innovations in burn sepsis prevention and management. Methods: This work reviews the current understanding of the systemic inflammatory response to burn injury and burn sepsis as well as current strategies in insolation and infection prevention, newer burn unit design strategies in the context of infection prevention, and novel therapies being considered in topical antimicrobial wound care management. Results: A review of burn sepsis is key to understanding current paradigms and innovation in burn management and prevention. Key management principles begin from the time of injury and persist throughout the patient's hospital course. This includes use of personal protective equipment, burn unit design considerations, and knowledge of critical care principles such as central venous catheter management strategies. Innovations on wound dressing types, forms, and use have been key to better controlling burn wound sepsis and improving wound healing. Products incorporating nanotechnology, novel anions, oxygen, and even light have been key to introducing previously unconsidered methods to fight or prevent infection. Conclusion: Understanding the pathophysiology and source identification of sepsis from burn wounds has been a key contributor in developing innovative prevention and therapeutic strategies in burn management. The emergence of drug-resistant pathogens and the difficulty of systemic antibiotic agents to reach poorly vascularized wounds have further reinforced the need to anticipate management strategies moving forward. A proactive, multidisciplinary approach is necessary to minimize the morbidity and mortality associated with infection control.

Platelet-rich plasma and/or sildenafil topical applications accelerate and better repair wound healing in rats through regulation of proinflammatory cytokines and collagen/TGF-β1 pathway.

Platelet-rich plasma (PRP) composites of various cytokines and growth factors whichhave the potential to activate and speed the process of wound repair. Sildenafil also is a potent stimulator of angiogenesis which favors its potential effects on wound healing in several models. Existing work planned to examine the effectiveness of topical application of PRP and/or sildenafil citrate hydrogel (SCH) in a non-splinted excision skin wound model. Adult male rats were allocated into control, PRP, SCH, and PRP/SCH groups. On the 7th and 14th days, blood and tissue samples were collected for hematobiochemical, histopathological, and immunohistochemistry analyses. PRP and/or SCH topical treatments caused an enhancement of wound healing parameters, including a rapid switch from inflammatory phase to connective tissue stage evident by less systemic hematological changes and decreased values of proinflammatory cytokines (IL-6, TNF-α, and IL-1β) and C-reactive protein (CRP) on the 7th or 14th days post-wounding. Also, tissue hydroxyproline, collagen, nitrite, and total protein contents were higher in therapeutically handled wounded rats. Histologically, PRP- and/or SCH-treated wounded rats exhibited less necrosis, inflammation, and fibrin with a higher level of granulation tissue formation on the 7th day post-wounding and abundant collagen remodeling, epithelization, and vascularization on the 14th day relative to control. Interestingly, combined PRP and SCH treatment was more efficient in wound healing scoring with less inflammation, more collagen remodeling, and more epithelization. Our findings confirm the effectiveness of PRP and/or SCH as a topical wound healing treatment, with better skin wound healing with their combination.

Uso del Plasma Rico en Plaquetas para el tratamiento de las úlceras de miembro inferior. Estudio piloto

Cada vez hay más pruebas que sugieren que la cicatrización de heridas en las úlceras crónicas vasculares y del pie diabético depende del factor de crecimiento y que el suministro terapéutico de estos factores de crecimiento a las heridas por vía tópica tiene la capacidad potencial de acelerar la cicatrización de las heridas junto con el cuidado convencional de las heridas&#x0D; Se ha diseñado y proyectado un estudio prospectivo cuasiexperimental con el objetivo de evaluar la seguridad y eficacia del gel de plasma autólogo rico en plaquetas para el tratamiento de las úlceras vasculares de miembros inferiores y de pie diabético con retraso de la cicatrización. Mediante este estudio piloto se ha valorado la viabilidad de dicho estudio y la idoneidad del protocolo de actuación, de las variables recogidas y del instrumento de medida.&#x0D; Este estudio piloto fue realizado entre septiembre de 2018 y marzo de 2020 en el Servicio de Cirugía Vascular del Hospital Universitario Reina Sofía de Córdoba. Participaron pacientes, con úlceras vasculares o de pie diabético que presentaban retraso en el proceso de cicatrización y a los que se les aplicó PRP&#x0D; En el estudio piloto han participado cuatro pacientes con una media de edad 62,25 años. El 100% fueron hombres con lesiones de pie diabético. El 50% presentaba arteriopatía periférica asociada, con una media en el retraso de la cicatrización de 17 meses con intervalo de 12-20. El tiempo medio de cicatrización de las úlceras fue de 7,6 semanas. En ningún caso se detectaron efectos adversos relacionados con la aplicación de PRP.&#x0D; Según estos resultados preliminares, la aplicación de PRP sobre el lecho de las heridas vasculares y de pie diabético que no cicatrizan es una opción terapéutica segura y eficaz.

Characterizing the Mechanism of Action of an Ancient Antimicrobial, Manuka Honey, against Pseudomonas aeruginosa Using Modern Transcriptomics.

Manuka honey has broad-spectrum antimicrobial activity, and unlike traditional antibiotics, resistance to its killing effects has not been reported. However, its mechanism of action remains unclear. Here, we investigated the mechanism of action of manuka honey and its key antibacterial components using a transcriptomic approach in a model organism, Pseudomonas aeruginosa We show that no single component of honey can account for its total antimicrobial action, and that honey affects the expression of genes in the SOS response, oxidative damage, and quorum sensing. Manuka honey uniquely affects genes involved in the explosive cell lysis process and in maintaining the electron transport chain, causing protons to leak across membranes and collapsing the proton motive force, and it induces membrane depolarization and permeabilization in P. aeruginosa These data indicate that the activity of manuka honey comes from multiple mechanisms of action that do not engender bacterial resistance.IMPORTANCE The threat of antimicrobial resistance to human health has prompted interest in complex, natural products with antimicrobial activity. Honey has been an effective topical wound treatment throughout history, predominantly due to its broad-spectrum antimicrobial activity. Unlike traditional antibiotics, honey-resistant bacteria have not been reported; however, honey remains underutilized in the clinic in part due to a lack of understanding of its mechanism of action. Here, we demonstrate that honey affects multiple processes in bacteria, and this is not explained by its major antibacterial components. Honey also uniquely affects bacterial membranes, and this can be exploited for combination therapy with antibiotics that are otherwise ineffective on their own. We argue that honey should be included as part of the current array of wound treatments due to its effective antibacterial activity that does not promote resistance in bacteria.

Manuka Honey Reduces NETosis on an Electrospun Template Within a Therapeutic Window.

Manuka honey, a topical wound treatment used to eradicate bacteria, resolve inflammation, and promote wound healing, is a focus in the tissue engineering community as a tissue template additive. However, its effect on neutrophil extracellular trap formation (NETosis) on a tissue engineering template has yet to be examined. As NETosis has been implicated in chronic inflammation and fibrosis, the reduction in this response within the wound environment is of interest. In this study, Manuka honey was incorporated into electrospun templates with large (1.7–2.2 µm) and small (0.25–0.5 µm) diameter fibers at concentrations of 0.1%, 1%, and 10%. Template pore sizes and honey release profiles were quantified, and the effect on the NETosis response of seeded human neutrophils was examined through fluorescence imaging and myeloperoxidase (MPO) analysis. The incorporation of 0.1% and 1% Manuka honey decreased NETosis on the template surface at both 3 and 6 h, while 10% honey exacerbated the NETosis response. Additionally, 0.1% and 1% Manuka honey reduced the MMP-9 release of the neutrophils at both timepoints. These data indicate a therapeutic window for Manuka honey incorporation into tissue engineering templates for the reduction in NETosis. Future in vivo experimentation should be conducted to translate these results to a physiological wound environment.

Development of bacterial resistant acrylamide-polyvinylpyrrolidone-metal oxide hydrogel nanocomposites

Fabrication of polymer-based nanocomposites for numerous biomedical applications represents a predominant form of therapeutics for combating microbial and bacterial infections. Herein, we firstly synthesized metal oxide nanoparticles (MONPs) by previously reported precipitation methods. Hydrogel nanocomposites were then prepared by free radical polymerization of a combination of the synthesized MONPs, polyvinylpyrrolidone (PVP) and acrylamide. The hydrogel nanocomposites were characterized by FTIR, XRD and investigated for potential antibacterial protection. FTIR spectra of the prepared hydrogel nanocomposites revealed significant characteristic peaks of the distinctive MONPs within the polymer matrix. XRD micrographs revealed slight shifting of peak positions in nanocomposites; the change in peak intensity, coupled with the observed slight shift in the diffraction peaks of both CuO and ZnO nanoparticles confirmed the successful incorporation of the MONPs into the polymer matrix. The presence of the MONPs, in combination with PVP, displayed a synergistic antibacterial activity, with increasing concentration of the MONPs. The treatment against S.pneumoniae, revealed a zone of inhibition phenomenon which showed zones of PVP-5 > PVP-8 > PVP-6 > PVP-9 > PVP-7. PVP-1, PVP-2, PVP-3, PVP-4 did not show any significant zone of inhibition on treatment due to the quantity of MONPs present. The findings show that the hydrogel nanocomposites are potential topical wound dressing materials for the management of bacterial infections.

Provesicular elastic carriers of Simvastatin for enhanced wound healing activity: An in-vitro/in-vivo study.

The aim of this study was to prepare and evaluate simvastatin (SIM) loaded elastic provesicular systems for effective topical wound management. SIM provesicles were prepared using the non-ionic surfactant Span 40, cholesterol and three edge activators i.e. Span 80, Tween 80 and sodium cholate. The vesicles revealed high SIM encapsulation efficiency ranging from 87.25 to 98.15%, whereas vesicle sizes ranged from 462.3 to 801.5nm. Vesicle sizes decreased with increasing the concentration of the edge activator. High negative zeta potential values were observed, revealing good stability of the vesicular formulations. The release of SIM from hydrated provesicular carriers was biphasic in nature. The selected SIM provesicular elastic carrier exerted approximately two-fold increase in the amount of SIM permeated through rat skin, compared to the free drug. Evaluation of wound healing activity of the selected provesicular formulation revealed significant reduction in wound size in rats, fourteen days post-wounding. These results were further confirmed by a significant increase in expression of vascular endothelial growth factor and collagen type I compared to the free drug. These results indicate that provesicular carriers could be a promising drug delivery system for encapsulating SIM and enhancing its wound healing efficacy.

Granulox-The Use of Topical Hemoglobin to Aid Wound Healing: A Literature Review and Case Series From Singapore.

Chronic wounds are an increasing burden on health care globally, and tissue hypoxia is a common issue in such wounds. Granulox (SastoMed GmbH, Georgsmarienhütte, Germany) is designed to provide wound bases with supplemental oxygen through facilitated diffusion and aid the physiological wound-healing process. It is a topical hemoglobin wound spray that is applied after wound cleaning and debridement to ensure continuous oxygen supplementation for up to 72 hours. Compared with other forms of topical oxygen therapy that require portable devices, Granulox is a spray-on application and the patient experience is similar to the use of a conventional dressing. Current clinical evidence suggests that Granulox aids with both wound healing and with symptom relief in chronic wounds, but current literature is limited by small study populations and further larger studies are required.

Minimally invasive, sutureless, adolescent male circumcision with topical anesthetic: a field trial of Unicirc, a single-use surgical instrument.

BackgroundCircumcision has been shown to reduce the rate of HIV transmission in Africa. It is most cost effective if performed in younger men. Surgical assist devices can increase the efficiency and potentially reduce the cost of performing circumcisions.MethodsWe used the Unicirc disposable instrument to perform circumcisions in an outpatient primary care clinic. The trial was non-blinded. Circumcisions were performed under topical anaesthetic and the wound was sealed with cyanoacrylate tissue adhesive. The primary outcome was intraoperative duration; secondary outcomes were intraoperative and postoperative pain; adverse events (AEs); time to healing and patient satisfaction; and, cosmetic result.ResultsA total of 82 adolescent boys (aged 10–15 years) were circumcised. The median intraoperative time was 10 minutes and the median blood loss was 1 mL. All wounds were healed by 4 weeks and cosmetic results were excellent. There were no AEs.ConclusionsAdolescent circumcision with Unicirc under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive is safe, rapid, and heals by primary intention with excellent cosmetic results. It is cost effective and can be used for large scale programs.