Treatment Of Burn Wounds Research Articles

Investigation of Tannic Acid Crosslinked PVA/PEI-Based Hydrogels as Potential Wound Dressings with Self-Healing and High Antibacterial Properties

This study developed hydrogels containing different ratios of TA using polyvinyl alcohol (PVA) and polyethyleneimine (PEI) polymers crosslinked with tannic acid (TA) for the treatment of burn wounds. Various tests, such as scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), swelling, moisture retention, contact angle, tensile strength, the scratch test, antibacterial activity and the in vitro drug-release test, were applied to characterize the developed hydrogels. Additionally, the hydrogels were examined for cytotoxic properties and cell viability with the WST-1 test. TA improved both the self-healing properties of the hydrogels and showed antibacterial activity, while the added gentamicin (GEN) further increased the antibacterial activities of the hydrogels. The hydrogels exhibited good hydrophilic properties and high swelling capacity, moisture retention, and excellent antibacterial activity, especially to S. aureus. In addition, the swelling and drug-release kinetics of hydrogels were investigated, and while swelling of hydrogels obeyed the pseudo-second-order modeling, the drug release occurred in a diffusion-controlled manner according to the Higuchi and Korsmeyer–Peppas models. These results show that PVA/PEI-based hydrogels have promising potential for wound dressings with increased mechanical strength, swelling, moisture retention, self-healing, and antibacterial properties.

Engineered Multifunctional Artificial Dermis for Infected Burn Wound Healing

AbstractBurn wound healing is a dynamic and interconnected process, with the complex status of the extracellular matrix (ECM) potentially leading to bacterial infections, drug resistance, or even fatality. However, it remains a grand challenge to assemble a skin‐like material showing similar biological properties as healthy ECM to accelerate burn healing. In this study, the ECM composition is closely mimicked and adaptive multifunctional artificial dermis is developed by leveraging Ag─S bonds, supramolecular interactions among recombinant proteins, Ag+, and hyaluronic acid (HA). The artificial dermis exhibits long‐lasting broad‐spectrum antibacterial activity, achieved though controlled Ag+ release via Ag─S bonds, supramolecular interactions, and recombinant protein‐guided multi‐level assembly, reaching a steady plateau of 83.7% in the later stage. It is found that inflammation is reduced by downregulating IL‐6 and TGF‐β expression. Furthermore, the epidermal growth factor (EGF) within the recombinant proteins stimulates Col1α, ELN, and CD31 upregulation, facilitating ECM remodeling. These adaptive multifunctional artificial dermis effectively address wound infections, accelerate collagen deposition, promote re‐epithelialization, and enhance angiogenesis in infected wounds, highlighting their potential to revolutionize burn wound treatment and offering a promising avenue to holistic care.

Fresh tilapia fish skin graft treatment of severe skin burns in a cat

AbstractAn entire female cat presented with extensive third‐degree burns covering greater than 30% of total body surface. The wound was cleaned and debrided with daily dressing management to heal with second intention. Dressing applied included honey‐based product, L‐Mesitran Ointment, and silver alginate dressing, Askina Calgitrol Thin, until healthy granulation tissue had formed. Fresh tilapia skin grafts were harvested and prepared and secured onto the wound bed. Daily lavage and graft evaluation occurred, and subsequently the skin grafts were removed on Day 13 and Day 7, respectively. Wound healing was observed without any complications or adverse side effects. In conclusion, the use of fresh tilapia skin grafts proves to be a safe, innovative, low‐cost, and effective therapeutic and promising option in treatment of challenging skin burn wounds. Tilapia fish skin grafts resulted in a clinically favourable outcome in a cat with extensive third‐degree burn wounds.

Development of N-alkylated benzimidazole based cubosome hydrogel for topical treatment of burns.

The current study focuses on assessing the activity of the N-alkylated benzimidazole based cubosomal hydrogel (cubogel) for the topical treatment of burn wounds. The study involves the synthesis of six benzimidazole derivatives (1-6) and their characterization by FT-IR and 1H and 13C NMR spectroscopy. The further study involves the design and formation of nanoparticles known as cubosomes loaded with selected 1-benzyl-1-benzimidazole (API 6) and the development of a cubogel for the topical treatment of burn wounds. Cubosomes were prepared by the homogenization method, using glyceryl monooleate (GMO) as a lipid polymer and poloxamer 407 (P407) as a surfactant. Cubosomes undergo in vitro characterizations (measurement of particle size, zeta potential, polydispersity index (PDI), % entrapment efficiency, drug release in phosphate buffer saline of pH 6.8, and surface morphology by utilizing TEM (transmission electron microscopy). Formulation D3 (2.5% of GMO, 1% of P407, and 2.5% of PVA) emerged as the optimized formulation, displaying a minimum particle size (PS) of 129.9 ± 1 nm, entrapment efficiency (%EE) of 96.67 ± 0.89%, and a drug release of 86 ± 2.7% at 24 h. Carbopol 940 hydrogel was prepared and incorporated with the optimized formulation to prepare cubogel. This optimized cubogel provided 92.56 ± 0.014% in vitro drug release within 24 h. An in vivo histopathological study was conducted on an animal model (rabbit) to assess the efficacy of cubogel in wound healing and wound contraction. Then cubogel was compared with the commercially available creams Clotrimazole® and Polyfax®. The wound treated with newly developed cubogel has maximum wound contraction (96.70%) as compared to the standard creams. The findings revealed that the newly formulated cubogel was highly effective in treating burns, showing superior performance to commercial products without inducing side effects. Additionally, benzimidazole derivative loaded cubogel caused a sustained release for treating burn wounds without any bacterial infections. The current results further suggested phase 0 clinical trials.

Individualized surgical treatment using decellularized fish skin transplantation after enzymatic debridement: a two years retrospective analysis

Treatment of burn injuries has developed over the past few years with the development of enzymatic debridement and new types of skin replacement materials beyond primary surgical therapy providing complex personalized therapy concepts with the goal of preserving and replacing the dermal layer of the skin.The aim of our study was to develop an individualized treatment algorithm for mixed depth burn wound and to evaluate the outcome of an individualized combined treatment of mixed depth burn wounds with an enzymatic debridement and decellularized fish skin.A total of 18 Patient treated could be analyzed with a mean age of 34.8 years and a mean follow-up of 447,6 days. The mean total burn surface area was 12.3%. All patients received an enzymatic debridement and an average area of ​​247.2 square centimeters decellularized fish skin. Days until complete epithelization was 49,4 ± 25,79. No Patient developed a scar contracture or a keloid. The POSAS Observer Scale showed an overall impression average of 2,2 ± 0,83. The POSAS patient scale showed an overall impression average 2 ± 0,7. The Vancouver Scar Scale showed an average score of 1,89 ± 1,45. In conclusion, a combined treatment of enzymatic debridement and decellularized fish skin, polylactide membrane or split skin grafts allows a more individualized therapy for mixed depth burn wounds. Fish skin was found to provide a satisfying result regarding the overall outcome of the developed scar tissue and could lead to a reduction of the area needed to be autologous transplanted.

Efficacy of Nano-Silver Dressing Combined with Silver Sulfadiazine Cream in the Treatment of Second-Degree Burn Wounds

Efficacy of Nano-Silver Dressing Combined with Silver Sulfadiazine Cream in the Treatment of Second-Degree Burn Wounds

Drug loaded marine polysaccharides-based hydrogel dressings for treating skin burns.

Marine polysaccharide-based biomaterials possess a range of excellent functions and properties, such as antiviral, antioxidant, immune regulation, and promoting cell migration, and are widely used in modern medicine. In this study, a marine polysaccharide-based composite hydrogel was synthesized using carboxymethyl chitosan and oxidized fucoidan as matrix, and loads therapeutic drugs for the treatment of burn wounds infected with bacteria. The composite hydrogels can slowly release drugs at the wound site, providing a long-lasting therapeutic effect including antibacterial, antioxidant, and analgesic, in this way to facilitate the restoring of infected burn wounds by inhibiting bacterial infections, promoting cell migration, facilitating collagen regeneration, and restoring the abnormal alteration of factors such as IL-1β and CD86.

Experimental burn models for evaluating wound healing agents and its current situation and existing disadvantages: a literature review

BACKGROUND: Burns remain a crucial part of the structure of injuries in Russia and abroad. Therefore, providing high-quality medical care to burn victims is relevant. Despite the large number of proposed solutions to this condition, developments in the field of tissue engineering and medical materials science still lack standardization and consideration of specific features of animal burn models for their testing. Many studies showed minor and major disadvantages from a technical and descriptive point of view. AIM: To analyze and identify the main disadvantages of existing burn models to assess the effect of wound healing agents. MATERIALS AND METHODS: This article examines the search results in the databases Google Scholar and PubMed using the keywords “burns,” “rats,” “animal model,” and “wound healing.” Sixty publications were analyzed. RESULTS: Seven quality criteria for the animal burn model have been determined, which allow obtaining reliable results and reproducing the described experiment: indication of the terms of quarantine and conditions of keeping laboratory animals, detailed description of the technique of applying burn injury, presence of one burn on a laboratory animal, presence of a control biopsy, indication of the absolute value of the initial burn area, presence of surgical treatment of burn wounds, and correct use of formulas for the planimetric assessment of wound healing. CONCLUSIONS: A solution to the problem of creating a standardized model may be a more detailed description of techniques and following the proposed quality criteria.

The ‘AfterBurn’ Longitudinal Exploratory (ABLE) study: Cohort profile

With advanced medical treatments more burns patients survive their injuries, requiring a better understanding of the quality-of-life outcomes experienced after the burn. The aims of the ABLE study cohort profile are to describe the baseline characteristics. The study included participants aged 18 years or over, admitted to a single state-wide burns centre in Queensland, Australia with a ‘major burn injury’. Baseline survey data were collected either in person or by telephone within 28 days of the injury and participants were followed up with in-person, or telephone interviews at 3-, 6- and 12-months post-burn. Injury and burns treatment information were collected from medical records or the hospital database and surveys collected demographic and psychosocial data. Health-Related Quality of Life (HRQoL) data were collected using the 12-item Short Form Survey – version 1 (SF-12v1) and the Burn Specific Health Scale – Brief version (BSHS-B). Of the 274 participants recruited, 71.5 % (N = 196) remained enrolled in the study at 12 months post-burn. The median age for the cohort was 41.5 years (range 18 to 87 years) and the majority were male (72 %) as well as non-Indigenous Australians (76 %). The median Total Body Surface Area (TBSA) burned was 4.75 % (IQR=1.5–10.13) with a range of 0.1 % to 79.75 %. The largest percentage of participants sustained a flame burn (N = 129, 47.1 %) followed by scald (N = 56, 20.4 %) then contact burn (N = 54, 19.7 %). Fewer participants were injured by chemical (N = 14, 5.1 %), friction (N = 11, 4 %), and electrical burns (N = 6, 2.2 %). There were 37.9 % participants who reported having been diagnosed with a psychological condition prior to their burn injury. These findings provide an overview of baseline characteristics with a greater understanding of personal, environmental, burn injury and burn treatment factors in a state-wide burn centre.

Commercial Silver-Based Dressings: In Vitro and Clinical Studies in Treatment of Chronic and Burn Wounds.

Chronic wounds are a major health problem because of delayed healing, causing hardships for the patient. The infection present in these wounds plays a role in delayed wound healing. Silver wound dressings have been used for decades, beginning in the 1960s with silver sulfadiazine for infection prevention for burn wounds. Since that time, there has been a large number of commercial silver dressings that have obtained FDA clearance. In this review, we examine the literature involving in vitro and in vivo (both animal and human clinical) studies with commercial silver dressings and attempt to glean the important characteristics of these dressings in treating infected wounds. The primary presentation of the literature is in the form of detailed tables. The narrative part of the review focuses on the different types of silver dressings, including the supporting matrix, the release characteristics of the silver into the surroundings, and their toxicity. Though there are many clinical studies of chronic and burn wounds using silver dressings that we discuss, it is difficult to compare the performances of the dressings directly because of the differences in the study protocols. We conclude that silver dressings can assist in wound healing, although it is difficult to provide general treatment guidelines. From a wound dressing point of view, future studies will need to focus on new delivery systems for silver, as well as the type of matrix in which the silver is deposited. Clearly, adding other actives to enhance the antimicrobial activity, including the disruption of mature biofilms is of interest. From a clinical point of view, the focus needs to be on the wound healing characteristics, and thus randomized control trials will provide more confidence in the results. The application of different wound dressings for specific wounds needs to be clarified, along with the application protocols. It is most likely that no single silver-based dressing can be used for all wounds.

Lysozyme-enhanced cellulose nanofiber, chitosan, and graphene oxide multifunctional nanocomposite for potential burn wound healing applications

The demand for advanced biomaterials in medical treatments is rapidly expanding. To address this demand, a nanocomposite of cellulose nanofiber (CNF) with chitosan (Ch) and graphene oxide (GO) was developed for burn wound treatment. The CNF-Ch-GO nanocomposites were characterized and their biological properties were evaluated. Microscopic images showed a uniform distribution of CNF, Ch, and GO with a porous structure. ATR-FTIR and XRD analyses confirmed the chemical structures, while a thermogravimetric study confirmed the stability of CNF-Ch-GO nanocomposite under a N2 atmosphere. The synthesized CNF-Ch-GO nanocomposite exhibited rapid absorption, absorbing 1781.7 ± 53.7 % PBS in 2 min. It demonstrated a Young's modulus of 11.90 ± 0.06 MPa in a hydrated condition, indicating its mechanical stability in water. Furthermore, it displayed excellent biocompatibility and hemocompatibility with 96.23 ± 12.21 % cell viability and 0.21 ± 0.08 % of hemolysis. Additionally, the blood clotting index of CNF-Ch-GO was comparable to that of standard dressing gauze. To enhance antimicrobial efficacy, CNF-Ch-GO was conjugated with lysozyme. This biotic and abiotic conjugation resulted in 92.17 % ± 3.02 % and 94.99 ± 2.1 % eradication of Escherichia coli and Staphylococcus aureus, respectively. The enhanced antimicrobial properties, biocompatibility, and mechanical stability of the superabsorbent CNF-Ch-GO nanocomposite indicate its significant potential for advanced burn wound healing applications.

Fighting A New Front On An Old Battlefield: Examining the Development of Topical Antimicrobial Care to Control Burn Wound Sepsis.

Recognition of invasive burn wound sepsis as a major cause of morbidity and mortality in burn injured patients has profoundly changed the management of burn wounds and its associated complications. The development of effective topical antimicrobial therapy is one of the last major developments of modern burn care and has been driven by major world events and scientific breakthroughs. Topical antimicrobial burn care has evolved from the use of anecdotal remedies to scientific breakthroughs such as Moyer's successful dilution of silver nitrate solution, Fox's described benefit of silver sulfadiazine use in animal models, and Pruitt's dramatic improvement in post-burn mortality using topical mafenide acetate in burn wounds. The objective of this manuscript is to review the definition of burn wound sepsis and highlight the major developments and breakthroughs in topical burn wound care throughout history. This includes historical events like major wars or domestic fires that have influenced or impacted the understanding and treatment of burn wounds. Newer advances in topical antimicrobial care such as nanosilvers and dressing technologies that improve the morbidity and mortality associated with burn wound sepsis and novel approaches to management will also be discussed. To improve burn care, it is prudent to look to the past and learn from the experiences of those who contributed to the control of burn wound sepsis.

Burn Care in the Street: A Survey of the Current Landscape of Burn Care Provided by Street Medicine Teams.

People experiencing homelessness are at increased risk for serious burn injuries and face additional barriers to care such as inability to perform wound care and difficulty with follow-up. Although not burn-specific, street medicine programs provide direct medical care to people experiencing unsheltered homelessness in their own environment and may be well positioned to bridge this gap in burn care for this population. We conducted a cross-sectional survey to characterize the burn care experience of street medicine teams with providing burn care for people experiencing homelessness. The 60 respondents included 18 (30%) physicians, 15 (25%) nurse practitioners or physician assistants, 15 (25%) registered nurses, and 6 (10%) medical students, and 6 (10%) other team members. The most common reported barriers to care were prior negative experiences with emergency departments, and transportation to burn centers. There was regional variability in frequency of providing burn care, which was reflected in respondent comfort with assessing and treating burns. Burns were most often dressed with daily dressings such as a non-adherent dressing over silver sulfadiazine or bacitracin. Silver-based contact dressings were rarely used. Street medicine teams in the United States are treating burn injuries among people experiencing homelessness, though management practices and experience treating burns was variable. As street medicine programs continue to grow, burn-related education, training, and connections to local burn centers for team members is important. Through strengthened partnerships between burn centers and street medicine teams, these programs may be well positioned to bridge the gap in burn care for people experiencing homelessness.

Physical therapy in burn care: Development of clinical prediction rules to determine the efficacy of low-level laser therapy

This study aimed to demonstrate the benefits of low-level laser therapy (LLLT) on burn healing and to investigate whether patients' age, burn wound size, wound stage, and total burned surface area influence the burn wound healing response to LLLT. This was a quasi-experimental study with a single-group design that included eighty male and female patients with partial-thickness burn wounds recruited from burn units. The participants were placed in a single intervention group receiving LLLT. The duration of the intervention was six weeks, divided into 18 sessions (three sessions per week). The statistical analysis was conducted using version 25 of the SPSS statistical package for Windows. The results showed a statistically significant negative relationship between wound improvement from LLLT and age (p < 0.05) and between total body surface area (TBSA) and wound improvement (p < 0.05). Additionally, a statistically significant positive relationship was found between initial wound size and wound improvement (p < 0.05). There was no statistically significant relationship between wound improvement and wound stage (p > 0.05). The current study revealed that age, TBSA, and initial wound size can predict the efficacy of low-level laser treatment for burn wounds.

Healing Potential of the Marine Polysaccharides Carrageenan and Ulvan on Second-Degree Burns.

The treatment of second-degree burn wounds presents a significant clinical challenge, often characterized by prolonged healing times and risk of complications. In this study, the wound healing potential of bioactive marine sulfated polysaccharides ulvan and carrageenan formulated in gels at concentrations of 1.5%, 5.0%, and 10% w/w was evaluated. Hairless female SKH-hr2 mice (n = 7 per treatment) with burn-inflamed skin were treated with the polysaccharide-based gels, and the therapeutic efficacy was assessed using a comprehensive array of evaluation methods, including a histopathological analysis, clinical observation, photo-documentation, an image analysis, an evaluation of biophysical skin parameters, and FT-IR spectroscopy. Our findings indicate that the 10% w/w carrageenan gel exhibited significant enhancement in wound healing, particularly in the early stages of the healing process. This was evidenced by the restoration of the α-helix structure of collagen and the configuration of glycosaminoglycans, as demonstrated by FT-IR absorption bands of the skin both in vivo and ex vivo. Furthermore, the 5% w/w ulvan gel also demonstrated notable efficacy in promoting wound healing, particularly in the later stages of the healing process. These results suggest that carrageenan and ulvan gels hold promise for improving the efficiency of wound healing in second-degree burn wounds. Our study contributes to the understanding of the therapeutic potential of marine polysaccharides and provides insights into their mechanism of action in promoting wound healing.

Prospects for the application of cell therapy in combustiology

Currently, one of the urgent problems in the field of surgery and traumatology is burn injury. A significant part of the victims has deep and extensive burns, the treatment of which is the most difficult problem of modern combustiology. In this aspect, one of the main problems faced by surgeons in combustiology is the lack of donor material and an increased risk of complications of burn wounds. In this regard, the most promising direction in kombustiology is the application of cell engineering methods, including the use of fibroblasts and stem cells. Fibroblasts have a number of advantages, such as efficiency, safety and accessibility. Stem cells are also a common method of cell therapy, they have great potential in regenerative processes. Mesenchymal stem cells (MSCs), which have a pronounced regenerative and immunosuppressive effect, are also used in kombustiology. In the treatment of infected burn wounds, phage therapy, which provides lysis of infectious pathogens, showed a positive result. In addition to fighting pathogens, bacteriophages, like MSCs, have an immunosuppressive effect, thereby reducing the risk of transplant rejection.

NOVEL USE OF NILE TILAPIA FISH (OREOCHROMIS NILOTICUS) SKIN AS XENOGRAFT IN ZOOLOGICAL SPECIES.

Nile tilapia fish skin (Oreochromis niloticus) has been increasingly used in human and veterinary medicine in xenografts for treatment of burn wounds. The objective of this study was to self-prepare the graft using a Brazilian patent (WO2017/035615 A1) as a guide and apply it to full-thickness wounds in zoological species (n = 4). The wounds, which were all characterized as contaminated wounds in which the entire dermal layer was missing, had all previously been surgically debrided and treated with traditional wound-healing techniques without success. This graft technique was developed in response to the poor treatment success. The graft was prepared and sutured to the affected area, leading to complete contraction and epithelialization in all cases. The patients were concurrently placed on one course of systemic antibiotics because of the severity of wound contamination. The frequency of dressing changes varied between species and no adverse effects were apparent. This method of processing Nile tilapia fish skin proves promising for use in contaminated wounds, as it is inexpensive and easy to acquire and develop, mitigates stress in wildlife patients because of a decreased frequency of dressing changes and therefore handling, and can be utilized in clinical environments.

Wound care used topical ointment made from a combination of cherry leaf extract (Muntingia calabura L) and manuka honey on the healing process of superficial second-degree burns: a case report

Background: Burns are one of the most common accidental injuries in the community. Improper treatment of burns can lead to disability and even death. Applying topical therapy aims to reduce excessive collagen repositioning and accelerate healing. We tried treating burn wounds with an ointment that uses a combination of cherry leaf extract and manuka honey to test the effectiveness of wound healing.Case presentation: We report two cases of superficial burns that underwent wound treatment using an ointment containing cherry leaf extract and manuka honey.Conclusion: Wound treatment with an ointment containing cherry leaf extract and manuka honey can speed up the healing process in patients with superficial second-degree burns.

A dopamine-assisted antioxidative in situ-forming hydrogel with photothermal therapy for enhancing scarless burn wound healing

Burn wounds are characterized by complex physiological and pathophysiological response and the management of burn wounds is challenging. In situ-forming hydrogels and photothermal therapy (PTT) are promising treatments for wound healing. However, current research on biomaterials for burn treatment mainly focuses on either promoting healing or inhibiting scar formation, few studies have combined the two functions of one material. In this study, we prepared a multifunctional, in-situ cross-linked hydrogel termed CPOD hydrogel, which integrates carboxymethyl chitosan (CMCS), polyvinyl alcohol (PVA), oxidized hyaluronic acid (OHA), and dopamine (DA), coupled with photothermal therapy (PTT). In vitro experiments showed that the CPOD hydrogel had outstanding biocompatibility, suitable tissue adhesion and mechanical properties, excellent antimicrobial and antioxidant properties. This hydrogel showed PTT properties, which could produce mild heat in the early stage and higher temperatures in the later stage under NIR radiation. In the treatment of burn wounds of mice, application of CPOD hydrogel with PTT significantly promoted wound healing in the early stage and inhibited scar formation in the later stage, showing great potential for future innovation and application.

Reassessing Long-Term Cryopreservation Strategies for Improved Quality, Safety, and Clinical Use of Allogeneic Dermal Progenitor Cells

In regenerative medicine, ongoing advancements in cell culture techniques, including isolation, expansion, banking, and transport, are crucial for clinical success. Cryopreservation ensures off-the-freezer availability of living cells, enabling long-term storage and transport. Customizing cryopreservation techniques and cryoprotective agents (CPAs) for specific cell types is crucial for cell source quality, sustainability, safety, and therapeutic intervention efficiency. As regenerative medicine progresses, it becomes imperative that the scientific community and industry provide a comprehensive, cell-specific landscape of available and effective cryopreservation techniques, preventing trial-and-error approaches and unlocking the full potential of cell-based therapies. Open-sharing data could lead to safer, more efficient cell therapies and treatments. Two decades of dermal progenitor cell use for burn wound treatment and Good Manufacturing Practice-compliant technology transfers have highlighted the need for further cryopreservation optimization in manufacturing workflows. In this paper, we present experimental data assessing 5 different cryopreservation formulae for long-term storage of clinical-grade FE002 primary progenitor fibroblasts, emphasizing the crucial difference between DMSO-based and DMSO-free CPAs. Our findings suggest that CryoOx, a DMSO-free CPA, is a promising alternative yielding cell viability similar to that of established commercial CPAs. This research highlights the importance of secure, robust, and efficient cryopreservation techniques in cell banking for maximizing quality, ensuring patient safety, and advancing regenerative medicine.