Rate Of Wound Closure Research Articles

Polyvinylpyrrolidone/chitosan-loaded dihydromyricetin-based nanofiber membrane promotes diabetic wound healing by anti-inflammatory and regulating autophagy-associated protein expression

The healing of wounds in diabetics is commonly delayed by recurring infections and persistent inflammation at the wound site. For this reason, we conducted a study using the electrospinning technique to create nanofiber membranes consisting of polyvinylpyrrolidone/chitosan (PVP/CS) and incorporated dihydromyricetin (DHM) into them. Infrared Fourier transform spectroscopy and scanning electron microscopy were used to analyze the nanofiber membrane. Experimental results in vitro have shown that PVP/CS/DHM has exceptional properties such as hydrophilicity, porosity, water vapor transport rate, antioxidant capacity, and antibacterial activity. Moreover, our study has demonstrated that the application of PVP/CS/DHM can significantly improve wound healing in diabetic mice. After an 18-day treatment period, a remarkable wound closure rate of 88.63 ± 1.37 % was achieved. The in vivo experiments revealed that PVP/CS/DHM can promote diabetic wound healing by suppressing the activation of TLR4/MyD88/NF-κB signaling pathway and enhancing autophagy-related protein as well as CD31 and HIF-1α expression in skin tissues. This study showed that PVP/CS/DHM is a promising wound dressing.

Electrospun radially oriented berberine-PHBV nanofiber dressing patches for accelerating diabetic wound healing.

A dressing patch made of radially oriented poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) nanofibers was successfully manufactured with a modified electrospinning strategy. The as-electrospun PHBV radially oriented nanofiber dressing patch exhibited uniform and bead-free nanofibrous morphology and innovative radially oriented arrangement, which was demonstrated to possess obviously improved mechanical property, increased surface hydrophilicity and enhanced biological properties compared to the PHBV nanofiber dressing patch control with traditionally randomly oriented pattern. Interestingly, it was found that the radially oriented pattern could induce the cell migration from the periphery to the center along the radially oriented nanofibers in a rapid manner. To further improve the biofunction of PHBV radially oriented nanofiber dressing patch, berberine (Beri, an isoquinoline alkaloid) with two different concentrations were encapsulated into PHBV nanofibers during electrospinning, which were found to present a sustained drug release behavior for nearly one month. Importantly, the addition of Beri could impart the dressing patch with excellent anti-inflammatory property by significantly inhibiting the secretion of pro-inflammatory factors of M1 macrophages, and also showed an additive influence on promoting the proliferation of human dermal fibroblasts (HDFs), as well as inhibiting the growth of E. coli, S. aureus and C. albicans, compared with the Beri-free dressing patch. In the animal studies, the electrospun PHBV radially oriented nanofiber dressing patch loading with high Beri content was found to obviously accelerate the healing process of diabetic mouse full-thickness skin wound with shortened healing time (100% wound closure rate after 18 days' treatment) and improved healing quality (improved collagen deposition, enhanced re-epithelialization and neovascularization and increased hair follicles). In all, this study reported an innovative therapeutic strategy integrating the excellent physical cues of electrospun PHBV radially oriented nanofiber dressing patch with the multiple biological cues of Beri for the effective treatment of hard-to-heal diabetic wounds.

Fibronectin Connecting Cell Sheet Based on Click Chemistry for Wound Repair.

As a living repair material, cell sheet exhibits significant potential in wound repair. Nonetheless, wound healing is a complicated and protracted process that necessitates specific repair functions at each stage, including hemostasis and antibacterial activity. In this work, on the basis of harvesting the cell sheet via a photothermal response strategy, a fibronectin attached cell sheet (FACS) is prepared to enhance its wound repair capability. For this purpose, the azide group (N3 ) is initially tagged onto the cell surface through metabolic glycoengineering of unnatural sugars, and then the conjugate (DBCO-fibronectin) comprises of the dibenzocyclooctyne (DBCO) and fibronectin with multiple wound repair functions is linked to N3 using click chemistry. Biological evaluations following this demonstrates that the FACS preparation exhibits excellent biocompatibility, and the fibronectin modification enhances the capacity for cell proliferation and migration. Moreover, in vivo wound healing experiment confirms the reparative efficacy of FACS. It not only has a wound closure rate 1.46 times that of a conventional cell sheet but also reduces inflammatory cell infiltration, promotes hair follicle and blood vessel regeneration, and encourages collagen deposition. This strategy holds enormous clinical potential and paves the way for advanced functional modifications of cell sheets.

Combined therapeutic strategy based on blocking the deleterious effects of AGEs for accelerating diabetic wound healing.

Diabetic foot ulcer is a serious complication of diabetes. Excessive accumulation of advanced glycation end products (AGEs) is one of the critical pathogenic factors in postponing diabetic wound healing. The main pathogenic mechanisms of AGEs include inducing cellular dysfunction, prolonging inflammatory response, increasing oxidative stress and reducing endogenous nitric oxide (NO) production. Combination therapy of blocking the deleterious effects of AGEs and supplementing exogenous NO is hypothesized to promote diabetic wound healing. Here, we presented nanoparticles/hydrogel composite dressings to co-delivery rosiglitazone and S-nitroso glutathione into the wound bed. The designed co-delivery system augmented the survival of fibroblasts, reduced oxidative stress levels, reversed the change of mitochondrial membrane potential and decreased the proinflammatory cytokine expression. Local sustained release of therapeutic agents significantly improved the wound healing of diabetic rats including increasing the wound closure rate, alleviating inflammation, promoting collagen fiber production and angiogenesis. Our finding indicated this local deliver strategy aimed at inhibiting the toxic effects of AGEs has great clinical potential for diabetic wound treatment.

Plasma Activated Water Solution as an Efficient Approach for Antiseptic and Wound Healing Applications: An Animal Model

The current investigation was aimed at identifying the potential of plasma activated water as an antiseptic and wound-healing solution. The simplicity and affordability of the indirect approach of plasma therapies led us to evaluate rinsing of wounds via plasma activated water (PAW) and compare to the direct approach of plasma jet. Although previous studies have shown the effectiveness of plasma-activated water in wound healing and disinfection, this study was conducted to investigate two PAWs with various compositions in wound management. In this regard, PAWs with two different treatment times were produced and used for rinsing of wounds. H<sub>2</sub>O<sub>2</sub> and NO<sub>2</sub>- concentrations as well as acidity values of PAW were measured. Wound healing was investigated to find an efficient solution using Masson trichrome and hematoxylin and eosin staining. The antibacterial effect and wound closure rate of the directly applied plasma jet were significantly improved compared to the PAW treatments. The results exhibited an increase in collagen expression, resulting in the best rate of wound closure. Thus, our results suggested that plasma jet treatment and PAW rinsing of wounds are effective methods without side effects in promoting wound healing.

Fetal progenitor cells for treatment of chronic limb ischemia.

This study investigated the therapeutic potential of fetal progenitor cells (FPCs) in the treatment of chronic non-healing wounds and ulcers associated with chronic limb ischemia (CLI). The research aimed to elucidate the mechanism of action of FPCs and evaluate their efficacy and safety in CLI patients. The researchers isolated FPCs from aborted human fetal liver, brain, and skin tissues and thoroughly characterized them. The preclinical phase of the study involved assessing the effects of FPCs in a rat model of CLI. Subsequently, a randomized controlled clinical trial was conducted to compare the efficacy of FPCs with standard treatment and autologous bone marrow mononuclear cells in CLI patients. The clinical trial lasted 12 months, with a follow-up period of 24-36 months. The primary outcomes included wound healing, frequency of major and minor amputations, pain reduction, and the incidence of complications. Secondary outcomes involved changes in local hemodynamics and histological, ultrastructural, and immunohistochemical assessments of angiogenesis. In the animal model, FPC treatment significantly enhanced angiogenesis and accelerated healing of ischemic wounds compared to controls. The clinical trial in CLI patients demonstrated that the FPC therapy achieved substantially higher rates of complete wound closure, prevention of major amputation, pain reduction, and improvement in ankle-brachial index compared to control groups. Notably, the study reported no serious adverse events. FPC therapy exhibited remarkable efficacy in promoting the healing of ischemic wounds, preventing amputation, and improving symptoms and quality of life in patients with CLI. The proangiogenic and provasculogenic effects of FPCs may be attributed to their ability to secrete specific growth factors. These findings provide new insights into the development of cellular therapeutic angiogenesis as a promising approach for the treatment of peripheral arterial diseases.

Wound Healing and Acute Dermal Toxicity Studies of Ludwigia octovalvis (Jacq.) P. H. Raven (Onagraceae) in Sprague–Dawley Rats

Introduction. The aerial part of Ludwigia octovalvis has been used traditionally in some parts of Asia for the management of wounds owing to the presence of phytochemicals such as tannins, flavonoids, and triterpenoids among others. The incidence of wounds, their associated complications, and the cost of wound care are on the increase globally, therefore, the need to develop alternative wound care agents. The aim of this study was to scientifically investigate the wound healing potential of the ethanolic extract of L. octovalvis using the excision wound healing model in rats and also carry out an acute dermal toxicity investigation of the plant extract. Method. A 70% ethanol extract of L. octovalvis was prepared for the wound healing activity using the excision wound healing model in Sprague–Dawley rats. Aqueous creams (1, 3, and 10%) were prepared and topically applied to the wounds once daily according to the groups of animals. The wounds were assessed for rates of wound closure on days 3, 5, 7, 9, and 11. Re‐epithelialization periods were also determined. Sections of wound tissues obtained on day 13 were subjected to histological investigations. An acute dermal toxicity of the plant extract was investigated. Results. L. octovalvis treatment (1, 3, and 10%) exhibited a mean percentage wound contraction range of 85.36 ± 7.22–94.14 ± 2.23 on day 11. The extract exhibited re‐epithelialization periods of 17.3 ± 1.2, 19.8 ± 2.6, and 16.0 ± 1.7 days for the 1, 3, and 10% extract creams, respectively, whereas the cream‐only and 1% silver sulfadiazine treatments resulted in a re‐epithelialization period of greater than 28 days. Histopathological investigation revealed enhanced fibroblast infiltration and collagen deposition in the treatment groups. No adverse reaction was observed in the acute dermal toxicity study. Conclusions. Extract of L. octovalvis exhibited wound healing by enhancing wound contraction, re‐epithelialization, fibroblast infiltration, and collagen deposition at the wound site. The extract did not exhibit any toxic reaction in the acute dermal toxicity study.

α-Terpineol loaded, electron beam crosslinked polyvinyl alcohol/tapioca starch hydrogel sheets; fabrication, characterization and evaluation of wound healing potential on a full thickness acid burn wound.

The multifaceted challenges in treating full-thickness acid burn wounds including impaired tissue regeneration, increased risk of infection, and the pursuit of functional and aesthetically pleasing outcomes, highlights the need for innovative therapeutic approaches for their treatment. The exceptional biochemical and mechanical properties of hydrogels, particularly their extracellular matrix-like nature and their potential to incorporate functional ingredients positions them as promising materials for wound dressings, offering a potential solution to the complexities of full-thickness burn wound management. The current study has integrated functional ingredients (starch and α-terpineol), known for their angiogenic, fibroblast-adhesive, and anti-inflammatory properties into an α-terpineol loaded, electron beam crosslinked polyvinyl alcohol/tapioca pearl starch hydrogel. The hydrogel was then explored for its efficacy in treating full-thickness acid burns. The hydrogel sheets, fabricated using a 25 kGy electron beam, were characterized for structural and functional properties. Surface morphology, gel fraction, swelling ratio, moisture retention capacity and thermal stability were also evaluated. PVA/tapioca starch hydrogel demonstrated optimal macroporosity, mechanical strength, thermal stability, water retention, and moisturizing ability, making it ideal for the intended application. In vitro skin compatibility analysis of α-terpineol-loaded hydrogel confirmed its biocompatibility, demonstrating 90% fibroblast viability. In vivo sensitivity testing on normal rat skin showed no inflammatory response. Analysis of the full-thickness rat chemical burn wounds treated with the hydrogels demonstrated that α-terpineol (AT) loaded e-beam crosslinked PVA/tapioca starch hydrogels increased the rate of wound closure, promoted re-epithelialization, facilitated collagen deposition, stimulated angiogenesis, and promoted keratin deposition, ultimately leading to healing of both thick dermal and epidermal tissues, as well as partial restoration of skin appendages over a duration of 30 days as confirmed by the histological and immunohistochemistry staining. Collectively, this study indicates that α-terpineol (AT) loaded e-beam crosslinked PVA/tapioca starch hydrogel holds promise as a cost-effective and efficient wound dressing for expediting full thickness acid burn wound healing, thus expanding the practical applications of the natural polymer based sheet hydrogel dressings.

Fabrication of fiber-particle structures by electrospinning/electrospray combination as an intrinsic antioxidant and oxygen-releasing wound dressing.

In this study, we employed a combination of electrospinning and electrospray techniques to fabricate wound dressings with a particle-fiber structure, providing dual characteristics of oxygen-releasing and intrinsic antioxidant properties, simultaneously. The electrospun part of the dressing was prepared from a blend of polycaprolactone/gallic acid-grafted-gelatin (GA-g-GE), enabling intrinsic ROS scavenging. To the best of our knowledge, this is the first time that PCL/GA-g-GE was fabricated by electrospinning. Furthermore, polyvinyl pyrrolidone (PVP) microparticles, containing calcium peroxide nanoparticles (CNPs), were considered as the oxygen production agent through the electrospray part. The CNP content was 1% and 3% w/w of PVP while biopolymer:PCL was 10% w/w. The fabricated structures were characterized in terms of fiber/particle morphology, elemental analysis, oxygen release behavior, ROS inhibition capacity, and water contact angle assessments. The covalent bonding of gallic acid to gelatin was confirmed by 1H-NMR, UV spectroscopy, and FTIR. According to the SEM results, the morphology of the prepared PCL/biopolymer fibers was bead-free and with a uniform average diameter. The analysis of released oxygen showed that by increasing the weight percentage of CNPs from 1 to 3 wt%, the amount of released oxygen increased from 120 mmHg to 195 mmHg in 24 h, which remained almost constant until 72 h. The obtained DPPH assay results revealed that the introduction of GA-g-GE into the fibrous structure could significantly improve the antioxidant properties of wound dressing compared to the control group without CNPs and modified gelatine. In vitro, the fabricated wound dressings were evaluated in terms of biocompatibility and the potential of the dressing to protect human dermal fibroblasts under oxidative stress and hypoxia conditions by an MTT assay. The presence of GA-g-GE led to remarkable protection of the cells against oxidative stress and hypoxia conditions. In vivo studies revealed that the incorporation of intrinsic ROS inhibition and oxygen-releasing properties could significantly accelerate the wound closure rate during the experimental period (7, 14, and 21 days). Additionally, histopathological investigations in terms of H&E and Masson's trichrome staining showed that the incorporation of the two mentioned capabilities remarkably facilitated the wound-healing process.

Correction to: Dehydrated human amnion/chorion membrane allograft for postoperative wounds following Mohs micrographic surgery: a retrospective comparative evaluation.

Introduction. Defects that remain after MMS cannot always be repaired immediately. When closure is not feasible, wounds are left to heal by secondary intention and may take weeks to close. In such cases, the use of an allograft that stimulates endogenous wound healing pathways may be desirable. Objective. This retrospective study assessed whether the use of dHACM allograft after MMS led to a statistically significant improvement in post-Mohs wound closure rates compared with secondary intention healing. Methods. This study evaluated 80 patients who underwent MMS and compared time to complete healing between wounds treated with dHACM allografts (n = 40) and wounds healed by secondary intention (n = 40). Wounds were assessed every 2 weeks, and photographs were taken. Statistical analysis was conducted. Results. Average time to complete wound healing was significantly reduced with the use of dHACM allograft compared with traditional secondary intention healing (5.2 weeks and 6.5 weeks, respectively; P = .01). Conclusion. The use of dHACM allograft resulted in more rapid wound healing, and this allograft is a potential alternative to traditional secondary intention healing methods. Further studies are needed to reinforce the results of this pilot study.

A novel chitosan-PEG hydrogel embedded with in situ silver nanoparticles of Clerodendrum glandulosum Lindl. extract: evaluation of its in vivo diabetic wound healing properties using an image-guided machine learning model.

The pathophysiology of chronic wounds related to diabetes mellitus is a result of a series of complications induced by hyperglycemia. The symptoms include impaired growth factor production, decreased keratinocyte proliferation and migration, reduced angiogenesis and cytokine synthesis, lowered matrix metalloproteinase (MMP) production, neuropathy, reduced nitric oxide synthase production, decreased fibroblast synthesis and migration, and impaired inflammatory cell functions. This multifaceted mechanism of diabetic wounds needs a suitable novel topical formulation that can deliver the active constituent by a controlled means, target the various stages of wound healing, absorb the wound exudates, and prevent secondary infections. To meet the above requirements, the Clerodendrum glandulosum (CG) extract reduced silver nanoparticle (AgNP) impregnated chitosan-polyethylene glycol (PEG) hydrogel was synthesized. The findings of the physicochemical characterization studies suggested that the hydrogel exhibited excellent formulation characteristics and showed controlled release for seven days, making it suitable for chronic wound healing studies. In subsequent studies, these formulations showed good antioxidant and antimicrobial properties, and hemocompatibility, with the least cytotoxic properties. The results of the diabetic wound healing studies showed a faster wound closure rate and improved extracellular matrix formation. These antioxidant, antimicrobial, anti-inflammatory and wound-healing properties suggest that the CG-AgNP loaded chitosan-PEG hydrogel is a promising material for novel topical formulation of diabetic wounds.

Fabrication and characterization of calcium peroxide and berberine loaded cryogels for enhanced wound healing.

Wound healing represents a complex biological process crucial for tissue repair and regeneration. In recent years, biomaterial-based scaffolds loaded with bioactive compounds have emerged as promising therapeutic strategies to accelerate wound healing. In this study, we investigated the properties and wound healing effects of cryogels loaded with calcium peroxide (CP) and berberine (BB). The cryogels were synthesized through a cryogenic freezing technique and displayed pore diameters of 83 ± 39 μm, with porosity exceeding 90%. Following 20 days of degradation, the percentage of remaining weight for GPC and GPC-CP-BB cryogels was determined to be 12.42 ± 2.45% and 10.78 ± 2.08%, respectively. Moreover, the swelling ratios after 3 minutes for GPC and GPC-CP-BB were found to be 22.10 ± 0.05 and 21.00 ± 0.07, respectively. In vitro investigations demonstrated the cytocompatibility of the cryogels, with sufficient adhesion and proliferation of fibroblast (NIH-3T3) cells observed on the scaffolds, along with their hemocompatibility. Furthermore, the cryogels exhibited sustained release kinetics of both calcium peroxide and berberine, ensuring prolonged therapeutic effects at the wound site. In vivo assessment using a rat model of full-thickness skin wounds demonstrated accelerated wound closure rates in animals treated with the GPC-CP-BB scaffold compared to controls. Histological analysis revealed enhanced granulation tissue formation, re-epithelialization, and collagen deposition in the GPC-CP-BB group. Overall, our findings suggest that the scaffold loaded with CP and BB holds great promise as a therapeutic approach for promoting wound healing. Its multifaceted properties offer a multifunctional platform for localized delivery of therapeutic agents while providing mechanical support and maintaining a favorable microenvironment for tissue regeneration.

Effect of Various Ancillary Operating Room Techniques on Wound Healing Outcomes After Total Knee Arthroplasty.

The successful management of wound healing after total knee arthroplasty (TKA) depends on several aspects of ancillary intraoperative techniques and surgical variables. Many of these have been evaluated in a few recent reports. The prior reviews studied many aspects of wound healing and, for example, found lower risks of wound complications with barbed sutures compared with interrupted closure with non-barbed sutures, no differences in wound complications between adhesives, subcuticular sutures, staples, glue, or mesh adhesives for the closure of the skin layer, and that mesh adhesives may be associated with faster closing times compared to subcuticular sutures or staples in TKA. However, some topics that can be influenced by the surgeon were not covered in these previous reviews. Namely, the use of deep vein thrombosis (DVT) prophylaxis, tourniquet application, management of intraoperative drains, surgical approach selection, and patellar handling techniques can all potentially influence wound healing. Therefore, in this comprehensive systematic review of the literature, we focused on these five factors that may influence wound healing. Specifically, we evaluated: (1) the impact of different DVT prophylaxis methods on wound healing and infection rates; (2) the role of tourniquet application on wound closure and potential infection risks; (3) the effects of intraoperative drain usage on wound healing; (4) the influence of different surgical approaches on wound closure and postoperative infection rates; and (5) the effects of varying patellar handling strategies on wound healing and infection rates. A systematic search of electronic databases, including PubMed, Cochrane Library, Medline, and Embase, was conducted to identify studies assessing auxiliary surgical techniques and their impact on wound healing in total knee arthroplasty (TKA). Relevant terms like "knee," "arthroplasty," and "wound healing" refined the search, which included English language publications until May 1, 2023. Independent screening by two authors and a third mediator facilitated the selection process, with 24 studies meeting the criteria. Assessment of these studies involved evaluating their evidence level and methodological quality using the Modified Coleman Methodology Score (MCMS). A comparison was made on wound healing outcomes in TKA, which included evaluating methodological quality parameters like sample sizes, follow-up durations, and clinical effect measurements. Data synthesis for the studies provided a comprehensive summary, categorizing them by evidence level. There were seven reports on DVT prophylaxis that showed no statistically significant differences in wound complications among various treatment methods and medications in patients undergoing total knee arthroplasty (TKA), with wound complication rates ranging from 0.25 to 1%, except that aspirin appeared to have lower wound complications rates in three recent studies than other methods. There were five reports on tourniquet application that showed a generally increased rate of wound complications, but no increase in deep infections. The five reports on intraoperative drain use showed that while there is an increase in total blood loss in the group with drains, ranging from 568ml to 1,856ml, compared to 119ml to 535ml in the no-drain group, there are no significant differences in wound complications, infection rates, or other postoperative outcomes such as swelling, deep vein thrombosis, and range of motion between the drain and no-drain groups. There were three studies on surgical approaches revealing no differences in wound complication rates between the mini-subvastus and medial parapatellar incisions. Also, the surgical variables of patella eversion and anterior tibial translation were only studied in one report. The current literature highlights the importance of using aspirin when possible for DVT prophylaxis and the possibility that tourniquets may lead to increased superficial wound complications. Drains or surgical approach do not appear to lead to wound problems. Surgical variables, such as patella eversion and anterior tibial translation, need more study.

Effect of Various Ancillary Operating Room Techniques on Wound Healing Outcomes After Total Hip Arthroplasty.

The successful management of wound healing following total hip arthroplasty (THA) is multifaceted, relying on various intraoperative techniques and surgical variables. Recent reviews have evaluated many of these factors, including the comparison between mesh-adhesive dressings and other skin closure methods, the closing time of different suture techniques, and the four aspects of closure for THA (deep fascial layer; subdermal layer; intradermal layer). However, previous articles did not cover certain topics that can be directly influenced by the surgeon. Specifically, these include the use of deep vein thrombosis (DVT) prophylaxis, the management of intraoperative drains, and the selection of surgical approaches. Therefore, in this comprehensive systematic review of the literature, we have focused on three factors that may influence wound healing. We evaluated the following: (1) the impact of different DVT prophylaxis methods on wound healing and infection rates; (2) the effects of intraoperative drain use on wound healing; (3) the influence of various surgical approaches on wound closure, and postoperative infection rates. By concentrating on these areas, this review aims to provide a more complete understanding of the factors that contribute to successful wound management after THA. A systematic search of electronic databases, including PubMed, Cochrane Library, Medline, and Embase, was conducted to identify studies assessing surgical variables and techniques, specifically focusing on DVT prophylaxis, intraoperative drain use, and surgical approaches and their impact on wound healing in THA. Relevant terms like "hip," "arthroplasty," "wound healing," "DVT prophylaxis," and "surgical approaches" refined the search, which included English language publications until May 1, 2023. Independent screening by two authors and a third mediator facilitated the selection process, with 13 studies meeting the criteria. Assessment of these studies involved evaluating their evidence level and methodological quality using the Modified Coleman Methodology Score (MCMS). A comparison was made on wound healing outcomes in THA, specifically focusing on the three factors outlined in the introduction: (1) the impact of different DVT prophylaxis methods on wound healing and infection rates; (2) the effects of intraoperative drain use on wound healing; and (3) the influence of various surgical approaches on wound closure and postoperative infection rates. Data synthesis for the studies provided a comprehensive summary, categorizing them by evidence level, and aimed to contribute to a more complete understanding of the factors that influence successful wound management after THA. In studies examining DVT prophylaxis for total knee arthroplasties (TKA), three reports found that both rivaroxaban and enoxaparin had similar wound infection rates at 0.36%. However, one study segment suggested a slightly higher infection rate for rivaroxaban at 0.71% compared to enoxaparin's 0.49%. Despite this difference, it was not statistically significant (odds ratio [OR] 1.34, 95% confidence interval [CI] 0.46 to 3.86). In recent research, a low dose of aspirin has been observed to yield fewer wound complications when contrasted with other techniques. Five studies on intraoperative drain use revealed mixed outcomes. A total of five studies were identified that evaluated wound complications with drains following THA, comprising two randomized controlled trials (RCTs) and three observational cohort studies, with a combined sample size of 765. Among these, four studies specifically compared the use of closed suction drains to no drains. Half of these studies (two out of four) reported no significant differences in wound complications between the two groups, while the other half presented mixed findings. In surgical approach comparisons by Jin et al., meta-analysis between the direct anterior approach (DAA) and posterolateral approach (PLA) showed no significant difference in complications (OR 0.57, p=0.952). Two studies analyzed bikini incision DAA versus PLA or conventional DAA, indicating comparable outcomes with no significant differences in wound complications between the approaches and no major variations in healing, acute PJI, or dysesthesia when comparing bikini incision DAA to conventional DAA. Wound healing post THA is a complex process, influenced by various surgical techniques and intraoperative decisions. This systematic review meticulously examined three critical factors: the role of DVT prophylaxis, the implications of intraoperative drain usage, and the impact of different surgical approaches. Our analysis revealed that rivaroxaban and enoxaparin exhibit similar wound infection rates in THA. The decision to use intraoperative drains in the current literature indicates no definite advantage or disadvantage regarding wound problems with the use of closed-suction drainage in THA. In exploring surgical methodologies, the DAA and the PLA showed comparable complication rates. Yet, specific techniques within the DAA category demonstrated variations in delayed wound healing, particularly among obese patients. These findings emphasize the nuanced role of surgical choices in determining wound healing outcomes. As the field of THA continues to evolve, it becomes important for surgeons to be well-informed, ensuring optimal patient outcomes.

Subcutaneous Anti-inflammatory Therapies to Prevent Burn Progression ina Swine Model ofContact Burn Injury.

If left untreated, burn injuries can deepen or progress in depth within the first 72 hours after injury as a result of increased wound inflammation, subsequently worsening healing outcomes. This can be especially detrimental to warfighters who are constrained to resource-limited environments with delayed evacuation times to higher roles of care and more effective treatment. Preventing this burn progression at the point of injury has the potential to improve healing outcomes but requires a field-deployable therapy and delivery system. Subcutaneous therapies known to treat inflammation delivered local to the wound site may prove to be one such avenue for success. Seven Yorkshire-cross swine received partial-thickness burn injuries using a previously established contact burn model. Each animal received one of the seven therapies: (1) saline, (2) heparin, (3) ibuprofen, (4) erythropoietin, (5) resolvin, (6) rapamycin, and (7) placental extract, all of which are either currently employed or are experimental in field use and indicated to treat inflammation. Treatments were delivered subcutaneously on the day of injury and 24 hours post-injury to simulate a prolonged field care scenario, before potential evacuation. Animals and wound development were observed for 28 days before euthanasia. Throughout the course of the study, wounds were observed macroscopically via non-invasive imaging. Histological analyses provided the critical metric of burn progression. Treatment success criteria were designated as the ability to prevent burn progression past 80% of the dermal depth in two of the three treated wounds, a clinically relevant metric of burn progression. It was determined that the applied model successfully created reproducible partial-thickness burn injuries in this porcine study. No significant differences with regard to lateral wound size or the rate of lateral wound closure were observed in any treatments. Several treatments including resolvin, rapamycin, ibuprofen, and erythropoietin successfully reduced burn progression to less than 80% of the dermal depth in two of the three wounds, 24 hours after injury. This report employs an established model of porcine contact burn injury in order to test the ability of local subcutaneous delivery of therapeutics to prevent burn progression at the point of injury, via what is believed to be the inhibition of inflammation. Several treatments successfully prevented burn progression to a full-thickness injury, potentially improving wound healing outcomes in a simulated battlefield scenario. Subcutaneously administered therapies combating burn-induced inflammation at the point of injury may serve as a field-deployable treatment modality to improve warfighter recovery and return to duty.

Hesperidin-loaded cubogel as a novel therapeutic armamentarium for full-thickness wound healing

Wounds are a physical manifestation of injury to the skin causing it to rupture or tear. The process of wound healing naturally restores skin integrity while minimizing the extent of the damage. Hesperidin (HPN) is a natural polyphenolic flavonoid and is effective in treating wounds due to its ability to reduce inflammation and stimulate angiogenesis. However, its use is limited by its poor physicochemical attributes such as poor solubility in water. Recently, nanoparticles, particularly Cubosomes, are found to be promising candidates for advancing wound-healing therapies, owing to their unique properties. The present study was conducted to develop a hydrogel system based on Cubosomes encapsulating HPN (HPN-Cubogel), with the potential to mitigate full-thickness wounds. The therapeutic efficacy of the formulation assessed in the animal model showed that the HPN-Cubogel formulation group exhibited a wound closure rate of 98.96 ± 1.50% after 14 days post-wounding compared to 89.12 ± 2.6% in the control group suggesting superior wound contraction activity. Collagen synthesis was superior in the formulation compared to the control group, as determined through MT staining. In summary, the HPN-Cubogel formulation was found to be the most effective in enhancing full-thickness wound healing.

Endogenous TSG-6 modulates corneal inflammation following chemical injury

PurposeTumor necrosis factor (TNF)-stimulated gene-6 (TSG-6) is upregulated in various pathophysiological contexts, where it has a diverse repertoire of immunoregulatory functions. Herein, we investigated the expression and function of TSG-6 during corneal homeostasis and after injury. MethodsHuman corneas, eyeballs from BALB/c (TSG-6+/+), TSG-6+/− and TSG-6−/− mice, human immortalized corneal epithelial cells and murine corneal epithelial progenitor cells were prepared for immunostaining and real time PCR analysis of endogenous expression of TSG-6. Mice were subjected to unilateral corneal debridement or alkali burn (AB) injuries and wound healing assessed over time using fluorescein stain, in vivo confocal microscopy and histology. ResultsTSG-6 is endogenously expressed in the human and mouse cornea and established corneal epithelial cell lines and is upregulated after injury. A loss of TSG-6 has no structural and functional effect in the cornea during homeostasis. No differences were noted in the rate of corneal epithelial wound closure between BALB/c, TSG-6+/− and TSG-6−/− mice. TSG-6−/− mice presented decreased inflammatory response within the first 24 h of injury and accelerated corneal wound healing following AB when compared to control mice. ConclusionTSG-6 is endogenously expressed in the cornea and upregulated after injury where it propagates the inflammatory response following chemical injury.

Nano-calcium incorporated piscean collagen scaffolds: potential wound dressing material

BackgroundCollagen proteins extracted from piscean sources are alternatives to bovine and porcine collagen because of their abundance, low price, and skin compatibility and are being explored as suitable wound dressing materials. Intracellular calcium ions are crucial for wound healing, and studies have shown that calcium ion supplementation via an external medium is equally beneficial for speedy recovery. This study explores the wound healing potential of dressing materials that encompass the benefits of nano-calcium and piscean collagen. Nano-calcium sulphate (NCS)-integrated scaffolds were prepared with 100 ppm of NCS and varying concentrations of piscean collagen and HPMC E15 LV. The thickness, tensile strength, folding endurance, pH, expansion profile, and moisture vapour transmission properties of the scaffolds were determined. An in vitro scratch assay and an excision rat wound model were employed to evaluate the wound healing properties of the scaffolds.ResultsThe NCS particles had a mean particle size of 220.7 nm. The scaffolds demonstrated an acceptable thickness, mechanical strength, and flexibility. The scratch assay results revealed that at the end of 24 h of the study, there was an increased wound closure rate with collagen scaffolds in contrast to the control group. In the vivo wound healing studies, formulation CS6 showed 100.0% healing on day 12 as compared to other formulations.ConclusionsWounds treated with scaffolds contracted faster than those treated with a commercial collagen dressing and the control group. The current study thus demonstrates the wound healing ability of nano-calcium sulphate-incorporated piscean collagen scaffolds.

Fabrication of dual drug-loaded polycaprolactone-gelatin composite nanofibers for full thickness diabetic wound healing.

Aim: Design of moxifloxacin and ornidazole co-loaded polycaprolactone and gelatin nanofiber dressing for diabetic wounds. Materials & methods: The composite nanofibers were prepared using electrospinning technique and characterized for in vitro drug release, antibacterial activity, laser doppler and in vivo wound healing. Results: The optimized nanofiber demonstrated an interconnected bead free nanofiber with average diameter <200nm. The invitro drug release & antimicrobial studies revealed that optimized nanofiber provided drug release for >120h, thereby inhibiting growth of Escherichiacoli and Stapyhlococcusaureus. An in vivo wound closure study on diabetic rats found that optimized nanofiber group had a significantly higher wound closure rate than marketed formulation. Conclusion: The nanofiber provided prolonged drug release and accelerated wound healing, making it a promising candidate for diabetic wound care.

EFFECTS OF RECOMBINED HUMAN BONE MORPHOGENETIC PROTEIN-2 AS ALVEOLAR RIDGE PRESERVATION ON PAIN REDUCTION AND SOFT TISSUE HEALING PROCESS: A SPLIT MOUTH DESIGNED PILOT STUDY

Background: The alveolar ridge undergoes physiological bone resorption following tooth extraction. Several alveolar ridge preservation (ARP) techniques have been researched and developed in an effort to reduce this process and maintain a favorable volume and morphology of the alveolar ridge for appropriate implant placement. Bone morphogenetic proteins (BMPs) are proteins derived from a subgroup of the transforming growth factor  family that accelerates ossification by controlling essential factors of the bone induction cascade, resulting in the proliferation of osteoblasts from mesenchymal stem cells and the biosynthesis of bone matrices. One of these BMPs is recombinant human bone morphogenetic protein-2 (rhBMP-2) that has been authorized to be used for ARP. Objective: This study aims to evaluate the effect of rhBMP-2 on the healing process and the level of pain following dental extraction. Methods: In this split-mouth pilot study, 11 patients underwent extractions of a minimum of two teeth, and randomly, one of the alveolar sockets was filled with a hemostatic sponge while the other was filled with a hemostatic sponge embedded with rhBMP-2. Both sockets were sutured using the X technique. Wound healing measurements were done on days 3, 7, and 14, and each participant was requested to document his pain experience using the Numerical Rating Scale (NRS). Results: In accordance with clinical evidence, it was observed that the mean pain score was at its peak on day 0 and progressively diminished in the subsequent days. Notably, this decline was more pronounced in the rhBMP-2 group compared to the control group. Importantly, a statistically significant reduction in pain level was detected on day 3 within the rhBMP-2 group, in contrast to the control group (P-value &lt; 0.05). This indicated that the application of rhBMP-2 led to a noteworthy and meaningful alleviation of pain on the third day after treatment, surpassing the impact observed in the control group. For the wound healing changes, it uncovered statistically significant mean differences across various time intervals: day 0 and day 3, day 0 and day 7, day 0 and day 14, day 3 and day 7, and day 7 and day 14 (P-value &lt; 0.0001). These significant differences strongly suggest dynamic changes in wound closure rates over time. Furthermore, the observed differences were more pronounced in the rhBMP-2-treated group compared to the control group. This augmentation of differences indicates that the utilization of rhBMP-2 for ARP within a fresh socket site resulted in a heightened acceleration of the wound healing process. Conclusion: Our results suggest that rhBMP-2 can decrease post-operative pain after tooth extraction and accelerate the soft tissue healing process.