Wound Fluid Research Articles

A tranexamic acid-functionalized acellular dermal matrix sponge co-loaded with magnesium ions: Enhancing hemostasis, vascular regeneration, and re-epithelialization for comprehensive diabetic wound healing

Excessive inflammation, accumulation of wound exudate, and blood seepage are common in diabetic wounds, hindering cell proliferation and disrupting tissue remodeling, leading to delayed healing. This study presents a multifunctional sponge scaffold (P5T3@Mg) created by combining an acellular dermal matrix with tranexamic acid and MgO nanoparticles, designed for hemostatic and anti-inflammatory effects. The P5T3@Mg scaffold effectively absorbs wound fluid while promoting healing. In vivo and in vitro hemostasis experiments demonstrate that the P5T3@Mg sponge exhibits excellent hydrophilicity, enhancing blood absorption at the wound site, inhibiting fibrinolysis, and expediting hemostasis. Additionally, the sustained release of Mg2+ from the P5T3@Mg sponge promotes collagen deposition and angiogenesis in diabetic rat wounds, suppressing chronic inflammation and accelerating tissue remodeling and repair.

International Burn Disaster Nursing: Care, Commitment, Compassion, and Cost.

Burn mass casualty incidents can overwhelm local resources, challenging effective communication, triage, and provision of care. International responders can help by providing education and direct patient care. On November 5, 2021, a fuel tanker truck exploded in Freetown, Sierra Leone, killing or injuring hundreds of people. The needs of the severely burned survivors overwhelmed local resources, requiring an international response. Burn specialist teams from several countries, including the United States, were deployed to provide assistance. Members of the US burn care team educated local health care practitioners about wound care, physical therapy, and fluid and pain management. Educational content was delivered through lecture and discussion, case studies, clinical application, and bedside teaching. Demonstration of cultural competence and humility, as well as attentiveness to nuances of local communication, helped avoid ethnocentrism and other barriers to collaboration. Public congratulations and formal completion certificates were used to provide meaningful recognition of successful class participation. Before the lecture and discussion intervention, 57 students participating in a pretest assessment had an average score of 53.9% (high, 80%; low, 27.5%). After the intervention, 38 students participating in a posttest assessment had an average score of 79.3% (high, 95%; low, 55%), and local health care providers delivered care with more attention to patient comfort and shared new knowledge with colleagues. Providing optimal burn care and education under austere conditions requires cultural humility and a spirit of inquiry. Attentiveness to communication and cultural nuances promotes collaboration, improves educational effectiveness, and builds local burn care capacity.

High-Throughput and High-Sensitivity Biomarker Monitoring in Body Fluid by Fast LC SureQuant IS-Targeted Quantitation

Targeted proteomics methods have been greatly improved and refined over the last decade and are becoming increasingly the method of choice in protein and peptide quantitative assays. Despite the tremendous progress, targeted proteomics assays still suffer from inadequate sensitivity for lower abundant proteins and throughput, especially in complex biological samples. These attributes are essential for establishing targeted proteomics methods at the forefront of clinical use. Here, we report an assay utilizing the SureQuantTM internal standard triggered targeted method on a latest generation mass spectrometer coupled with an EvoSep One liquid chromatography platform, which displays high sensitivity and a high throughput of 100 samples per day (SPD). We demonstrate the robustness of this method by quantifying proteins spanning six orders of magnitude in human wound fluid exudates, a biological fluid that exhibits sample complexity and composition similar to plasma. Among the targets quantified were low-abundance proteins such at tumor necrosis factor A (TNFA) and interleukin 1-β (IL1B), highlighting the value of this method in the quantification of trace amounts of invaluable biomarkers that were until recently hardly accessible by targeted proteomics methods. Taken together, this method extends the toolkit of targeted proteomics assays and will help to drive forward mass spectrometry-based proteomics biomarker quantification.

Hypothermically Stored Amnion Is Robust and Provides a Scaffold for Supporting Wound Healing by Retaining the Characteristics of Native Tissue.

Placental-derived products have been used since the early 1900s for wound applications and have shown clinical utility in supporting wound healing. A hypothermically stored amniotic membrane (HSAM) was developed using a proprietary process to allow for the retention of the extracellular matrix (ECM), viable cells, and key proteins. To evaluate its utility, we characterized the HSAM and compared it to a native unprocessed amniotic membrane (uAM) and a dehydrated amniotic membrane (dAM), as well as assessing the functionality of the HSAM as a scaffold to promote cell growth. The HSAM, uAM, and dAM were compared using scanning electron microscopy (SEM), histology, and thickness. Scaffold durability was assessed in vitro using mechanical testing and a simulated wound fluid (SWF) model. The ability of the HSAM to act as a scaffold was evaluated using an in vitro attachment model. The HSAM showed similar structural characteristics compared to the uAM; however, the dAM was significantly more compact. There were no significant differences between the HSAM and the uAM following degradation in an SWF model. ECM- and placental-related proteins were shared between the HSAM and uAM, and the HSAM enhanced the attachment and proliferation of fibroblasts in vitro. The HSAM is substantially similar to the uAM by retaining key regulatory proteins, resisting degradation in SWF, and acting as a scaffold for cellular growth and invasion.

EP202 - Mesh-Mediated Fascial Traction (MMFT) and Negative Pressure Abdominal Dressing (ABTHERA): Useful in Difficult Open Abdomens?

Abstract Background Challenging abdominal surgical emergencies may require an 'Open Abdomen (OA)' as a life-saving procedure. OA has serious complications: wound infection, fluid and protein loss, catabolic state, loss of abdominal domain, and entero-atmospheric fistula. To assess the efficacy of mesh-mediated fascial traction (MMFT) & Abthera Dressing in achieving definitive abdominal closures. Patients and Method Retrospective analysis of prospectively collected data of 6 patients managed between August and November 23 in a large DGH. Following laparotomy and management of primary pathology, Abthera Dressing combined with bilateral continuous 2-0 PDS suture fixation at 0.5cm gap of macroporous Prolene (Merinium, Meril Life) meshes to each rectus sheath followed by sequential midline mesh traction closure over a time period that allowed subsequent definitive abdominal wound closure. Data collection included patient demographics (age, sex, BMI, ASA), intervention details for OA, wound characteristics, follow-up, and outcome. Results Six included M: F 4:2, age 61* (40-76 ) years, BMI 30* ( 24-35), ASA 3. Three were strangulated incisional hernia, 2 burst abdomens from faecal peritonitis, and 1 necrotizing fasciitis. Initial wound length 25*(20-32) cm, width 12.5* (4-17) cm after management of primary pathology reduced to width 4.5* (0-9) cm through MMFT and Abthera Dressing followed by definitive abdominal closure. Relook surgery required were 4* (1-9) with one full and 4 bridged mesh closures. Length of stay 39* (14-74) days. One death from respiratory failure. Conclusion The study highlights the benefit of MMFT & Abthera Dressing in achieving definitive abdominal closure for challenging OA where primary abdominal closure was not possible. * Median

Analysis of Biogenic Amines and Small Molecule Metabolites in Human Diabetic Wound Ulcer Exudate.

Diabetic foot ulcers (DFUs) pose a significant challenge in wound care due to their chronic nature and impaired healing processes. This study examines the biogenic amines and small molecule metabolites present in DFU wound exudates to identify their potential roles in wound healing. Under an IRB-approved protocol, wound fluid samples were collected from 25 diabetic patients and analyzed using ultrahigh-pressure liquid chromatography coupled with electrospray ionization quadrupole time-of-flight tandem mass spectrometry. The analysis identified 721 metabolites, with 402 confirmed through stringent criteria. Key metabolites significantly contributing to the wound exudates include betaine, lactic acid, carnitine, choline, creatine, and metformin (a widely used first-line treatment for type 2 diabetes). These molecules are known to influence wound healing processes, such as collagen synthesis, angiogenesis, inflammation modulation, and energy metabolism. Notably, the presence of drugs such as metformin and beclomethasone in the exudates suggests significant pharmacodynamic interactions that could influence wound healing. Specifically, we discovered that the combined use of insulin and metformin administered systemically significantly increased the concentration of metformin in the wound exudates (from 0.3% ± 0.0 to 3.1% ± 3.4; p = 0.00 49). This study highlights the complexity of DFU exudate composition and underscores the potential for targeted metabolic profiling to develop personalized wound care strategies.

Cytokine stability in chronic wound fluid and its association to fibroblast proliferation.

Cytokines are commonly deregulated in venous leg ulcers. We have investigated cytokine stability by incubating sterile-filtered wound fluids from chronic venous leg ulcers in vitro. Incubation of wound fluids for 24 h at 37°C decreased IL-1β levels by 88% and TNF-α levels by 64%. IL-1β was degraded by serine proteinases and metalloproteinases while the mechanism for reduced TNF-α remains elusive. The levels of the other peptides did not change significantly (p > 0.05). Normal human dermal fibroblasts exposed to five of the six wound fluids showed increased proliferation with the length of prior incubation using an assay optimised for evaluation of wound fluid bioactivity. Exogenous IL-1β and TNF-α unexpectedly increased (p < 0.001) cell proliferation at concentrations that were measured in the wound fluids. In conclusion, the stability of the eight investigated cytokines in wound fluids differed and presumably the loss of detrimental factors, unlikely IL-1β or TNF-α, resulted in increased fibroblast proliferation.

Flipping the Script: Are Cellular Assays and Wound Fluids the Next Frontier in Personalized Wound Care?

Flipping the Script: Are Cellular Assays and Wound Fluids the Next Frontier in Personalized Wound Care?

Fungal Enzyme-Responsive Hydrogel Drug Delivery Platform for Triggered Antifungal Release.

Fungal infections can lead to debilitating consequences if they are not treated effectively. Antifungal drugs used to treat these infections can be toxic and overuse contributes to growing antifungal resistance. Candida spp., particularly C. albicans, are implicated in a majority of these infections. Virulent C. albicans produce secreted aspartic proteases (Saps) that aid in pathogen tissue invasion and proliferation at an infected site. Here, fungi-responsive hydrogels are developed that degrade in the presence of Saps to provide a triggered release of encapsulated liposomal antifungals. The hydrogel backbone incorporates a Sap-cleavable peptide sequence enabling Sap-responsive degradation. Hydrogels are found to effectively degrade in the presence of Saps extracted from C. albicans. Encapsulated liposomal antifungals show similar release kinetics as hydrogel degradation products in the presence of Saps, supporting a degradation-dependent release mechanism. Antifungal liposome-loaded responsive hydrogels exhibit successful eradication of C. albicans cultures and remain stable in sterile murine wound fluid. Finally, no significant cytotoxicity is observed for murine fibroblast cells and red blood cells exposed to hydrogel degradation products. These fungi-responsive hydrogels have the potential to be used for local, on-demand delivery of antifungal drugs, for effective treatment of fungal infections while helping to limit unnecessary exposure to thesetherapeutics.

Vildagliptin promotes diabetic foot ulcer healing through autophagy modulation

The study aimed to investigate the molecular mechanisms underlying the effects of Vildagliptin on the healing of diabetic foot ulcers (DFUs). The research compared patients who received 12 weeks of Vildagliptin treatment to those who did not. Various molecular markers associated with wound healing were measured. Wound fluid samples were collected from DFUs using a filter paper absorption technique, and total RNA was extracted for quantitative real-time PCR (qPCR). The results showed that the autophagy marker NUP62 was significantly downregulated in the Vildagliptin group at week 12 compared to baseline (median expression 0.57 vs. 1.28; P = 0.0234). No significant change was observed in the placebo group (median expression 1.61 vs. 1.48; P = 0.9102). Both groups showed substantial downregulation of RIPK3, a necroptosis marker, at week 12 compared to their respective baselines. In addition to its effects on blood sugar levels, Vildagliptin may promote DFU healing by reducing autophagy in patients with diabetes.

Effect of placental mesenchymal stem cells on promoting the healing of chronic burn wounds

The treatment of chronic burn wounds is difficult in clinical practice. The ideal therapy is required to be continuously explored. Mesenchymal stem cells revolutionize the treatment of many diseases. The placental mesenchymal stem cells (PMSCs) have the characteristics of easy access, strong proliferation ability and multi-directional differentiation potential. The aim of this study was to investigate the potential of PMSCs in chronic burn wound healing. In this study, species of bacteria of 317 patients with chronic burn wounds have been analyzed. Samples of chronic burn wound fluid were collected from representative patients and then co-cultured with cells. In vitro studies showed that chronic burn wound fluid inhibited the proliferation of human keratinocytes and fibroblasts, while PMSCs can counteract the effects of burn wound fluid on inhibiting the proliferation and migration of human keratinocytes and fibroblasts. In addition, in vivo studies showed that a rat chronic burn wound model was successfully created. The expression of MMP-2, MMP-9, MDA, IL-6 and TNF-α in chronic burn wounds was significantly higher than that in acute burn wounds. Finally, the rat chronic burn wound model was used to verify that placental mesenchymal stem cell transplantation increased the wound healing rate, decreased the wound healing time, and promoted wound healing by increasing the thickness of epidermis and promoting the expression of P63 and CK10. The findings provide support for the hypothesis that PMSCs promote the repair of chronic burn wounds and key scientific data for the application of PMSCs as a new method for treating chronic burn wounds.

Peptide clustering enhances large-scale analyses and reveals proteolytic signatures in mass spectrometry data

Recent advances in mass spectrometry-based peptidomics have catalyzed the identification and quantification of thousands of endogenous peptides across diverse biological systems. However, the vast peptidomic landscape generated by proteolytic processing poses several challenges for downstream analyses and limits the comparability of clinical samples. Here, we present an algorithm that aggregates peptides into peptide clusters, reducing the dimensionality of peptidomics data, improving the definition of protease cut sites, enhancing inter-sample comparability, and enabling the implementation of large-scale data analysis methods akin to those employed in other omics fields. We showcase the algorithm by performing large-scale quantitative analysis of wound fluid peptidomes of highly defined porcine wound infections and human clinical non-healing wounds. This revealed signature phenotype-specific peptide regions and proteolytic activity at the earliest stages of bacterial colonization. We validated the method on the urinary peptidome of type 1 diabetics which revealed potential subgroups and improved classification accuracy.

Comprehensive Care for Burn Patients

Burn injuries represent a primary public health concern with significant global and personal repercussions. These injuries can create complex and potentially life-threatening situations that require advanced care. This review delves into the epidemiology, significance, and state-of-the-art treatments for burn injuries. It covers definitions, risk factors, complications, and various management strategies. The discussion highlights recent advancements in burn care, such as early wound excision, fluid resuscitation, infection control, and rehabilitation support. Emphasis is placed on the evolving research landscape in burn treatment, which aims to improve patient outcomes. The article underscores the importance of a multidisciplinary approach in managing burn patients and the ongoing need for research to enhance the quality of life for burn survivors.

Antimicrobial Peptide-Based Sensor for the Electrochemical Detection of Methicillin-Resistant Staphylococcus Aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is a gram-positive bacterium that colonizes on the skin and nasal track of humans, which can lead to serious illnesses such as skin and soft tissue infections, pneumonia, and septicemia.MRSA is resistant to an entire class of antibiotics called beta-lactams, including penicillin, amoxicillin, and oxacillin, making it more difficult to treat. Culture based methods and molecular based methods like PCR are currently being used for the detection of MRSA, but these methods possess the drawbacks of being slow and expensive, respectively. Thus, we focused on developing a reagentless, cost-effective, near real-time detection method for intact MRSA cells.Antimicrobial peptides (AMPs) possess the ability to interact with bacterial cells by inhibiting their growth or by lysing them.However, this initial interaction between the cationic AMPs and the negatively charged bacterial cells can be used for the detection of pathogens like MRSA. Here, we used a MRSA-specific antimicrobial peptide, DP7, to fabricate an electrochemical peptide-based (E-PB) sensor. The DP7 probe was further modified with a methylene blue redox label and an alkanethiol chain which allows for the formation of a thiol-gold self-assembled monolayer. The sensor surface was passivated with both 6-mercapto-1-hexanol and a thiolated tetra-thymine sequence to prevent surface fouling. Electrochemical detection of MRSA was accomplished using alternating current voltammetry. Control experiments were performed using two gram-positive bacteria, Bacillus subtilis and Staphylococcus epidermidis, and two gram-negative bacteria, Escherichia coli and Pseudomonas aeruginosa. The DP7 sensor responded to MRSA in a concentration-dependent manner and was proven to be selective for MRSA over the other four microbes. Specifically, the % signal suppression obtained for MRSA was much larger when compared to those obtained for the other microbes. The same behavior was observed in pure buffer and 5% synthetic wound fluid. In addition, the detection time was relatively short, with signal saturation in less than 60 min. Overall, the DP7 sensor has demonstrated to possess attributes similar to other E-PB sensors. It has the potential to be developed as a rapid, reliable, and cost-effective diagnostic tool for MRSA, which will be useful in preventing the spread of the pathogen in the community. Furthermore, this sensing platform is versatile and can be redesigned for detection of other pathogenic bacteria.

Barley β-glucan bioactive films: Promising eco-friendly materials for wound healing

Mixtures containing β-glucans were extracted from barley, under both mild and high alkaline conditions, to prepare biodegradable films (MA and HA, respectively), as natural dressings with intrinsic therapeutic properties. An in-depth characterization was performed to evaluate the impact of mild and high alkaline conditions on chemical, physicochemical, and biological features for potential use in wound treatments. Both MA and HA films exhibited a good ability to absorb water and simulate wound fluid, which helps maintain optimal tissue hydration. Moreover, their oxygen permeability (147.6 and 16.4 cm3 × μm/m2 × 24 h × Pa × 107, respectively) appeared adequate for the intended application. Biocompatibility tests showed that the films do not harm human dermal fibroblasts. Impressively, they promote cell attachment and growth, with MA having a stronger effect due to its higher β-glucan content. Furthermore, MA films can modulate macrophage behaviour in an inflamed microenvironment, reducing oxidative stress and pro-inflammatory cytokines, while simultaneously increasing levels of anti-inflammatory cytokines. In a scratch test, HA films allowed for faster fibroblast migration within the first 16 h compared to MA.Overall, this study demonstrates that developing β-glucan based films from barley, through a sustainable and cost-effective process, holds great promise for skin applications. These films exhibit significant potential to promote wound healing and modulate inflammation.

Ferulic acid-g-tamarind gum/guar gum based in situ gel-forming powders as wound dressings

The current research endeavour aimed to synthesize ferulic acid grafted tamarind gum/guar gum (FA-g-TG/GG) based powders as wound dressings, which could form in situ gels upon contact with wound exudates. In this context, variable amounts of FA were initially grafted with TG via the Steglich esterification reaction protocol and the resulting conjugates were subsequently amalgamated with GG and lyophilized to produce dry powders (F-1 – –F-3) with average particle size within 5.10–5.54 μm and average angle of repose ∼30°. These powders were structurally characterized with 1H NMR, FTIR, DSC, TGA, XRD and SEM analyses. Pristine TG, FA-g-TG and FA-g-TG/GG powders (F-2) revealed their distinct morphological structures and variable negative zeta potential values (−11.06 mV–25.50 mV). Among various formulation (F-1–F-3), F-2 demonstrated an acceptable powder-to-gel conversion time (within 20 min), suitable water vapour transmission rates (WVTR, 2564.94 ± 32.47 g/m2/day) and excellent water retention abilities and swelling profiles (4559.00 ± 41.57 %) in wound fluid. The powders were cytocompatible and conferred antioxidant activities. The powders also displayed fibroblast cell proliferation, migration and adhesion properties, implying their wound-healing potentials. Thus, the developed in situ gel-forming powders could be employed as promising dressings for wound management.

Pharmacokinetic study of local and systemic gentamicin concentrations after subcutaneous implantation of a gentamicin-impregnated collagen sponge in dogs

This study evaluated the pharmacokinetics of commercial gentamicin-impregnated collagen sponges (GICS) applied subcutaneously in dogs. In six healthy beagles, an 11 ×6 cm subcutaneous pocket was created, a folded 10×10 cm GICS was inserted, and saline was injected to mimic a seroma. Wound fluid samples were aspirated, and the gentamicin concentration was determined. Simultaneously, blood samples were collected to evaluate the corresponding systemic gentamicin concentration. All samples were collected before and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, 18, 24, 36, 48, 72, 96, 120, and 168 hours after GICS placement. The local Cmax of gentamicin was reached after 0.5 hours (range, 0.5–1.0 hours) post-implantation in 5/6 dogs at a median concentration of 2053.3 µg/mL (range, 918.0–2791.9 µg/mL). Whitin 24 hours, the local concentration dropped below the MIC for Staphylococcus sp. (4 µg/mL) in 5/6 dogs. Plasma Cmax was achieved at a median of 1.2 hours post-implantation (range, 1.0–2.0 hours) and reached a median concentration of 10.3 µg/mL (range, 8.8–18.03 µg/mL). After 6 hours, the gentamicin concentration in the plasma was below 4 µg/mL in all dogs. The GICS provided a high local concentration of gentamicin in a short time with a local Cmax:MIC ratio of 513:1, largely sufficient to eliminate susceptible bacteria, including methicillin-resistant Staphylococcus pseudintermedius (MRSP) and Pseudomonas sp., in a clinical setting. The repeated administration of saline in the present study seemed to have induced a quicker gentamicin release from the GICS than described in previous studies that typically dealt with "drier" wounds.

A closed-loop patch based on bioinspired infection sensor for wound management

Pathogenic wound infections remain a major global health challenge. When skin tissue is wounded, some colonizing pathogenic bacteria secrete large amounts of hyaluronidase (HAase) to degrade the extracellular matrix (ECM), enabling their diffusion and proliferation. Current clinical techniques for detecting infection rely on basic visual cues or analysis of wound fluids, enabling only reactive treatment once severe signs manifest. Herein, we present the use of a closed-loop patch (CLP) for advanced wound management. The patch contains a bio-inspired sensor based on an engineered hyaluronic acid (HA) hydrogel that detects HAase secreted by invading pathogens. This detection triggers a quantifiable change in the capacitance of the interdigital electrode and achieving in-time detection of Staphylococcus aureus (S. aureus) infection in a murine wound model before obvious visual signs appear. In response, the release of titanium hydride (TiH1.924) nanodots from hydrogel decomposition can eradicate pathogens under ultrasound (US) irradiation. Concurrently, the product, HA fragments further promoted cell migration and angiogenesis to significantly improve wound healing by ∼14.6-fold rates in 12 days. Overall, the CLP provides a sensory act-treat effect according to the wound status, which facilitate the closed-loop integration of monitoring and rehabilitation. This strategy may provide additional possibilities for the design of future wound management systems.

Activation of the Calcium-Sensing Receptor by a Subfraction of Amino Acids Contained in Thyroid Drainage Fluid.

Hypoparathyroidism is a common sequela of thyroid surgery; in this study, we aimed at exploring the pathogenesis behind it. The following premises suggest that wound fluid might be a causative agent. (i) Parathyroid hormone secretion is under feedback control by the calcium-sensing receptor, which responds to a diverse array of activating ligands. (ii) Postoperative hypoparathyroidism arises from a secretory deficiency of the parathyroid glands. Even in patients later unaffected by hypoparathyroidism, parathyroid hormone levels drop within hours after surgery. (iii) Wound fluid is bound to enter the tissue around the thyroid bed, where the parathyroid glands are located. Its composition is shaped by a series of proteolytic reactions triggered by wounding. Using thyroid drainage as a surrogate, we addressed the possibility that wound fluid contains compounds activating the calcium-sensing receptor. Drainage fluid ultrafiltrate was found to be rich in amino acids, and on separation by HPLC, compounds activating the calcium-sensing receptor partitioned with hydrophilic matter that rendered buffer acidic. The data show that glutamate and aspartate at millimolar concentrations supported activation of the calcium-sensing receptor, an effect contingent on low pH. In the presence of glutamate/aspartate, protons activated the calcium-sensing receptor with a pH50 of 6.1, and at pH 5, produced maximal activation. This synergistic mode of action was exclusive; glutamine/asparagine did not substitute for the acidic amino acids, nor did Ca2+ substitute for protons. NPS-2143, a negative allosteric receptor modulator completely blocked receptor activation by glutamate/aspartate and by fractionated drainage fluid. Thus, wound fluid may be involved in suppressing parathyroid hormone secretion.

Exploring the effect of wound related pain on psychological stress, inflammatory response, and wound healing.

The relationship between pain and poor healing is intricate, potentially mediated by psychological stress and aberrations in inflammatory response. The purpose of this study was to examine the biopsychosocial model of pain by assessing the relationships between pain, stress, inflammation and healing in people with chronic wounds. This was a 4-week prospective observational study to explore the relationship of pain, stress, inflammation and wound healing in a convenience sample of patients with chronic wounds in a chronic care hospital in Canada. Only subjects over 18 with chronic wounds were recruited into the study. Chronic wounds were defined by the duration of wounds for more than 4 weeks of various aetiologies including wounds caused by pressure injuries, venous disease, arterial insufficiency, surgery or trauma and diabetic neuropathy. Participants were evaluated for pain by responding to the Brief Pain Inventory-Short Form, the McGill Pain Questionnaire-Short Form and the Leeds Assessment of Neuropathic Symptoms and Signs scale. Stress was measured by the Perceived Stress Scale (PSS). All wounds were assessed with the Pressure Ulcer Scale for Healing tool. The levels of matrix metalloproteinases were analysis by obtaining wound fluid from all participants. A total of 32 individuals with chronic wounds participated in the study. Correlation analysis indicated pain severity was positively and significantly related to pain interference, McGill Pain Questionnaire scores, neuropathic pain and matrix metalloproteinase levels. Logistic regression was used to determine the predictors for high or low perceived stress. The only significant variable that contributed to the stress levels was BPI-I. Results suggested that participants who experienced higher levels of pain interference also had an increased odds to report high level of stress by 1.6 times controlling for all other factor in the model. Pain is a complex biopsychosocial phenomenon affecting quality of life in people with chronic wounds. Results of this study identified a significant relationship between pain, stress and wound healing.