Tag: Wound Healing

The Role of Early Revascularization and Biomarkers in the Management of Diabetic Foot Ulcers

A Single Center Experience

Diabetic neuropathy and Peripheral Arterial Disease (PAD) are the main etiological factors in foot ulceration. Herein, we report our experience of diabetic foot ulceration (DFU) management, with an analysis of the relationship between the rate of lower extremity amputation, in persons with infected DFU, after revascularization procedures performed to prevent major amputation. This study highlights the role of different biomarkers, showing their usefulness and potentiality in diabetic foot ulcer management, especially for the early diagnosis and therapy effectiveness monitoring. A retrospective analysis, from September 2016 to January 2021, of diabetic patients presenting diabetic foot with DFU, was performed. All patients were treated with at least one vascular procedure (endovascular, open, hybrid procedures) targeting PAD lesions … read more


Skin wounds heal by coordinated induction of inflammation and tissue repair, but the initiating events are poorly defined. Here we uncover a fundamental role of commensal skin microbiota in this process and show that it is mediated by the recruitment and the activation of type I interferon (IFN)-producing plasmacytoid DC (pDC). Commensal bacteria colonizing skin wounds trigger activation of neutrophils to express the chemokine CXCL10, which recruits pDC and acts as an antimicrobial protein to kill exposed microbiota, leading to the formation of CXCL10–bacterial DNA complexes … read more

Utilizing Nanofibers for Treatment of Skin Infections

With the advancement in nanotechnology, its medical applications have provided a significant difference to the level of diagnosis and therapeutics. The use of nanotechnology for regenerative medicine, including wound healing, is an example of how this industry has advanced and developed novel treatments to provide better care to patients … read more

How Might Protein Alteration From NPWT Affect Wound Healing?

Excellent continued efforts in elucidating the role that perturbation of the wound matrix (via negative pressure wound therapy (NPWT)) has on angiogenesis, healing and regeneration. A recent study in Molecular Medicine Reports used label‑free quantitative mass spectrometry to analyze differences in granulation tissue protein expression profiles before and after NPWT for patients with diabetic foot ulcers (DFUs).1 They aimed to take a closer look at how NPWT promotes DFU healing. As such, the study identified multiple novel proteins altered by NPWT, paving the way for future studies in this area … read more

Healing of a Chronic Pressure Injury in a Patient Treated With Medical Cannabis for Pain and Sleep Improvement

A Case Report
A small body of evidence suggests medical cannabis may facilitate wound healing, but the exact mechanism of this effect is unclear. PURPOSE: This case report describes a patient with a pressure injury (PI) who received cannabis oil treatment for pain management and sleep improvement. METHODS: A 37-year-old woman with multiminicore disease, scoliosis, short-chain acyl-CoA dehydrogenase deficiency, and epilepsy presented to the Neurology Centre of Toronto with chronic pain and sleep disturbance, including difficulty initiating and maintaining sleep. She also had a 5-year history of a PI between her right iliac crest and right rib cage that had progressively worsened. The patient received a medical cannabis oil protocol that used a combination of cannabidiol and tetrahydrocannabinol … read more

Probiotics accelerate wound healing in patients with diabetic foot ulcer

Patients with diabetic foot ulcer (DFU) who were given probiotic supplements for 12 weeks had faster wound healing and improved glycemic control compared with similar patients on placebo, according to researchers who recently published their results in Diabetes/Metabolism Research and Reviews.

ADMIN2-Probiotics pick up the pace

Diabetic foot ulcers healed faster in patients given probiotics.

“Due to the increasing global antimicrobial drug resistance issues, the idea of probiotic consumption is interesting and pertinent because probiotics have the ability to strengthen the immune system, have anti-inflammatory effects, and therefore, could increase the wound healing process,” wrote lead co-author Zatollah Asemi, PhD … read more

A single center’s 15-year experience with palliative limb care for chronic limb threatening ischemia in frail patients

Our institution’s multidisciplinary Prevention of Amputation in Veterans Everywhere (PAVE) program allocates veterans with critical limb threatening ischemia (CLTI) to immediate revascularization, conservative, primary amputation or palliative limb care based on previously published criteria. These four groups align with the approaches outlined by the Global Guidelines for management of CLTI. The current study delineates the natural history of the palliative limb care group of patients and quantifies procedural risks and outcomes … read more

What COVID-19 taught us: New opportunities and pathways from telemedicine and novel antiseptics in wound healing

The COVID-19 pandemic deeply impacted the capacity of the health systems to maintain preventive and curative services, especially for the most vulnerable populations. During the pandemic, the wound healing centres in Italy assisted a significant reduction of the frequency of their hospital admission, since only urgencies, such as severe infections or wound haemorrhagic complications, were allowed to the hospital. The aim of this multidisciplinary work is to highlight the importance of a new pathway of wound care with patient-based therapeutic approach, tailored treatments based on the characteristics of the wound and fast tracks focused on the outpatient management, reserving hospital assessment only for patients with complicated or complex wounds. This analysis highlights the point that patients with chronic wounds need to be critically evaluated in order to find the best and most appropriate care pathway, which should vary according to the patient … read more

Foot Revascularization Avoids Major Amputation in Persons with Diabetes and Ischaemic Foot Ulcers

The study aims to evaluate the effectiveness of foot revascularization in persons with diabetic foot ulcers (DFUs) and below-the-ankle (BTA) arterial disease. Consecutive patients referred for a new active ischaemic DFU requiring lower limb revascularization were considered. Among those, only patients with a BTA arterial disease were included. Revascularization procedures were retrospectively analysed: in the case of successful foot revascularization (recanalization of pedal artery, or plantar arteries or both) or not, patients were respectively divided in two groups, successful foot perfusion (SFP) and failed foot perfusion (FFP). Healing, minor and major amputation at 12 months of follow-up were evaluated and compared. Eighty patients (80) were included. The mean age was 70.5 ± 10.9 years, 55 (68.7%) were male, 72 (90%) were affected by type 2 diabetes with a mean duration of 22.7 ± 11.3 years. Overall 45 (56.2%) patients healed, 47 (58.7%) had minor amputation and 13 (16.2%) major amputation. Outcomes for SFP and FFP were respectively: healing … read more

Effectiveness of a synthetic human recombinant epidermal growth factor in diabetic patients wound healing

Pilot, double-blind, randomized clinical controlled trial

To investigate whether the addition of human recombinant epidermal growth factor (h-EGF) to 2% carboxymethyl cellulose gel is more effective in diabetic wound healing than standard treatment, a pilot, double-blind, randomized and controlled clinical trial with therapeutic intervention was performed at a university hospital. The sample consisted of 25 patients (14 in the intervention group that used rh-EGF and 11 in the control group that used 2% carboxymethyl cellulose gel). Data were tabulated in SPSS and analysed by intention to treat, without loss or exclusion of participants. Twenty-five subjects participated with a mean age of 60.6 years, a predominance of males in both groups and 100% prevalence of type-2 diabetes. Within 12 weeks, complete wound healing occurred in three ulcers in the intervention group versus one ulcer in the control group. The percent reduction in the wound area was significantly higher in the intervention group than in the control group (p = 0.049). Concerning the types of tissue, an increase in … read more

Targeted Nutrition Therapy: Key Ingredients to Support Wound Healing

Time may not be able to heal wounds, as the saying goes, but the body can—with proper medical and nutritional support, according to recent data for targeted nutrition therapy.During the Symposium on Advanced Wound Care Spring 2021 virtual meeting, Maritza Molina, RDN, and David G. Armstrong, PhD, DPM, of the Keck School of Medicine of USC, in Los Angeles, discussed how incorporating nutrition as part of the overall treatment plan can promote healing, decrease treatment duration and improve patients’ overall quality of life … read more

As an Active Cleanser, Nexodyn(R) AOS Shows Superior Wound Healing Performance Compared to Standard of Care

Relief’s Subsidiary, APR Applied Pharma Research, Reports Data Published in Journal of Wound Care, Indicating Nexodyn(R) AOS Highly Effective Treatment to Support Healing of Hard-to-Heal Leg Ulcers … RELIEF THERAPEUTICS Holding SA (SIX:RLF)(OTCQB:RLFTF) (“Relief”), a biopharmaceutical company seeking to provide patients therapeutic relief from serious diseases with high unmet need, today announced that its wholly owned subsidiary, APR Applied Pharma Research SA (“APR”), reported data published in the peer reviewed Journal of Wound Care, indicating that the company’s Nexodyn(R) acid-oxidizing solution (AOS), developed with APR’s proprietary Tehclo(R) technology, was found to be a highly effective treatment to support wound healing in infected or non-infected hard-to-heal leg ulcers. The data also confirmed the safety and tolerability of Nexodyn(R) … Conducted by Robert Strohal, M.D., Professor and Department Head, Department of Dermatology, Federal Academic Teaching Hospital of Feldkirch, Austria, and colleagues, the open-label, randomized controlled MACAN study was conducted at two centers is Austria. A total of 50 patients were enrolled, with either infected or non-infected hard-to-heal leg ulcers of different etiology. Patients were treated for six weeks either with Nexodyn(R) AOS or standard of care (SOC) wound dressings … In the patient group treated with Nexodyn(R) AOS, wounds exhibited a faster and more pronounced wound size reduction compared with wounds in the SOC group. Additionally, compared to SOC, the treatment group showed a markedly greater percentage of complete healing of hard-to-heal ulcers by the end of the study period (32% versus 8%, respectively). Furthermore, Nexodyn(R) demonstrated its ability to significantly reduce the wound pH (p<0.0001) and thus promote a faster healing process. In all patients with infected leg ulcers, local infection was overcome more rapidly with Nexodyn(R) AOS treatment. Overall, the efficacy of Nexodyn(R) AOS was found to be not only non-inferior but superior to SOC wound dressings … read more

The wound healing effect of local leukocyte platelet-rich plasma after total hip arthroplasty

A randomized controlled trial:
Rapid wound closure is important after arthroplasty procedures to prevent postoperative complications. Platelets are rich in growth factors and leukocytes contribute to innate immunity. We hypothesized that topical leukocyte platelet-rich plasma (L-PRP) derived from the blood of patients would be beneficial to wound healing. In this randomized controlled trial, patients subjected to elective total hip arthroplasty (THA) were assigned by concealed allocation either L-PRP application onto the sutured fascia or no application (control) after the THA intervention. In addition, all patients received 1.5 g protein/kg, 5 g L-arginine, 500 mg vitamin C and 44 mg zinc daily over the 4-week postoperative period to obtain optimal nutrition. The primary endpoint was complete healing of the skin incision. The secondary endpoints were blood transfusions, length of hospital stay, pain and wound infections. Sixteen patients in the L-PRP group and 17 patients in the control group completed the trial. L-PRP treatment accelerated complete wound healing after 3 weeks (seven in the L-PRP group vs. zero in the control group, p = 0.003) and after 4 weeks … read more


From PMC: Current Clinical Recommendations for Use of Platelet-Rich Plasma

Physical activity, sleep and wound healing in adults with venous leg ulcers: a prospective observational cohort pilot study protocol

Background Adults with venous leg ulcers (VLUs) are less likely to be physically active and show greater sleep disturbances than the general population. Limited evidence suggests these issues contribute to VLU healing delays.

Objectives The primary objective is to determine if physical activity (PA) and sleep levels are associated with VLU healing. The secondary objectives are to: 1) evaluate the feasibility and acceptability of a wrist-worn accelerometer device, wActiSleep-BT device wear (ActiGraph); 2) evaluate the utility of self-reported PA instruments to measure PA for people with VLU; and 3) determine whether PA and sleep levels are associated with i) delayed healing, ii) self-reported quality of life (QoL) and/or iii) self-reported VLU pain …

Innovation Medical Group Selects SnapshotNIR to Visualize Wound Healing in Advanced Wound Care

ent Imaging is pleased to announce that Innovation Medical Group (formerly Utah Foot and Ankle), in Salt Lake City, Utah, has selected SnapshotNIR as a standard of care throughout their clinical network.

Innovation Medical Group provides unique, advanced wound therapy for a wide variety of foot and ankle conditions including diabetic foot and wound care. SnapshotNIR provides physicians at their clinics the ability to conduct rapid wound assessments, allowing for more accurate healing trajectory predictions, the potential to mitigate risks early and improve clinical outcomes. SnapshotNIR provides a tracked and documented assessment of tissue viability and wound healing, supporting the responsible use of appropriate advanced wound care modalities and monitoring the therapeutic benefit.

“Understanding the wound is the first step to healing,” states Dr. Doug Toole. “Tissue oxygenation values are not detectable through the unaided eye or with traditional perfusion imaging … read more

RITA: The Wound Pros Leverages Artificial Intelligence With Its Wound Measurement App

The Wound Pros (https://thewoundpros.com/) today introduced its automatic wound measurement app, RITA designed to aid healthcare providers in the management and treatment of chronic, non-healing wounds. The Wound Pros is a physician owned and managed wound care company and a leading supplier of wound care dressings with a presence in 16 states across the United States … RITA represents The Wound Pros’ “high-tech” approach that leverages the power of artificial intelligence and machine learning to measure chronic non-healing wounds with pinpoint accuracy. According to Dr. Bill Releford, RITA creator and CEO of the Wound Pros, capturing highly accurate measurements is essential for delivering timely and comprehensive treatments to prevent wounds from worsening and improving healing outcomes.” Clinicians just need to take a picture of a patient’s wound with a smartphone or tablet and RITA will measure its size and generate professional documentation to support treatment and billing alignment. The application integrates seamlessly into The Wound Pros digital wound management platform and allows care teams to remotely monitor patients’ wound progression. RITA offers online and offline capabilities to ensure efficiency and reliability regardless of network connection status … read more

What Measurement Of Wound Healing Is Most Valuable?

Great, provocative work recently in the International Wound Journal by our colleagues Professor Keith Harding and coworkers.1 In their study, they note that healing in total can be a challenging metric to measure, as every wound is very different. In the research world, this translates into difficulty in matching study cohorts, especially when there are not very large subject pools available. Also, they note that the lengthy time necessary to heal many wounds requires that the associated study also takes substantial time. This makes high-quality RCTs with statistically significant and applicable data few and far between.

Taking a slightly different viewpoint on evaluating outcomes in wound healing … read more

Silver Ion Hydrocolloid Gauze and Self-Adhesive Polyurethane Foam Dressing Combination Therapy Can Better Promote Healing of Skin Graft Donor Area Than Traditional Therapy

The management of skin graft donor area has been a troublesome problem in reconstructive surgery. Currently, no guidelines exist for the management of skin graft donor areas, and the disposal methods vary from clinician to clinician. Objective. With the goal of providing a better basis for improved patient care, the authors conducted a case control study to investigate whether a combination of silver ion hydrocolloid gauze and self-adhesive polyurethane foam dressing (AG+foam group) was effective in healing skin graft donor sites. Materials and Methods. Forty-eight patients requiring intermediate-thickness skin graft between January 2014 and December 2015 were included in the study. Inclusion criteria included a skin graft measuring at least 40 cm2 to be harvested from the ipsilateral thigh and patient age of 14 years to 60 years. All patients were treated differently according to the … read more

Evaluation of Wound Healing Activity of Methanolic Crude Extract and Solvent Fractions of the Leaves of Vernonia auriculifera Hiern

Medicinal plants play an important role in treating various diseases. Vernonia auriculifera Hiern is one of the medicinal plants used traditionally for the management of wounds. However, there were no scientific reports documented so far on the wound healing activities to substantiate the claim. Thus, the present study provides a scientific evaluation for the wound healing potential of the crude extract as well as solvent fractions of the leaves of Vernonia auriculifera Hiern …

Wound Care: Wearable Sensors and Systems for Wound Healing-Related pHand Temperature Detection

Wound healing is a delicate tissue regeneration procedure that entails numerous changes in various physiological parameters.

FREMONT, CA: Wearable sensors and systems refer to devices that can detect minute amounts of biological or chemical analytes and convert chemical reactions or physical changes into usable signals (optical or electrical signals, for example) following predefined rules. Wearable sensors/systems for monitoring markers in or around the wound environment can provide real-time symptom information and hold promise for therapy studies, which also meets the World Union of Wound Healing Societies’ requirement that “diagnostic tools be moved into the clinic or patient’s home to ensure optimal care is provided for patients with wounds.” Researchers have developed various wearable sensors/systems based on optical (fluorescence, colorimetry, etc.) or electrical (impedance, potentiometry, amperometry, etc.) mechanisms integrated with conventional wound dressings to form innovative wound dressings. These smart wound dressings convert changes in these biomarkers into visual or electrical signals, allowing for real-time monitoring of wound healing … read more

Emerging Roles of Long Non-Coding RNAs in Diabetic Foot Ulcers

Diabetes mellitus is one of the most widespread metabolic diseases in the world, and diabetic foot ulcer (DFU), as one of its chronic complications, not only causes a large amount of physiological and psychological pain to patients but also places a tremendous burden on the entire economy and society. Despite significant advances in knowledge on the mechanism and in the treatment of DFU, clinical practice is still not satisfactory, and our understanding of its cellular and molecular pathogenesis is far from complete. Fortunately, progress in studying the roles of long non-coding RNAs (lncRNAs), which play important regulatory roles in the expression of genes at multiple levels, suggests that we can apply them in the early diagnosis and potential targeted intervention of DFU. In this review, we briefly summarize the current knowledge regarding the functional roles and potential mechanisms of reported lncRNAs in regulating DFU … read more

Wound Healing Activity of Opuntia ficus-indica Fixed Oil Formulated in a Self-Nanoemulsifying Formulation

Delayed wound healing represents a common health hazard. Traditional herbal products have been often utilized to promote wound contraction. The current study aimed at assessing the wound healing activity of Opuntia ficus-indica seed oil (OFI) and its self-nanoemulsifying drug delivery system (OFI-SNEDDS) formula in a rat model of full-thickness skin excision.
Methods: Based on droplet size, an optimized OFI-SNEDDS formula was prepared and used for subsequent evaluation. Wound healing activity of OFI and OFI-SNEDDS was studied in vivo.
Results: The optimized OFI-SNEDDS formula droplet size was 50.02 nm. The formula exhibited superior healing activities as compared to regular OFI seed oil-treated rats at day 14 of wounding. This effect was further confirmed by histopathological examinations of H&E and Masson’s Trichrome-stained skin sections. Moreover, OFI-SNEDDS showed the highest antioxidant and anti-inflammatory activities as compared to OFI seed oil-treated animals. Both OFI and OFI-SNEDDS significantly enhanced hydroxyproline skin content and upregulated Col1A1 mRNA expression … read more

A new approach to understanding the biology of wound healing

Our bodies frequently heal wounds, like a cut or a scrape, on their own. However patients with diabetes, vascular disease, and skin disorders, sometimes have difficulty healing. This can lead to chronic wounds, which can severely impact quality of life. The management of chronic wounds is a major cost to healthcare systems, with the U.S alone spending an estimated 10-20 billion dollars per year. Still, we know very little about why some wounds become chronic, making it hard to develop effective therapeutics to promote healing. New research from Jefferson describes a novel way to sample the cells found at wounds – using discarded wound dressings. This non-invasive approach opens a window into the cellular composition of wounds, and an opportunity to identify characteristics of wounds likely to heal versus those that become chronic, as well as inform the development of targeted therapies … read more

RedDress Selected to Exhibit ActiGraft at Vizient Innovative Technology Exchange

RedDress has been selected to exhibit ActiGraft®, a wound solution that recreates the natural wound healing environment by utilizing the patient’s own blood, at the Vizient Innovative Technology Exchange. Vizient, Inc, the nation’s largest member-driven health care performance improvement company, will hold the Exchange virtually September 21-23, 2021 read more

What Is a Kennedy Terminal Ulcer?

Many questions arise and confusion develops when wound care providers mention Kennedy terminal ulcers (KTUs). Because these wounds are not frequently seen, and because they develop rapidly and observation ends abruptly with the death of the patient, wound care providers may have never observed a KTU, even in a long career in wound care. Although the literature reveals that there is a lack of knowledge regarding the exact cause of a KTU, let’s look at the facts currently known from published resources … continue

Effective Wound Bed Preparation Using Maggot Debridement Therapy

     for Patients with Critical Limb Ischemia


An important factor in wound healing is adequate blood flow; thus patients with critical limb ischemia (CLI) and complex wounds are poor healers. Primary treatment for CLI is revascularization. Wound healing can be prolonged as a consequence of cyclical protease production by necrotic tissue during the inflammatory phase of healing. Debridement of necrotic tissue is therefore necessary to reduce inflammation and progress the healing cycle, as well as to promote epithelialization and reduce risk of infection. Conventional debridement therapy can be difficult in patients with CLI because of limitations in visualizing wound margins and time effectiveness. Maggot debridement therapy (MDT) is a traditional debridement therapy using live, sterilized fly larvae. This study investigated MDT in patients with CLI after midfoot amputation following revascularization by endovascular therapy. The outcomes of wound bed preparation were compared with the outcomes in patients receiving conventional therapy … read more

Chitosan-polyvinyl alcohol nanoscale liquid film-forming system

     facilitates MRSA-infected wound healing by enhancing antibacterial and antibiofilm properties


Sha Yang,* Yun Yang,* Sixin Cui, Ziqi Feng, Yuzhi Du, Zhen Song, Yanan Tong, Liuyang Yang, Zelin Wang, Hao Zeng, Quanming Zou, Hongwu Sun


National Engineering Research Center of Immunological Products & Department of Microbiology and Biochemical Pharmacy, College of Pharmacy, Third Military Medical University of Chinese PLA, Chongqing, 400038, People’s Republic of China


*These authors contributed equally to this work


Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most predominant and fatal pathogens at wound infection sites. MRSA is difficult to treat because of its antibiotic resistance and ability to form biofilms at the wound site.


Methods: In this study, a novel nanoscale liquid film-forming system (LFFS) loaded with benzalkonium bromide was produced based on polyvinyl alcohol and chitosan.


Results: This LFFS showed a faster and more potent effect against MRSA252 than benzalkonium bromide aqueous solution both in vitro and in vivo. Additionally, the LFFS had a stronger ability to destroy biofilms (5 mg/mL) and inhibit their formation (1.33 µg/mL). The LFFS inflicted obvious damage to the structure and integrity of MRSA cell membranes and caused increases in the release of alkaline phosphate and lactate dehydrogenase in the relative electrical conductivity and in K+ and Mg2+ concentrations due to changes in the MRSA cell membrane permeability.


Conclusion: The novel LFFS is promising as an effective system for disinfectant delivery and for application in the treatment of MRSA wound infections.

Download Article (pdf)

Molecular study of wound healing after using biosynthesized

     BNC/Fe3O4 nanocomposites assisted with a bioinformatics approach


Department of Bioprocess Technology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; Young Researcher and Elite Club, Sabzevar Branch, Islamic Azad University, Sabzevar, Iran; Department of Cell and Molecular Biology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; Institute of Tropical Forestry and Forest Products, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; 6Young Research and Elite Club, Parand Branch, Islamic Azad University, Parand, Iran; Department of Medical Genetics, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran; Muthayammal Centre for Advanced Research, Muthayammal College of Arts and Science, Rasipuram, Tamilnadu, India … read more

Spider silk could be used to create artificial skin to help heal wounds

Unless your name is Peter Parker, you may not be aware of quite how versatile spider silk is as a material. In fact, aside from spinning webs, spider silk can also be used for a plethora of applications — from improving the quality of microphones in hearing aids to forming incredibly strong-yet-lightweight shields to forming microcapsules for delivering anti-cancer vaccines.


Now researchers from Sweden and India have come up with yet another novel use for spider silk’s unusual mix of strength and elasticity: Creating artificial skin and wound dressings for helping heal wounds.


“We have developed two types of silk-based constructs: Nanofibrous matrices which serve as bioactive wound dressings, and microporous sponges cultured with human skin cells to serve as artificial skin,” Biman Mandal, an associate professor in the Department of Biosciences … full article in Digital Trends

Medilight develops light system to heal wounds

European project makes bandage that bathes wound in blue light to speed recovery.


With the objective of using light to improve wound healing and within the framework of the European project MEDILIGHT, Swiss company CSEM and six partners have developed a new solution for treating chronic wounds. This portable device delivers blue light to improve and accelerate the healing process. The prototype was first presented this week at the project wrap-up event on July 2nd, at the URGO Laboratories in Dijon, France.

Chronic wounds are often difficult to treat, because they do not follow the typical injury healing process or time-frame. The resulting burden is significant, affecting over 40 million patients worldwide and costing healthcare systems an estimated €40 billion annually.

Blue light is known for its anti-microbial and anti-inflammatory effects in the initial stages of the healing process; it does not damage tissue, unlike the hazardous UV light. However, clear evidence of the beneficial effects of blue-light irradiation in the later stages of wound healing was still missing, thus hindering the development of effective solutions for complete therapy … read more

Moldable Hyaluronan Hydrogel Enabled by Dynamic

     Metal–Bisphosphonate Coordination Chemistry for Wound Healing


Biomaterial‐based regenerative approaches would allow for cost‐effective off‐the‐shelf solution for the treatment of wounds. Hyaluronan (HA)‐based hydrogel is one attractive biomaterial candidate because it is involved in natural healing processes, including inflammation, granulation, and reepithelialization. Herein, dynamic metal–ligand coordination bonds are used to fabricate moldable supramolecular HA hydrogels with self‐healing properties. To achieve reversible crosslinking of HA chains, the biopolymer is modified with pendant bisphosphonate (BP) ligands using carbodiimide coupling and chemoselective “click” reactions. Hydrogel is formed immediately after simple addition of silver (Ag+) ions to the solution of HA containing BP groups (HA‐BP). Compared with previous HA‐based wound healing hydrogels, the HA‐BP·Ag+ hydrogel is highly suitable for clinical use as it can fill irregularly shaped wound defects without the need for premolding. The HA‐BP·Ag+ hydrogel shows antimicrobial properties to both Gram‐positive and Gram‐negative bacterial strains, enabling prevention of infections in wound care. In vivo evaluation using a rat full‐thickness skin wound model shows significantly lower wound remaining rate and a thicker layer of regenerated epidermis as compared with the group left without treatment. The presented moldable and self‐healing supramolecular HA hydrogel with “ready‐to‐use” properties possesses a great potential for regenerative wound treatment … read more

Eggshell membrane waste beneficial for wound healing

EU research has brought the benefits of eggshell membrane (ESM) protection from the chick to ‘hard-to-heal’ open wounds.


Delayed chronic wound healing is the so-called ‘vicious cycle’ of many illnesses. Chronic inflammation, excess protease, a key risk factor in healing, and tissue degradation are the hallmarks of this condition that can lead to further debilitation for the patient including a deterioration in psychological health. What’s more, already high healthcare costs are set to escalate the longer the wound goes unchecked.


ESM: Material mastermind behind wound healing


ESM is a low-cost alternative to currently used collagen-derived dressings that are often too expensive to use. Based on a novel biomaterial derived from ESM, it is extracted from waste eggshells. Protecting the egg and its chick during development, ESM is a thin, structural protein-rich lining that performs similar key functions in wound healing to the extracellular membrane in skin … read more

Wound healing is complex, almost miraculous process

Without the ability to heal wounds every scratch, nick, scrape and cut would remain open, a permanent and painful reminder of the body’s frailty.


Yet this basic process of life goes largely unrecognized because it works so effectively.


Wound healing requires the activation of over 10,000 genes, a precise, sequential release of hundreds of chemicals and the growth, division and migration of millions of different types of cells. It is usually only when wound healing fails, leaving us with a chronic wound, that we ever are aware of the process.


Normal wound healing involves four distinct phases: the clotting of blood, inflammation, proliferation and remodeling. Chemicals released from the cells of the damaged capillaries, the work of platelets and formation of the blood clot initiate the healing process …. full article

Micelle‐Coated, Hierarchically Structured Nanofibers with Dual‐Release

     Capability for Accelerated Wound Healing and Infection Control


Tailoring nanofibrous matrices—a material with much promise for wound healing applications—to simultaneously mitigate bacterial colonization and stimulate wound closure of infected wounds is highly desirable. To that end, a dual‐releasing, multiscale system of biodegradable electrospun nanofibers coated with biocompatible micellar nanocarriers is reported. For wound healing, transforming growth factor‐β1 is incorporated into polycaprolactone/collagen (PCL/Coll) nanofibers via electrospinning and the myofibroblastic differentiation of human dermal fibroblasts is locally stimulated. To prevent infection, biocompatible nanocarriers of polypeptide‐based block copolymer micelles are deposited onto the surfaces of PCL/Coll nanofibers using tannic acid as a binding partner. Micelle‐modified fibrous scaffolds are favorable for wound healing, not only supporting the attachment and spreading of fibroblasts comparable to those on noncoated nanofibers … read more

IMR team receives prestigious award for wound healing with maggots

KUALA LUMPUR: A research team from the Institute of Medical Research (IMR) that made a breakthrough in wound healing with the use of maggots has been conferred the Dr Lee Jong-Wook Memorial Prize for Public Health at the 71st World Health Assembly (WHA).


The World Health Organisation (WHO) in Geneva, Switzerland made the announcement on Friday (May 25), said Health director-general Datuk Dr Noor Hisham Abdullah.


The WHA president conferred the prize to lead researcher Dr Nazni Wasi Ahmad, from the IMR, for her exemplary contributions in Maggot Debridement Therapy (MDT).


It is a type of biotherapy using live, sterile fly larvae or maggots in non-healing wound of a human or animal to remove dead cells and reduce bacterial contamination of the wound and stimulate healing, he said.


“It is a safe, effective and affordable alternative treatment that is available at any time and in any healthcare setting, mainly primary healthcare facilities, to treat diabetic foot ulcers.” said Dr Noor Hisham in a statement

Read more at https://www.thestar.com.my/news/nation/2018/05/25/imr-team-receives-prestigious-award-for-wound-healing-with-maggots/#OPMgFDYuWe9IzjPL.99

Wound Debridement Options

     The 5 Major Methods


There are five types of non-selective and selective debridement methods, but many factors determine what method will be most effective for your patient.1 Determining the debridement method is based not only on the wound presentation and evaluation, but also on the patient’s history and physical examination. Looking at the “whole patient, not only the hole in the patient,” is a valuable quote to live by as a wound care clinician. Ask yourself or your patient these few questions: Has the patient had a previous chronic wound history? Is your patient compliant with the plan of care? Who will be performing the dressing changes? Are there economic factors that affect the treatment plan? Take the answers to these questions into consideration when deciding on debridement methods.


The Primary Methods of Debridement: BEAMS
BEAMS is an mnemonic that is widely used to remember the five types of wound debridement … read more


Molecular study of wound healing after using biosynthesized

     BNC/Fe3O4 nanocomposites assisted with a bioinformatics


Magnetic nanoparticles were biosynthesized by using Aloe vera extract in new isolated bacterial nanocellulose (BNC) RM1. The nanocomposites were characterized using X-ray diffraction, Fourier transform infrared, and field emission scanning electron microscopy. Moreover, swelling property and metal ions release profile of the nanocomposites were investigated. The ability of nanocomposites to promote wound healing of human dermal fibroblast cells in vitro was examined. Bioinformatics databases were used to identify genes with important healing effect. Key genes which interfered with healing were studied by quantitative real time PCR.


Results: Spherical magnetic nanoparticles (15–30 nm) were formed and immobilized within the structure of BNC. The BNC/Fe3O4 was nontoxic (IC50>500 μg/mL) with excellent wound healing efficiency after 48 hours. The nanocomposites showed good antibacterial activity ranging from 6±0.2 to 13.40±0.10 mm against Staphylococcus aureusStaphylococcus epidermidis and Pseudomonas aeruginosa. The effective genes for the wound healing process were TGF-B1MMP2MMP9Wnt4CTNNB1hsa-miR-29b, and hsa-miR-29c with time dependent manner. BNC/Fe3O4 has an effect on microRNA by reducing its expression and therefore causing an increase in the gene expression of other genes, which consequently resulted in wound healing … read more

Chronic Wound Management

     Optimizing the Wound Healing Environment


Chronic wounds are any types of wounds that have failed to heal in 90 days. Identifying the cause of a chronic wound is most important in the healing process. We as clinicians must help bolster advanced wound care by sharing advances in education in evidence-based treatment, prevention, and wound assessment.


A wound must go through hemostasis, inflammation, proliferation, and remodeling, along with various cellular contributions. The scaffolding of the extracellular matrix is what provides the elasticity and tensile strength to the skin structure. Various proteins such as collagen, fibronectins, elastins, and laminins make up this vital matrix to aid and complete the process of wound closure. We see extracellular matrix damage mostly in our geriatric population … read more

The Whole Patient Approach

Addressing Common Comorbidities That Affect Wound Healing


When developing the plan of care for the patient with a chronic wound, it is imperative first to look at the “whole” patient and not just the “hole” in the patient.1 As we do, we are able to review any medical conditions or disease states that may affect wound repair and healing. Millions of Americans are affected by chronic wounds each year. These wounds include causes such as diabetic foot ulcers, venous leg ulcers, arterial insufficiency, and pressure ulcers. Common comorbid conditions that can affect healing include diabetes, venous insufficiency, peripheral arterial disease, cardiopulmonary and oxygen transport conditions, immune deficiencies, and dementia.2 This discussion is focused on these conditions and factors that contribute to chronic wounds and their management … read more

The Healing Trajectory: The Process of Wound Healing

There are four stages of wound healing. This systematic process moves in a linear direction. The four stages of wound healing are: hemostasis, inflammation, proliferation, and maturation. It is imperative to remember that wound healing is not linear. It is possible for a patient to move forward or backward through the wound healing phases due to intrinsic and extrinsic forces … read more



Hemoglobin A1c Levels Not Tied to Wound Outcomes

HealthDay News — There does not appear to be a clinically meaningful association between baseline or prospective hemoglobin A1c (A1C) and wound healing in patients with diabetic foot ulcers (DFUs), according to a study published online April 16 in Diabetes Care.


Betiel K. Fesseha, MD, from Johns Hopkins University in Baltimore, and colleagues retrospectively evaluated the association between A1C and wound outcomes in 270 patients with 584 DFUs over a study period of 4.7 years… read more



Protecting Periwound Skin in Chronic Wounds

The periwound is as important as the wound. As clinicians, we should carefully assess the wound bed, but we need to remember also to assess the periwound and surrounding skin. The periwound should be considered the 4cm of surrounding skin extending from the wound bed. Chronic wounds may manifest any of the following characteristics, depending on wound type: erythema, induration, epibole, ecchymosis, hyperkeratosis, and changes in shape.

Five-Step Periwound Assessment

  1. Temperature
  2. Location
  3. Shape
  4. Color
  5. Wound depth

The temperature of the periwound can be a good indicator of whether active infection is present or to determine whether there is normal blood flow. The back of the hand is most accurate … read more

An evaluation of an ultrasonic debridement system

in patients with diabetic foot ulcers: a case series


Ferdinando CampitielloMD , Manfredi ManconeMD , Angela Della CorteMD , Raffaella GuernieroMD , Silvestro Canonico


This study evaluated the use of ultrasonic debridement in patients with diabetic foot ulcers (DFU).


In this prospective, single-arm, open-label study, all patients with DFUs underwent wound debridement by ultrasonic debridement system (SonicOne OR Ultrasonic debridement system). Wherever possible, the edges were approximated by means of stitches. In other cases, the surgical breach healed by secondary intention, or a partial thickness skin graft (with or without Integra Dermal Regeneration Template or Integra Flowable Wound Matrix) was applied, and subsequently healed by primary intention … read more

Amniotic membrane can be a valid source for wound healing


Amniotic membrane (AM) can promote proper epithelialization with suppression of excessive fibrosis by creating a supportive milieu for regeneration of chronic ulcer bed.


The objective of this study is to investigate whether AM scaffold can modulate the healing of a wound by promoting tissue reconstruction rather than promoting scar tissue formation.

Subjects and methods

AM was obtained and prepared and then applied to patients with chronic leg ulcers who were randomly divided into two different groups. Group I (control group) included eleven patients in whom ulcers were treated with conventional wound dressings that were changed daily for 8 weeks. Group II (study group) included 14 patients in whom the AM was placed in contact with the ulcer and held in place with a secondary dressing, which was changed daily. Follow-up was done to detect healing rate and detection of ulcer size, assessment of pain, and to take ulcer images (days 0, 7, 14, 21, 30, 45, and 60).


In group I, all ulcers showed no reduction in their size, and ulcer floor remained the same. Healthy granulations were present in two ulcers (18.2%) and absent in nine ulcers (81.8%). There was no improvement of pain level in the eleven ulcers. In group II, complete healing of 14 ulcers occurred in 14–60 days with a mean of 33.3±14.7; healing rate range was 0.064–2.22 and the mean 0.896±0.646 cm2/day. Healthy granulations were present in 13 ulcers (92.9%) and absent in one ulcer (7.1%). Three ulcers (21.4%) were of mild severity (grade 1 ulcers) while eleven ulcers (78.6%) were of moderate severity (grade 2 ulcers). The healing rate was faster in ulcers of mild severity (1.7±0.438 cm2/day) in comparison to ulcers of moderate severity (0.673±0.498 cm2/day). Eleven cases (78.6%) showed improvement in their pain level on a scale from 0 to 10.


AM graft can be of value in wound healing. Further studies are needed to confirm these findings.

Keywords: amniotic membrane, ulcer, placenta, cesarean section


Amniotic membrane (AM) is an attractive method of grafting for wounds as it has unique properties, including anti-inflammatory effects, bacteriostatic, wound protection, decreased scarring, and pain reduction properties, as well as epithelialization initialization capacities. Furthermore, AM is widely available and less costly than other bioengineered skin substitutes. Human AM was used for 2,308 ophthalmologic reconstructions in Germany 2008. Its special success in ophthalmology may be due to the immune privileged properties of the AM.


The anti-inflammatory property of AM seems to be a result of production of anti-inflammatory proteins and reduction of expression of transforming growth factor B and pro-inflammatory cytokines, such as interleukin. Also, AM produces B defensins, elastase inhibitors, elastin, and lactoferrin that contribute to its anti-inflammatory and antimicrobial effects. The reduction in scarring after application of AM to wounds might be due to the anti-inflammatory effects, acceleration of epithelialization, and inhibition of fibrosis. Accelerated reepithelialization was also demonstrated by Maral et al after covering split thickness skin graft with AM in rats. Loeffelbein et al demonstrated accelerated formation of basement membrane in wounds treated with AM that might be due to the release of growth factors. One of the most important properties of AM as a skin substitute is pain relieving which may be due to diminished inflammation, better hydration of wound bed, and protection of exposed nerve endings. AM expresses few antigens, which accounts for its good tolerability and the absence of rejection reactions. AM expresses many neurotrophic and angiogenic factors: endothelin-2 and -3, vascular endothelial growth factor, vascular endothelial growth factor-B, Tie-2 angiopoietin receptor, ephrin-A2, ephrin receptors A2, B1, B3, B4, B5, neuropilin-2, nerve growth factor receptor, and semaphorin-F19 as well as erythropoietin and its receptor that contribute to healing of wounds. Some studies demonstrated the effectiveness of AM graft for healing of wounds. Mermet et al put an AM graft for 15 chronic leg ulcers and healing occurred in all patients. Pesteil et al used cryopreserved AM in eight patients with resistant vascular ulcers. Tolerance to the graft was excellent with healing of six out of eight patients with significant improved pain. Alsina-Gibert and Pedregosa-Fauste used AM for four refractory ulcers with a mean 81.93% reduction of ulcer size after 16 weeks. Litwiniuk et al suggested the potential role of matrix metalloproteinase inhibitors present in radiation-sterilized amnion dressing in healing of 23 out of 25 patients with chronic venous ulcers. Sheikh et al used dehydrated amnion to provoke healing of chronic wounds in four patients and healed wounds did not recur on long-term follow-up. A similar study was done by Zelen et al who used dehydrated AM in diabetic foot ulcers with complete healing of 37 out of 40 ulcers. With respect to the low cost, wide availability, and easy preparation, AM can be an ideal graft for chronic refractory ulcers.

Subjects and methods

Study design

This was an experimental, comparative, and randomized clinical trial.

Description of patients and collection of data

This study was performed to test a technique for the treatment of chronic nonhealing wounds using AM to express its effect on the rate of healing of such nonhealing ulcers. Patients were recruited from the outpatient clinics or the inpatient wards of the Department of General Surgery, Faculty of Medicine, Cairo University and Department of Vascular Surgery, Faculty of Medicine, Assiut University from June 2012 to June 2015. Each patient signed an informed consent after accepting to be enrolled in the study. Ethical aspects whether substantial or procedural have been implicated in this study and approval was obtained from the Faculty of Medicine, Ethical Committee of Cairo University (30-9-2012).


Patients were then randomly divided into two different groups. Group I (the control group) included eleven patients with eleven chronic leg ulcers in whom ulcers were treated with conventional wound dressings that were changed daily for 8 weeks. Group II (the study group) included 14 patients with 14 chronic leg ulcers. The AM was placed in contact with the ulcer and held in place with a secondary dressing, which was changed daily. Inclusion criteria were presence of leg ulcers for more than 3 months with no improvement despite standard treatment and age between 26 and 43 years. Exclusion criteria were ulcers with ongoing active infection and presence of diabetes. Full history taking and clinical assessment were done with special reference to previous treatment and surgery, diagnosed diabetes and/or hypertension, causes, types, and duration of ulcers present.


The follow-up during treatment period includes assessment of ulcer healing and pain. Ulcer healing was assessed using the percentage of the healed wound area and healing rate. Using ImageJ program (Rasband, W.S., ImageJ, US National Institutes of Health, Bethesda, Maryland, USA), the wound areas were analyzed and a percentage of the healed wound area was calculated, in respect to the original wound area and the final wound area after 2 weeks and at the end of 2 months according to the formula:


Percentage of healed wound area=Original wound areaFinal wound areaOriginal wound area×100
The healing rate was then determined, in respect to the original wound area, and the final wound area reached according to the formula:
Healing rate=Original wound area-Final wound areaTime cons uumed to reach final wound area

The wound area is calculated by the formula for determining the area of an ellipse ((length × width) × π/4). Results of measured ulcer area size were used for follow-up, and ulcers were categorized with respect to surface area, exudate, and type of wound tissue. A comparison of total measurements over time provided an indicator of improvement or deterioration in ulcer healing. Pain was assessed using a visual analog scale, where 0 represented no pain and 10 represented the worst pain. Each patient has a special file in which all the data were present. Then, merging of data of all patients was done before statistical analysis.

AM isolation, preservation, grafting, and follow-up of patients

Human AM was prepared from placentae obtained from scheduled delivery by cesarean section following a noncomplicated pregnancy. Exclusion criteria were symptoms of infection in the newborn, delivery before 34 weeks gestation, and membrane rupture more than 12 hours before delivery. The donors gave written informed consent for the donation and use of the AM. One placenta can provide four to five AM tissue fragments 5 cm in diameter.


Preparation was performed in a classified (class D) room with a microbiological safety workstation (class A). The placenta was washed with physiological saline and left in contact with an antibiotic solution in its collection container until preparation within 2 hours of the cesarean delivery. The entire membrane structure was immersed in a sterile packing container. The AM is mixed with antibiotics and antifungal in the container. The AM was then cut into different sizes and AM tissue fragments were obtained (Figure 1). For cryopreservation of AM, a cryoprotective agent was added (Roswell Park Memorial Institute medium [RPMI] and glycerol), and then stored in a temperature of −80°C with each piece of the AM stored in a separate container. Three AM samples are collected for bacteriological examination. The placenta rinse fluid (8–10 mL) was used to inoculate two vials of aerobic and anaerobic organisms for bacteriological testing. The placenta was also prepared for a pathological evaluation. On the day of the cesarean section, test tubes containing blood from the mother were collected for the following serology tests: HIV-1 and -2, Ag p24, HCV, HTLV; syphilis: VDRL-TPHA; and HBV: HBs antigen-HBc antibody. Final validation of the AM was performed after a repeat serology test by testing again the donor woman after 120 days. Before use, the AM can be transported to hospital and stored on dry ice up to 24 hours and conserved up to 2 hours in normal saline at room temperature after thawing before utilization.

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Figure 1

Preparation of amniotic membrane pieces.

The preparation of the ulcers includes cleaning and mechanical debridement with a scalpel. The membrane preservation solution was removed by washing with physiological saline and the membrane was applied directly onto the ulcer bed (Figure 2). The graft was then covered with vaseline dressing (Figure 3). Patients were confined to bed for 2 hours and then allowed to do moderate activity for the next 5 days.

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Figure 2

Amniotic membrane application over two leg ulcers.

Notes: Two leg ulcers in one patient (A); application of amniotic membrane over the leg ulcers (B and C); image of the patient after amniotic membrane grafting (D).

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Figure 3

Vaseline dressing is added over amniotic membrane and then covered with dressing.


Notes: Application of vaseline dressing (A and B); application of gauze dressing after vaseline (C); gauze wrapping at the end (D).


Follow-up was done to detect healing rate and detection of ulcer size, assessment of pain, and to take ulcer images (days 0, 7, 14, 21, 30, 45, and 60). Statistical analyses of all data were performed with SPSS software version 15.0 for Windows (SPSS Inc, Chicago, IL, USA). A two-sided value of P<0.05 was considered statistically significant for all analyses. Continuous variables are presented as mean ± standard deviation (SD).


Demographic data of the sample

All patients were males between 26 and 43 years. In group I, there were a total of eleven leg ulcers. Age ranged from 26 to 43 years with a mean value 34.45±7.03. Nine ulcers (81.8%) were venous ulcers, while two ulcers (18.2%) were traumatic ulcers. In group II, there were a total number of 14 leg ulcers. Age ranged from 26 to 43 years with a mean value 32.86±6.94. Twelve ulcers (85.7%) were venous ulcers, while two ulcers (14.3%) were traumatic ulcers. All patients of groups I and II were nondiabetics, with no history of smoking, hypertension, or any other medical condition.

Results of the study

Only conventional treatment was performed for the control group. Chronicity of leg ulcers varied from 24 to 60 months. The ulcer area at the beginning of the study was 4.8±0.65 cm2 (mean ± SD). Mean percentage of healing rate was 0%, and all ulcers in this group showed no reduction in their size (Tables 1and ​and 2), and ulcer floor remained the same. Healthy granulations were present in two ulcers (18.2%) and absent in nine ulcers (81.8%). There is no improvement of pain level in the eleven ulcers (Table 3).

Table 1

Chronicity of leg ulcers, reduction in ulcer size with treatment, and healing rate

Parameters of healing Group I Group II
Chronicity of leg ulcer (range) 24–60 months 24–84 months
Chronicity of leg ulcer (mean + SD) 45.82+14.01 months 50.57+16.43 months
Reduction of ulcer size with treatment 0% 100% reduction in size
Reduction of ulcer size with treatment (mean + SD) 0.0+0.0 100.0+0.0
Healing rate cm2/day (range) 0.0–0.0 0.064–2.22
Healing rate cm2/day (mean + SD) 0.0+0.0 0.896±0.646

Abbreviation: SD, standard deviation.

Table 2

Percentage of healed ulcers

Ulcer healing Group I Group II
No healing 11 100% 0 0%
Complete healing 0 0% 14 100%
Incomplete healing 0 0% 0 0%

Notes: Group I included patients without amniotic membrane application; while Group II included patients with amniotic membrane application.

Table 3

Pain level improved or remained the same from day 0 till the end of study

Pain level Group I Group II
No pain 0 0.0% 3 21.4%
Improved 0 0.0% 11 78.6%
The same 11 100% 0 0.0%

In the study group, the AM was directly applied on leg ulcers. This group included 14 leg ulcers. Chronicity of leg ulcers varied from 24 to 84 months. The ulcer area at the start of the study was 5.1±0.48 cm2 (mean ± SD). Results obtained from the study group showed complete healing of 14 ulcers in 14–60 days with a mean of 33.3±14.7; healing rate range was 0.064–2.22 and mean 0.896±0.646 cm2/day with a 100% reduction in ulcer size. Ulcer floor improved in all ulcers. Healthy granulations were present in 13 ulcers (92.9%) and absent in one ulcer (7.1%). Three ulcers (21.4%) were of mild severity (grade 1 ulcers) while eleven ulcers (78.6%) were of moderate severity (grade 2 ulcers). The healing rate was faster in ulcers of mild severity (1.7±0.438 cm2/day) in comparison to ulcers of moderate severity (0.673±0.498 cm2/day). Eleven cases (78.6%) showed improvement in their pain level on a scale from 1 to 10. Three patients had no pain (Tables 1​1–3; Figure 4). AM graft was taken in four cases (28.6%), while AM was not taken in ten cases (71.4%) in the days following the graft application. In these ten cases, the ulcers also showed complete healing on follow-up. Reduction in ulcer size shows significant difference between group I (control group) in comparison to group II (P=0.001) in which we used AM alone.

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Figure 4

Healing of two leg ulcers after amniotic membrane application.

Notes: Two leg ulcers in one patient (A); application of amniotic membrane on the two ulcers (B); reduction in size of both ulcers (C); complete healing of the upper ulcer and 70% reduction in the size of the lower one on follow up (D).


Chronic leg ulcers are defined as a defect in the skin, below the level of the knee and above the foot, persisting for 6 weeks or more. A previous study found that ~60%–80% of chronic leg ulcers had a venous component, 10%–30% was associated with arterial insufficiency, and other factors included diabetes mellitus and rheumatoid disease. Arterial and venous insufficiency combined in 10%–20% of cases.


Chronic leg ulcers often heal poorly if there is no revascularization. Different lines of treatment are based on optimized local wound care: cleansing, debridement and dressings, compression therapy, and skin grafting. AM graft can be used as placental tissues contain a large quantity of growth factors. Furthermore, AM downregulates transforming growth factor (TGF)-β and its receptor expression by fibroblasts and in doing so it reduces the risk of fibrosis. Therefore, an AM scaffold can modulate the healing of a wound by promoting tissue reconstruction rather than promoting scar tissue formation.


AM is a natural scaffold, which is the supporting matrix upon which cells and tissues grow, and so it is considered an important component of tissue repair with multiple clinical applications. In addition, the AM has other biological properties important for tissue repair, including anti-inflammatory, antimicrobial, antifibrosis, antiscarring, and low immunogenicity as previously discussed. AM may thus be regarded as a bio-therapeutic product composed of a single layer of epithelial cells that lie on a basement membrane and of a nonvascular collagenous stroma. These three components give AM its beneficial properties, including antiadhesive effects, bacteriostatic properties, wound protection, pain reduction, and epithelialization effects.


The AM epithelial cells reside on the inner layer of the AM, while amniotic mesenchymal stromal cells form the outer layer.


Results obtained from our study group showed complete healing of 14 ulcers in 14–60 days with a mean of 33.3±14.7; healing rate range was 0.064–2.22 and mean 0.896±0.646 cm2/day with a 100% reduction in ulcer size. Ulcer floor improved in all ulcers. Healthy granulations were present in 13 ulcers (92.9%) and absent in one ulcer (7.1%). Three ulcers (21.4%) were of mild severity (grade 1 ulcers) while eleven ulcers (78.6%) were of moderate severity (grade 2 ulcers). Eleven cases (78.6%) showed improvement in their pain level on a scale from 1 to 10. AM graft was taken in four cases (28.6%), while AM was not taken in ten cases (71.4%).


The current study results were supported by the results of Mermet et al in a prospective pilot study, in which they evaluated the safety, feasibility, and the effects on healing of AM graft in 15 patients with chronic venous leg ulcers. The percentage of granulation tissue increased significantly (from 17% on day 0 to 69% on day 14, P<0.0001), along with a significant decrease of fibrinous slough (from 36% at day 0 to 16% at day 14, P<0.001). There was significant reduction in ulcer size and pain level as well. Also, Alsina-Gibert and Pedregosa-Fauste performed AM transplantation for four refractory vascular ulcers. Complete wound reepithelialization was achieved for one ulcer by week 8; in the other three cases, there was a 50% reduction in size compared to baseline. At week 16, the mean reduction in wound size for the four ulcers was 81.93%. The corresponding reduction in pain intensity was 86.6%. No adverse effects were observed.


To our knowledge, this is the first study to prove the possible efficacy of AM in treating nonvascular (traumatic) refractory wounds (two cases in this study) in addition to efficacy in treating vascular refractory ulcers (12 cases in this study) that was shown by previous similar studies. The limitation of this study is the small number that needs further studies to support it.


AM graft can be an ideal choice instead of tissue-engineered skin equivalents to be used in wound healing. In addition to being an excellent scaffold, it has unique biological properties that are important for tissue repair, including anti-inflammatory, antimicrobial, antifibrosis, antiscarring, as well as a reasonable cost and low immunogenicity. Furthermore, presence of its own progenitor cells help in tissue repair.

Recommendations and implications to practice

Further studies should be done to support this study results. Comparing AM with alternative allogeneic or autologous skin substitutes in a randomized study will be worthwhile to determine the best therapeutic option and establish the potential of using AM in the treatment of leg ulcers. Routine preparation and preservation of AM will be of great value in tissue repair programs and implementation of biotherapy especially in developing countries due to its efficacy and low cost.



The authors report no conflicts of interest in this work.


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Articles from International Journal of Women’s Health are provided courtesy of Dove Press

Ultrasonic debridement system in patients with diabetic foot ulcers

     A case series

This study evaluated the use of ultrasonic debridement in patients with diabetic foot ulcers (DFU).


In this prospective, single-arm, open-label study, all patients with DFUs underwent wound debridement by ultrasonic debridement system (SonicOne OR Ultrasonic debridement system). Wherever possible, the edges were approximated by means of stitches. In other cases, the surgical breach healed by secondary intention, or a partial thickness skin graft (with or without Integra Dermal Regeneration Template or Integra Flowable Wound Matrix) was applied, and subsequently healed by primary intention … read more

Roles of alternative activation of macrophages phenotypes in normal wound healing

Normal wound healing process is characterized by highly organized controlled overlapping phases including haemostasis, inflammation, proliferation, and remodeling; through which acute wounds come to a complete healing with predictable time frame (Schreml et al, 2010). These phases are orchestrated by the interaction of different cell types and biochemical components to regulate and accomplish the different wound healing process such as coagulation, chemotaxis, phagocytosis, synthesis of extracellular matrix components, angiogenesis, epithelial migration, and remodeling components (Velnar et al, 2009). Components of the main cellular wound healing process include macrophages, keratinocytes, endothelial cells, fibroblast, neutrophils, and lymphocytes. These components are recruited, stimulated and activated according to their role in the healing process by which specific generic cytokines, growth factors, chemokines, and respective receptors are created to achieve physiological wound healing of skin wounds (Schreml et al, 2010) … read more

Bioelectrical Impedance Assessment of Wound Healing

Objective assessment of wound healing is fundamental to evaluate therapeutic and nutritional interventions and to identify complications. Despite availability of many techniques to monitor wounds, there is a need for a safe, practical, accurate, and effective method. A new method is localized bioelectrical impedance analysis (BIA) that noninvasively provides information describing cellular changes that occur during healing and signal complications to wound healing. This article describes the theory and application of localized BIA and provides examples of its use among patients with lower leg wounds. This promising method may afford clinicians a novel technique for routine monitoring of interventions and surveillance of wounds.


Wound healing is a dynamic, interactive cascade of molecular, cellular and biochemical processes. Despite accumulating knowledge of the biology of wound healing, the estimated annual cost of treating wounds exceeds $20 billion in the United States, particularly for wounds of the lower body. Although many therapeutic interventions are utilized to treat wounds, physician decisions are hampered by the lack of objective and convenient methods to monitor treatment effects and to assess wound healing. Contemporary methods have limitations including cost, time commitment, reliability, and accuracy. Thus, the need persists for an objective, suitable, and practical method to assess wound healing.


Assessment of the effectiveness of treatment to foster wound healing is a complex and broad field. Traditional methods estimate the dimensions of wounds including surface area and volume. Physiological approaches utilize molecular and biochemical indicators that provide less subjective information. Because successful wound healing is a dynamic process that integrates physiological and biochemical factors and mechanisms, reliance on a single aspect of the process may be inadequate. This article describes the use of localized bioelectrical impedance analysis (BIA) measurements to monitor cellular processes involved in wound healing …  read more

How Activity Benefits the Healing Patient

Maintaining an active lifestyle is critical to good health; this is especially true for patients recovering from wounds or extended hospital stays. Robust activity can improve mental health, reduce the risk of infection, and accelerate wound healing.1 Staying active can be challenging for patients with wounds, however, and it is critical that health care professionals take steps to enable their patients to stay as active as possible.


The Healing Benefits of Activity

Aside from the long-term benefits to heart health, mental health, and longevity, exercise provides many direct and indirect benefits to patients healing from wounds. Physical activity can promote rapid wound healing, reduce oxidative damage, and promote a healthy lifestyle. This can improve patient outcomes and reduce the costs of treatment.

Exercise Benefits Mental Health –
 There is ample evidence that exercise promotes good mental health, reduces the effects of depression, and causes people to report a greater level of happiness. These effects are especially important for those who have had an extended stay in a hospital or who are in a long-term care facility because these populations may be at greater risk of developing mental health problems.

Exercise Reduces Inflammation – 
Inflammation is one of the major causes of delayed healing. Research shows that wounds with low levels of inflammation heal much more quickly and completely. Exercise and other physical activity have been shown to reduce the level of inflammatory markers in the blood, thus helping to reduce the level of inflammation and promote rapid healing. Reduced inflammation may also provide palliative benefits by decreasing pain and discomfort in wounds … read more

Researchers Examine Link Between Wound Healing and Time of Day

In addition to where a wound is located and how it developed, researchers now also believe that the time of day you get your wound may have something to do with how it heals and the type of wound care you receive as well.


Daytime and nighttime wounds
According to a team of British scientists, wounds (including burn wounds and cuts) healed almost 60 percent sooner if the injury originally occurred during the daytime as opposed to during the night, as reported by CNN.


The researchers from the Medical Research Council Laboratory of Molecular Biology in Cambridge, England, looked at the treatment records of more than 110 burn patients from facilities in Wales and England. The findings were published in Science Translational Magazine.


The scientists found that patients whose burn wounds occurred between 8 p.m. and 8 a.m.took more time to heal than those that happened between 8 a.m. and 8 p.m. More specifically, wounds that happened at night healed in approximately 28 days, compared to wounds incurred in the day, which healed in approximately 17 days … read more

Understanding Debridement: An Important Part of Wound Healing

During wound healing, the affected area can become overrun with necrotic – or dead – tissue. This can be harmful to the body’s ability to recover and develop new skin, so debridement may be necessary to remove that dead material. In this way, debridement is essential for preparing the wound bed to promote speedy and efficient healing.


Why is debridement important?
Debridement promotes the wound healing process in a variety of ways. Not only does dead skin inhibit the development of healthy new tissue, but it makes the affected area more susceptible to infection. It can also hide the signs of infection, as dead tissue can increase odor and exudate, making it easier for bacteria and other harmful foreign invaders to spread.


How does debridement work?
Sometimes, debridement occurs naturally on its own thanks to the body’s own ability to shed off dead tissue. However, more often, it requires a medical procedure. There are two different categories of debridement: active and autolytic. Autolytic debridement involves application of hydrocolloids and hydrogels to enhance moisture in the affected area in order to degrade it so the body will naturally deslough the dead tissue. Active debridement involves the manual removal of necrotic material, and it comes in several types of procedures, such as … read more

Diabetic Wound Healing and LED Irradiation

Introduction: Light-Emitting Diode Therapy for Chronic Non-Healing Diabetic Wounds


Diabetes mellitus is frequently associated with chronic non-healing wounds, many of which result in amputation. The combination of peripheral vascular disease, neuropathy, and impaired immune function contributes to a higher risk of injury and deficiency in healing. Wound healing is a complex process comprising eight important factors: (1) collagen synthesis, (2) cell migration, (3) cell cycle and differentiation, (4) angiogenesis and growth hormone, (5) blood clotting, (6) extracellular matrix and focal adhesion, (7) calcium ion signaling, and (8) immune and inflammatory response. In the diabetic cell, all these processes malfunction, with the exception of collagen synthesis, cell migration, and cell cycle or differentiation.


Previous studies found an association between diabetes and the precursor protein pro-opiomelanocortin (POMC) gene. POMC is normally expressed in pituitary melanotroph and corticotroph cells and functions to control body weight. Studies have suggested that a mutation in the POMC gene leads to early-onset type 2 diabetes and obesity. This correlation is under investigation for its potential use in diabetic therapy.


Light-emitting diode (LED) phototherapy at 660 and 890nm has been shown to significantly accelerate wound healing in normal, healthy patients. This therapy works through molecules with porphyrin structures that are able to trap photon energy and subsequently activate downstream processes. The current study investigated the results of a range of different LED phototherapies on gene expression and cellular function of diabetic cells compared with normal, healthy cells … read more

Treating Hard-to-Heal Wounds

An Evidence-Based Approach for DFU and Chronic Wounds


This is a brief summary of a presentation given at the annual conference of Wounds Canada, in Mississauga, Ontario, on November 16th, 2017. It has been produced with the financial support of Integra Life Sciences. The presenter was Robert Fridman, DPM FACFAS CWSP, a fellowship-trained podiatric surgeon at the Department of Orthopaedic Surgery at New York-Presbyterian Columbia University Medical Center and the Department of Surgery at New York-Presbyterian Weill-Cornell Medical Center.


Normal Wound Healing
For health-care professionals, standard wound management consists of preparing the wound bed to support the healing process. When treating diabetic foot ulcers (DFUs), health-care professionals must work toward controlling infection, correcting ischemia, optimizing nutrition, correcting hyperglycemia and offloading of the wound.


Offloading is one of the cornerstones of effective management of a diabetic foot ulcer, as it helps to minimize repetitive trauma to the area. Total contact casting (TCC) has been established as the gold standard to achieve offloading while enabling patients to ambulate. TCC enables pressure to be transmitted to the cast wall or rearfoot, resulting in decreased forefoot pressure. The device also reduces gait speed and shortens stride length, resulting in reduction of pressure. Ankle movement and the propulsive phase of gait are reduced, resulting in a reduction in vertical loading forces (see Figure 1). Ninety percent of DFUs have been shown to heal within six weeks when treated with a TCC … read more

Pressure Injury Prevention, Is It All About Protein?

by Nancy Munoz, DCN, MHA, RDN, FAND


The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure injury as localized damage to the skin and/or underlying soft tissue, usually over a bony prominence or related to a medical or other device. The injury can manifest as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure, occasionally in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities, and the condition of the soft tissue.


Pathophysiologic and intrinsic factors at the core of pressure injury development include nutrition. Maintaining adequate nutrition is considered a best practice for both the prevention and treatment of pressure injuries. Individuals with or at risk for developing pressure injuries should strive to achieve or maintain adequate nutrition parameters … read more

HBOT, sham procedure lead to similar wound healing rates

Adults with diabetes and chronic lower limb wounds randomly assigned to 6 weeks of hyperbaric oxygen therapy or a sham procedure met similar amputation criteria and experienced similar wound healing rates at the conclusion of treatment, according to research in Diabetes Care.


In a prospective, double blind, randomized controlled trial, Ludwik Fedorko, MD, PhD, FRCPC, of Toronto General Hospital and University Health Network in Ontario, Canada, and colleagues analyzed data from 107 adults with type 1 or type 2 diabetes and chronic lower limb wounds persisting for a minimum of 4 weeks. Within the cohort, 49 participants were randomly assigned to 30 daily sessions of hyperbaric oxygen therapy lasting 90 minutes each (breathing oxygen at 244 kPa); 54 participants were assigned to a sham procedure (breathing oxygen at 125 kPa; equivalent to breathing 27% oxygen by face mask), in addition to receiving comprehensive wound care …


“The adjuvant [hyperbaric oxygen therapy] care provided no incremental benefit in improving measures of wound healing,” the researchers wrote. “These results are in contrast to several cohort and open-label randomized trials where no sham placebo was used.”  by Regina Schaffer

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Roles of alternative activation of macrophages phenotypes in normal wound healing

Normal wound healing process is characterized by highly organized controlled overlapping phases including haemostasis, inflammation, proliferation, and remodeling; through which acute wounds come to a complete healing with predictable time frame (Schreml et al, 2010). These phases are orchestrated by the interaction of different cell types and biochemical components to regulate and accomplish the different wound healing process such as coagulation, chemotaxis, phagocytosis, synthesis of extracellular matrix components, angiogenesis, epithelial migration, and remodeling components (Velnar et al, 2009). Components of the main cellular wound healing process include macrophages, keratinocytes, endothelial cells, fibroblast, neutrophils, and lymphocytes. These components are recruited, stimulated and activated according to their role in the healing process by which specific generic cytokines, growth factors, chemokines, and respective receptors are created to achieve physiological wound healing of skin wounds (Schreml et al, 2010).

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Can Lactic Acid Bacteria Speed Wound Healing?

David G. Armstrong DPM MD PhD

Researchers are showing faster wound healing following the administration of lactic acid bacteria into wounds.


The study, published online in the Proceedings of the National Academy of Sciences of the United States of America, used a mice model to show wound healing.1 Researchers transformed Lactobacilli with a plasmid encoding C-X-C motif chemokine 12 (CXCL12), noting this enhanced wound closure via proliferation of dermal cells and macrophages, also leading to higher transforming growth factor-beta (TGF-β) expression in macrophages. The study notes that bacteria-produced lactic acid reduced the local pH, which inhibited the peptidase CD26 and facilitated a higher availability of bioactive CXCL12.


The authors also note that Lactobacilli delivering CXCL12 improved wound closure in mice with hyperglycemia or peripheral ischemia, conditions associated with chronic wounds.1 The study adds that the treatment showed macrophage proliferation on human skin in an in vitro model of wound epithelialization … read more

Wound Temperature and Healing

You’ve probably heard that it’s important to keep wounds moist and warm, But what’s the optimal temperature for healing a wound, and how do you maintain it? Read on for details.


When moisture evaporates from a surface, the surface cools. Sweat operates by this principle. So, unfortunately, do wounds. Whenever a wound loses moisture, the tissues of the wound drop in temperature.


The cells and enzymes of the body function best at normal temperature, around 37° C (98.6° F).  When wound temperature decreases by as little as 2° C, healing can slow or even cease. In shortwhen the temperature drops, the healing stops.


Furthermore, cooled tissues cause vasoconstriction and increase hemoglobin’s need for oxygen. As a result, there’s less oxygen available for the type of white blood cells called neutrophils to fight any potential infection.


Here’s the kicker: once the wound tissues cool– such as when left open to air during a dressing change– the wound base can take up to 4 hours to return to normal healing temperature. If a clinician changes a dressing TID, the wound may be outside of the optimal healing range 50% of the time … read more


Hyperbaric oxygen add-on may not aid wound healing in diabetes

The addition of hyperbaric oxygen therapy to standard care did not substantially improve outcomes in adults with diabetes with an ischemic wound compared with standard care treatment alone, according to findings published in Diabetes Care.

Dirk T. Ubbink, MD, PhD, of the department of surgery at Academic Medical Center in Amsterdam, and colleagues evaluated data from the DAMO2CLES trial on 120 adults with diabetes and an ischemic wound randomly assigned to standard care with (n = 60) or without hyperbaric oxygen therapy (n = 60) to determine whether hyperbaric oxygen therapy is beneficial for ischemic wound treatment. Participants were recruited between June 2013 and December 2015. The primary outcomes included limb salvage and wound healing after 12 months. Follow-up visits occurred at 3, 6 and 12 months after recruitment … read more

Mathematics Used to Improve Wound Healing

Chandan Sen, a research professor in the surgery department at Ohio State University, teamed up with Avner Friedman, professor of mathematicians at the university, and Chuan Xue, a postdoc at Ohio State’s Mathematical Biosciences Institute, to create a mathematical model for ischemic wounds. This new computational tool should provide predictive guidance on how a given wound might progress, allowing researchers to develop more precise protocols to deal with wounds and dehiscences.


The mathematical model, to date, simulates both non-ischemic wounds – those typical of wounds in healthy people with good circulation – and ischemic wounds. The current model produced results that generally match pre-clinical expectations: that a normal wound will close in about 13 days, and that 20 days after the development of an ischemic wound, only 25 percent of the wound will be healed.

The model also showed that normal wounds have higher concentrations of proteins and cells expected to be present during the healing process … read more

Self-sealing miniature ‘wound’ created by engineers

Biomedical engineers have developed a miniature self-sealing model system for studying bleeding and the clotting of wounds. The researchers envision the device as a drug discovery platform and potential diagnostic tool.


A description of the system, and representative movies, were published Tuesday online by Nature Communications.


Lead author Wilbur Lam, MD, PhD says that blood clotting involves the damaged blood vessel, platelets, blood clotting proteins that form a net-like mesh, and the flow of the blood itself.


“Current methods to study blood clotting require isolation of each of these components, which prevents us from seeing the big picture of what’s going with the patient’s blood clotting system,” says Lam, assistant professor in the Department of Pediatrics at Emory University School of Medicine and in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University read more

Screenshot from video showing blood cells streaming through a “wound” and a clot forming. The red-stained cells are actually white blood cells. A green extracellular glue can be seen at the top of the wound; this is fibrin, which holds the clot together. See the full video at: https://youtu.be/l7k1dGfKG0g

Unexpected helpers in wound healing

Nerve cells in the skin help wounds to heal. When an injury occurs, cells known as glial cells change into repair cells and disseminate into the wound, where they help the skin to regenerate, researchers from the University of Zurich have shown.

An essential step in skin wound healing is wound closure, which is why shortly after an injury occurs, blood coagulates and seals the wound. For the injury to be able to heal permanently, however, the affected layers of the skin need to be newly formed. For that to happen, a complex, only partially understood interplay takes place between various cell types in our skin. Together with a team from ETH, Lukas Sommer, a professor in the Institute of Anatomy at the University of Zurich … read more

Cell signals that trigger wound healing are surprisingly complex

In a sharp and pointy world, wound healing is a critical and marvelous process.


Despite a tremendous amount of scientific study, many outstanding mysteries still surround the way in which cells in living tissue respond to and repair physical damage.


One prominent mystery is exactly how wound-healing is triggered: A better understanding of this process is essential for developing new and improved methods for treating wounds of all types.


Using an ultrafast, ultraprecise ultraviolet laser, a team of physicists and biologists at Vanderbilt University has taken an important step toward understanding the nature of these trigger signals. Their new insights are described in a paper titled “Multiple mechanisms drive calcium signal dynamics around laser induced epithelial wounds” published Oct. 3 by the Biophysical Journal read more

DermaStream CST for Active Wound Management

Israel21C is reporting that EnzySurge out of Rosh Ha’ayin, Israel is expecting to begin FDA approval process for the complete DermaStream CST system. The wound healing device is designed to be placed over a wound to provide continuous cleaning and washing away of debris and extravasated fluid. Although the device itself received FDA clearance, the bio-active chemical solution that it is supposed to work with it has yet to get a green light … read more

New technology for accelerated wound healing discovered

Researchers have found a new way of accelerating wound healing. The technology and the mode of action involves using lactic acid bacteria as vectors to produce and deliver a human chemokine on site in the wounds. The research group is the first in the world to have developed the concept for topical use and the technology could turn out to be disruptive to the field of biologic drugs … Researchers at Uppsala University and SLU have found a new way of accelerating wound healing. The technology and the mode of action method published in the highly ranked journal PNAS involves using lactic acid bacteria as vectors to produce and deliver a human chemokine on site in the wounds. The research group is the first in the world to have developed the concept for topical use and the technology could turn out to be disruptive to the field of biologic drugs … Treatment of large and chronic wounds are a high cost burden to the health care system since effective tools to accelerate healing are lacking. Wound care is today limited to mechanical debridement, use of different dressings and significant amounts of antibiotics preventing or treating wound infections. With the aging population, occurrence of chronic diseases such as diabetes and the alarming global spread of antibiotic resistance, a treatment that kick-starts and accelerates wound healing … read more

The Future of Wound Healing: Autologous Patient Gels

Seems like yesterday that those of us with gaping lacerations were told to “walk it off.” These days, instead of just using sutures, surgeons have been using a natural fibrin glue to close up wounds and secure fractured bones. The next step in the process is actually using a patient’s own wound-healing cells like platelets to pseudo-naturally speed up the process.
A sample of blood is taken from the patient and the red blood cells are removed. The platelets are concentrated and when combined with thrombin, form a very strong gel that is not too different from the body’s natural healing process.
Pilot studies are springing up all over the place demonstrating reduced wound healing … read more

Topical gel containing blood pressure drugs shown effective in healing chronic wounds …

Topical Gel Made From Oral Blood Pressure Drugs Shown Effective in Healing Chronic Wounds in Test Animals

An international team of researchers led by Johns Hopkins has shown that a topical gel made from a class of common blood pressure pills that block inflammation pathways speeds the healing of chronic skin wounds in mice and pigs.


A report of the findings, published Oct. 16 in the Journal of Investigative Dermatology, marks efforts to seek approval from the U.S. Food and Drug Administration (FDA) to use the gel application in treatment-resistant skin wounds among diabetics and others, particularly older adults.


“The FDA has not issued any new drug approval for wound healing in the past 10 years,” says Peter Abadir, M.D., associate professor …. read more


Biofilm and Wound Healing

Composition of Biofilm

Biofilm is a complex microbial community containing self- and surface-attached microorganisms that are embedded in an extracellular polymeric substance.1,2 The extracellular polymeric substance is a primarily polysaccharide protective matrix synthesized and secreted by the microorganisms that attaches the biofilm firmly to a living or non-living surface. This protective covering does not allow the body’s immune system to recognize the presence of the microorganism; therefore, the bacteria evade an immune response, avoid detection by standard diagnostic techniques, and avoid destruction by standard treatments. Because of the tenacity of the attached biofilm, the microoganisms are able to resist physical forces, such shear, and are able to withstand nutrient and moisture deprivation, altered pH, and the impact of antibiotics and antiseptics. For the purposes of this discussion we break down the formation and actions of biofilms and discuss their impact on wound healing … read more