Tag: Wound Healing

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

 

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

 

Method:
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

Ultrasonic debridement system in patients with diabetic foot ulcers

     A case series

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

 

Method:
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
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

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 (free account required)

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