Advances in Wound Healing: A Review of Current Wound Healing Products

Successful wound care involves optimizing patient local and systemic conditions in conjunction with an ideal wound healing environment. Many different products have been developed to influence this wound environment to provide a pathogen-free, protected, and moist area for healing to occur. Newer products are currently being used to replace or augment various substrates in the wound healing cascade. This review of the current state of the art in wound-healing products looks at the latest applications of silver in microbial prophylaxis and treatment, including issues involving resistance and side effects, the latest uses of negative pressure wound devices, advanced dressings and skin substitutes, biologic wound products including growth factor applications, and hyperbaric oxygen as an adjunct in wound healing. With the abundance of available products, the goal is to find the most appropriate modality or combination of modalities to optimize healing

Progress and Perspectives in the Management of Wound Infections

The progress in nanotechnology and the medical application of novel generations of nanomaterials have opened new horizons in the definition of non-conventional approaches against multiple diseases. Biomaterials coated with antimicrobial metal nanoparticles, along with the topical applications of zinc, silver or copper-based formulations have demonstrated huge potential in prevention from infections associated with implantable medical devices and in biofilm eradication. In wound healing, in particular, the increasing healthcare costs and the antibiotic resistance demonstrated by several microorganisms have encouraged researchers and companies in the development of innovative wound dressings with antibacterial properties and capability to promote and enhance the healing process. Supported by scientific evidence, many formulations have been proposed and a large number of works involves the use of hybrid metal nanoparticles/polymer products, which have demonstrated encouraging results both in vitro and in vivo. In this chapter, recent progress in the development of novel wound dressings based on antibacterial metal nanoparticles is presented, along with the most interesting results achieved by the authors, mainly devoted to the application of silver nanocoatings in wound management

A Systematic Comparison of Antimicrobial Wound Dressings using a Planktonic Cell and an Immobilised Cell Model. Kamran

Aim: The aim of the study was to evaluate the ability of in-vitro planktonic and immobilised cell models for determining the antimicrobial efficacy of common antimicrobial wound dressings. Methods and Results: Five strains of A.baumannii , P.aeruginosa and S. aureus (MRSA) were tested against four antimicrobial wound dressings containing silver, honey or PHMB, using both a planktonic and immobilised cell model. Across all species and models used, the NSCD demonstrated the best antimicrobial activity being as good if not better than all the other dressings. The planktonic cell model was less effective at differentiating the dressings on antimicrobial performance as the immobilised cell model indicating that a diffusion barrier had a significant impact on the performance of some dressings. In the presence of the diffusion barrier antimicrobial impact of the Honey and PHMB dressings was significantly reduced particularly in the case of A. baumannii. Activity was at least an order of magnitude lower in the immobilised cell model vs. the planktonic cell model. Conclusions: The use of a planktonic cell model within standard tests may overestimate the efficacy of honey and PHMB. The use of an immobilised cell model provides a more demanding test for antimicrobial dressings allowing dressing to dressing and pathogen to pathogen differences to be more clearly quantified. Significance and Impact of study: The introduction of planktonic and immobilised cell models as part of testing regimens for wound dressings will provide a more thorough understanding of their antimicrobial and antibiofilm properties

Antimicrobial silver nanoparticles for wound healing application: Progress and future trends

none2noRecent data have reported that the burden of infections related to antibiotic-resistant bacteria in the European Union and European Economic Area (EEA) can be estimated as the cumulative burden of tuberculosis, influenza, and human immunodeficiency virus (HIV). In wound management, the control of infections represents a crucial issue and a multi-billion dollar industry worldwide. For diabetic wounds ulcers, in particular, infections are related to the majority of amputations in diabetic patients, which today represent an increasing number of the elderly. The greatest barrier to healing is represented by the biofilm, an organized consortium of bacteria encapsulated in a self-produced extracellular polymeric substance with high resistance to conventional antimicrobial therapies. There is an urgent need for novel anti-biofilm strategies and novel antimicrobial agents and, in this scenario, silver nanotechnology has received tremendous attention in recent years in therapeutically enhanced healthcare. Due to its intrinsic therapeutic properties and the broad-spectrum antimicrobial efficacy, silver nanoparticles have opened new horizons towards novel approaches in the control of infections in wound healing. This review aims at providing the reader with an overview of the most recent progress in silver nanotechnology, with a special focus on the role of silver in the wound healing process.openPaladini F.; Pollini M.Paladini, F.; Pollini, M

A Bacterial Cellulose - Nanosilver System

Both nanocrystalline silver and bacterial cellulose have been used as biomedical materials. Silver has been used as an antimicrobial agent, and bacterial cellulose as a wound dressing. The combination of both these technologies has the potential to create a synergistic scenario. A novel method for the attachment of nanocrystalline silver to bacterial cellulose has been developed. The cellulose is oxidized with sodium metaperiodate to dialdehyde cellulose and functionalized with silver using thiosemicarbazide, silver protienate and ammoniacal silver. The samples were prepared using both a commercially available bacteria cellulose wound dressing, Biofill, and lab made, wet pellicle, as the substrate. The antimicrobial efficacy against E. coli and S. aureus has been determined using a modified disk diffusion test procedure, and the release profiles of silver into deionized water were determined. These tests have shown an antimicrobial efficacy ranging between 1 day for the Biofill prepared samples and 5 days for the pellicle based samples

Certain Aspects of Silver and Silver Nanoparticles in Wound Care: A Minireview

Resistance to antimicrobial agents by pathogenic bacteria has emerged in recent years and is a major health problem. In this context silver and silver nanoparticles (AgNP) have been known to have inhibitory and bactericidal effects and was used throughout history for treatment of skin ulcer, bone fracture, and supporting wound healing. In all of these applications prevention and treatment of bacterial colonized/infected wounds are critical. In this context silver and its derivatives play an important role in health care. Silver is widely used in clinical practice in the form of silver nitrate and/or silver sulfadiazine. In the last few years silver nanoparticles entered into clinical practice as both antimicrobial and antifungal agents. In addition, nanosilver is used in coating medical devices (catheters) and as component of wound dressings. In this paper we present summarized information about silver and nanoparticles made of silver in the context of their useful properties, especially antibacterial ones, being of a great interest for researchers and clinicians

DEVELOPMENT OF A NEXT-GENERATION ANTIMICROBIAL WOUND DRESSING

Odgođeno cijeljenje rana zbog infekcije je teret zdravstvenim sustavima, a jednako tako i pacijentu i onome koji skrbi za njega. Bitan čimbenik u nastajanju infekcije i odgođenog cijeljenja je razvoj i prisutnost biofi lma u ranama. Biofi lm je zajednica mikroorganizama, zaštićena izvanstaničnim sluzavim matriksom u rani, koji može tolerirati obranu domaćina i primijenjena antimikrobna sredstva, kao što su antibiotici ili antimikrobne obloge. Rastući broj znanstvenih dokaza upućuje da biofilm već egzistira u većini kroničnih rana, a može biti i prethodnik infekciji dok istodobno uzrokuje odgođeno cijeljenje. In vivo modeli pokazali su da su upala, granulacija i epitelizacija, te procesi normalnog cijeljenja rane narušeni prisustvom biofilma. Izazov u razvoju nove antimikrobne obloge za ranu bio je da standardna antimikrobna sredstva učinimo učinkovitija protiv biofilma, a rješenje je uslijedilo nakon opsežnih istraživanja i ispitivanja biofi lma. Kombinacija metalnog kelatora, površinski aktivne tvari i kontrole pH faktora pokazala je snažnu sinergističku anti-biofi lm akciju u oblozi od karboksimetilceluloze sa 1,2 % ionskog srebra. Ta je učinkovitost testirana i dokazana u kompleksnim in vitro i in vivo modelima rana s biofilmom, a zatim i u klinički kontroliranim studijama, i to u studiji na 42-pacijenta i 113 kliničkih evaluacija. Naknadno ispitivanje nastavljeno je nakon dostupnosti obloge u evaluaciji na 112 slučaja, gdje je obloga pokazala učinkovito kontroliranje eksudata i suspektnog biofi lma na ranama koje teško cijele i pri tome poticanje procesa cijeljenja rana i to nakon prosječno 4 tjedna primjene nove obloge u inače standardnom protokolu njege. To je bilo popraćeno niskim brojem nuspojava. U drugoj procjeni bili su evaluirani i klinički znakovi infekcije i podatci o veličini rane, prije i nakon procjene. Nakon prosječno 5,4 tjedana uporabe obloge, svi su klinički znakovi infekcije bili reducirani, s prosječnom učestalošću od 36 % do 21 %. U prosjeku u 62 % rana postignuta je redukcija veličine, uz smanjenje veličine do 90 % i 10 potpuno zacijeljenih rana. Najnoviji kliničkih dokazi za novu generaciju antimikrobne obloge za ranu potvrđuju njenu sigurnost i učinkovitost u kontroli eksudata, infekcije i biofi lma, a osim toga potvrđuju i zacijeljivanje rana koje dugo i teško ili uopće ne cijele. Znanstvenu potporu za najnoviju tehnologiju i generaciju antimikrobne obloge potvrđuju in vitro i in vivo dokazi, tako da su buduća komparativna i randomizirana klinička ispitivanja neophodna za potpuno razumijevanje kliničke i ekonomske učinkovitosti koju može donijeti ova najnovija tehnologija.Delayed wound healing due to infection is a burden on healthcare systems, and the patient and caregiver alike. An emerging factor in infection and delayed healing is the presence development of biofilm in wounds. Biofilm is communities of microorganisms, protected by an extracellular matrix of slime in the wound, which can tolerate host defences and applied antimicrobials such as antibiotics or antimicrobial dressings. A growing evidence base exists suggesting that biofi lm exists in a majority of chronic wounds, and can be a precursor to infection while causing delayed healing itself. In vivo models have demonstrated that the inflammatory, granulation and epithelialization processes of normal wound healing are impaired by biofi lm presence. The challenge in the development of a new antimicrobial wound dressing was to make standard antimicrobial agents more effective against biofilm, and this was answered following extensive biofilm research and testing. A combination of metal chelator, surfactant and pH control displayed highly synergistic anti-biofi lm action with 1.2% ionic silver in a carboxymethylcellulose dressing. Its effectiveness was challenged and proven in complex in vitro and in vivo wound biofi lm models, followed by clinical safety and performance demonstrations in a 42-patient study and 113 clinical evaluations. Post-market surveillance was conducted on the commercially available dressing, and in a 112-case evaluation, the dressing was shown to effectively manage exudate and suspected biofi lm while shifting diffi cultto-heal wounds onto healing trajectories, after an average of 4 weeks of new dressing use in otherwise standard wound care protocols. This was accompanied by a low frequency of dressing related adverse events. In a second evaluation, clinical signs of infection and wound dimension data, before and after the evaluations, were also available. Following an average of 5.4 weeks of dressing use, all signs of clinical infection were reduced, from an average frequency of 36% to 21%. An average of 62% wound size reduction was achieved, with 90% of wounds reducing in size and 10 wounds healing completely. The new clinical evidence for this next-generation antimicrobial wound dressing suggests it is safe and effective at managing exudate, infection and biofilm, while it can shift established, stubborn wounds onto healing trajectories. The scientific rationale for this new dressing technology is supported by in vitro and in vivo evidence, so now further comparative, randomized and outcome-based clinical studies are required to fully understand the clinical and economic benefits this new dressing technology can bring

Combatting wound biofilm and recalcitrance with a novel anti-biofilm Hydrofiber® wound dressing

AbstractBackgroundBiofilm is an impediment to wound healing as a consequence of its proven ability to impair epithelialization, granulation tissue formation and normal inflammatory processes, as well as protecting wound pathogens from antibiotics and antiseptics. With this in mind, a project was initiated to develop a combined anti-biofilm/antimicrobial technology that could be incorporated into a wound dressing to maximize effectiveness against wound pathogens existing in their predominant biofilm form.MethodsInitially, a wide range of anti-biofilm agents in combination with ionic silver were screened in a rapid throughput in vitro biofilm model. Selected agents were incorporated into a new wound dressing format and subsequently tested in vitro against antibiotic-resistant pathogens in their most tolerant biofilm form.ResultsThe combination of ionic silver with a metal chelating agent and a surfactant was shown to produce a synergistic effect (referred to as Ag+ Technology) that substantially improved the antimicrobial efficacy of ionic silver against biofilm pathogens in a simulated wound biofilm model.ConclusionBy combining anti-biofilm and antimicrobial components that work in synergy to disrupt biofilm and expose associated wound pathogens to the antimicrobial action of ionic silver, it is anticipated that this new technology incorporated into an advanced Hydrofiber® wound dressing will contribute significantly to managing biofilm infections and encouraging healing in patients debilitated by recalcitrant wounds

Antibacterial strategies to tackle wound infections

L'abstract è presente nell'allegato / the abstract is in the attachmen