Dual Drug Delivery for Augmenting Bacterial Wound Complications via Tailored Ultradeformable Carriers.

Addressing the complex challenge of healing of bacterially infected wounds, this study explores the potential of lipid nanomaterials, particularly advanced ultradeformable particles (UDPs), to actively influence the wound microenvironment. The research introduces a novel therapeutic approach utilizing silver sulfadiazine (SSD) coupled with vitamin E (VE) delivered through UDPs (ethosomes/transferosomes/transethosomes). Comparative physicochemical characterization of these nanosized drug carriers reveals the superior stability of transethosomes, boasting a zeta potential of -36.5 mV. This method demonstrates reduced side effects compared to conventional therapies, with almost 90% SSD and 72% VE release achieved in wound pH in a sustained manner. Cytotoxicity assessment shows 60% cell viability even at the highest concentration (175 µg/mL), while hemolysis test demonstrates RBC lysis below 5% at a concentration of 250 µg/mL. Vitamin E-SSD-loaded transethosomes (VSTEs) significantly enhance cellular migration and proliferation, achieving 95% closure within 24 h, underscoring their promising efficacy. The synergistic method effectively reduces bacterial burden, evidenced by an 80% reduction in Escherichia coli and Staphylococcus aureus within the wound microenvironment. This approach offers a promising strategy to address complications associated with skin injuries.

The healing effect of a mixture of Arnebia euchroma and animal fat on burn wounds in rats in comparison with sulfadiazine.

OBJECTIVE: Thermal burn is a serious cause of morbidity and mortality that affects millions of people worldwide. The aim of this experimental study was to investigate the efficacy of Arnebia euchroma (AE) to treat burn wounds in a rat model. METHOD: A total of 80 male rats (200-250g) were shaved over the back of the neck (2×3cm2) and a second-degree burn wound was induced at this site under general anaesthesia. The rats were then randomly assigned to one of four groups (each n=20) and the burns were treated daily for 14 days as follows: (1) dressed with animal fat; (2) dressed with sulfadiazine; (3) dressed with a mixture of AE and animal fat; (4) no treatment (control). Five rats from each group were sacrificed on days 3, 5, 9 and 14 post-burn and the wounds were evaluated histologically and immunohistochemically for the expression of interleukin (IL)-1 and IL-6. RESULTS: There was a significant increase at day 3 and decrease on day 5 samples for the expression of IL-1 in the AE plus fat group and IL-6 in the AE plus fat and sulfadiazine groups, compared to the control and fat treatment groups, respectively. Both AE plus fat and sulfadiazine treatments reduced inflammation and granulation tissue formation by day 5 post-burn, while re-epithelialisation commenced by day 9 post-burn. In addition, burns treated with AE plus fat exhibited keratinised epidermis, associated with regular collagen fibres, compared to moderately dense collagen fibres without vascularisation in the sulfadiazine group. CONCLUSION: These findings suggested that AE plus fat was superior to sulfadiazine in enhancing burn wound healing in rats.

Thermosensitive black phosphorus hydrogel loaded with silver sulfadiazine promotes skin wound healing.

Wounds can lead to skin and soft tissue damage and their improper management may lead to the growth of pathogenic bacteria at the site of injury. Identifying better ways to promote wound healing is a major unmet need and biomedical materials with the ability to promote wound healing are urgently needed. Here, we report a thermosensitive black phosphorus hydrogel composed of black phosphorus nano-loaded drug silver sulfadiazine (SSD) and chitosan thermosensitive hydrogel for wound healing. The hydrogel has temperature-sensitive properties and enables the continuous release of SSD under near-infrared irradiation to achieve synergistic photothermal and antibacterial treatment. Additionally, it exerts antibacterial effects on Staphylococcus aureus. In a rat skin injury model, it promotes collagen deposition, boosts neovascularization, and suppresses inflammatory markers. In summary, the excellent thermosensitivity, biocompatibility, and wound-healing-promoting qualities of the reported thermosensitive hydrogel make it suitable as an ideal wound dressing in the clinic.

The Effect of an Autologous Protein-Based Topical Serum on Cutaneous Burns.

BACKGROUND: Burns are skin lesions that can be life-threatening. Platelet-rich plasma (PRP) is growing as an effective alternative for the management of burns. The objective of this study was to assess the use of a storable topical serum based on plasma rich in growth factors (PRGF) in promoting burn wound healing, called Endoret-Serum (ES). MATERIALS AND METHODS: 3D skin models were used to assess thermal burn injury. Extracellular matrix remodeling, tissue damage, and metabolic activity of explants were analyzed, and a histomorphometric examination was carried out. Silver sulfadiazine cream (SC) was used as control ointment for burn management. Three patients suffering from skin burns were also treated with ES and clinically assessed. RESULTS: Endoret-Serum was based on an enriched platelet fraction with neutral pH and containing a high load of growth factors. Both ES and SC reduced tissue damage after burn, with ES being more effective. ES treatment maintained the metabolic activity of explants at a healthy level, and increased collagen and elastin deposition. Both treatments preserved the cutaneous connective tissue and induced newly synthesized matrix, with ES being more effective. Both treatments induced an intense collagenization, but ES showed better results as it restored the basal layer network with reduced signs of fibrosis. ES decreased the apoptotic cell number. Patients suffering from skin burns showed complete healing after ES treatment. CONCLUSION: Endoret-Serum might promote cutaneous healing and may be useful for accelerating the regeneration of skin burns. J Drugs Dermatol. 2022;21(12):1330-1339. doi:10.36849/JDD.6763.

Effects of resveratrol topical ointment on wound healing of full-thickness cutaneous burns in albino rats.

OBJECTIVE: In this study, the effects of resveratrol topical ointment on wound contraction and histopathology of full-thickness cutaneous burn wounds were evaluated. METHOD: Adult albino rats were grouped into four equal-sized groups of 15 rats each, as follows: Group A-no wound, no treatment (control); Group B-1% silver sulphadiazine; Group C-5% resveratrol, and Group D-wound without treatment (control). A burn wound measuring 23.5mm was created on the skin at the dorsum of all rats in groups B-D after shaving. The percentage of wound contraction was measured using a digital Vernier Caliper on days 1, 3, 5, 7, 10, 14, 16, 18 and 21, post-wounding. From each group, five rats were then euthanised and tissue samples of the skin, liver and kidney were collected in 10% buffered formalin for histopathology. RESULTS: The percentage of wound contraction was significant (p<0.05) on 7, 14 and 18 days post treatment. Histopathologically, 5% resveratrol topical ointment application resulted in a thicker epidermis with neovascularisation and an increased collagen distribution. Resveratrol topical ointment ameliorated the extent of hepatocellular and nephrotubular injuries following burn-induced hepatocellular and acute kidney injuries. CONCLUSION: In this study, topical application of 5% resveratrol ointment appeared to enhance burn wound healing by increasing the rate of wound contraction through collagen fibre synthesis, granulation tissue formation and epithelial regeneration.

Wound healing in second-degree burns in rats treated with silver sulfadiazine: a systematic review and meta-analysis.

OBJECTIVE: This study aims to assess the wound healing efficacy in second-degree burns in rats treated with 1% silver sulfadiazine (SSD)-a sulfonamide antibiotic. METHOD: This is a systematic literature review and meta-analysis performed according to the PICO (Population, Intervention, Comparison and Outcomes) strategy. RESULTS: The review found 100 studies in PubMed, Web of Science and other search engines. Of these, 70 studies were pre-selected after removing duplicates. After independent analysis by two reviewers, only seven studies met the inclusion criteria for meta-analysis. All studies except one showed faster wound closure by the application of silver sulfadiazine ointment. Using a random effects model, healing was faster in SSD-treated groups when compared to the control group on day 21, with a statistically significant mean difference of -2.72 days (95% confidence interval: -4.99, -0.45) between treatment and control groups (p<0.01). CONCLUSION: The results of this meta-analysis revealed that SSD aided in faster healing of second-degree burns.

In Vitro Evaluation of Resistance Development to Silver Sulfadiazine and Subsequent Cross-Resistance to Antibiotics.

Treatment of chronic wounds that are at risk of infection, or that are infected, require the use of antimicrobial dressings, most often those that contain silver. Silver exerts its antimicrobial effects by binding to multiple cellular components and, as such, bacterial resistance to it is low; however, molecular silver resistance has been documented and is attributed to the presence of the sil operon or changes in genes encoding porin and efflux pump expression. The aim of this study was to evaluate spontaneous silver resistance development in common opportunistic pathogens, Staphylococcus, Pseudomonas and Enterococcus cloacae, as well as resistance development when exposed to subtherapeutic concentrations over a prolonged period. Furthermore, following silver resistance development, cross-resistance to several classes of antibiotics was evaluated. Following exposure of the strains to silver sulfadiazine (SSD) at two times and four times minimum inhibitory concentration (MIC), the mutation rate was <1010 colony forming unit (CFU)/mL. Serial passage of S. aureus and P. aeruginosa in subinhibitory concentrations of SSD selected for no resistant mutants. The SSD MIC of E. cloacae increased past the solubility limit of SSD at serial passage 17. MIC testing of this isolate showed a >2048-fold increase in MIC to silver in comparison to the parent strain. MIC testing of the serial passage isolates demonstrated no cross-resistance to antibiotics from six different classes. Overall, the results of this study show resistance development to silver is low and, if it does occur, it does not confer resistance to several antibiotic classes. However, as this study was carried out with a small number of strains, a study with a larger panel of strains and sequencing of the strains to determine the exact mechanism of resistance would be needed to investigate the threat of silver resistance further.

A New Insight to Silver Sulfadiazine Antibacterial Dressings: Nanoparticle-Loaded Nanofibers for Controlled Drug Delivery.

The aim of this study was formulating a new-generation antibacterial dressing in a form of polymer-based hybrid nanofiber-nanoparticles, effective on Gram-negative and Gram-positive bacteria using silver sulfadiazine (SSD), an FDA-approved topical antibiotic. In this study, SSD nanoparticles were prepared with chitosan for taking the advantage of antibacterial and wound healing properties. Chitosan nanoparticles of SSD were prepared by using tripolyphosphate (TPP) or sulfobutylether-ß-cyclodextrin (SBE-ß-CD) as crosslinkers via ionic gelation method and then loaded to PVP-K30 and PVP-K90 nanofibers to obtain polymer-based nanofiber-nanoparticles. SSD-loaded chitosan nanoparticles prepared with SBE-ß-CD had lower particle size (359.6 ± 19.9 nm) and polydispersity index (0.364 ± 0.113) as well, indicating a more desired particle size distribution but lower encapsulation efficiency (56.04% ± 4.33). It was found that loading drug in SBE-ß-CD crosslinked nanoparticles and dispersing in nanofiber matrix lowered SSD release compared to  TPP crosslinked nanoparticle-loaded nanofibers. Drug release obtained by both TPP or SBE-ß-CD crosslinked nanoparticle-loaded PVP-K30 nanofibers is significantly higher than nanoparticle-loaded PVP-K90 nanofibers, indicating that SSD release was mainly affected by polymer type. SSD nanoparticle-loaded PVP-K30 nanofibers were found to be effective against Gram-negative (Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii) and Gram-positive bacteria (Staphylococcus aureus and Enterococcus faecalis). SSD release was sustained by PVP-K90, resulting in lower antibacterial efficiency especially against Gram-positive bacteria. PVP-K30-based nanofiber-CS nanoparticle hybrids offer a new platform by combining and improving advantages of nanofibers and nanoparticles for obtaining controlled drug release and antibacterial efficacy.

The Therapeutic Application of Tamarix aphylla Extract Loaded Nanoemulsion Cream for Acid-Burn Wound Healing and Skin Regeneration.

Background and Objectives: Nanomedicine is a constantly growing field for the diagnosis and treatment of various diseases as well as for regenerative therapy. Nanotechnology-based drug-delivery systems improve pharmacological and pharmacokinetic profiles of plants based biologically active molecules. Based on traditional claims, leaves of the Tamarix aphylla (TA) were investigated for their potential healing activity on burn wounds. Materials and Methods: In this study, TA-based nanoemulsion was prepared. The nanoemulsion was characterized for size, zeta potential, pH, viscosity, and stability. The nanoemulsion containing plant extract was converted into cream and evaluated for its efficacy against acid-burn wounds inflicted in the dorsum of rabbits. The animals were classified into four main groups: Group A as a normal control group, Group B as a positive control (treated with cream base + silver sulfadiazine), Group C as a standard drug (silver sulfadiazine), and Group D as a tested (treated with nanoemulsion cream containing TA extract). The prepared system could deliver TA to the target site and was able to produce pharmacological effects. On days 0, 7, 14, 21, 28, and 35, wound contraction rate was used to determine healing efficacy. The wound samples were collected from the skin for histological examination. Results: Based on statistical analysis using wound-healing time, Group D showed a shorter period (21.60 ± 0.5098) (p < 0.01) than the average healing time of Group C (27.40 ± 0.6002) (p < 0.05) and Group B (33.40 ± 0.8126) (p < 0.05). The histopathological assessment showed that burn healing was better in Group D compared with Group C and Group B. The nanoemulsion cream had a non-sticky texture, low viscosity, excellent skin sensations, and a porous structure. By forming a protective layer on the skin and improving moisture, it enhanced the condition of burnt skin. Conclusions: According to the findings of this study, nanoemulsion cream containing TA extract has great potential in healing acid-burn wounds

Contribution of Topical Agents such as Hyaluronic Acid and Silver Sulfadiazine to Wound Healing and Management of Bacterial Biofilm.

Background and Objectives: Wound healing is commonly associated with critical bacterial colonization or bacterial infection, which induces prolonged inflammation, resulting in delayed re-epithelialization. An appropriate wound dressing requires a humid environment, which also functions as a barrier against bacterial contamination and will accelerate a regenerative response of the wound. Silver sulfadiazine (SSD) is used to prevent wound infection. Hyaluronic acid (HA) is an extracellular matrix component involved in tissue regeneration. This retrospective study was conducted to evaluate the effectiveness of cream and gauze pads based on hyaluronic acid at low molecular weight (200 kDa) and silver sulfadiazine 1% in the wound healing process. In addition, we examined SSD action on biofilms in vitro and on animal wounds, obtaining positive outcomes therefrom. Materials and Methods: We selected 80 patients with complicated chronic wounds of different etiologies, including diabetes mellitus (10), post-traumatic ulcers (45), burns (15), and superficial abrasion (10). Results: After 8 weeks, ulcer size was decreased in 95 ± 2% of the treated patients; a significant reduction in the inflammatory process was observed from day 14 onwards (p < 0.01 vs. baseline), considering improvement of the surrounding skin and reduction of the bacterial load. The SSD treatment decreased bacterial colony proliferation, both in planktonic state and in biofilm, in a dose-dependent manner on the wound but inhibited the development of tissue granulation at the highest dose (800 µg/wound). Conclusions: In conclusion, the combined action of SSD and HA is clinically effective in improving wound healing.

Mechanisms of ivermectin-induced wound healing.

BACKGROUND: Wounds cause structural and functional discontinuity of an organ. Wound healing, therefore, seeks to re-establish the normal morphology and functionality through intertwined stages of hemostasis, inflammation, proliferation, and tissue remodelling. Ivermectin, a macrolide, has been used as an endectoparasiticide in human and veterinary medicine practice for decades. Here, we show that ivermectin exhibits wounding healing activity by mechanisms independent of its well-known antiparasitic activity. This study aimed to evaluate the wound healing property of ivermectin cream using histochemistry and enzyme-linked immunosorbent assay techniques. RESULTS: Non-irritant dose of ivermectin cream (0.03-1%) decreased wound macroscopic indices such as exudation, edge edema, hyperemia, and granulation tissue deposition by day 9 compared to day 13 for the vehicle-treated group. This corresponded with a statistically significant wound contraction rate, hydroxyproline deposition, and a decreased time to heal rate. The levels of growth factors TGF-ß1 and VEGF were significantly elevated on day 7 but decreased on day 21. This corresponded with changes in cytokines (IL-1α, IL-4, IL-10, and TNF-α) and eicosanoids (LTB4, PGE2, and PGD2) levels on days 7 and 21.. Interestingly, low doses of ivermectin cream (0.03-0.1%) induced wound healing with minimal scarring compared to higher doses of the cream and the positive control, Silver Sulfadiazine. CONCLUSION: Ivermectin promotes wound healing partly through modulation of the inflammatory process and the levels of Transforming Growth Factor-Beta 1 and Vascular Endothelial Growth Factor. Low doses of ivermectin cream have the potential to be used in treating wounds with minimal scar tissue formation.

Antibiofilm Potential of Silver Sulfadiazine-Loaded Nanoparticle Formulations: A Study on the Effect of DNase-I on Microbial Biofilm and Wound Healing Activity.

Biofilm resistance is one of the severe complications associated with chronic wound infections, which impose extreme microbial tolerance against antibiotic therapy. Interestingly, deoxyribonuclease-I (DNase-I) has been empirically proved to be efficacious in improving the antibiotic susceptibility against biofilm-associated infections. DNase-I hydrolyzes the extracellular DNA, a key component of the biofilm responsible for the cell adhesion and strength. Moreover, silver sulfadiazine, a frontline therapy in burn wound infections, exhibits delayed wound healing due to fibroblast toxicity. In this study, a chitosan gel loaded with solid lipid nanoparticles of silver sulfadiazine (SSD-SLNs) and supplemented with DNase-I has been developed to reduce the fibroblast cytotoxicity and overcome the biofilm-imposed resistance. The extensive optimization using the Box-Behnken design (BBD) resulted in the formation of SSD-SLNs with a smooth surface as confirmed by scanning electron microscopy and controlled release (83%) for up to 24 h. The compatibility between the SSD and other formulation excipients was confirmed by Fourier transform infrared, differential scanning calorimetry, and powder X-ray diffraction studies. Developed SSD-SLNs in combination with DNase-I inhibited around 96.8% of biofilm of Pseudomonas aeruginosa as compared to SSD with DNase-I (82.9%). In line with our hypothesis, SSD-SLNs were found to be less toxic (cell viability 90.3 ± 3.8% at 100 µg/mL) in comparison with SSD (Cell viability 76.9 ± 4.2%) against human dermal fibroblast cell line. Eventually, the results of the in vivo wound healing study showed complete wound healing after 21 days' treatment with SSD-SLNs along with DNase-I, whereas marketed formulations SSD and SSD-LSNs showed incomplete healing after 21 days. Data in hand suggest that the combination of SSD-SLNs with DNase-I is an effective treatment strategy against the biofilm-associated wound infections and accelerates wound healing.

Flaminal® versus Flamazine® in the treatment of partial thickness burns: A randomized controlled trial on clinical effectiveness and scar quality (FLAM study).

Although partial thickness burns are the most frequently reported burn injuries, there is no consensus on the optimal treatment. The objective of this study was to compare the clinical effectiveness and scar quality of Flaminal® Forte to silver sulfadiazine (Flamazine®) in the treatment of partial thickness burns. In this two-arm open label multicenter randomized controlled trial, adult patients with acute partial thickness burns and an affected total body surface area of less than 30% were randomized between Flaminal® Forte and Flamazine® and followed for 12 months. Dressing changes in the Flamazine® group were performed daily, and in the Flaminal® group during the first 3 days post burn and thereafter every other day until complete wound healing or surgery. Forty-one patients were randomly allocated to Flaminal® Forte and 48 patients to Flamazine®. The primary outcome was time to wound healing, which did not differ between the groups: median 18 days with Flaminal® Forte (range 8-49 days) versus 16 days with Flamazine® (range 7-48 days; p = 0.24). Regarding the secondary outcomes during hospital admission, there were no statistically significant differences between the groups concerning need for surgery, pain scores, pruritus, or pain-related and anticipatory anxiety. More patients in the Flaminal® group developed wound colonization (78% versus 32%, p < 0.001), but the treatment groups did not differ regarding the incidence of local infections and use of systemic antibiotics. In terms of scar quality, no statistically significant differences between both treatment groups were found regarding subjective scar assessment (Patient and Observer Scar Assessment Scale (POSAS)), scar melanin and pigmentation (DermaSpectrometer®), and scar elasticity and maximal extension (Cutometer®) during 12 month postburn. In conclusion, time to wound healing did not differ, but the use of Flaminal® Forte seemed favorable because less dressing changes are needed which lowers the burden of wound care.

In vitro activity of antimicrobial-impregnated catheters against biofilms formed by KPC-producing Klebsiella pneumoniae.

AIM: To evaluate the activity and effectiveness of impregnated central venous catheters (CVC) against Klebsiella pneumoniae biofilms. METHODS AND RESULTS: The antimicrobial activity and durability of impregnated-CVCs were evaluated over time and the size of zones of inhibition (ZI) was measured. Biofilm formation was observed by quantitative culture and also by scanning electron microscopy. The catheters impregnated with chlorhexidine/silver sulfadiazine (CHX/SS) reduced bacteria counts by 0·3 log and were most effective (P < 0·01) against Klebsiella pneumoniae biofilms N-acetylcysteine/levofloxacin (NAC/LEV) catheters. It was observed that the catheter impregnated with NAC/LEV had initially the largest average ZI size being statistically significant (P < 0·01). The NAC/LEV combination remained active until day 30, whereas the combination of CHX/SS was completely inactivated from day 15 on. CONCLUSIONS: The NAC/LEV combination showed greater durability on the catheters, but it was the CHX/SS combination that had the greater initial efficacy in bacterial inhibition. It was also observed that NAC/LEV-impregnated catheters do not prevent the emergence of resistant subpopulations inside the inhibition halos during antimicrobial susceptibility tests. SIGNIFICANCE AND IMPACT OF THE STUDY: Our results highlighted that the in vitro efficacy of antimicrobial-impregnated CVCs is limited by time and that their colonization occurred earlier than expected. Our data also demonstrated that NAC/LEV remained active until day 30 of evaluation and CHX/SS combination was completely inactivated from day 15 on. Our findings suggested that implantable devices should be carefully used by medical community.

Determination of minimum inhibitory concentrations for silver sulfadiazine and other topical antimicrobial agents against strains of Pseudomonas aeruginosa isolated from canine otitis externa.

BACKGROUND: Otitis externa is a common presenting complaint in practice. Ear infections by Pseudomonas aeruginosa are particularly problematic due to the organism's high level of resistance and ability to damage the tympanum. Treatment should be based on susceptibility testing although minimum inhibitory concentrations (MICs) are not available for all treatment options. Silver sulfadiazine has been used in cases of recurrent P. aeruginosa otitis, although a MIC for silver sulfadiazine as a single agent has not been established. OBJECTIVES: To describe susceptibility patterns of P. aeruginosa isolated from canine otitis externa and determine the MIC for silver sulfadiazine and other topical antimicrobials. ANIMALS: Thirty-six P. aeruginosa isolates were collected from client-owned dogs, suffering from otitis externa. METHODS AND MATERIALS: Susceptibility patterns were established using disc diffusion susceptibility testing against 17 antimicrobial agents. For determination of the MIC, selected strains were tested against increasing concentrations of marbofloxacin, enrofloxacin, gentamicin, polymyxin B and silver sulfadiazine using broth microdilution. RESULTS: For nine of 17 antimicrobial agents, complete resistance was seen in all isolates tested via disk diffusion susceptibility testing. Approximately 94% and 96% of isolates were susceptible to gentamicin and imipenem, respectively. These findings were consistent with broth dilution, where all strains were susceptible to gentamicin. Resistance was higher against polymyxin B and the fluoroquinolones. Silver sulfadiazine was effective in vitro with a MIC ranging from 1 to 64 µg/mL. CONCLUSIONS AND CLINICAL SIGNIFICANCE: As the MIC of silver sulfadiazine was lower than the concentration in a 1% preparation, such a product potentially represents a treatment option for dogs with P. aeruginosa otitis.

Sauromatum guttatum extract promotes wound healing and tissue regeneration in a burn mouse model via up-regulation of growth factors.

Contexts: Sauromatum guttatum (Wall.) Schott (Araceae) has been traditionally used for the treatment of wounds. Objectives: This study evaluates the healing and tissue regeneration potential of S. guttatum extract in burn wounds. Materials and methods: S. guttatum extract was analysed using various chemical tests, thin layer chromatography (TLC) and high-performance liquid chromatography (HPLC). Moreover, the extract was tested against burn associated bacteria and minimum inhibitory concentration (MIC) was also calculated. Wound healing and tissue regeneration potential was assessed using a thermally induced burn BALBc mouse model. S. guttatum extract (2% w/w) prepared in petroleum jelly, vehicle and positive control [silver sulfadiazine (SD)] groups was applied three times a day. The treatment was continued for 15 d and wound closure was measured and photographed on day 5, 10 and 15. The burnt tissues excised from wounds were subjected to histological and comparative gene expression analysis. Results: The results of the chemical tests indicated the presence of alkaloids, saponins, phenols, phytosterols, tannins, and flavonoids, while TLC and HPLC analysis indicated the presence of various compounds. The extract showed excellent activity against the tested pathogens. The lowest MIC (125 µg/mL) was observed against Staphylococcus aureus. A considerable decrease in wound area (72%) was observed in extract-treated group. Histological examination of extract-treated group showed good signs of wound healing with complete re-epithelialization and better tissue regeneration. Comparative gene expression analysis revealed the up-regulation of wound healing related PDGF, EGF and FGF genes. Conclusions: S. guttatum extract may be used to isolate bioactive constituents for the treatment of burn wounds.

Silver delivery approaches in the management of partial thickness burns: A systematic review and indirect treatment comparison.

Silver-containing products play an important role in the management of burn wound infections. We sought to compare the efficacy of commonly used silver delivery approaches including nanocrystalline silver, silver-impregnated hydrofiber dressing, and silver-impregnated foam dressing as the main products in the management of partial thickness burns. A systematic review was performed by searching PubMed, EMBASE, Cochrane, and other databases to identify relevant randomized controlled trials and observational studies. Due to the paucity of direct head-to-head trials, an indirect treatment comparison was performed. The use of nanocrystalline silver was associated with a statistically significant reduction in length of stay when compared to silver-impregnated hydrofiber dressing (p = 0.027) and a shorter time to healing when compared to silver-impregnated foam dressing (p = 0.0328). There were no statistically significant differences in infection rates and surgical procedures between nanocrystalline silver, silver-impregnated hydrofiber dressing, and silver-impregnated foam dressing; however, nanocrystalline silver was found to be the most beneficial for all the outcomes, including infection rates and surgical procedures, according to the Monte Carlo simulation method. In conclusion, current evidence from the published literature suggests that where the clinical and microbiological priority is to get in control of infection quickly it would seem prudent to use the most potent silver delivery system, which is nanocrystalline silver. Nanocrystalline silver may offer both clinical and economic benefits compared to alternative treatments in the management of patients with mixed burns that are at high risk of infection.

Medical Adhesive-Related Skin Injury Following Emergent Appendectomy: A Case Study of MARSI and Missed Opportunities in Nursing Care.

BACKGROUND: The potential for skin damage from adhesive products is documented in the literature. Nevertheless, health care providers continue to lack understanding of the impact and seriousness of skin injury associated with use of tapes or other adhesive devices when applied to a patient with a history or hypersensitivity or allergy to adhesives. CASE: A 67-year-old woman with a history of tape allergy underwent emergency appendectomy. Initial removal of an adhesive bandage placed over the surgical incision revealed medical adhesive-related skin injury (MARSI). The largest of the 3 wounds was a Class III skin tear based on the Payne-Martin Classification System. It measured (L) 4.4 cm × (W) 1.8 cm × (D) 0.3 cm and required 3 months to heal. CONCLUSIONS: Experiences with this case revealed the need for evidence-based practice innovations to prevent physical, emotional, and economic cost resulting from MARSI. We recommend early identification and careful documentation of susceptibility to MARSI prior to surgery and implementation of consensus-based recommendations for prevention of MARSI as advocated by the MARSI consensus group when preparing patients for surgery and treating wounds.

Nondermal irritating hyperosmotic nanoemulsions reduce treatment times in a contamination model of wound healing.

Increased microbial burden within the wound often complicates wound healing and may lead to subsequent infection or delayed healing. Here, we investigate a novel topical for addressing wound contamination that utilizes hyperosmotic saccharides with a cell membrane disrupting emulsion. These hyperosmotic nanoemulsions (HNE) were administered topically in a full-thickness biopsy model of wound healing. Results show that HNE were well tolerated in noninfected animals with no indications of dermal irritation or acute toxicity. Additionally, HNE was able to reduce bacterial bioburden (Escherichia coli and Enterococcus faecalis) levels by 3 logs within 24 h when wounds were inoculated with 5 × 10(6) total CFU. These bactericidal values were similar to wounds treated with silver sulfadiazine. Wound closure showed HNE wounds closed in 7.6 ± 0.2 days while SSD and control required 10.2 ± 0.4 and 10.4 ± 0.3 days, respectively. HNE maintained a moist wound environment, were well debrided, and exhibited improved hemostatic response. Further histological examination revealed enhanced granulation tissue as compared to silver sulfadiazine and control cohorts. These results were corroborated with 3D topographical imprints of the wounds at day 14 which qualitatively showed a smoother surface. In contrast, silver sulfadiazine appeared to delay wound closure. Finally, dermal sensitization and irritation studies conducted in guinea pig and rabbits did not reveal any acute dermal side effects from HNE exposure. The cumulative data indicates nonantibiotic-based HNEs may be a promising topical treatment for the management of contaminated wounds.

Antimicrobial Wound Dressing Containing Silver Sulfadiazine With High Biocompatibility: In Vitro Study.

Many patients all over the world suffer from acute wounds caused by traumas or burns. In most crucial cases, skin regeneration cannot be promoted spontaneously, and skin grafts are applied as the main treatment. However, this therapy has some drawbacks which motivate researchers to develop wound dressings. In this study, electrospun mats consisting of polycaprolactone (PCL) and polyvinyl alcohol (PVA) incorporated with silver sulfadiazine (SSD) are proposed to be used as antimicrobial wound dressings with the capability of cell seeding. Various amounts of SSD were loaded into PVA nanofibers, and the effects of SSD particles on the morphological characteristics of nanofibers, mechanical behaviors, and physical properties of the mats were studied for the first time. The cellular viability, antimicrobial properties of the scaffolds, and release behavior of silver were also examined. Finally, the best concentration of SSD was determined based on the quality of nanofibers, antibacterial features, and the ability of cellular attachment and proliferation. Fibronectin was also coated to enhance the biocompatibility of the selective scaffold. It was shown that the mats have appropriate mechanical properties with good handling ability in wet environment and also have a hydrophilic surface to adhere to the wound bed. Results indicate that SSD particles increase the fiber diameter and hydrophilic properties, while they weaken the mechanical characteristics of the mats. Furthermore, 5 wt% SSD/PVA was determined as the best concentration of SSD as it results in a desirable fiber quality for the mats with enough antimicrobial properties and acceptable cell proliferation on the surface. Coating fibronectin was also introduced as an effective method to increase the biocompatibility of the scaffolds incorporated with SSD particles.