Advances of antimicrobial dressings loaded with antimicrobial agents in infected wounds.

Wound healing is a complex process that is critical for maintaining the barrier function of the skin. However, when a large quantity of microorganisms invade damaged skin for an extended period, they can cause local and systemic inflammatory responses. If left untreated, this condition may lead to chronic infected wounds. Infected wounds significantly escalate wound management costs worldwide and impose a substantial burden on patients and healthcare systems. Recent clinical trial results suggest that the utilization of effective antimicrobial wound dressing could represent the simplest and most cost-effective strategy for treating infected wounds, but there has hitherto been no comprehensive evaluation reported on the efficacy of antimicrobial wound dressings in promoting wound healing. Therefore, this review aims to systematically summarize the various types of antimicrobial wound dressings and the current research on antimicrobial agents, thereby providing new insights for the innovative treatment of infected wounds.

The effectiveness of punch grafts in promoting the healing of surgical injuries and hard-to-heal wounds.

Punch grafting is a technique that can improve and accelerate the healing of hard-to-heal wounds and reduce the associated pain. It is a simple and inexpensive procedure that can be performed in the examination room. It is a technique that uses small split-thickness skin grafts (STSG) to promote the growth of epithelial tissue. It has been described as being used mainly to treat ulcers of venous, arterial, hypertensive and diabetic aetiology. Punch grafting has also been used successfully in postoperative dermatological surgical wounds. This article describes and details the performance of the punch-graft technique, with special emphasis on aftercare and the role of nurses in the procedure. A clinical case is presented of a patient who underwent surgery for cutaneous squamous cell carcinoma and whose primary closure was rejected. It was decided to place the STSGs obtained from the anterior aspect of the patient's thigh after preparation of the recipient area to ensure an optimal wound bed. The patient's pain subsided within a few days, and the wound healed within weeks with weekly dressing changes.

Clinical Study on the treatment of chronic infectious ulcers using Platelet-Rich technology combined with moist dressings.

Objective: To explore the clinical efficacy of platelet-rich technology combined with moist dressings in the treatment of chronic infectious ulcers. Methods: This was a retrospective study. The subjects of the study were 48 patients with chronic infectious ulcers in Sichuan Provincial Orthopedics Hospital from January 2019 to June 2022. Enrolled patients were randomly divided into four groups(n=12), and received different treatment methods respectively. Further analysis and comparison were performed on the changes in wound volume, wound healing status, wound bacterial culture results, and the incidence of adverse reactions among the four groups. Results: Three months after debridement, the wound volume of all four groups of patients was significantly reduced compared with that before debridement, with a statistically significant difference in intra-Group-Comparison(P<0.05). The inter-Group-Comparison revealed a statistically significant difference in wound volume in Group-A, Group-B, and Group-C than that in Group-D(P<0.05). After treatment, the wound healing status of patients in groups A, B, and C was significantly better than that of patients in Group-D, with a statistically significant difference(P<0.05). During treatment, patients in all four groups had decreased count of would bacteria, and showed negative results of wound bacterial culture by the three-month follow-up. No serious adverse reactions were observed in the four groups during treatment, and all improved after management, with no statistically significant difference in the incidence of adverse reactions(P>0.05). Conclusion: Platelet-rich technology combined with moist dressings may effectively promote the repair of chronic infectious ulcer wounds, with good clinical safety.

Barrier films or dressings for the prevention of acute radiation dermatitis in breast cancer: a systematic review and network meta-analysis.

BACKGROUND: Barrier films or dressings were reported to be effective in preventing radiation dermatitis (RD) in breast cancer patients, but their comparative efficacy is unknown. METHODS: A systematic literature search was performed on Embase, MEDLINE and Cochrane CENTRAL Registry of Clinical Trials from inception to October 20, 2023. Randomised controlled trials (RCTs) comparing barrier films or dressings to the standard of care (SOC) or other interventions were included. We estimated summary odds ratios and mean differences using network meta-analysis with random effects. This study was registered with PROSPERO (ID: CRD42023475021). RESULTS: Fourteen RCTs met inclusion criteria. Six interventions were analysed: 3M™ Moisturizing Double Barrier Cream (MDBC), 3M™ No Sting Barrier Film (BF), Hydrofilm® (HF), Mepitel® Film (MF), Silver Leaf Nylon Dressing and StrataXRT®. HF, MF and StrataXRT® reduced the incidence of moist desquamation compared to SOC (HF: OR = 0.08; p = 0.02; MF: OR = 0.31 p < 0.01; StrataXRT®: OR = 0.22, p = 0.04). The ranking of agents from most to least effective in preventing moist desquamation according to P-scores was HF (92.5%), MF (78.5%), StrataXRT® (70.1%), BF (46.4%), Silver Leaf Nylon Dressing (24.9%), MDBC (22.9%) and SOC (14.7%). Only four RCTs on HF and MF included patient-reported outcome (PRO) assessments that allowed pooling for analysis. HF and MF were more effective in reducing pain, itchiness and burning sensation compared to SOC (p < 0.01 for all symptoms). CONCLUSION: HF and MF were effective in preventing RD in breast cancer. Future RCTs should compare these interventions to effective cream preparations, such as topical corticosteroids.

Rhamnus prinoides leaf extract loaded polycaprolactone-cellulose acetate nanofibrous scaffold as potential wound dressing: An in vitro study.

Rhamnus prinoides leaf contains carbohydrates, saccharides, phenolic acids, and diterpenes with antibacterial, wound-healing, and anti-inflammatory properties. In this study, Rhamnus prinoides leaf extract was successfully incorporated into polycaprolactone-cellulose acetate (PCL-CA) nanofibers through electrospinning technique for the first time. The mats' morphology, diameter, chemical, and crystalline structure were characterized. The study investigated the mats' antibacterial activity, wound healing, cytotoxicity, drug release behaviour, hydrophilicity, and water absorbency properties. The results revealed that the mats exhibited continuous, smooth, without-beads, and interconnected structures, with average fiber diameters ranging from 385 ±â€¯21 nm to 332 ±â€¯74 nm. The antibacterial effeciency was remarkable against S. aureus and E. coli, achieving bacterial reduction percentages exceeding 99 % at concentrations of 3 % and above against S. aureus and 5 % and above against E. coli. Cytotoxic tests showed low-cytotoxicity up to an extract concentration of 7 %. The extract release increases with an increase in concentration. In vitro wound healing assay, the mats enhanced cell migration to the wound area. Additionally, the incorporation of Rhamnus prinoides significantly improved the hydrophilicity and water absorbency of the nanofibers. Overall, the study highlights the mats' broad antimicrobial and wound healing properties with less cytotoxicity, hydrophilicity, and water absorbency, making them promising for use as wound dressings.

Bacteria-Derived Cellulose Membranes Modified with Graphene Oxide-Silver Nanoparticles for Accelerating Wound Healing.

This study reports on the modification of bacterial cellulose (BC) membranes produced by static fermentation of Komagataeibacter xylinus bacterial strains with graphene oxide-silver nanoparticles (GO-Ag) to yield skin wound dressings with improved antibacterial properties. The GO-Ag sheets were synthesized through chemical reduction with sodium citrate and were utilized to functionalize the BC membranes (BC/GO-Ag). The BC/GO-Ag composites were characterized to determine their surface charge, morphology, exudate absorption, antimicrobial activity, and cytotoxicity by using fibroblast cells. The antimicrobial activity of the wound dressings was assessed against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. The results indicate that the BC/GO-Ag dressings can inhibit ∼70% of E. coli cells. Our findings also revealed that the porous BC/GO-Ag antimicrobial dressings can efficiently retain 94% of exudate absorption after exposure to simulated body fluid (SBF) for 24 h. These results suggest that the dressings could absorb excess exudate from the wound during clinical application, maintaining adequate moisture, and promoting the proliferation of epithelial cells. The BC/GO-Ag hybrid materials exhibited excellent mechanical flexibility and low cytotoxicity to fibroblast cells, making excellent wound dressings able to control bacterial infectious processes and promote the fast healing of dermal lesions.

Undertaking a structured assessment of a hard-to-heal wound.

A thorough, holistic wound assessment is essential to identify the aetiology of a hard-to-heal wound and formulate a diagnosis, which will underpin the treatment plan. This article describes the fundamental elements of assessing a patient with a hard-to-heal wound holistically, including taking a patient history, performing a clinical examination and investigations, and considering the patient's physical, psychological, spiritual and social needs. The author also outlines the aspects of the TIMERS (tissue, infection/inflammation, moisture, edge, regeneration and social factors) wound assessment tool in detail, and explains some of the challenges associated with accurately assessing a wound.

Development of pectin/chitosan-based electrospun biomimetic nanofiber membranes loaded with dihydromyricetin inclusion complexes for wound healing application.

Accidents and surgical procedures inevitably lead to wounds, presenting clinical challenges such as inflammation and microbial infections that impede the wound-healing process. This study aimed to address these challenges by developing a series of novel wound dressings known as electrospun biomimetic nanofiber membranes. These membranes were prepared using electrostatic spinning technique, incorporating hydroxypropyl-ß-cyclodextrin/dihydromyricetin inclusion complexes. The prepared electrospun biomimetic nanofiber membranes exhibited randomly arranged fiber morphology with average fiber diameters ranging from 200 to 400 nm, resembling the collagen fibers in the native skin. These membranes demonstrated excellent biocompatibility, hemocompatibility, surface hydrophilicity, and wettability, while also releasing dihydromyricetin in a sustained manner. In vitro testing revealed that these membranes, loaded with hydroxypropyl-ß-cyclodextrin/dihydromyricetin inclusion complexes, displayed higher antioxidant potential and inhibitory effects against Staphylococcus aureus and Escherichia coli. Furthermore, these membranes significantly reduced the M1 phenotypic transition in RAW264.7 cells, even when stimulated by lipopolysaccharides, effectively restoring M2 polarization, thereby shortening the inflammatory period. Additionally, the in vivo wound healing effects of these membranes were validated. In conclusion, this study introduces a promising nanofiber membrane with diverse biological properties that holds promise for addressing various crucial aspects of the wound-healing process.

Analysis of therapeutic effect of silver-based dressings on chronic wound healing.

Chronic wounds are susceptible to bacterial infections and at high risk of developing antibiotic-resistant bacterial infections. Silver is an antimicrobial by targeting almost all types of bacteria in chronic wounds to reduce the bacterial load in the infected area and further facilitate the healing process. This study focused on exploring whether silver-based dressings were superior to non-silver dressings in the treatment of chronic wounds. PubMed, Web of Science and Embase were comprehensively searched from inception to March 2024 for randomized clinical trials and observational studies. The endpoints in terms of wound healing rate, complete healing time, reduction on wound surface area and wound infection rate were analysed using Review Manager 5.4 software. A total of 15 studies involving 5046 patients were eventually included. The results showed that compared with patients provided with non-silver dressings, patients provided with silver-based dressings had higher wound healing rate (OR: 1.43, 95% CI: 1.10-1.85, p = 0.008), shorter complete healing time (MD: -0.96, 95% CI: -1.08 ~ -0.85, p < 0.00001) and lower wound infection rate (OR: 0.56, 95% CI: 0.40-0.79, p = 0.001); no significant difference in the reduction on wound surface area (MD: 12.41, 95% CI: -19.59-44.40, p = 0.45) was found. These findings suggested that the silver-based dressings were able to enhance chronic wound healing rate, shorten the complete healing time and reduce wound infection rate, but had no significant improvement in the reduction on wound surface area. Large-scale and rigorous studies are required to confirm the beneficial effects of silver-based dressings on chronic wound healing.

Incorporation of natural and synthetic polymers into honey hydrogel for wound healing: A review.

Background and Aims: The difficulty in treating chronic wounds due to the prolonged inflammation stage has affected a staggering 6.5 million people, accompanied by 25 billion USD annually in the United States alone. A 1.9% rise in chronic wound prevalence among Medicare beneficiaries was reported from 2014 to 2019. Besides, the global wound care market values were anticipated to increase from USD 20.18 billion in 2022 to USD 30.52 billion in 2030, suggesting an expected rise in chronic wounds financial burdens. The lack of feasibility in using traditional dry wound dressings sparks hydrogel development as an alternative approach to tackling chronic wounds. Since ancient times, honey has been used to treat wounds, including burns, and ongoing studies have also demonstrated its wound-healing capabilities on cellular and animal models. However, the fluidity and low mechanical strength in honey hydrogel necessitate the incorporation of other polymers. Therefore, this review aims to unravel the characteristics and feasibility of natural (chitosan and gelatin) and synthetic (polyvinyl alcohol and polyethylene glycol) polymers to be incorporated in the honey hydrogel. Methods: Relevant articles were identified from databases (PubMed, Google Scholar, and Science Direct) using keywords related to honey, hydrogel, and polymers. Relevant data from selected studies were synthesized narratively and reported following a structured narrative format. Results: The importance of honey's roles and mechanisms of action in wound dressings were discussed. Notable studies concerning honey hydrogels with diverse polymers were also included in this article to provide a better perspective on fabricating customized hydrogel wound dressings for various types of wounds in the future. Conclusion: Honey's incapability to stand alone in hydrogel requires the incorporation of natural and synthetic polymers into the hydrogel. With this review, it is hoped that the fabrication and commercialization of the desired honey composite hydrogel for wound treatment could be brought forth.

Comparing Outcomes Between Standard Mepilex and Mepilex Silver for Tracheotomy Dressings.

OBJECTIVE: The purpose of the study is to compare the incidence of early postoperative tracheotomy stoma wound complications in pediatric patients using a silver-impregnated barrier dressing (Mepilex Ag) versus a standard absorbent foam dressing (standard Mepilex). METHODS: This is a prospective, non-blinded, randomized trial of pediatric patients undergoing tracheotomy at a tertiary care children's hospital. Patients were randomized to receive Mepilex Ag versus standard Mepilex tracheostoma dressings following tracheotomy. All patients received standard postoperative wound care and daily stomal examination. Wound related complications, breakdown, granulation, and infection were recorded for the first 7 days after surgery. A non-inferiority study design was used to test the hypothesis that the Mepilex group had a non-inferior wound complication rate (within 10% margin) compared to the Mepilex Ag group. RESULTS: Eighty-two patients were enrolled; 52 received Mepilex Ag, and 30 received standard Mepilex. There was no difference between the groups with respect to age, sex, race, surgical indication, or postoperative length of stay. Non-inferiority testing demonstrated that the Mepilex standard cohort had no more than 10% greater stomal wound complication rate than that of Mepilex Ag dressing group (p = 0.0108). CONCLUSION: Standard Mepilex was found to be non-inferior to Mepilex Ag in the prevention of tracheotomy stomal wound complications. Standard Mepilex may be used effectively in the postoperative period, potentially reducing costs to caregivers and the institution. Further work is needed to analyze additional factors that could contribute to poor postoperative stoma healing such as bacterial colonization. LEVEL OF EVIDENCE: Randomized Controlled Trial, Level 2 Laryngoscope, 2024.

Current progress of protein-based dressing for wound healing applications - A review.

Protein-based wound dressings have garnered increasing interest in recent years owing to their distinct physical, chemical, and biological characteristics. The intricate molecular composition of proteins gives rise to unique characteristics, such as exceptional biocompatibility, biodegradability, and responsiveness, which contribute to the promotion of wound healing. Wound healing is an intricate and ongoing process influenced by multiple causes, and it consists of four distinct phases. Various treatments have been developed to repair different types of skin wounds, thanks to advancements in medical technology and the recognition of the diverse nature of wounds. This review has literature reviewed within the last 3-5 years-the recent progress and development of protein in wound dressings and the fundamental properties of an ideal wound dressing. Herein, the recent strides in protein-based state-of-the-art wound dressing emphasize the significant challenges and summarize future perspectives for wound healing applications.

Developmental prospects of carrageenan-based wound dressing films: Unveiling techno-functional properties and freeze-drying technology for the development of absorbent films - A review.

This review explores the intricate wound healing process, emphasizing the critical role of dressing material selection, particularly for chronic wounds with high exudate levels. The aim is to tailor biodegradable dressings for comprehensive healing, focusing on maximizing moisture retention, a vital element for adequate recovery. Researchers are designing advanced wound dressings that enhance techno-functional and bioactive properties, minimizing healing time and ensuring cost-effective care. The study delves into wound dressing materials, highlighting carrageenan biocomposites superior attributes and potential in advancing wound care. Carrageenan's versatility in various biomedical applications demonstrates its potential for tissue repair, bone regeneration, and drug delivery. Ongoing research explores synergistic effects by combining carrageenan with other novel materials, aiming for complete biocompatibility. As innovative solutions emerge, carrageenan-based wound-healing medical devices are poised for global accessibility, addressing challenges associated with the complex wound-healing process. The exceptional physico-mechanical properties of carrageenan make it well-suited for highly exudating wounds, offering a promising avenue to revolutionize wound care through freeze-drying techniques. This thorough approach to evaluating the wound healing effectiveness of carrageenan-based films, particularly emphasizing the development potential of lyophilized films, has the potential to significantly improve the quality of life for patients receiving wound healing treatments.

Spray-assisted layer-by-layer deposition of quaternized chitosan/tannic acid for the construction of multifunctional bio-based nonwoven dressings.

Gauze wound dressings have received considerable attention due to their cost-effectiveness, excellent mechanical properties, and widespread applications. However, their inability to actively combat microorganisms and effectively scavenge free radicals results in suboptimal wound management. In this study, a novel nonwoven-based gauze dressing coated with quaternized chitosan/tannic acid (QCS/TA), based on electrostatic interaction and hydrogen bonding, was successfully prepared using a spray-assisted layer-by-layer assembly method. The bio-based nonwoven dressing, assembled with multiple interlacing bilayers, demonstrated outstanding antimicrobial properties, eliminating 99.99 % of Staphylococcus aureus (S. aureus) and 85 % of Escherichia coli (E. coli). Compared to the pristine nonwoven dressing, the QCS/TA-coated nonwoven dressing scavenged >85 % of the surrounding radicals within 2 h. Additionally, the nonwoven dressing exhibits excellent coagulation properties. Notably, the facile spraying procedure preserved most of the softness and breathability of the nonwoven substrate. After the deposition of seven bilayers, the bending stiffness and drape coefficient increased by only 37.63 % and 3.85 %, respectively, while the air permeability and moisture permeability reached 1712 mm/s and 3683.58 g/m2/d, respectively. This bio-based nonwoven dressing, derived from safe and non-toxic ingredients, holds promise as the next generation of multifunctional gauze dressings.

Review on application of herbal extracts in biomacromolecules-based nanofibers as wound dressings and skin tissue engineering.

The skin, which covers an area of 2 square meters of an adult human, accounts for about 15 % of the total body weight and is the body's largest organ. It protects internal organs from external physical, chemical, and biological attacks, prevents excess water loss from the body, and plays a role in thermoregulation. The skin is constantly exposed to various damages so that wounds can be acute or chronic. Although wound healing includes hemostasis, inflammatory, proliferation, and remodeling, chronic wounds face different treatment problems due to the prolonged inflammatory phase. Herbal extracts such as Nigella Sativa, curcumin, chamomile, neem, nettle, etc., with varying properties, including antibacterial, antioxidant, anti-inflammatory, antifungal, and anticancer, are used for wound healing. Due to their instability, herbal extracts are loaded in wound dressings to facilitate skin wounds. To promote skin wounds, skin tissue engineering was developed using polymers, bioactive molecules, and biomaterials in wound dressing. Conventional wound dressings, such as bandages, gauzes, and films, can't efficiently respond to wound healing. Adhesion to the wounds can worsen the wound conditions, increase inflammation, and cause pain while removing the scars. Ideal wound dressings have good biocompatibility, moisture retention, appropriate mechanical properties, and non-adherent and proper exudate management. Therefore, by electrospinning for wound healing applications, natural and synthesis polymers are utilized to fabricate nanofibers with high porosity, high surface area, and suitable mechanical and physical properties. This review explains the application of different herbal extracts with different chemical structures in nanofibrous webs used for wound care.

Evaluating the Efficacy of Topical Phenytoin in the Healing of Neuropathic Diabetic Foot Ulcers: A Comparative Study.

OBJECTIVE: This study aims to observe the outcomes of topical phenytoin treatment in healing neuropathic diabetic foot ulcers with mild infection and compare these outcomes with those obtained from conventional dressing methods. METHODS: A retrospective observational study was conducted by reviewing the medical records of patients with neuropathic diabetic foot ulcers treated at a tertiary care center from 2015 to 2020. Two groups were identified: (1) patients treated with topical phenytoin (for ulcers measuring less than 5 cm, a dosage of 100 mg was used; for ulcers measuring between 5 cm and 9 cm, a dosage of 150 mg was used; for ulcers measuring between 10 cm and 15 cm, a dosage of 200 mg was used; and for ulcers measuring greater than 15 cm, a dosage of 300 mg was used. The tablets were crushed and dispersed before administration) and (2) those were treated with conventional dressings (the conventional method includes wound wash with 0.9 normal saline and betadine solution with application of sterile gauze dressing). Data on wound healing rate, time to achieve complete healing, and recurrence rates were collected. RESULTS: The study included 120 patients, with 60 receiving topical phenytoin and 60 receiving conventional dressings. Preliminary findings indicated that the topical phenytoin group experienced a 27 (45%) reduction in ulcer size by week four, compared to a 15 (25%) reduction in the conventional group. The median time to complete healing was significantly shorter in the phenytoin group (eight weeks) compared to the conventional dressing group (12 weeks; p < 0.05). Additionally, granulation tissue appeared earlier in the phenytoin group, with an average onset of 10 days, compared to 18 days in the conventional group (p < 0.01). The incidence of ulcer recurrence was lower in the phenytoin group (6, 10%) compared to the conventional group (18, 30%; p < 0.05). CONCLUSIONS: Topical phenytoin demonstrated a promising enhancement in the healing of mildly infected neuropathic diabetic foot ulcers compared to conventional dressings. Further studies are recommended to substantiate these findings and explore the mechanisms underlying the observed benefits.

Construction and Performance Study of a Dual-Network Hydrogel Dressing Mimicking Skin Pore Drainage for Photothermal Exudate Removal and On-Demand Dissolution.

In recent years, negative pressure wound dressings have garnered widespread attentions. However, it is challenging to drain the accumulated fluid under negative pressures for hydrogel dressings. To address this issue, this study prepared a chemical/physical duel-network PEG-CMCS/AG/MXene hydrogel composed by chemical disulfide crosslinked network of four-arm polyethylene glycol/carboxymethyl chitosan (4-Arm-PEG-SH/CMCS), and the physical network of hydrogen bond of agar (AG). Under near-infrared light (NIR) irradiation, the PEG-CMCS/AG/MXene hydrogel undergoes photothermal heating due to integrate of MXene, which destructs the hydrogen bond network and allows the removal of exudate through a mechanism mimicking the sweat gland-like effect of skin pores. The photothermal heating effect also enables the antimicrobial activity to prevent wound infections. The excellent electrical conductivity of PEG-CMCS/AG/MXene can promote cell proliferation under the external electrical stimulation (ES) in vitro. The animal experiments of full-thickness skin defect model further demonstrate its ability to accelerate wound healing. The conversion between thioester and thiol achieved with L-cysteine methyl ester hydrochloride (L-CME) can provides the on-demand dissolution of the dressing in situ. This study holds promises to provide a novel solution to the issue of fluid accumulations under hydrogel dressings and offers new approaches to alleviating or avoiding the significant secondary injuries caused by frequent dressing changes.

Recent Advances in Poly(vinyl alcohol)-Based Hydrogels.

Poly(vinyl alcohol) (PVA) is a versatile synthetic polymer, used for the design of hydrogels, porous membranes and films. Its solubility in water, film- and hydrogel-forming capabilities, non-toxicity, crystallinity and excellent mechanical properties, chemical inertness and stability towards biological fluids, superior oxygen and gas barrier properties, good printability and availability (relatively low production cost) are the main aspects that make PVA suitable for a variety of applications, from biomedical and pharmaceutical uses to sensing devices, packaging materials or wastewater treatment. However, pure PVA materials present low stability in water, limited flexibility and poor biocompatibility and biodegradability, which restrict its use alone in various applications. PVA mixed with other synthetic polymers or biomolecules (polysaccharides, proteins, peptides, amino acids etc.), as well as with inorganic/organic compounds, generates a wide variety of materials in which PVA's shortcomings are considerably improved, and new functionalities are obtained. Also, PVA's chemical transformation brings new features and opens the door for new and unexpected uses. The present review is focused on recent advances in PVA-based hydrogels.

Smart Dressings and Their Applications in Chronic Wound Management.

During chronic wound healing, the inflammatory phase can endure for extended periods, heavily impeding or halting the process. Regular inspections and dressing changes are crucial. Modern dressings like hydrogels, hydrocolloids, and foam provide protection and an optimal healing environment. However, they have limitations in offering real-time wound bed status and healing rate. Evaluation relies heavily on direct observation, and passive dressings fail to identify subtle healing differences, preventing adaptive adjustments in biological factors and drug concentrations. In recent years, the clinical field recognizes the value of integrating intelligent diagnostic tools into wound dressings. By monitoring biomarkers linked to chronic wounds' inflammatory state, real-time data can be captured, reducing medical interventions and enabling more effective treatment plans. This fosters innovation in chronic wound care. Researchers have developed smart dressings with sensing, active drug delivery, and self-adjustment capabilities. These dressings detect inflammatory markers like temperature, pH, and oxygen content, enhancing drug bioavailability on the wound surface. As wound healing technology evolves, these smart dressings hold immense potential in chronic wound care and treatment. This comprehensive review updates our understanding on the role and mechanism of action of the smart dressings in chronic refractory wounds by summarizing and discussing the latest research progresses, including the intelligent monitoring of wound oxygen content, temperature, humidity, pH, infection, and enzyme kinetics; intelligent drug delivery triggered by temperature, pH, near-infrared, and electricity; as well as the intelligent self-adjustment of pressure and shape. The review also delves into the constraints and future perspectives of smart dressings in clinical settings, thereby advancing the development of smart wound dressings for chronic wound healing and their practical application in clinical practice.

Hyaluron-Based Bionanocomposites of Silver Nanoparticles with Graphene Oxide as Effective Growth Inhibitors of Wound-Derived Bacteria.

Keeping wounds clean in small animals is a big challenge, which is why they often become infected, creating a risk of transmission to animal owners. Therefore, it is crucial to search for new biocompatible materials that have the potential to be used in smart wound dressings with both wound healing and bacteriostatic properties to prevent infection. In our previous work, we obtained innovative hyaluronate matrix-based bionanocomposites containing nanosilver and nanosilver/graphene oxide (Hyal/Ag and Hyal/Ag/GO). This study aimed to thoroughly examine the bacteriostatic properties of foils containing the previously developed bionanocomposites. The bacteriostatic activity was assessed in vitro on 88 Gram-positive (n = 51) and Gram-negative (n = 37) bacteria isolated from wounds of small animals and whose antimicrobial resistance patterns and resistance mechanisms were examined in an earlier study. Here, 69.32% of bacterial growth was inhibited by Hyal/Ag and 81.82% by Hyal/Ag/GO. The bionanocomposites appeared more effective against Gram-negative bacteria (growth inhibition of 75.68% and 89.19% by Hyal/Ag and Hyal/Ag/Go, respectively). The effectiveness of Hyal/Ag/GO against Gram-positive bacteria was also high (inhibition of 80.39% of strains), while Hyal/Ag inhibited the growth of 64.71% of Gram-positive bacteria. The effectiveness of Hyal/Ag and Hyal/Ag/Go varied depending on bacterial genus and species. Proteus (Gram-negative) and Enterococcus (Gram-positive) appeared to be the least susceptible to the bionanocomposites. Hyal/Ag most effectively inhibited the growth of non-pathogenic Gram-positive Sporosarcina luteola and Gram-negative Acinetobacter. Hyal/Ag/GO was most effective against Gram-positive Streptococcus and Gram-negative Moraxella osloensis. The Hyal/Ag/GO bionanocomposites proved to be very promising new antibacterial, biocompatible materials that could be used in the production of bioactive wound dressings.