WOUND HEALING CONCEPTS: CONTEMPORARY PRACTICES AND FUTURE PERSPECTIVES
Keywords:Wound healing, Moist healing, Skin substitute, Negative pressure therapy
The advancements in the development of wound dressings have seen tremendous growth in the past few decades. Wound healing approach has majorly shifted from dry healing to moist healing. There has been a significant advancement in our understanding of the underlying physiology involved in wound healing and the associated systemic factors having a direct or indirect influence on the healing. This has resulted in the development of wound dressings designed to treat specific types of wounds. The present review discusses the physiology of wound healing, followed by different factors that contribute to healing. The advancements in wound dressings with their merits and limitations, newer approaches in wound care i.e., hyperbaric oxygen, negative pressure therapy, skin substitutes and role of growth factors in wound healing, have been highlighted. In addition, more recent approaches for effective wound care like smart devices with sensing, reporting and responding functions are discussed.
Takeo M, Lee W, Ito M. Wound healing and skin regeneration. CSH Perspect Med 2015;5:a023267.
Kim GH, Kang YM, Kang KN, Kim DY, Kim H. Wound dressings for wound healing and drug delivery. Tissue Eng Regen Med 2011;8:1–7.
Rossi S, Faccendini A, Bonferoni M, Ferrari F, Sandri G, Del Fante C, et al. “Sponge-like” dressings based on biopolymers for the delivery of platelet lysate to skin chronic wounds. Int J Pharm 2013;440:207-15.
Boateng J, Matthews K, Stevens H, Eccleston G. Wound healing dressings and drug delivery systems: a review. J Pharm Sci 2008;97:2892-923.
Kapoor M, Clarkson A, Sutherland B, Appleton I. The role of antioxidants in models of inflammation: emphasis on l-arginine and arachidonic acid metabolism. Inflammopharmacol 2005;12:505-19.
Hanna J, Giacopelli J. A review of wound healing and wound dressing products. J Foot Ankle Surg 1997;36:2-14.
Velnar T, Bailey T, Smrkolj V. The wound healing process: an overview of the cellular and molecular mechanisms. J Int Med Res 2009;37:1528-42.
Thomas Hess C. Checklist for factors affecting wound healing. Adv Skin Wound Care 2011;24:192.
Guo S, Di Pietro L. Factors affecting wound healing. J Dent Res 2010;89:219-29.
Howard M Kimmel, Anthony Grant, James Ditata. The presence of oxygen in wound healing. Wounds 2016;28:264–70.
Sen C. Wound healing essentials: let there be oxygen. Wound Repair Regen 2009;17:1-18.
Rodriguez P, Felix F, Woodley D, Shim E. The role of oxygen in wound healing: a review of the literature. Dermatol Surg 2008;34:1159-69.
Schreml S, Szeimies R, Prantl L, Karrer S, Landthaler M, Babilas P. Oxygen in acute and chronic wound healing. Br J Dermatol 2010;163:257-68.
Edwards R, Harding K. Bacteria and wound healing. Curr Opin Infect Dis 2004;17:91-6.
Negut I, Grumezescu V, Grumezescu A. Treatment strategies for infected wounds. Molecules 2018;23:2392.
Bowler P, Duerden B, Armstrong D. Wound microbiology and associated approaches to wound management. Clin Microbiol Rev 2001;14:244-69.
Ki V, Rotstein C. Bacterial skin and soft tissue infections in adults: a review of their epidemiology, pathogenesis, diagnosis, treatment and site of care. Can J Infect Dis Med 2008;19:173-84.
Rodgers A, Lynne W. Maceration and its effect on periwound margins. Diabetic Foot. 2003;6:S2+.
Haryanto H, Arisandi D, Suriadi S, Imran I, Ogai K, Sanada H, et al. Relationship between maceration and wound healing on diabetic foot ulcers in Indonesia: a prospective study. Int Wound J 2016;14:516-22.
Grey J, Enoch S, Harding K. Wound assessment. Br Med J 2006;332:285-8.
Demidova Rice T, Hamblin M, Herman I. Acute and impaired wound healing. Adv Skin Wound Care 2012;25:304-14.
Ovington L. Advances in wound dressings. Clin Dermatol 2007;25:33-8.
Atiyeh B, Ioannovich J, Al-Amm C, El-Musa K. Management of acute and chronic open wounds: the importance of moist environment in optimal wound healing. Curr Pharm Biotechnol 2002;3:179-95.
Jones PL, Millman A. Wound healing and the aged patient. Nurs Clin N Am 1990 Mar; 25:263-77
Sgonc R, Gruber J. Age-related aspects of cutaneous wound healing: a mini-review. Gerontology 2013;59:159-64.
Gerstein A, Phillips T, Rogers G, Gilchrest B. Wound healing and aging. Dermatol Clin 1993;11:749-57.
Rojas I, Padgett D, Sheridan J, Marucha P. Stress-induced susceptibility to bacterial infection during cutaneous wound healing. Brain Behav Immun 2002;16:74-84.
Christian L, Graham J, Padgett D, Glaser R, Kiecolt Glaser J. Stress and wound healing. Neuroimmunomodulation 2006;13:337-46.
Lucas VS. Psychological stress and wound healing in humans: what we know. Wounds-a Compendium Clin Res Practice 2011;23:76-83.
Wynn M, Holloway S. The impact of psychological stress on wound healing: a theoretical and clinical perspective. Wounds UK; 2019. p. 15.
Gouin J, Kiecolt Glaser J. The impact of psychological stress on wound healing: methods and mechanisms. Immunol Allergy Clin 2011;31:81-93.
Tandara A, Mustoe T. Oxygen in wound healing? More than a Nutrient. World J Surg 2004;28:294-300.
Rosenberg CS. Wound healing in the patient with diabetes mellitus. Nurs Clin N Am 1990;25:247-61.
Pence BD, Woods JA. Exercise, obesity, and cutaneous wound healing: evidence from rodent and human studies. Adv Wound Care 2014;1:71-9.
Wagner IJ, Szpalski C, Allen Jr RJ, Davidson EH, Canizares O, Saadeh PB, Warren SM. Obesity impairs wound closure through a vasculogenic mechanism. Wound Repair Regen 2012;20:512-22.
Wigston CH, Hassan SH, Turvey SU, Bosanquet DA, Richards AL, Holloway SA, et al. Impact of medications and lifestyle factors on wound healing: a pilot study. Wounds UK 2013;9:22-8.
Payne WG, Naidu DK, Wheeler CK, Barkoe D, Mentis M, Salas RE, et al. Wound healing in patients with cancer. Eplasty 2008;8:e9.
Tershakowec M, Ferguson MK. The effect of antineoplastic agents on wound healing. Plast Reconstr Surg 1982;70:785.
Cohen SC, Gabelnick HL, Johnson RK, Goldin A. Effects of antineoplastic agents on wound healing in mice. Surg 1975;78:238-44.
Kaiser GA, Herter FP, Malm JR, Demetz A, Campione MP. Effects of chemotherapeutic agents administered by isolated perfusion upon wound healing. Surg 1961;49:745-50.
Bairy KL, Rao CM, Ramesh KV, Kulkarni DR. Effects of antihistamines on wound healing. Indian J Exp Biol 1991;29:398-9.
Drugs that delay wound healing. Prescrire Int 2013;22:94-8.
Anderson K, Hamm RL. Factors that impair wound healing. J Am Coll Clin Wound 2012;4:84-91.
Bootun R. Effects of immunosuppressive therapy on wound healing. Int Wound J 2013;10:98-104.
Allegranzi B, Bischoff P, De Jonge S, Kubilay NZ, Zayed B, Gomes SM, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016;16:e276-87.
Jung MK, Callaci JJ, Lauing KL, Otis JS, Radek KA, Jones MK, et al. Alcohol exposure and mechanisms of tissue injury and repair. Alcohol Clin Exp Res 2011;35:392-9.
Mc Daniel JC, Browning KK. Smoking, chronic wound healing, and implications for evidence-based practice. J Wound Ostomy Continence Nursing 2014;41:415.
Pullar JM, Carr AC, Vissers M. The roles of vitamin C in skin health. Nutrients 2017;9:866.
Schectman G, Byrd JC, Gruchow HW. The influence of smoking on vitamin C status in adults. Am J Public Health 1989;79:158-62.
Williams JZ, Barbul A. Nutrition and wound healing. Surg Clin N Am 2003;83:571-96.
Dhivya S, Padma VV, Santhini E. Wound dressings–a review. Bio Medicine 2015;5:22.
Jones V, Grey JE, Harding KG. Wound dressings. Br Med J 2006;332:777-80.
Boateng JS, Matthews KH, Stevens HN, Eccleston GM. Wound healing dressings and drug delivery systems: a review. J Pharm Sci 2008;97:2892-923.
Shah JB. The history of wound care. J Am Coll Clin Wound Spec 2011;3:65-6.
Sarabahi S. Recent advances in topical wound care. Indian J Plast Surg 2012;45:379-87.
Baranoski S, Ayello EA. Wound dressings: an evolving art and science. Adv Skin Wound Care 2012;25:87-92.
Abdelrahman T, Newton H. Wound dressings: principles and practice. Surg (Oxford) 2011;29:491-5.
Swezey L. The continuum of wound dressings–semipermeable film dressings. In: Woundeducators.com blog; 2015. Available from: https://woundeducators.com/semipermeable-film-dressings [Last accessed on 13 Jul 2020]
Murphy PS, Evans GR. Advances in wound healing: a review of current wound healing products. Plast Sur Int 2012. DOI:10.1155/2012/190436
acelity.com [Internet] Nu-Derm hydrocolloid wound dressing Available from: https://www.acelity.com/healthcare-professionals/global-product-catalog/catalog/nu-derm-hydrocolloid-wound-dressing. [Last accessed on 13 Jul 2010]
bifixmed.com medical poly surgical foam dressing; Available from: http://www.bifixmed.com/product/medical-poly-surgical-foam-dressing. [Last accessed on 13 Jul 2020]
Cooper C. Fundamentals of hand therapy-e-book: clinical reasoning and treatment guidelines for common diagnoses of the upper extremity. Elsevier Health Sciences; 2014.
Leveriza-Oh M, Phillips T. Dressings and postoperative care. Lower Extremity Soft Tissue Cutaneous Plastic Surgery 2012:471-88. DOI:10.1016/B978-0-323-02752-6.50013-4
Agarwal A, McAnulty JF, Schurr MJ, Murphy CJ, Abbott NL. Polymeric materials for chronic wound and burn dressings. In: Advanced Wound Repair Therapies. Woodhead Publishing; 2011. p. 186-208.
Aderibigbe BA, Buyana B. Alginate in wound dressings. Pharmaceutics 2018;10:42.
buyemp.com. Dynarex dynaginate calcium alginate dressing; Available from https://www.buyemp.com/product/dynarex-dynaginate-calcium-alginate-dressing. [Last accessed on 13 Jul 2020].
Kamoun EA, Kenawy ER, Chen X. A review on polymeric hydrogel membranes for wound dressing applications: PVA-based hydrogel dressings. J Adv Res 2017;8:217-33.
Koehler J, Brandl FP, Goepferich AM. Hydrogel wound dressings for bioactive treatment of acute and chronic wounds. Eur Polym J 2018;100:1-1.
kikgel.com.pl [Internet] sterile hydrogel wound dressing for moist wound management. Available from: https://kikgel.com.pl/produkty/neoheal. [Last accessed on 13 Jul 2020]
Braund R, Hook S, Medlicott NJ. The role of topical growth factors in chronic wounds. Curr Drug Delivery 2007;4:195-204.
Park JW, Hwang SR, Yoon IS. Advanced growth factor delivery systems in wound management and skin regeneration. Molecules 2017;22:1259.
buyemp.com [Internet] Dynarex dynaginate calcium alginate dressing. Available from: https://www.buyemp.com/ product/dynarex-dynaginate-calcium-alginate-dressing. [Last accessed on 13 Jul 2020].
Briquez PS, Hubbell JA, Martino MM. Extracellular matrix-inspired growth factor delivery systems for skin wound healing. Adv Wound Care 2015;4:479-89.
Zelen CM, Gould L, Serena TE, Carter MJ, Keller J, Li WW. A prospective, randomised, controlled, multi-center comparative effectiveness study of healing using dehydrated human amnion/chorion membrane allograft, bioengineered skin substitute or standard of care for treatment of chronic lower extremity diabetic ulcers. Int Wound J 2015;12:724-32.
Mian M, Beghe F, Mian E. Collagen as a pharmacological approach in wound healing. Int J Tissue React 1992;14:1-9.
Guest JF, Weidlich D, Singh H, La Fontaine J, Garrett A, Abularrage CJ, et al. Cost-effectiveness of using adjunctive porcine small intestine submucosa tri-layer matrix compared with standard care in managing diabetic foot ulcers in the US. J Wound Care 2017;26:S12-24.
Dai C, Shih S, Khachemoune A. Skin substitutes for acute and chronic wound healing: an updated review. J Dermatol Treat 2018;28:1-33.
Chiummariello S, Guarro G, Pica A, Alfano C. Evaluation of negative pressure vacuum-assisted system in acute and chronic wounds closure. Our Exp 2012;33:358-62.
Putnis S, Khan WS, Wong JM. Suppl 1: Negative pressure wound therapy–a review of its uses in orthopaedic trauma. Open Orthop J 2014;8:142.
acelity.com V. A. C. White foam dressing kits. Available from: https://www.acelity.com/healthcare-professionals/global-productcatalog/catalog/vac-therapy-whitefoam-dressings. [Last accessed on 13 Jul 2020]
omegamedicalsystems.com. Negative pressure wound treatment system. Available from: http://www.omegamedicalsystems.com/html/negative_pressure_wound_therap.html. [Last accessed on 13 Jul 2020]
Jones SM, Banwell PE, Shakespeare PG. Advances in wound healing: topical negative pressure therapy. Postgrad Med J 2005;81:353-7.
Bhutani S, Vishwanath G. Hyperbaric oxygen and wound healing. Indian J Plast Surg 2012;45:316-24.
Dick Clarke. An evidence-based approach to hyperbaric wound healing; 1998.
Derakhshandeh H, Kashaf SS, Aghabaglou F, Ghanavati IO, Tamayol A. Smart bandages: the future of wound care. Trends Biotechnol 2018;36:1259-74.
Tamayol A, Akbari M, Zilberman Y, Comotto M, Lesha E, Serex L, et al. Flexible pH‐sensing hydrogel fibers for epidermal applications. Adv Healthc Mater 2016;5:711-9.
Kassal P, Kim J, Kumar R, De Araujo WR, Steinberg IM, Steinberg MD, et al. Smart bandage with wireless connectivity for uric acid biosensing as an indicator of wound status. Electrochem Commun 2015;56:6-10.
Panzarasa G, Osypova A, Toncelli C, Buhmann MT, Rottmar M, Ren Q, et al. The pyranine-benzalkonium ion pair: a promising fluorescent system for the ratiometric detection of wound pH. Sensors Actuators B: Chem 2017;249:156-60.
Hattori Y, Falgout L, Lee W, Jung SY, Poon E, Lee JW, et al. Multifunctional skin‐like electronics for quantitative, clinical monitoring of cutaneous wound healing. Adv Healthc Mater 2014;3:1597-607.
Salvo P, Calisi N, Melai B, Dini V, Paoletti C, Lomonaco T, et al. Temperature-and pH-sensitive wearable materials for monitoring foot ulcers. Int J Nanomed 2017;12:949.
Mostafalu P, Lenk W, Dokmeci MR, Ziaie B, Khademhosseini A, Sonkusale SR. Wireless flexible smart bandage for continuous monitoring of wound oxygenation. IEEE Transactions Biomed Circuits Systems 2015;9:670-7.
Li Z, Roussakis E, Koolen PG, Ibrahim AM, Kim K, Rose LF, et al. Non-invasive transdermal two-dimensional mapping of cutaneous oxygenation with a rapid-drying liquid bandage. Biomed Opt Express 2014;5:3748-64.
Milne SD, Seoudi I, Al Hamad H, Talal TK, Anoop AA, Allahverdi N, et al. A wearable wound moisture sensor as an indicator for wound dressing change: an observational study of wound moisture and status. Int Wound J 2016;13:1309-14.
Bagherifard S, Tamayol A, Mostafalu P, Akbari M, Comotto M, Annabi N, et al. Dermal patch with integrated flexible heater for on demand drug delivery. Adv Healthc Mater 2016;5:175-84.
Mostafalu P, Kiaee G, Giatsidis G, Khalilpour A, Nabavinia M, Dokmeci MR, et al. A textile dressing for temporal and dosage controlled drug delivery. Adv Funct Mater 201;27:1702399.