Department of Mechanical Engineering, Bursa Technical University, Bursa, Turkey; Department of Mechanical Engineering, University of Victoria, Victoria, BC, CanadaCanada
Faculty of Medicine, Department of Pathology and Laboratory Medicine, University of Ottawa, ON, CanadaCanada
Also available as PDF (figures and tables appear in the PDF).
Health care professionals often come across patients inflicted with exuding wounds and burn injuries which get infected with broad range of micro-organisms because wounds often provide a favourable environment for the colonization of microbes. Staphylococcus aureus and Trichophyton rubrum are the most common pathogens which are responsible for skin and nail infection.1 Some deep wounds and burns damage the underlying structures like muscle, tendon, blood vessels, nerves, and bone which need persistent medical care to prevent systemic infection and loss of organ function.2 Sometimes, aggressive wound infection can cause septicemia and death. The remit of this editorial is to highlight the innovation of biocompatible nanofiber dressings for the localized delivery of antiseptics, antibiotics and growth factors which promote wound and burn healing.
Sukhwinder K. Bhullar, PhD1,2*; Harpal S. Buttar, DVM, MSc, PhD3 1Department of Mechanical Engineering, Bursa Technical University, Bursa, Turkey 2Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada 3Faculty of Medicine, Department of Pathology and Laboratory Medicine, University of Ottawa, ON, Canada *Corresponding author Sukhwinder K. Bhullar, PhD Department of Mechanical Engineering Bursa Technical University Bursa, Turkey; Department of Mechanical Engineering University of Victoria Victoria, BC, Canada E-mail: kaur.bhullar@btu.edu.tr; sbhullar@uvic.ca Article History Received: November 30th, 2016 Accepted: November 30th, 2016 Published: November 30th, 2016 Citation Bhullar SK, Buttar HS. Innovation of wound and burn care dressings from traditional to nonwoven polymeric scaffolds. Pathol Lab Med Open J.
doi: 10.17140/PLMOJ-1-e002 Copyright ©2016 Bhullar SK. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Volume 1 : Issue 2 Article Ref. #: 1000PLMOJ1e002 Innovation of Wound and Burn Care Dressings from Traditional to Nonwoven Polymeric Scaffolds Page e4 Editorial Health care professionals often come across patients inflicted with exuding wounds and burn injuries which get infected with broad range of micro-organisms because wounds of- ten provide a favourable environment for the colonization of microbes. Staphylococcus aureus and Trichophyton rubrum are the most common pathogens which are responsible for skin and nail infection.1 Some deep wounds and burns damage the underlying structures like muscle, tendon, blood vessels, nerves, and bone which need persistent medical care to prevent sys- temic infection and loss of organ function.2 Sometimes, aggressive wound infection can cause septicemia and death. The remit of this editorial is to highlight the innovation of biocompat- ible nanofiber dressings for the localized delivery of antiseptics, antibiotics and growth factors which promote wound and burn healing.
Figure 1 depicts 3 generations of dressings used for wound and burn healing. Tradi- tional dressings consisted of cotton swabs and gauze dressings for managing the chronic and highly exuding wounds over centuries. This practice subsequently led to the development of advanced wound and burn care dressings for the localized delivery of therapeutic products and the modern nonwoven polymeric wound care scaffolds. Advanced antimicrobial wound care dressings or bioactive dressings are comprised of a wide variety of materials such as sodium alginate, ionic silver, chitosan, hydrocolloid, foam, gel or paste, molecular iodine, and have been marketed for several years. The fabrication of modern and novel biocompatible dress- ings which incorporate bioactive wound healing materials like growth factors are summarized in Table 1.3 Growth factors help to repair the damaged tissues and promote healthy cellular growth.
Figure 1: Three generations of dressings for wound and burn care.
Examples of a number of modern dressings containing antimicrobial agents and their manufacturers are shown in Table 2.4 Incorporated antiseptic and anti-inflammatory agents are slowly released at the wound surface. Because of its effectiveness against a broad range of micro-organisms, silver is included in many wound and healthcare products. Silver nanopar-
Page e5 Growth factor or cytokin Effect on wound Current status Transforming growth factor β Re-epitheliasation Initial studies in venous ulcers encouraging Neovascularisation Increased granulation tissue and collagen Reduced scar formation Platelet derived growth factor Re-epithelialisation Licensed for the treatment of neuropathic diabetic foot ulcers Neovascularisation Increased granulation tissue and collagen Fibroblast growth factor Re-epitheliasation Biological effects in pressure ulcers demon- strated to date Neovascularisation of a provisional matrix Interleukin 1 β Healing of infected wounds Currently under trail for pressure ulcers Granulocyte macrophage-colony stimulating factor Improved healing in acute wounds Pilot studies in infected diabetic foot ulcers encouraging ticles release silver ions in sustainable form to maintain desired concentration for antimicrobial, anti-inflammatory, and wound healing activity, while minimizing the toxic effect of silver. Silver accelerates healing of injured tissue through antimicrobial, anti- inflammatory, and antioxidant effect. The emergence of bacterial resistance to silver and its potential to induce cross-resistance to antibiotics has also been reported.5 In cell culture experiments done with human mesenchymal stem cells, silver ions were found to be much more toxic than silver nanoparticles.6 However, despite of these risks, the use of silver-containing dressings (e.g. hydrofiber dressing, polyurethane foams and gauzes) is increasing in wound and burn care products.
Currently, the development of a variety of biocompatible dressings are the focus of attention of biomedical researchers.4,7 These dressings serve as vehicle for the promising delivery of wound or burn care ingredients or even allogenic cells which may provide a specific wound healing benefit. Further, the dressing acts to maintain a locally moist environment needed for wound heal- ing.
Biocompatible and biodegradable polymer micro- and nano-fiber devices fabricated from nanofiber materials with sizes less than 1 µm or 1 nm are especially useful in the field of medicine because these nanomaterials tend to replicate the molecular com- ponents of in vivo cellular and bimolecular environment. The synthetic and natural nanofibers of biodegradable and biocomatible polymers are good career vehicles for targeted drug delivery in wound or burn care as well as anti-cancer drugs. Also, the nanofiber- ous devices are beneficial for burn and wound healing due to their large surface-area-to-volume ratio, high porosity, improved cell adherence, cellular proliferation and migration, as well as controlled in vivo biodegradation rates. The large surface area of polymer nanofiber dressings not only allows increased close interaction of therapeutic agents and exchange of O2 and CO2 with tissues, but also provides a mechanism for sustained release and localized delivery of antiseptic remedies, analgesics, and growth factors needed for burn and wound healing. In addition, the high porosity of nanofiber dressings permits diffusion of nutrients and removal of waste products from the application site. With all these attributes and functions, nanofiber devices promote wound and burn healing. Ow- ing to their multifaceted properties, the nanofiber dressings created from both natural and synthetic polymers have attracted the at- tention of surgeons, physicians, biomedical researchers, and industry. Their envisioned potential applications are due to the optically Table 1: Examples of growth factros in wound healing.
Table 2: Examples of antimicrobial dressings.
Dressing Name Antimicrobial ingredient Dressing Format Manufacturer Acticoat absorbent Ionic silver Calcium alginate Smith & Nephew, Inc., Largo, FL, USA Actisorb Silver 220 Ionic silver and activated charcoal Silver impregnated activated charcoal cloth Johnson and Johnson Wound Management, Somerville, NJ, USA Arglaes Ionic silver Transparent film or powder Medline Industries, Inc., Mundelein, IL, USA Aquacel AG Ionic silver Hydrofiber Convatec, Skillman, NJ, USA Contreet H Ionic silver Hydrocolloid Coloplast Corp., Marietta, GA, USA Contreet F Ionic silver Foam Coloplast Corp., Marietta, GA, USA Iodosorb Molecular iodine Gel or paste HealthPoint Ltd., Ft. Worth, TX, USA Silvasorb Antimicrobial Silver Dressing Ionic silver Hydrogel sheet or amorphous gel Medline Industries, Inc., Mundelein, IL, USA Kerlix AMD Gauze PHMB Gauze Tyco Healthcare/Kendall, Mansfield, MA, USA Page e6 transparent functional materials and nano-composites required for making scaffolds to grow stem cells, wound healing dressings and mats, transdermal patches, targeted drug-delivery systems, tissue compatibility and biodegradability, improved cell adherence, and relatively lower manufacturing cost.8-11 Several studies and experimental evidence suggest that nanofibers with diameter range of 50-100 nm have a great potential for making nanofiber dressings for wound care due to their large surface area, high porosity, and small pore size. Nonwoven nano- fibrous scaffolds or patches for wound care have shown to produce skin substitutes with optimal cellular organization, proliferation and to reduce wound contraction. As the skin provides perfect protection from external environment, therefore for wound care, an ideal wound dressing should be compatible with skin and native tissue, should have the capacity to provide thermal insulation, gas- eous exchange, and to help drainage and debris removal thus promoting tissue reconstruction processes. Further, an ideal dressing should be biocompatible and not provoke any allergic or immune response reaction, protect the wound from secondary infections, and should be easily removable without causing trauma.12-18 A variety of wound and burn care dressings in the form of foam, mem- branous and nonwoven materials with natural or synthetic polymers, as well as combination of both, and impregnated hydrogels are being investigated by researchers worldwide.19,20 In addition, nanofibrous biodegradable polymers impregnated with wound healing materials are also under investigation.21-24 In summary, it’s estimated that the global wound care products market is expected to reach $18.3 billion by 2019 from $15.6 billion in 2014.25 Such, dollar figures suggest that sophisticated and innovative wound care dressings would form a significant part of the total medical devices market. Therefore, continued attention of the biomedical researchers and industry is needed to ad- dress the opportunities and challenges posed by wound and burn healing products and to improve the quality of patient care. CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest.