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Recent progress in polysaccharide and polypeptide based modern moisture-retentive wound dressings

Swetha Menon NP, Kamaraj M, Anish Sharmila M, Govarthanan M

Int J Biol Macromol, 2024 Jan;256(Pt 2):128499.
PMID: 38048932 DOI: 10.1016/j.ijbiomac.2023.128499

Wounds were considered as defects in the tissues of the human skin and wound healing is said to be a tedious process as there are possibilities of infection or inflammation due to microorganisms. Modern moisture-retentive wound dressing (MMRWD) is opening a new window toward wound therapy. It comprises different types of wound dressing that has classified based on their functionality. Selective polysaccharide-polypeptide fiber composite materials such as hydrogels, hydrocolloids, hydro fibers, transparent-film dressing, and alginate dressing are discussed in this review as a type of MMRWD. The highlight of this polysaccharide and polypeptide based MMRWD is that it supports and enhances the healing of different types of wounds by moisture absorption thus preventing infection. This study has given enlightenment on the application of selected polysaccharide and polypeptide based MMRWD that enhances wound healing actions still it has been observed that the composite wound healing dressing is more effective than the single one. The nano-sized materials (synthetic nano drugs and phyto drugs) were found to increase the efficiency of healing action while coated in the wound dressing material. Future research is required to find out more possibilities of the different composite types of wound dressing in the healing action.

Matched MeSH terms: Bandages*
Marine-derived polysaccharides and their therapeutic potential in wound healing application - A review

Kumar M, Kumar D, Garg Y, Mahmood S, Chopra S, Bhatia A

Int J Biol Macromol, 2023 Dec 31;253(Pt 6):127331.
PMID: 37820901 DOI: 10.1016/j.ijbiomac.2023.127331

Polysaccharides originating from marine sources have been studied as potential material for use in wound dressings because of their desirable characteristics of biocompatibility, biodegradability, and low toxicity. Marine-derived polysaccharides used as wound dressing, provide several benefits such as promoting wound healing by providing a moist environment that facilitates cell migration and proliferation. They can also act as a barrier against external contaminants and provide a protective layer to prevent further damage to the wound. Research studies have shown that marine-derived polysaccharides can be used to develop different types of wound dressings such as hydrogels, films, and fibres. These dressings can be personalised to meet specific requirements based on the type and severity of the wound. For instance, hydrogels can be used for deep wounds to provide a moist environment, while films can be used for superficial wounds to provide a protective barrier. Additionally, these polysaccharides can be modified to improve their properties, such as enhancing their mechanical strength or increasing their ability to release bioactive molecules that can promote wound healing. Overall, marine-derived polysaccharides show great promise for developing effective and safe wound dressings for various wound types.

Matched MeSH terms: Bandages
Fabrication of amine-functionalized and multi-layered PAN-(TiO2)-gelatin nanofibrous wound dressing: In-vitro evaluation

Khan R, Haider S, Khan MUA, Haider A, Razak SIA, Hasan A, et al.

Int J Biol Macromol, 2023 Dec 31;253(Pt 5):127169.
PMID: 37783243 DOI: 10.1016/j.ijbiomac.2023.127169

The development of advanced multifunctional wound dressings remains a major challenge. Herein, a novel multilayer (ML) electrospun nanofibers (NFs) wound dressing based on diethylenetriamine (DETA) functionalized polyacrylonitrile (PAN), TiO2 nanoparticles (NPs) coating (Ct), and bioderived gelatin (Gel) was developed for potential applications in wound healing. The ML PAN-DETA-Ct-Gel membrane was developed by combining electrospinning, chemical functionalization, synthesis, and electrospray techniques, using a layer-by-layer method. The ML PAN-DETA-Ct-Gel membrane is comprised of an outer layer of PAN-DETA as a barrier to external microorganisms and structural support, an interlayer TiO2 NPs (Ct) as antibacterial function, and a contact layer (Gel) to improve biocompatibility and cell viability. The NFs membranes were characterized by scanning electron microscopy (SEM), surface profilometry, BET analysis, and water contact angle techniques to investigate their morphology, surface roughness, porosity, and wettability. The ML PAN-DETA-Ct-Gel wound dressing exhibited good surface roughness, porosity, and better wettability. Cell morphology, proliferation, and viability were determined using fibroblasts (3T3), and antibacterial assays were performed against six pathogens. The ML PAN-DETA-Ct-Gel NFs membrane showed good cell morphology, proliferation, viability, and antibacterial activity compared with other membranes. This new class of ML NFs membranes offers a multifunctional architecture with adequate biocompatibility, cell viability, and antibacterial activity.

Matched MeSH terms: Bandages
Efficacy of Mobiderm® Bandage in Compression Therapy for Venous Ulcers: A Prospective Case Series

Nair HKR, Lew X, Liew KY, Kamis SA, Nik Kub NMH, Zakaria AM, et al.

Int J Low Extrem Wounds, 2023 Dec;22(4):759-766.
PMID: 34806457 DOI: 10.1177/15347346211058273

Background: Venous leg ulcers severely affect patients' quality of life due to its high morbidity and recurrent nature. Currently, compression therapy is the first-line treatment for venous leg ulcers. Aim: This study sought to evaluate the efficacy of the Mobiderm® technology developed by Thuasne in a prospective case series of venous leg ulcers. Methods: Nine patients (N = 9) with venous leg ulcers were enrolled into this case series. Mobiderm® bandage was applied on to the affected limbs of the patients in the multi-component bandages system. The bandages were changed as frequent as the patients had their wound dressing for their standard treatment in a 12-week duration. Wound size and calf circumference were measured at week 0 and week 12. Paired sample t-test was used to compare the mean values of wound size and calf circumference pre- and post-treatment. Results: Reductions in wound size and calf circumference were observed in all nine patients (100%). Five patients were evaluable at week 12. The wound sizes significantly reduced by 27.2% to 53.2% (p = 0.02), and the calf circumferences significantly reduced by 3.2% to 26.0% (p = 0.02) after 12 weeks (N = 5). Safety was unremarkable, with no occurrence of treatment-emergent-related adverse event. Conclusion: Mobiderm® bandage was reported to be effective in promoting wound healing and reducing swelling, suggesting it to be integrated in the compression therapy for the management of venous leg ulcers.

Matched MeSH terms: Bandages
Use of bioelectric dressings for patients with hard-to-heal wounds: a case report

Nair HK, Yan TD

J Wound Care, 2023 Oct 01;32(Sup10a):S8-S14.
PMID: 37830843 DOI: 10.12968/jowc.2023.32.Sup10a.S8

There are many types of dressings available for the management of hard-to-heal (chronic) wounds. This case report illustrates the efficacy of bioelectric dressings in healing hard-to-heal wounds in five patients. Of the patients, four had diabetic foot ulcers (DFUs) and one had a surgical site infection. Wounds were examined using the TIMES concept and debridement was carried out if needed. Amorphous hydrogel was used as conduction fluid before the application of the bioelectric wound dressings. The wound was covered with foam dressing and crepe bandage. In this case report, among all five wounds, one wound healed completely while the other four reduced in size, with the presence of more granulation and re-epithelialisation. In this case report, bioelectric wound dressings were effective in managing infection and promoting wound healing.

Matched MeSH terms: Bandages, Hydrocolloid*
Use of a portable negative pressure wound therapy device on a hard-to-heal wound with exposed bone: a case study

Wen CWY, Nasir FABM, Charl MK, Jane CA, Abdullah NSKH, Ping LB, et al.

J Wound Care, 2023 Oct 01;32(Sup10a):S16-S20.
PMID: 37830842 DOI: 10.12968/jowc.2023.32.Sup10a.S16

This case study examines the effectiveness of using negative pressure wound therapy (NPWT) in the management of a hard-to-heal (chronic) wound with exposed ankle bone to reduce associated wound exudate and promote production of granulation tissue. A 60-year-old male patient who was able to attend wound follow-up diligently twice weekly for eight weeks, and weekly thereafter, was selected from a private hospital to take part. During each dressing change, the wound was cleansed with superoxidised cleansing solution, and minimal sharp debridement was performed. In the authors' opinion, the NPWT device used in this study is light and convenient for use in the community or home care setting. The NPWT wound dressing was connected to the NPWT machine via a connecting tube and the device then switched on using the default setting of a negative pressure of 125mmHg. Following the application of the NPWT device, the exposed ankle bone was successfully covered with healthy granulation tissue and healed within 20 weeks with minimal exudate formation in the wound. In the authors' opinion, NPWT is able to promote progress to wound healing; to minimise unnecessary dressing changes and, based on feedback from the patient, is comfortable to wear and when in use.

Matched MeSH terms: Bandages
Effectiveness of collagen and gatifloxacin in improving the healing and antibacterial activities of gellan gum hydrogel films as dressing materials

Bakar AJA, Azam NSM, Sevakumaran V, Ismail WIW, Razali MH, Razak SIA, et al.

Int J Biol Macromol, 2023 Aug 01;245:125494.
PMID: 37348586 DOI: 10.1016/j.ijbiomac.2023.125494

The demand for advanced wound care products is rapidly increasing nowadays. In this study, gellan gum/collagen (GG/C) hydrogel films containing gatifloxacin (GAT) were developed to investigate their properties as wound dressing materials. ATR-FTIR, swelling, water content, water vapor transmission rate (WVTR), and thermal properties were investigated. The mechanical properties of the materials were tested in dry and wet conditions to understand the performance of the materials after exposure to wound exudate. Drug release by Franz diffusion was measured with all samples showing 100 % cumulative drug release after 40 min. Strong antibacterial activities against Staphylococcus aureus and Staphylococcus epidermis were observed for Gram-positive bacteria, while Escherichia coli and Pseudomonas aeruginosa were observed for Gram-negative bacteria. The in-vivo cytotoxicity of GG/C-GAT was assessed by wound contraction in rats, which was 95 % for GG/C-GAT01. Hematoxylin and eosin and Masson's trichrome staining revealed the appearance of fresh full epidermis and granulation tissue, indicating that all wounds had passed through the proliferation phase. The results demonstrate the promising properties of the materials to be used as dressing materials.

Matched MeSH terms: Bandages/microbiology
Analyzing and mapping the research status, hotspots, and frontiers of biological wound dressings: An in-depth data-driven assessment

Shen S, Deng L, Du Y, Gao J, Zhang C, Wang Y, et al.

Int J Pharm, 2022 Dec 15;629:122385.
PMID: 36375685 DOI: 10.1016/j.ijpharm.2022.122385

Wound dressings can be applied over the wound sites to provide long-lasting wound management and improve wound healing. Biological wound dressings are superior to synthetic materials due to biodegradability and biocompatibility. These biomaterials have demonstrated huge potential in the field of wound dressings. Applying bibliometric analysis combined with results-based descriptions to characterize the research status, hotspots, and cutting-edge topics, this study is the first in-depth qualitative, quantitative, data-driven overview of biological wound dressings research in recent decades. Filtered data were used to construct co-citation, heatmaps, bi-clustering, strategy maps, and other analyses and visualization. The results show that research on biological wound dressings has progressed considerably in the last 5 years with extensive global collaboration. A clear knowledge base has been developed. Chitosan hydrogels, bacterial cellulose, active agents (silver nanoparticles, growth factors, curcumin, etc.), and electrospinning fibers stand out as research hotspots. The research frontiers include novel starting materials, precise and controlled release systems, and clinical and regenerative medicine applications. We interpreted an overview of the excavated topics and expected the findings here to provide a guide and inspire innovations for developing the next generation wound dressings.

Matched MeSH terms: Bandages
Fulltext Diverse nanocomposites as a potential dressing for diabetic wound healing

Renuka RR, Julius A, Yoganandham ST, Umapathy D, Ramadoss R, Samrot AV, et al.

Front Endocrinol (Lausanne), 2022;13:1074568.
PMID: 36714604 DOI: 10.3389/fendo.2022.1074568

Wound healing is a programmed process of continuous events which is impaired in the case of diabetic patients. This impaired process of healing in diabetics leads to amputation, longer hospitalisation, immobilisation, low self-esteem, and mortality in some patients. This problem has paved the way for several innovative strategies like the use of nanotechnology for the treatment of wounds in diabetic patients. The use of biomaterials, nanomaterials have advanced approaches in tissue engineering by designing multi-functional nanocomposite scaffolds. Stimuli-responsive scaffolds that interact with the wound microenvironment and controlled release of bioactive molecules have helped in overcoming barriers in healing. The use of different types of nanocomposite scaffolds for faster healing of diabetic wounds is constantly being studied. Nanocomposites have helped in addressing specific issues with respect to healing and improving angiogenesis. Method: A literature search was followed to retrieve the articles on strategies for wound healing in diabetes across several databases like PubMed, EMBASE, Scopus and Cochrane database. The search was performed in May 2022 by two researchers independently. They keywords used were "diabetic wounds, nanotechnology, nanocomposites, nanoparticles, chronic diabetic wounds, diabetic foot ulcer, hydrogel". Exclusion criteria included insulin resistance, burn wound, dressing material.

Matched MeSH terms: Bandages
Fulltext Recent Progress in Development of Dressings Used for Diabetic Wounds with Special Emphasis on Scaffolds

Awasthi A, Gulati M, Kumar B, Kaur J, Vishwas S, Khursheed R, et al.

Biomed Res Int, 2022;2022:1659338.
PMID: 35832856 DOI: 10.1155/2022/1659338

Diabetic wound (DW) is a secondary application of uncontrolled diabetes and affects about 42.2% of diabetics. If the disease is left untreated/uncontrolled, then it may further lead to amputation of organs. In recent years, huge research has been done in the area of wound dressing to have a better maintenance of DW. These include gauze, films, foams or, hydrocolloid-based dressings as well as polysaccharide- and polymer-based dressings. In recent years, scaffolds have played major role as biomaterial for wound dressing due to its tissue regeneration properties as well as fluid absorption capacity. These are three-dimensional polymeric structures formed from polymers that help in tissue rejuvenation. These offer a large surface area to volume ratio to allow cell adhesion and exudate absorbing capacity and antibacterial properties. They also offer a better retention as well as sustained release of drugs that are directly impregnated to the scaffolds or the ones that are loaded in nanocarriers that are impregnated onto scaffolds. The present review comprehensively describes the pathogenesis of DW, various dressings that are used so far for DW, the limitation of currently used wound dressings, role of scaffolds in topical delivery of drugs, materials used for scaffold fabrication, and application of various polymer-based scaffolds for treating DW.

Matched MeSH terms: Bandages, Hydrocolloid
Smart and pH-sensitive rGO/Arabinoxylan/chitosan composite for wound dressing: In-vitro drug delivery, antibacterial activity, and biological activities

Khan MUA, Haider S, Raza MA, Shah SA, Razak SIA, Kadir MRA, et al.

Int J Biol Macromol, 2021 Dec 01;192:820-831.
PMID: 34648803 DOI: 10.1016/j.ijbiomac.2021.10.033

Carbohydrate polymers are biological macromolecules that have sparked a lot of interest in wound healing due to their outstanding antibacterial properties and sustained drug release. Arabinoxylan (ARX), Chitosan (CS), and reduced graphene oxide (rGO) sheets were combined and crosslinked using tetraethyl orthosilicate (TEOS) as a crosslinker to fabricate composite hydrogels and assess their potential in wound dressing for skin wound healing. Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), atomic force microscopy (AFM), transmission electron microscopy (TEM), and biological assays were used to evaluate the composite hydrogels. FTIR validated the effective fabrication of the composite hydrogels. The rough morphologies of the composite hydrogels were revealed by SEM and AFM (as evident from the Ra values). ATC-4 was discovered to have the roughest surface. TEM revealed strong homogeneous anchoring of the rGO to the polymer matrix. However, with higher amount of rGO agglomeration was detected. The % swelling at various pHs (1-13) revealed that the hydrogels were pH-sensitive. The controlled release profile for the antibacterial drug (Silver sulfadiazine) evaluated at various pH values (4.5, 6.8, and 7.4) in PBS solution and 37 °C using the Franz diffusion method revealed maximal drug release at pH 7.4 and 37 °C. The antibacterial efficacy of the composite hydrogels against pathogens that cause serious skin diseases varied. The MC3T3-E1 cell adhered, proliferated, and differentiated well on the composite hydrogels. MC3T3-E1 cell also illustrated excellent viability (91%) and proper cylindrical morphologies on the composite hydrogels. Hence, the composite hydrogels based on ARX, CS, and rGO are promising biomaterials for treating and caring for skin wounds.

Matched MeSH terms: Bandages*
Fulltext Development of Antibacterial, Degradable and pH-Responsive Chitosan/Guar Gum/Polyvinyl Alcohol Blended Hydrogels for Wound Dressing

Khan MUA, Iqbal I, Ansari MNM, Razak SIA, Raza MA, Sajjad A, et al.

Molecules, 2021 Sep 30;26(19).
PMID: 34641480 DOI: 10.3390/molecules26195937

The present research is based on the fabrication preparation of CS/PVA/GG blended hydrogel with nontoxic tetra orthosilicate (TEOS) for sustained paracetamol release. Different TEOS percentages were used because of their nontoxic behavior to study newly designed hydrogels' crosslinking and physicochemical properties. These hydrogels were characterized using Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and wetting to determine the functional, surface morphology, hydrophilic, or hydrophobic properties. The swelling analysis in different media, degradation in PBS, and drug release kinetics were conducted to observe their response against corresponding media. The FTIR analysis confirmed the components added and crosslinking between them, and surface morphology confirmed different surface and wetting behavior due to different crosslinking. In various solvents, including water, buffer, and electrolyte solutions, the swelling behaviour of hydrogel was investigated and observed that TEOS amount caused less hydrogel swelling. In acidic pH, hydrogels swell the most, while they swell the least at pH 7 or higher. These hydrogels are pH-sensitive and appropriate for controlled drug release. These hydrogels demonstrated that, as the ionic concentration was increased, swelling decreased due to decreased osmotic pressure in various electrolyte solutions. The antimicrobial analysis revealed that these hydrogels are highly antibacterial against Gram-positive (Staphylococcus aureus and Bacillus cereus) and Gram negative (Pseudomonas aeruginosa and Escherichia coli) bacterial strains. The drug release mechanism was 98% in phosphate buffer saline (PBS) media at pH 7.4 in 140 min. To analyze drug release behaviour, the drug release kinetics was assessed against different mathematical models (such as zero and first order, Higuchi, Baker-Lonsdale, Hixson, and Peppas). It was found that hydrogel (CPG2) follows the Peppas model with the highest value of regression (R2 = 0.98509). Hence, from the results, these hydrogels could be a potential biomaterial for wound dressing in biomedical applications.

Matched MeSH terms: Bandages
Understanding Stress-Strain Behavioral Change in Fabrics for Compression Bandaging

Ruznan WS, Laing RM, Lowe BJ, Wilson CA, Jowett TJ

Int J Low Extrem Wounds, 2021 Sep;20(3):244-250.
PMID: 32248708 DOI: 10.1177/1534734620912093

Bandages are common in many health-related treatments, including management of edema of the lower limb where they may remain in place for several days. The behavior of 2 bandage fabrics was investigated after exposure for up to 5 days to a multiaxial extension laboratory setup on a tensile tester in compression mode. The fabrics were extended 20% and remained under that machine setting. Stress-relaxation over time was determined by analyzing the rate of change over 24 hours and over 5 days. Most change, a rapid drop in force, occurred during the first 15 minutes; thereafter, for the next 12-hour period, a slower rate of decrease was observed. Both fabrics continued to relax gradually during the next 12 hours and continued to do so for up to 5 days. Little further change was evident during the last 12 hours or so. This phenomenon suggests that rewrapping may be appropriate (albeit not practical) after 12 hours of compression therapy to optimize the compression given to the lower leg. Relaxation behavior of these 2 fabrics can be explained using the generalized Maxwell-Wiechert model.

Matched MeSH terms: Bandages*
Fulltext The Role of Calcium in Wound Healing

Subramaniam T, Fauzi MB, Lokanathan Y, Law JX

Int J Mol Sci, 2021 Jun 17;22(12).
PMID: 34204292 DOI: 10.3390/ijms22126486

Skin injury is quite common, and the wound healing is a complex process involving many types of cells, the extracellular matrix, and soluble mediators. Cell differentiation, migration, and proliferation are essential in restoring the integrity of the injured tissue. Despite the advances in science and technology, we have yet to find the ideal dressing that can support the healing of cutaneous wounds effectively, particularly for difficult-to-heal chronic wounds such as diabetic foot ulcers, bed sores, and venous ulcers. Hence, there is a need to identify and incorporate new ideas and methods to design a more effective dressing that not only can expedite wound healing but also can reduce scarring. Calcium has been identified to influence the wound healing process. This review explores the functions and roles of calcium in skin regeneration and reconstruction during would healing. Furthermore, this review also investigates the possibility of incorporating calcium into scaffolds and examines how it modulates cutaneous wound healing. In summary, the preliminary findings are promising. However, some challenges remain to be addressed before calcium can be used for cutaneous wound healing in clinical settings.

Matched MeSH terms: Bandages
Antibacterial efficacy of quaternized chitosan/poly (vinyl alcohol) nanofiber membrane crosslinked with blocked diisocyanate

Wu JY, Ooi CW, Song CP, Wang CY, Liu BL, Lin GY, et al.

Carbohydr Polym, 2021 Jun 15;262:117910.
PMID: 33838797 DOI: 10.1016/j.carbpol.2021.117910

N-[(2-hydroxyl-3-trimethylammonium) propyl] chitosan chloride (HTCC), which is a type of chitosan derivative with quaternary ammonium groups, possesses a higher antibacterial activity as compared to the pristine chitosan. The nanofiber membranes made of HTCC are attractive for applications demanding for antibacterial function. However, the hydrophilic nature of HTCC makes it unsuitable for electrospinning of nanofibers. Hence, biodegradable polyvinyl alcohol (PVA) was proposed as an additive to improve the electrospinnability of HTCC. In this work, PVA/HTCC nanofiber membrane was crosslinked with the blocked diisocyanate (BI) to enhance the stability of nanofiber membrane in water. Microbiological assessments showed that the PVA/HTCC/BI nanofiber membranes possessed a good antibacterial efficacy (∼100 %) against E. coli. Moreover, the biocompatibility of PVA/HTCC/BI nanofiber membrane was proven by the cytotoxicity test on mouse fibroblasts. These promising results indicated that the PVA/HTCC/BI nanofiber membrane can be a promising material for food packaging and as a potential wound dressing for skin regeneration.

Matched MeSH terms: Bandages
Gelatin Hydrogels Loaded with Lactoferrin-Functionalized Bio-Nanosilver as a Potential Antibacterial and Anti-Biofilm Dressing for Infected Wounds: Synthesis, Characterization, and Deciphering of Cytotoxicity

Suleman Ismail Abdalla S, Katas H, Chan JY, Ganasan P, Azmi F, Fauzi MB

Mol Pharm, 2021 05 03;18(5):1956-1969.
PMID: 33822631 DOI: 10.1021/acs.molpharmaceut.0c01033

Gelatin hydrogels are attractive for wound applications owing to their well-defined structural, physical, and chemical properties as well as good cell adhesion and biocompatibility. This study aimed to develop gelatin hydrogels incorporated with bio-nanosilver functionalized with lactoferrin (Ag-LTF) as a dual-antimicrobial action dressing, to be used in treating infected wounds. The hydrogels were cross-linked using genipin prior to loading with Ag-LTF and characterized for their physical and swelling properties, rheology, polymer and actives interactions, and in vitro release of the actives. The hydrogel's anti-biofilm and antibacterial performances against S. aureus and P. aeruginosa as well as their cytotoxicity effects were assessed in vitro, including primary wound healing gene expression of human dermal fibroblasts (HDFs). The formulated hydrogels showed adequate release of AgNPs and LTF, with promising antimicrobial effects against both bacterial strains. The Ag-LTF-loaded hydrogel did not significantly interfere with the normal cellular functions as no alteration was detected for cell viability, migration rate, and expression of the target genes, suggesting the nontoxicity of Ag-LTF as well as the hydrogels. In conclusion, Ag-LTF-loaded genipin-cross-linked gelatin hydrogel was successfully synthesized as a new approach for fighting biofilms in infected wounds, which may be applied to accelerate healing of chronic wounds.

Matched MeSH terms: Bandages*
Fulltext Resuscitative transesophageal echocardiography in the diagnosis of post-CABG loculated pericardial clot causing cardiac tamponade

Adi O, Ahmad AH, Fong CP, Ranga A, Panebianco N

Ultrasound J, 2021 Apr 15;13(1):22.
PMID: 33856577 DOI: 10.1186/s13089-021-00225-7

BACKGROUND: Pericardial effusion is a known complication of post-open cardiac surgery which can progress to life-threatening cardiac tamponade. Classical signs of tamponade such as hypotension and pulsus paradoxus are often absent. Diagnosing acute cardiac tamponade with transthoracic echocardiography (TTE) can be challenging in post-cardiac surgical patients due to distorted anatomy and limited scanning windows by the presence of surgical dressings or scar. Additionally, this patient population is more likely to have a loculated pericardial effusion, or an effusion that is isoechoic in appearance secondary to clotted blood. These findings can be challenging to visualize with traditional TTE. Missed diagnosis of cardiac tamponade due to loculated pericardial clot can result in delayed diagnosis and clinical management.
CASE PRESENTATION: We report a case series that illustrates the diagnostic challenge and value of resuscitative transesophageal echocardiography (TEE) in the emergency department (ED) for the diagnosis of cardiac tamponade due to posterior loculated pericardial clot in post-surgical coronary artery bypass graft (CABG) patients.
CONCLUSIONS: Cardiac tamponade due to loculated posterior pericardial clot post-CABG requires prompt diagnosis and appropriate management to avoid the potential for hemodynamic instability. Transesophageal echocardiography allows a rapid diagnosis, early appropriate referral and an opportunity to institute appropriate therapeutic measures.

Matched MeSH terms: Bandages
Benefits of sucrose octasulfate (TLC-NOSF) dressings in the treatment of chronic wounds: a systematic review

Nair H, Venkateshwaran N, Seetharaman S S, Deng W, Uthaipaisanwong A, Galea E

J Wound Care, 2021 Apr 01;30(Sup4):S42-S52.
PMID: 33856929 DOI: 10.12968/jowc.2021.30.Sup4.S42

OBJECTIVE: Management of chronic wounds remains one of the major challenges for health professionals and patients. An evidence-based decision is important to ensure that patients are receiving the best treatment proven to reduce healing time and improve outcomes, including economic benefits and patients' health-related quality of life (HRQoL). Due to recent restrictions because of the COVID-19 pandemic, including closure of wound care centres within hospitals and a drop in patient volume, chronic wound management needs simple-to-use dressings which are still effective and evidence-based solutions. This systematic review was conducted to identify the clinical evidence available on a sucrose octasulfate dressing (TLC-NOSF, UrgoStart dressing range, Laboratoires Urgo, France) to explore its efficacy in the management of chronic wounds, particularly lower limb ulcers, diabetic foot ulcers and pressure ulcers.
METHOD: A literature search of PubMed, Cochrane Library and Google Scholar was conducted based on the PICO model (patient/population, intervention, comparison and outcomes) to retrieve publications of different levels of evidence in order to evaluate outcomes of the use of TLC-NOSF dressings.
RESULTS: A total of 21 publications of different levels, ranging from double-blind randomised control trials to case reports, involving over 12,000 patients, were identified through PubMed, with a further eight publications through Google Scholar and two publications through Cochrane Library. A total of seven results were omitted due to the lack of relevance or repetition.
CONCLUSION: All the evidence provided suggest that these dressings provide clinicians with an evidence-based option for the management of chronic wounds; that the TLC-NOSF dressings are beneficial in promoting the healing process, reducing healing times, enhancing patients' HRQoL, and in allowing a more cost-effective procedure.

Matched MeSH terms: Bandages, Hydrocolloid*
Skin ulceration as a complication from unexpected extravasation injury: A case report

Chong HC, Fong KK, Hayati F

Ann Med Surg (Lond), 2021 Apr;64:102267.
PMID: 33889406 DOI: 10.1016/j.amsu.2021.102267

Background: Extravasation injury (EVI) is common, yet it is always underestimated and underreported. Severity varies ranging from thrombophlebitis up to disability. Unrecognised EVI is a potential medicolegal case in medicine.
Case presentation: We experience a 47-year-old lady who developed an unrecognised EVI after being admitted for sepsis. The EVI turned out to be a huge and sloughy skin ulcer. A series of wound debridement with vacuum dressing were conducted until the wound was able to be closed.
Discussion: The EVI can be categorised according to Amjad EVI grading and Loth and Eversmann's EVI classification. Adult EVI tends to be overlooked, especially during critical care because patients cannot complain upon sedation and ventilation. In order to prevent EVI, firstly prevention is better than cure. Secondly, if EVI is recognised early, infusion should be stopped immediately. Thirdly, analgesia is mandatory. Finally, the plastic team needs to be engaged if it is deemed required.
Conclusion: Prevention and early intervention before the occurrence of progressive tissue damage is the key to treatment. Early radical wound debridement and immediate or delayed wound coverage with skin graft or skin flap are indicated in full thickness skin necrosis, persistent pain, and chronic ulcer.

Matched MeSH terms: Bandages
Fulltext Approaches for Mitigating Microbial Biofilm-Related Drug Resistance: A Focus on Micro- and Nanotechnologies

Rao H, Choo S, Rajeswari Mahalingam SR, Adisuri DS, Madhavan P, Md Akim A, et al.

Molecules, 2021 Mar 26;26(7).
PMID: 33810292 DOI: 10.3390/molecules26071870

Biofilms play an essential role in chronic and healthcare-associated infections and are more resistant to antimicrobials compared to their planktonic counterparts due to their (1) physiological state, (2) cell density, (3) quorum sensing abilities, (4) presence of extracellular matrix, (5) upregulation of drug efflux pumps, (6) point mutation and overexpression of resistance genes, and (7) presence of persister cells. The genes involved and their implications in antimicrobial resistance are well defined for bacterial biofilms but are understudied in fungal biofilms. Potential therapeutics for biofilm mitigation that have been reported include (1) antimicrobial photodynamic therapy, (2) antimicrobial lock therapy, (3) antimicrobial peptides, (4) electrical methods, and (5) antimicrobial coatings. These approaches exhibit promising characteristics for addressing the impending crisis of antimicrobial resistance (AMR). Recently, advances in the micro- and nanotechnology field have propelled the development of novel biomaterials and approaches to combat biofilms either independently, in combination or as antimicrobial delivery systems. In this review, we will summarize the general principles of clinically important microbial biofilm formation with a focus on fungal biofilms. We will delve into the details of some novel micro- and nanotechnology approaches that have been developed to combat biofilms and the possibility of utilizing them in a clinical setting.

Matched MeSH terms: Bandages

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