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Therapeutic Potential of Nanocarrier-Mediated Delivery of Phytoconstituents for Wound Healing: Their Current Status and Future Perspective

Kumar M, Keshwania P, Chopra S, Mahmood S, Bhatia A

AAPS PharmSciTech, 2023 Jul 20;24(6):155.
PMID: 37468691 DOI: 10.1208/s12249-023-02616-6

The treatment of wounds is a serious problem all over the world and imposes a huge financial burden on each and every nation. For a long time, researchers have explored wound dressing that speeds up wound healing. Traditional wound dressing does not respond effectively to the wound-healing process as expected. Therapeutic active derived from plant extracts and extracted bioactive components have been employed in various regions of the globe since ancient times for the purpose of illness, prevention, and therapy. About 200 years ago, most medical treatments were based on herbal remedies. Especially in the West, the usage of herbal treatments began to wane in the 1960s as a result of the rise of allopathic medicine. In recent years, however, there has been a resurgence of interest in and demand for herbal medicines for a number of reasons, including claims about their efficacy, shifting consumer preferences toward natural medicines, high costs and negative side effects of modern medicines, and advancements in herbal medicines brought about by scientific research and technological innovation. The exploration of medicinal plants and their typical uses could potentially result in advanced pharmaceuticals that exhibit reduced adverse effects. This review aims to present an overview of the utilization of nanocarriers in plant-based therapeutics, including its current status, recent advancements, challenges, and future prospects. The objective is to equip researchers with a comprehensive understanding of the historical background, current state, and potential future developments in this emerging field. In light of this, the advantages of nanocarriers based delivery of natural wound healing treatments have been discussed, with a focus on nanofibers, nanoparticles, nano-emulsion, and nanogels.

Matched MeSH terms: Wound Healing
The wound healing properties of Channa striatus-cetrimide cream-wound contraction and glycosaminoglycan measurement

Baie SH, Sheikh KA

J Ethnopharmacol, 2000 Nov;73(1-2):15-30.
PMID: 11025135

Haruan has been proved to influence the different phases of wound healing process. The current research focuses on the effects of haruan on the different constituents of extracellular matrix of healing wounds in normal and diabetic rats. Anaesthetized normal and streptozotocin induced diabetic rats were provided with excision wounds at the back and then animals were divided into four groups as: group 1, wounds treated with cetrimide+haruan cream; group 2, wounds treated with haruan cream; group 3, wounds treated with cetrimide (commercial) cream; and group 4, wounds untreated and served as control. Animals were sacrificed after 3, 6, 9 and 12 days. These wounds were used to determine the hexosamine, protein, uronic acid and glycosaminoglycan contents and the wound contraction. The results suggested a marked increase (P<0.05) in the uronic acid, hexosamine and dermatan sulfate contents on day 3 of group 1 when compared with groups 2-4. Wound contraction of group 1 was also markedly enhanced of group 1 (P<0.01) when compared with groups 2- 4. On the basis of these results, we conclude that haruan enhances the synthesis of different glycosaminoglycans in healing wounds, which are the first component of extracellular matrix to be synthesized during the wound healing process. The enhanced levels of glycosaminoglycans may help in the formation of a resistant scar and enhanced wound contraction represents the positive influence of haruan on the fibroplastic phase of wound healing.

Matched MeSH terms: Wound Healing/drug effects*
The wound healing properties of Channa striatus-cetrimide cream-- tensile strength measurement

Baie SH, Sheikh KA

J Ethnopharmacol, 2000 Jul;71(1-2):93-100.
PMID: 10904151

Channa striatus, a fresh water snakehead fish, is reported to enhance dermal wound healing. Biochemical components such as amino acids and fatty acids are important for the synthesis of collagen fibers during wound healing. Arachidonic acid, a precursor of prostaglandin plays a vital role in healing the wounds. Haruan (C. striatus) contains all the essential amino acids for wound healing particularly glycine as well as high contents of arachidonic acid and polyunsaturated fatty acids that can promote prostaglandin synthesis. In the present work we have studied the wound healing effect of C. striatus in Sprague-Dawley rats. Cream formulations having different haruan fish extract concentrations as the active ingredient were prepared and stabilized, and they were applied to the wounds. The healing of wounds was characterized by an increase in the tensile strength of the skin, determined on the 7th post-operative day in each case. Haruan treatment of wounds promotes remodeling of collagen, by the synthesis of inter- and intra-molecular protein crosslinking and thus produces a marked increase (P<0.05) in tensile strength as compared to the cetrimide treated group. On the basis of our experiment we conclude that C. striatus helps in wound healing as indicated by the increase in tensile strength. We hypothesise that this effect may be due to its high content of arachidonic acid, glycine and polyunsaturated fatty acids. The mechanism of wound healing will be investigated in future studies.

Matched MeSH terms: Wound Healing/drug effects*
The use of glycerol-preserved skin allograft in conjunction with reconstructive and flap surgery: seven years of experience

Saad AZ, Halim AS, Khoo TL

J Reconstr Microsurg, 2011 Feb;27(2):103-8.
PMID: 20976667 DOI: 10.1055/s-0030-1268208

Major reconstructive surgery may be extensive and prolonged, and it may cause edema and compromise the flap pedicle if closed under tension. Glycerol-preserved skin allograft (GPA) can provide a means for tension-free closure and temporary cover of the wound. Seven years of analysis on GPA used in conjunction with major reconstruction was undertaken to highlight its indications, results, and outcomes. Forty-seven patients were included, aged between 9 and 73 years. Majority of patients had reconstruction following tumor resection and trauma. The main indication for use of GPA was temporary, loose cover of the wound in 44% of cases; flap pedicle protection in 31% of cases; donor site wound cover in 10%; flap monitoring in one case; and management of flap-related complications in 6% of cases. Free flap reconstruction was performed in 72% of cases. In conclusion, GPA is a useful adjunct in reconstructive surgery. It can be used temporarily to allow tension-free wound closure, as well as to protect the flap pedicle until edema subsides and the pedicle becomes stable. This latter approach allows secondary wound closure and good esthetic outcome.

Matched MeSH terms: Wound Healing/physiology
Fulltext The use of collagen biomaterial in oral cancer: a systematic review

Muhammad Lutfi Mohamed Halim, Nora Azirah Mohd Zayi, Mohd Yusof Mohamad, Mohd Hafiz Arzmi

Malaysian Journal of Medicine and Health Sciences, 2019;15(108):33-33.
MyJurnal

Introduction: Oral cancer is the sixth most common malignancy in the world. It is a major concern in Southeast Asia primarily due to betel quid chewing, smoking, and alcohol consumption. In Malaysia, oral cancer related cases accounts for 1.55% of the cause of deaths. Despite recent advances in cancer diagnoses and therapies, the survival rate of oral cancer patients only reached 50% in the last few decades. Tissue engineering (TE) principles may pro-vide new technology platforms to study mechanisms of angiogenesis and tumour cell growth as well as potentially tumour cell spreading in cancer research. The use of biomaterial, appropriate cell source and proper signalling mol-ecules are vital components of TE. Collagen biomaterial are widely used scaffold or membrane in oral application. Nevertheless, no review has been performed on the its usage for the study of oral cancer. This study aimed to sys-tematically review the use of collagen scaffold in oral cancer application. Methods: Research articles were searched using Scopus, Pubmed and Web of Science (WOS) databases. The keywords were limited to “collagen membrane OR collagen scaffold” AND “oral cancer”. Results: Initial search yielded 61 papers (Scopus:37, Pubmed: 12, WOS: 12). Further scrutinization of the papers based on the inclusion criteria resulted total of 3 papers. Two of the papers used collagen membrane for regeneration of oral mucosal defect and increment of alveolar ridge height post-surgery. The remaining paper utilize collagen biomaterial as scaffold for the culture of adenoid cystic carcinoma (ACC) cells. All papers reported significant role of collagen biomaterial in terms of tissue formation, healing scaffold and cellular proliferation. Conclusion: Collagen utilization as biomaterial offers potential use for regeneration of oral related structures as well providing useful model for therapeutics anti-cancer research.

Matched MeSH terms: Wound Healing
The use of an aberrant flexor carpi ulnaris tendon with an ulnar artery island forearm flap for reconstruction of a dorsal defect of the hand

Jeyaratnam TS, Ahmad TS, Kassim NM

Hand Surg, 2001 Jul;6(1):99-102.
PMID: 11677671
Matched MeSH terms: Wound Healing
The treatment of wounds

Cameron JAP

Journal of the Malaya Branch of the British Medical Association, 1939;3:297-304.

Matched MeSH terms: Wound Healing
Fulltext The surgical treatment of carbuncles: a tale of two techniques

Hee TG, Jin BJ

Iran Red Crescent Med J, 2013 Apr;15(4):367-70.
PMID: 24083015 DOI: 10.5812/ircmj.2992

The treatment of carbuncles is early administration of antibiotics and surgery. The commonest surgical approaches are saucerization, and incision and drainage (I&D). Although these two techniques are vastly different, there is a lack of evidence to determine which one produces a better outcome. Three cases of carbuncles are presented to illustrate the contrasting surgical techniques and their results. Three consecutive patients who presented to this hospital with carbuncles were treated with either saucerization or I&D. They were followed up for 8 weeks to assess their outcome. One patient had saucerization while two other patients underwent I&D of their carbuncles. Saucerization produced the shortest length of hospital stay. I&D resulted in earlier wound healing. A randomized controlled is needed to determine the best surgical approach for the treatment of carbuncles.

Matched MeSH terms: Wound Healing
The role of macrophages in the induction of murine immune response to Actinobacillus actinomycetemcomitans

Sosroseno W, Herminajeng E

J Med Microbiol, 2002 Jul;51(7):581-8.
PMID: 12132775

The aim of this study was to determine the role of macrophages in the Actinobacillus actinomycetemcomitans-induced murine immune response. BALB/c mice were given carrageenan solution by intraperitoneal injection before immunisation with heat-killed A. actinomycetemcomitans. Mice immunised with antigens and phosphate-buffered saline served as positive and negative controls, respectively. One week after the last immunisation, the delayed-type hypersensitivity (DTH) response was assessed by measurement of footpad swelling. Serum IgG and IgM anti-A. actinomycetemcomitans antibody levels and culture supernate levels of interferon (IFN)-gamma were determined by ELISA. The diameter of abscess formation was determined every 5 days. Sham-immunised spleen cells were transferred to carrageenan-untreated recipients (groups A and B) and to carrageenan-treated recipients (group D). Antigen-immunised spleen cells were transferred to carrageenan-untreated (group C) and carrageenan-treated (group E) recipients. The carrageenan-treated recipients in groups F and G received macrophages from antigen- and sham-immunised mice respectively. All mice except those in group A were immunised with antigen 24 h after cell transfer. After 1 week, a partial suppression of DTH response, reduced levels of IFN-gamma, serum IgG and IgM anti-A. actinomycetemcomitans antibodies and delayed healing were seen in carrageenan-treated mice when compared with the positive control. The immune response to A. actinomycetemcomitans in groups A, B and D was lower than that in groups C and E. Healing of the lesion in the former groups was also delayed when compared with the latter groups. The immune response and the healing of the lesion could be partially restored in carrageenan-treated mice that received antigen-pulsed macrophages (group F) but not in those that received naive macrophages (group G). These results suggest that macrophages play a partial role in the induction of the murine immune response to A. actinomycetemcomitans.

Matched MeSH terms: Wound Healing
The role of CD4+ cells in vivo on the induction of the immune response to Porphyromonas gingivalis in mice

Sosroseno W, Bird PS, Gemmell E, Seymour GJ

J. Periodontol., 2002 Oct;73(10):1133-40.
PMID: 12416770

It has previously been suggested that CD4+ T cells play a pivotal role in regulating the immune response to periodontal pathogens. The aim of the present study therefore was to determine delayed type hypersensitivity (DTH), spleen cell proliferation, serum and splenic anti-Porphyromonas gingivalis antibody levels, and lesion sizes following challenge with viable P. gingivalis in CD4-depleted BALB/c mice immunized with P. gingivalis outer membrane proteins (OMP).

Matched MeSH terms: Wound Healing/immunology
The relationship between infection severity, wound categorization, and foot care in type 2 diabetes mellitus patients with recurring diabetic foot ulcers

Haryanto, Amrullah S, Pratama SF, Agustini F, Pasmawati, Khairillah YN, et al.

Med J Malaysia, 2024 Jan;79(1):60-67.
PMID: 38287759

INTRODUCTION: Research on diabetic foot ulcers (DFU) infection is limited to the first wound. Therefore, this study aimed to evaluate the relationship between wound classification (Wagner and SHID), and foot care against severity infection of DFU recurrent that may contribute to an increased susceptibility to infection among individuals with recurrent DFUs.
MATERIALS AND METHODS: A cross-sectional design was used in this study involving 245 participants of type 2 diabetes mellitus (T2DM) was conducted at a Kitamura Wound Care Clinic, PKU Muhammadiyah, located in Pontianak, West Kalimantan, Indonesia, between September 2022 and February 2023. The Kruskal-Wallis test was used to assess the relationship between the foot care practices and infection status. A linear regression test to examine the independent risk factors.
RESULTS: Wounds' characteristics regarding foot care practice group were significantly including more than 5 months wound heal from previous wounds (p = 0.045), the percentage of wound site on dorsal was higher in the foot care practice group (p < 0.001), the percentage had no deformity feet was higher in the foot care practice group (p < 0.001), the percentage had no previous amputation feet was higher in the foot care practice group (p < 0.001). Also, the percentage had grade three was higher in the foot care practice group (p < 0.001), the percentage had grade three was higher in the foot care practice group (p < 0.001), and the percentage had mild infection status was higher in the foot care practice group (p < 0.001). The predictors of diabetic foot infection were Wagner and SHID classification and foot care (p < 0.001, p < 0.001, and p < 0.01) respectively.
CONCLUSION: This study demonstrated that foot-care behaviour in diabetic patients in Indonesia is poor. In addition, this study also has shown Wagner grading, SHID grading, and foot-care are predictors of infection in recurrent DFUs.

Matched MeSH terms: Wound Healing
The perspectives of the application of biofilm in the prevention of chronic infections

Ali Ahmed AB, Taha RM

Adv. Food Nutr. Res., 2011;64:403-16.
PMID: 22054964 DOI: 10.1016/B978-0-12-387669-0.00031-4

Biofilms are a natural part of the ecology of the earth. Many biofilms are quite harmful and must be treated or controlled. Other biofilms are beneficial and can be used to help fix serious problems. Biofilms can grow on many different surfaces, including rocks in water, foods, teeth, and various biomedical implants. This bacterial colonization may present the need for additional operations, amputation, or it may even lead to death. The fundamental principles of bacterial cell attachment and biofilm formation are discussed. Biofilms represents a new, wide-open field practice and research that is only going to get hotter with time. Functional organic plasma polymerized coatings are also discussed for their potential as bio-sensitive interfaces, connecting metallic electronic devices with their physiological environments.

Matched MeSH terms: Wound Healing
Fulltext The new Silk Road

Nair HK

J Wound Care, 2020 Dec 01;29(Sup12):S3.
PMID: 33320766 DOI: 10.12968/jowc.2020.29.Sup12.S3
Matched MeSH terms: Wound Healing*
The mechanisms of fibroblast-mediated compaction of collagen gels and the mechanical niche around individual fibroblasts

Feng Z, Wagatsuma Y, Kikuchi M, Kosawada T, Nakamura T, Sato D, et al.

Biomaterials, 2014 Sep;35(28):8078-91.
PMID: 24976242 DOI: 10.1016/j.biomaterials.2014.05.072

Fibroblast-mediated compaction of collagen gels attracts extensive attention in studies of wound healing, cellular fate processes, and regenerative medicine. However, the underlying mechanism and the cellular mechanical niche still remain obscure. This study examines the mechanical behaviour of collagen fibrils during the process of compaction from an alternative perspective on the primary mechanical interaction, providing a new viewpoint on the behaviour of populated fibroblasts. We classify the collagen fibrils into three types - bent, stretched, and adherent - and deduce the respective equations governing the mechanical behaviour of each type; in particular, from a putative principle based on the stationary state of the instantaneous Hamiltonian of the mechanotransduction system, we originally quantify the stretching force exerted on each stretched fibrils. Via careful verification of a structural elementary model based on this classification, we demonstrate a clear physical picture of the compaction process, quantitatively elucidate the panorama of the micro mechanical niche and reveal an intrinsic biphasic relationship between cellular traction force and matrix elasticity. Our results also infer the underlying mechanism of tensional homoeostasis and stress shielding of fibroblasts. With this study, and sequel investigations on the putative principle proposed herein, we anticipate a refocus of the research on cellular mechanobiology, in vitro and in vivo.

Matched MeSH terms: Wound Healing
The healing of ulcers

Walkingshaw R

Malayan Medical Journal, 1930;5:65.

Matched MeSH terms: Wound Healing
Fulltext The guru-UKM method: synergistic effect of hydrogel, hydrofibre and dermal conservation in burn wound management

Farrah-Hani Imran, Ian, Chik, Kelly, Enda Gerard, Razman Jarmin

International Medical Journal Malaysia, 2018;17(3):89-94.
MyJurnal

Initial wound care idioms were designed around a moist dressing in presumed better wound healing. As wound care advances, innovations of dressings were formed. In the Guru-UKM Method (GUM), we combined two well-established dressings producing a synergistic effect in burn wound management. Patients with deep partial thickness burns were selected for the GUM. From the time of admission, they receive 2 cycles of paraffin tulle dressings once every two days to allow demarcation, then are reassessed for suitability of the GUM technique. We discuss 7 different burn cases that presented to our Burn Unit from January 2014 – June 2015.All dressings should create a suitable moist environment for healing, yet should be a painless dressing to help the patient return to normal function as soon as possible. In burn wounds, a suitable dressing ideally also biochemically debrides fibrin and softens hardened eschar and slough, without necessitating the patient to undergo general anaesthesia and surgical debridement. The Guru-UKM Method is a combination dressing technique that facilitates optimal burn wound management.

Matched MeSH terms: Wound Healing
The evidence-base for elevated vacuum in lower limb prosthetics: Literature review and professional feedback

Gholizadeh H, Lemaire ED, Eshraghi A

Clin Biomech (Bristol, Avon), 2016 08;37:108-116.
PMID: 27423025 DOI: 10.1016/j.clinbiomech.2016.06.005

BACKGROUND: An optimal suspension system can improve comfort and quality of life in people with limb loss. To guide practice on prosthetic vacuum suspension systems, assessment of the current evidence and professional opinion are required.
METHODS: PubMed, Web of Science, and Google Scholar databases were explored to find related articles. Search terms were amputees, artificial limb, prosthetic suspension, prosthetic liner, vacuum, and prosthesis. The results were refined by vacuum socket or vacuum assisted suspension or sub-atmospheric suspension. Study design, research instrument, sample size, and outcome measures were reviewed. An online questionnaire was also designed and distributed worldwide among professionals and prosthetists (www.ispoint.org, OANDP-L, LinkedIn, personal email).
FINDINGS: 26 articles were published from 2001 to March 2016. The number of participants averaged 7 (SD=4) for transtibial and 6 (SD=6) for transfemoral amputees. Most studies evaluated the short-term effects of vacuum systems by measuring stump volume changes, gait parameters, pistoning, interface pressures, satisfaction, balance, and wound healing. 155 professionals replied to the questionnaire and supported results from the literature. Elevated vacuum systems may have some advantages over the other suspension systems, but may not be appropriate for all people with limb loss.
INTERPRETATION: Elevated vacuum suspension could improve comfort and quality of life for people with limb loss. However, future investigations with larger sample sizes are needed to provide strong statistical conclusions and to evaluate long-term effects of these systems.

Matched MeSH terms: Wound Healing
Fulltext The efficacy of honey-cinnamon commixture in diabetic wound healing. [Abstract]

Azib FN, Lee CH, Mohd Yusof NM, Yusuf N, Mohd Fuad NF, Saharuddin NS, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):23-0.
MyJurnal

1st UMS INTERNATIONAL NURSING CONFERENCE IN CONJUNCTION WITH 11TH INTERNATIONAL NURSING STUDENTS’ FORUM
A view into the future of nursing: Nursing Transformation towards IR-4.0, Held at the Faculty of Medicine and Health Sciences,, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia, On 6-8th March 2020
Introduction: Delayed wound healing and a hefty cost of treatment poses a burden to those undergoing treatment for Diabetic wound care. An alternative wound product to speed up wound healing may address this problem. Honey has been recognized around the world for its efficacy as treating wounds, eczema, and inflammation while cinnamon has a variety of biological functions including anti-diabetic, anti-microbial, and anti-inflammatory. As both cinnamon and honey possess different properties in wound healing, it is hypothesized that combining both products can accelerate wound healing. This study is to compare the efficacy of pure honey, pure cinnamon and honey-cinnamon commixture in diabetic wound healing.
Methods: Three volunteers were selected from Kitamura clinic, Pontianak, Indonesia participated in this study. Each of them was given a different wound product which were pure honey (subject 1), pure cinnamon extract (subject 2), and honey-cinnamon commixture (subject 3). The wound bed percentage, size, and characteristics were recorded and compared. Results: Usage of pure cinnamon was discontinued during the second visit due to its drying effect. Subjects 1 and 3 both presented with an increase in granulation and reduction in sloughing of cells and biofilm. However, subject 3 showed faster wound contraction and reduction in maceration as compared to subject 1.
Conclusion: Pure cinnamon extract should not be used as a standalone wound product due to its drying properties. However, topical co-administration of honey and Cinnamon cassia extract has a synergistic interaction effect, improves wound healing in diabetic individuals and is recommended as a new topical herbal drug production for treating of the diabetic wound. Further studies on the therapeutic concentration of honey-cinnamon commixture should be conducted.

Matched MeSH terms: Wound Healing
Fulltext The efficacy of Morinda citrifolia leaves extracts in diabetic wound treatment

Xin Ying Chong, Syafiiqa Parlan, Tiu Ling Yii, Dayang Nurafiqah Awang Lokman, Clementine Jrillus, Nur Syamira Zainal Abidin, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):12-0.
MyJurnal

Introduction: An economical and alternative diabetic wound care product is needed to address the escalating cost of diabetic wound ulcer treatment in Indonesia. Morindac itrifolia or commonly called noni, is a medicinal plant, dietary supplement, and traditional wound care product. This leaves extract contains antioxidant, anti-inflammatory, immune-stimulant, and antimicrobial properties. Trigona honey which is currently used to treat the diabetic wound at Kitamura Wound Specialist Clinic, Pontianak, Indonesia is known for its anti-inflammatory, anti-microbial and anti-proliferative properties. This study aims to compare the effectiveness of Morinda citrifolia leaves extract and Trigona honey in diabetic wound healing. Methods: A quasi-experimental study (a randomized control trial design) was conductedin the clinicon two subjects with diabetic foot ulcers (DFU). Trigona honey and Morinda citrifolia leaves extract packing was done to the ulcer of controlled subject and treatment subject respectively as a primary dressing. DFU assessment was done every 2 days using the MUNGS assessment tool and a wound closure rate for- mula. Wound C&S was analysed using a bacterial count machine. Results: Morinda citrifolia leaves extract was able to promote wound contraction, improved MUNGS score (from 9 to 8), reduced bacteria count significantly (from
8.51 x 105 to 1.00 x 105), reduced the percentage of slough by 70% and increased granulating tissue by 60% after the first application. Whereas, Trigona honey extract showed no wound contraction but improved MUNGS score (from 11 to 7). However, bacteria count was maintained at the lowest level (1.00 x 105), reduce the percentage of slough by 10%, and only increased granulating tissues by 10% after the first application. Conclusion: Both products were able to promote diabetic wound healing but the Morinda citrifolia leaves extract was found to be more effective, thus concludes the potential use of Morinda citrifolia leaves extract in treating DFU.

Matched MeSH terms: Wound Healing
Fulltext The efficacy of 3 irrigating solution in surgical removal of lower wisdom tooth: a pilot study

Keat, John Hon Chong, Ahmad Dzulfikar Samsudin, Mei, Siang Ma

Archives of Orofacial Sciences, 2016;11(1):1-6.
MyJurnal

Surgical removal of impacted lower wisdom tooth has become increasingly costly to patient while still remains as the most common dental surgical procedure that is performed on outpatient basis. In the present study, a total of 23 patients with impacted lower wisdom tooth were surgically removed under local anaesthesia by using different irrigating solution namely, normal saline, distilled water and chlorhexidine. The samples underwent standard operating procedures and medication. Post operative complications in terms of pain, swelling, infection and delayed wound healing were assessed and compared on Day 1 and Day 7 after surgery. The result of this study showed that there is no significant difference between the three irrigating solution used in surgical removal of impacted lower wisdom tooth in terms of postoperative complication. A bigger scale of research with more samples is recommended to evaluate the most efficacy irrigating solution during surgical removal of impacted lower wisdom tooth.
Study site: Oral surgery clinic, Universiti Sains Islam Malaysia (USIM), Kuala Lumpur, Malaysia

Matched MeSH terms: Wound Healing

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