<i>Aloe vera</i>—Mechanisms of Action, Uses, and Potential Uses in Plastic Surgery and Wound Healing

Aloe vera has been used for centuries for medicinal purposes. Clinical and experimental evidence indicates usefulness for skin moisturization, promoting wound healing, thermal skin injury, frostbite, and ischemic skin insults. Aloe vera has anti-inflammatory, vasodilatory, antimicrobial, and proliferative actions, which have been investigated in various experimental models and in various in vitro studies. This extensive literature review of the properties and actions of Aloe vera finds substantial evidence for the reported and also likely clinical usefulness for Aloe vera in Plastic Surgery and in wound care and wound healing. Though further clinical investigation is warranted, Aloe vera use may likely be indicated in situations where its effects could positively influence outcomes, such as wound healing, flap vascularity, and inflammatory skin pathologies.

Downregulation of Scar Fibroblasts by Antineoplastic Drugs: A Potential Treatment for Fibroproliferative Disorders

The various fibroproliferative disorders affecting humans have in common excess fibroblast activity and persistent overexpression or dysregulated activity of transforming growth factor beta (TGF-β). Cancer has many similar characteristics. Antineoplastic drugs can downregulate fibroblast activity and cytokine growth factors. This study evaluates the effect of six antineoplastic drugs on keloid and Dupuytren’s disease fibroblasts. Keloid, normal scar, Dupuytren’s affected palmar fascia, and normal palmar fascia fibroblasts were grown and seeded into Fibroblast Populated Collagen Lattices (FPCLs). The FPCLs were treated with one of six antineoplastic drugs or left untreated as controls. At 7 days, supernatants were extracted from all FPCLs and assayed for expression of Transforming Growth Factor beta (TGF)-β1 and TGF-β2. All six antineoplastic drugs significantly inhibited FPCL contraction in both fibroproliferative conditions compared with the untreated controls (p β1 and TGF-β2 expression was downregulated in the supernatants of all FPCLs by the drug exposure. Cytotoxicity did not occur in these studies and was not the reason for the results. Although antineoplastic drugs can have significant side effects when given systemically, these results may be minimized when given to small areas involved in fibroproliferative scarring or when given topically or intralesionally. These in vitro results suggest that antineoplastic drugs may have a utility for treating various fibroproliferative disorders and warrant further investigation.

<i>In Vitro</i>Mitigation of Pathogenic Bacteria and Virulence Factors Using a Hydroconductive Dressing

Wound infections can have devastating effects on healing as well as the health of the patient. Complications increase when the pathogens are capable of producing virulence factors and/or are drug resistant. Novel methods are needed to take on the challenges of treating such wounds. Drawtex&reg;?dressing is purported to have hydroconductive properties that allow it to draw away debris and exudate from the wound into the dressing. The goal of this work is to better define these interactions of this experimental dressing with bacteria and virulence factors. Two series of in vitro experiments were performed. First, pieces of experimental dressing were submerged in a series of cultures in flasks and samples of the dressing and cultures were taken over 90 minutes and assayed for bacteria and virulence factor levels. Second, experimental or standard care (control) dressings were placed on selective agar plated with pathogens of interest. Dressings and the agar covered by them were used to quantify bacteria and virulence factors over time. The experimental dressing took up both bacteria and virulence factors to a larger extent than the control dressing. Experimental dressing significantly reduced the load of bacteria and virulence factors in cultures compared to control culture without dressing. Based on the ability of the dressing to take up bacteria and virulence factors in this study, the data point to the potential for this dressing to be similarly effective in reducing or eliminating pathogen from wounds, potentially increasing the chances of successful wound healing.

The Treatment of Partial-Thickness Burns with a Hydroconductive Wound Dressing: Clinical and Mechanistic Effects

Objectives: Edema in partial-thickness burn wounds can decrease tissue perfusion, increase tissue ischemia, and deepen the burn injury. We report the results of a clinical trial comparing the effectiveness of a hydro-conductive dressing to our standard burn dressing at removing edema fluid from partial-thickness burns and present the proposed mechanisms of action of the hydroconductive dressing. Methods: An internally controlled comparison of two wound dressings was performed on 10 patients with non-contiguous partial-thickness burns. Each patient served as his/her own control. One burn was treated with our standard burn dressing and the other with hydroconductive dressing. Dressings were weighed prior to application, removed at 24 and 48 hours, weighed, and new pre-weighed dressings applied. Weight gain of each dressing at 24 and 48 hours was determined. Statistics were applied using the Student’s paired T-test. The VAS pain scale was measured prior to, during, and after each dressing change. Results: At 24 hours, the hydroconductive dressing had increased 85.6% ± 29.3% in weight compared with 61.3% ± 32.7% for the control (P = 0.053). For the second 24 hour period, the respective numbers were statistically significantly different at 59.7% ± 23.4% vs. 34.2% ± 19.1% (P = 0.038). Averaging the weight gain over the two dressing periods demonstrated that the differences were highly statistically significant as the hydroconductive dressing increased in weight by 71.0% ± 20.3% compared with 44.5% ± 17.4% for the gauze dressing (P = 0.005). VAS scores revealed no statistical differences. Mechanisms of action included capillary, hydroconductive, and electrostatic actions. Conclusions: A hydroconductive dressing designed to draw off excessive wound fluid removes more wound edema fluid than standard burn gauze dressings.