The Application of Bilayer Artificial Dermis Combined with VSD Technology in Chronic Wounds

Background: Bilayer artificial dermis promotes wound healing and offers a treatment option for chronic wounds. Aim: Examine the clinical efficacy of bilayer artificial dermis combined with Vacuum Sealing Drainage (VSD) technology in the treatment of chronic wounds. Method: From June 2021 to December 2023, our hospital treated 24 patients with chronic skin tissue wounds on their limbs using a novel tissue engineering product, the bilayer artificial dermis, in combination with VSD technology to repair the wounds. The bilayer artificial dermis protects subcutaneous tissue, blood vessels, nerves, muscles, and tendons, and also promotes the growth of granulation tissue and blood vessels to aid in wound healing when used in conjunction with VSD technology for wound dressing changes in chronic wounds. Results: In this study, 24 cases of chronic wounds with exposed bone or tendon larger than 1.0 cm2 were treated with a bilayer artificial skin combined with VSD dressing after wound debridement. The wounds were not suitable for immediate skin grafting. At 2 - 3 weeks post-treatment, good granulation tissue growth was observed. Subsequent procedures included thick skin grafting or wound dressing changes until complete wound healing. Patients were followed up on average for 3 months (range: 1 - 12 months) post-surgery. Comparative analysis of the appearance, function, skin color, elasticity, and sensation of the healed chronic wounds revealed superior outcomes compared to traditional skin fl repairs, resulting in significantly higher satisfaction levels among patients and their families. Conclusion: The application of bilayer artificial dermis combined with VSD technology for the repair of chronic wounds proves to be a viable method, yielding satisfactory therapeutic effects compared to traditional skin flap procedures.

Study on the effect of Shixiang plaster on the expression of CD31,serum FN,and VEGF in a rat model with chronic wounds

Background:Chronic wounds pose a significant surgical challenge,often requiring traditional treatments with limited efficacy.This study explores the promising impact of Shixiang plaster,a classic Chinese ointment,on wound healing.We investigated the cluster of differentiation 31(CD31)expression,serum fibronectin(FN),and vascular endothelial growth factor(VEGF)levels in SPF rats with induced wounds to elucidate the mechanism behind Shixiang plaster’s effectiveness.We investigated the effect and explored the role of Shixiang plaster on the expression of CD31,serum FN,and VEGF in chronic wounds.Methods:The study involved 36 SPF rats divided into model,rb-bFGF,and Shixiang plaster groups.Penicillin was injected into the rats before modelling for 3 days to prevent infection.The skin was excised 2 cm below the horizontal line of the inferior border of the shoulder bone in the middle of the rat column up to the deep fascial layer and inoculated with a certain concentration of Staphylococcus aureus;the wound was covered aseptically for 3 days.The trauma area of the rats was observed at 3,7,and 14 days,respectively.Histopathology was observed using haematoxylin eosin and Masson staining.CD31 expression was detected using immunohistochemistry staining.FN and VEGF expression was detected using serum ELISA.Statistical analyses were carried out by the method of SPSS.Results:Regarding wound morphology,at 3 days,the recovery area of the Shixiang plaster group was larger than that of the other two groups,at 7 days,the wound healing rate of the Shixiang plaster group was significantly higher,and at 14 days,the wounds of the Shixiang plaster group had been mostly healed,with a healing rate of 98.3%.Haematoxylin eosin staining revealed a large amount of granulation tissue at 3 days in the Shixiang plaster group,and the epidermal scales disappeared at 14 days,with thinner epidermal thickness at 1 lesion and a large reduction in inflammatory cell infiltration.Masson staining showed that at 3,7,and 14 days,blue staining was the most abundant and deeper in the Shixiang plaster group,with richer collagen and a compact tissue matrix.Immunohistochemical testing showed strong positive expression of CD31 in the Shixiang plaster group,with abundant neovascularisation and large official lumens extending towards the surface of the wound.Statistically significant elevated expression of FN at 7 and 14 days was determined by ELISA in the Shixiang plaster group,and VEGF expression was significantly increased at 7 days,but expression had been expressed at a low level at 14 days.Conclusion:Shixiang plaster exhibits remarkable efficacy in healing chronic wounds.The proposed mechanism involves FN’s promotion of angiogenesis and cell proliferation,VEGF’s impact on angiogenesis and inflammation,and CD31’s regulatory role in inhibiting inflammation while promoting angiogenesis.

The Impact of Psychosocial Influences on Chronic Wound Healing

This comprehensive review explores the intricate dynamics between psychosocial factors and chronic wound healing processes, specifically focusing on prevalent conditions such as pressure ulcers, diabetic foot ulcers, and venous leg ulcers. By examining the roles of psychiatric conditions, including depression, anxiety, and post-traumatic stress disorder (PTSD), this paper illuminates how these factors intricately influence wound healing dynamics, including mechanisms of pain perception and inflammatory responses. Furthermore, we evaluate the effectiveness of integrated biopsychosocial interventions, which encompass a holistic approach to wound care, thereby enhancing healing outcomes for dermatology patients. Future studies should focus on investigating the specific psychosocial determinants that significantly influence wound healing, exploring novel therapeutic strategies, and implementing personalized interventions to meet the unique needs of each patient. Such endeavors hold promise in advancing the fields of psychodermatology and wound management, fostering a deeper understanding and application of psychosocial considerations in dermatological care.

Empowerment in chronic wound care——exploring the scope for patient contribution

Objective:In this study,we investigated the concept of empowerment in chronic wound care and propose to facilitate patient control by making use of degrees of freedom(DOF):that is,shaping of everyday wound care tasks initiated by patients and based on their wishes,mostly in terms of patients executing treatment steps,requesting or directing health care professionals to under take changes,or modifications of internal states.Methods:As a first step,we conducted a systematic literature search,followed by an inductive form of qualitative content analysis,which resulted in the identification of 5 dimensions as main elements of empowerment:education and shared decision making,adherence to self-care behaviors,responsibility and control,general call for empowerment,and DOF.However,the latter are noticeably absent in the literature.To investigate patients'freedom in shaping the wound care process,we conducted a second literature search.Results:A number of possibilities for patients to influence the wound care process could be identified,but experimental or clinical evidence about their effects is missing,their variety is limited,and they are only inadequately described.Conclusions:However,DOF should be an indispensable aspect of genuine empowerment,since they allow patients to occupy the role of the agent in the treatment process and give rise to the subjective experience of feeling empowered.Thus,in the third part,we develop a research proposal on how to investigate and include DOF in the clinical practice of wound care.Finally,limitations about implementations are discussed(e.g.,patients being reluctant to overcome their passive role,resulting in frustration for health care professionals).

Research Progress of Continuous Nursing for Patients with Chronic Wounds After Discharge

The research status of continuous nursing of patients with chronic wounds is reviewed.Since the research on continuous nursing of chronic wound patients in China is still in the initial stage,if necessary,learn from foreign experience,improve relevant systems,develop corresponding evaluation tools,actively implement telemedicine,and carry out hospital-community linkage models,etc.to provide high-quality nursing services for patients with chronic wounds.

Role of stem cell therapies in treating chronic wounds:A systematic review

BACKGROUND The impairment of cutaneous wound healing results in chronic,non-healing wounds that are caused by altered wound environment oxygenation,tissue injury,and permissive microbial growth.Current modalities for the treatment of these wounds inadequately address the complex changes involved in chronic wound pathogenesis.Consequently,stem cell therapies have emerged as a potential therapeutic modality to promote cutaneous regeneration through trophic and paracrine activity.AIM To investigate current literature regarding use of stem cell therapies for the clinical treatment of chronic,non-healing wounds.METHODS PubMed,EMBASE,Cochrane Library,Web of Science,and Scopus were queried with combinations of the search terms“mesenchymal stem cells,”“adult stem cells,”“embryonic stem cells,”“erythroid precursor cells,”“stem cell therapies,”and“chronic wounds”in order to find relevant articles published between the years of 2000 and 2019 to review a 20-year experience.Reference lists from the articles were reviewed to identify additional pertinent articles.Retrieved manuscripts(reviews,case reports/series,retrospective/prospective studies,and clinical trials)were evaluated by the authors for their depiction of clinical stem cell therapy use.Data were extracted from the articles using a standardized collection tool.RESULTS A total of 43 articles describing the use of stem cell therapies for the treatment of chronic wounds were included in this review.While stem cell therapies have been explored in in vitro and in vivo applications in the past,recent efforts are geared towards assessing their clinical role.A review of the literature revealed that adipose-derived stem cells,bone marrow-derived stem cells,bone marrowderived mononuclear cells,epidermally-derived mesenchymal stem cells,fibroblast stem cells,keratinocyte stem cells,placental mesenchymal stem cells,and umbilical cord mesenchymal stem cells have all been employed in the treatment of chronic wounds of various etiologies.Most recently,embryonic stem cells have emerged as a novel stem cell therapy with the capacity for multifaceted germ cell layer differentiation.With the capacity for self-renewal and differentiation,stem cells can enrich existing cell populations in chronic wounds in order to overcome barriers impeding the progression of wound healing.Further,stem cell therapies can be utilized to augment cell engraftment,signaling and activity,and resultant patient outcomes.CONCLUSION Assessing observed clinical outcomes,potential for stem cell use,and relevant therapeutic challenges allows wound care stakeholders to make informed decisions regarding optimal treatment approaches for their patients’chronic wounds.

Effectiveness of fire needle combining with moist healing dressing to promote the growth of granulation tissue in chronic wounds:A case report

In this case study,we analyzed the wound-healing process of a patient with a chronic wound who underwent fire needle treatment,and we tracked the coverage of granulation tissue and decrease of slough and exudate.An 85-year-old man had repeated right shoulder and back pain,itching,and skin festering for more than 1.5 years.A fire needle was administered combined with moist dressing once every 5 days to promote wound healing.After six rounds of fire needle treatment,granulation tissue formed over the surface of the wound base,the depth of the wound had become shallow,and the wound area was reduced.No complications occurred during the intervention.Fire needle therapy combined with a moist wound-healing dressing can be an effective alternative approach in managing chronic wounds.

Comparison of Chronic Wound Inpatients and Outpatients’ Diets and Meals Nutrient Content in Taabo Wound Management Unit, Côte d’Ivoire

Chronic and potential non-healing wounds are a great challenge for patients, physicians, and wound care professionals and the health system. A balanced nutrition intake is essential for health as well as a speedy recovery of such wounds. The study objective was to compare chronic wound inpatients supplemented with food nutrient content with outpatients with their usual intake in a cross-sectional study. Patients’ food samples were taken for chemical analyses. The protein, beta-carotene, sodium, magnesium, manganese, and potassium content prove statistically significant differences. Outpatients’ diets are more diversified than inpatients’ diets, and supplementation diet richest in beta-carotene and in protein. Outpatients have better dietary diversity than those who were hospitalized. The result provides insights of supplementary food as critical issues pertaining to chronic wounds management. However, analyzing bioavailability of nutrient on patients’ blood may provide more knowledge in the appropriate integrated wound management.

Case Report of a Chronic Wound Due to Venous Insufficiency Following a Traumatic Arteriovenous Fistula

Chronic lower limb wounds are common. They can be of arterial or venous origin. In this article, we will present a clinical case of a 30-year-old patient with a chronic injury to the right medial malleolus. In his history, we can note a gunshot wound to the right leg. Ultrasonography and CT angiography helped in the diagnosis of traumatic arteriovenous fistula. The patient underwent a fistula embolization which allowed the wound to heal. The clinical presentation, additional examinations and the latest treatment recommendations will be discussed in this article.

Efficacy of lidocaine wet compress combined with red-light irradiation for chronic wounds

BACKGROUND Chronic wounds that fail to progress through normal phases of healing present a significant healthcare burden owing to prolonged treatment and associated costs.Traditional wound care typically involves regular dressing changes,which can be painful.Recent approaches have explored the use of lidocaine to manage pain and red-light irradiation(RLI),known for its anti-inflammatory and cell proliferation effects,to potentially enhance wound healing.AIM To investigate the therapeutic efficacy of lidocaine wet compression(LWC)combined with RLI for chronic wounds.METHODS We enrolled 150 patients with chronic wounds from the Wound and Ostomy Outpatient Clinic of the Second Hospital of Anhui Medical University from April to September 2022.The wounds were treated with dressing changes.The patients were randomly assigned to the control and experimental groups using a random number table and given the same first dressing change(2%LWC for 5 min and routine dressing change).From the second dressing change,in addition to 2%LWC for 5 min and routine dressing change,the experimental group received RLI,whereas the control group continued to receive the same LWC and dressing change.The first and second dressing changes were performed on days 1 and 2,respectively.The third dressing change was performed 3 d after the second change.The frequency of subsequent dressing changes was determined based on wound exudation and pain.Pain during the first three dressing changes was evaluated in both groups.The average number of dressing changes within 28 d and the degree of wound healing on day 28 were also recorded.RESULTS During the initial dressing change,no noticeable differences were observed in the pain levels experienced by the two groups,indicating similar pain tolerance.However,during the second and third dressing changes,the experimental group reported significantly less pain than the control group.Furthermore,over 28 d,the experimental group required fewer dressing changes than the control group.CONCLUSION Notably,the effectiveness of wound healing on the 28th day was significantly higher in the experimental group than that of in the control group.The combination of LWC and RLI was effective in reducing early-stage pain,promoting wound healing,decreasing the frequency of dressing changes,and enhancing patients’overall quality of life with chronic wounds.

Antibacterial Properties of Crateva adansonii (Capparidaceae) on Strains Isolated from Chronic Wounds Diagnosed in the Commune of Ouinhi in 2021

Plants have always been used by people for therapeutic purposes. They are still the main source of therapeutic substances in developing countries. Crateva adansonii, a member of the Capparidaceae family, is a medicinal plant with antibacterial properties used in Benin. The aim of this study was to assess the efficacy of an aqueous extract of C. adansonii on bacterial strains isolated from chronic wounds in the Ouinhi population. To achieve this, the bacterial flora present in chronic wounds was identified using the Ikram method (2014) coupled with the API Remoel One method. The antibacterial properties of the aqueous extract of C. adansonii on the microbial strains isolated were then assessed by determining the Inhibition Diameters (ID), the Minimum Inhibitory Concentrations (MIC) and finally the Minimum Bactericidal Concentrations (MBC). A total of eighty (80) strains were isolated and identified on the basis of morphological, cultural and biochemical characteristics. The species S. Aureus species accounted for the largest proportion (67.5%). Other species such as Listeria sp, Pseudomonas proteus, S. epidermidis and Bacillus cereus, Citrobacter freundii, Steno maltophila;Axin calcoaceticus, E. coli, K. pneumonia, Lem. richardii, Salmonella paratyphi A, Salmonella sp, Shigella sp were determined in variable proportions. At a concentration of 10 mg/ml, only S. aureus was sensitive to contact with the extract. However, at 20 mg/ml, 89% of strains were sensitive and 11% very sensitive. The highly sensitive strains are Salmonella sp and E. coli. The Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) are 20 mg/ml and 40 mg/ml respectively. The MBC/MIC ratio of the aqueous mixture of Crateva adansonii (Capparidaceae) varied from 1.2 to 2, with a bactericidal effect on 100% of the strains tested.

Combined debridement in chronic wounds:A literature review

Wounds debridement is important for healing of chronic wounds. Combined debridement is a new technique to deal with the complex chronic wounds. This review introduces several topical methods of combined debridement according to the various color classifications. Methods include combined sharp and hydrogel debridement, combined ultrasonic and enzymatic debridement, ultrasonic debridement combined with surgical debridement and vacuum aspiration on debridement, and other types of debridement. This article also explores why each combined debridement mentioned above can achieve a good effect.

Depression and anxiety,peripheral blood inflammatory factors,and stress levels on therapeutic outcomes in patients with chronic wounds

BACKGROUND The incidence of chronic wounds is rising due to an aging population and lifestyle changes in our country.In addition,as the disease spectrum evolves,chronic wounds have become common clinical issues that seriously threaten health and impose significant social and economic burdens.AIM To investigate how depression,anxiety,peripheral blood inflammatory factors,and stress levels affect therapeutic outcomes in patients with chronic wounds.METHODS Retrospectively collected clinical data from 110 patients with chronic wounds treated at Changde Hospital,Xiangya School of Medicine,Central South University(The First People’s Hospital of Changde City)between January 2021 and December 2023,categorizing them into effective and ineffective groups based on treatment effects.Differences between both groups were analyzed using univariate analysis,independent risk factors identified via logistic regression,and their predictive value assessed through receiver operating characteristic analysis.RESULTS Following treatment,95 cases were classified as the effective group(cured or improved),while 15 cases with improvement formed the ineffective group.Significant differences between both groups were noted in wound area,infection status,daily bed time,Hamilton Anxiety Rating Scale(HAMA)scores,Hamilton Depression Rating Scale(HAMD)scores,and levels of interleukin-6,tumor necrosis factor-alpha,and superoxide dismutase(P<0.05).Logistic regression analysis identified a wound area≥7 cm^(2),HAMA≥9 scores,and HAMD≥8 scores were independent risk factors for ineffective treatment in patients with chronic wounds(P<0.05).The receiver operating characteristic curve analysis revealed that the area under the curve for ineffective treatment based on wound area,HAMA,and HAMD was 0.767,0.805,and 0.768 respectively.CONCLUSION Wound size,anxiety,and depression are significant factors influencing the therapeutic outcomes in patients with chronic wounds that require careful attention,alongside the development of appropriate strategies.

Antimicrobial hydrogel foam dressing with controlled release of gallium maltolate for infection control in chronic wounds

Effective treatment of infection in chronic wounds is critical to improve patient outcomes and prevent severe complications,including systemic infections,increased morbidity,and amputations.Current treatments,including antibiotic administration and antimicrobial dressings,are challenged by the increasing prevalence of antibiotic resistance and patients’sensitivity to the delivered agents.Previous studies have demonstrated the potential of a new antimicrobial agent,Gallium maltolate(GaM);however,the high burst release from the GaMloaded hydrogel gauze required frequent dressing changes.To address this need,we developed a hydrogel foambased wound dressing with GaM-loaded microspheres for sustained infection control.First,the minimal inhibitory and bactericidal concentrations(MIC and MBC)of GaM against two Staphylococcus aureus strains isolated from chronic wounds were identified.No significant adverse effects of GaM on dermal fibroblasts were shown at the MIC,indicating an acceptable selectivity index.For the sustained release of GaM,electrospraying was employed to fabricate microspheres with different release kinetics.Systematic investigation of loading and microsphere size on release kinetics indicated that the larger microsphere size and lower GaM loading resulted in a sustained GaM release profile over the target 5 days.Evaluation of the GaM-loaded hydrogel dressing demonstrated cytocompatibility and antibacterial activities with a zone of inhibition test.An equine distal limb wound model was developed and utilized to demonstrate the efficacy of GaM-loaded hydrogel foam in vivo.This antimicrobial hydrogel foam dressing displayed the potential to combat methicillin-resistant S.aureus(MRSA)infection with controlled GaM release to improve chronic wound healing.

Blow‑Spun Si_(3)N_(4)‑Incorporated Nanofibrous Dressing with Antibacterial,Anti‑Inflammatory,and Angiogenic Activities for Chronic Wound Treatment

The effective and safe healing of chronic wounds,such as diabetic ulcers,presents a significant clinical challenge due to the adverse microenvironment in the wound that hinders essential processes of wound healing,including angiogenesis,inflammation resolution,and bacterial control.Therefore,there is an urgent demand for the development of safe and cost-effective multifunctional therapeutic dressings.Silicon nitride,with its distinctive antibacterial properties and bioactivities,shows great potential as a promising candidate for the treatment of chronic wounds.In this study,a silicon nitride-incorporated collagen/chitosan nanofibrous dressing(CCS)were successfully fabricated using the solution blow spinning technique(SBS).SBS offers compelling advantages in fabricating uniform nanofibers,resulting in a three-dimensional fluffy nanofibrous scaffold that creates an optimal wound healing environment.This blow-spun nanofibrous dressing exhibits excellent hygroscopicity and breathability,enabling effective absorption of wound exudate.Importantly,the incorporated silicon nitride within the fibers triggers surface chemical reactions in the aqueous environment,leading to the release of bioactive ions that modulate the wound microenvironment.Here,the CCS demonstrated exceptional capabilities in absorbing wound exudate,facilitating water vapor transmission,and displaying remarkable antibacterial properties in vitro and in a rat infected wound model(up to 99.7%,4.5×10^(7)CFU/cm^(2)for Staphylococcus aureus).Furthermore,the CCS exhibited an enhanced wound closure rate,angiogenesis,and anti-inflammatory effects in a rat diabetic wound model,compared to the control group without silicon nitride incorporation.

Chronic intractable nontuberculous mycobacterial-infected wound after acupuncture therapy in the elbow joint:A case report

BACKGROUND Musculoskeletal nontuberculous Mycobacterium(NTM)infections are rare,partic-ularly post-acupuncture therapy,and present diagnostic challenges due to their infrequency and potential severity.Prompt recognition and appropriate manage-ment are crucial for optimal outcomes.NTM-infected wounds involving the joints are difficult to treat,and only a few cases have been reported.CASE SUMMARY We present a case of a chronic intractable NTM-infected wound on the elbow joint that completely healed with conservative wound care and antibiotic treatment.An 81-year-old woman presented with a chronic,ulcerative wound on the right elbow joint where she had undergone repeated acupuncture therapy for chronic intolerable pain.Magnetic resonance imaging revealed synovial thickening,effusion,and subcutaneous cystic lesions.An orthopedic surgeon performed open synovectomy and serial debridement.However,1 month postoperatively,the wound had not healed and became chronic.A wound culture revealed NTM(Mycobacterium abscessus),and the patient was referred to the Department of Plastic and Reconstructive Surgery.Instead of surgical intervention,conservative wound care with intravenous antibiotics was provided,considering the wound status and the patient’s poor general condition.Complete wound healing was achieved in 12 months,with no impact on the range of motion of the elbow joint.CONCLUSION With clinical awareness,musculoskeletal NTM infection can be treated with conservative wound care and appropriate antimicrobial agents.

Recent advances on the association of apoptosis in chronic non healing diabetic wound

Generally, wounds are of two categories, such as chronic and acute. Chronic wounds takes time to heal when compared to the acute wounds. Chronic wounds include vasculitis, non healing ulcer, pyoderma gangrenosum, and diseases that cause ischemia. Chronic wounds are rapidly increasing among the elderly population with dysfunctional valves in their lower extremity deep veins, ulcer, neuropathic foot and pressure ulcers. The process of the healing of wounds has several steps with the involvement of immune cells and several other cell types. There are many evidences supporting the hypothesis that apoptosis of immune cells is involved in the wound healing process by ending inflammatory condition. It is also involved in the resolution of various phases of tissue repair. During final steps of wound healing most of the endothelial cells, macrophagesand myofibroblasts undergo apoptosis or exit from the wound, leaving a mass that contains few cells and consists mostly of collagen and other extracellular matrix proteins to provide strength to the healing tissue. This review discusses the various phases of wound healing both in the chronic and acute wounds especially during diabetes mellitus and thus support the hypothesis that the oxidative stress, apoptosis, connexins and other molecules involved in the regulation of chronic wound healing in diabetes mellitus and gives proper understanding of the mechanisms controlling apoptosis and tissue repair during diabetes and may eventually develop therapeutic modalities to fasten the healing process in diabetic patients.

Role of copper nanoparticles in wound healing for chronic wounds:literature review

Chronic wounds are defined as wounds that fail to proceed through the normal phases of wound healing in an orderly and timely manner.The most common and inevitable impairment to wound healing is the installation of an infection,usually in the case of chronic wounds.Therefore,the objective of the present review was to identify the importance of copper nanoparticles in dressings for wound healing.Nanoparticles such as silver,gold and copper combat infectious processes through the inhibition of protein synthesis,peroxidation of the cell membrane and destroying the nucleic acids of bacteria and viruses.Among bioactive nanoparticles,copper plays a complex role in various cells,it modulates several cytokines and growth factor mechanisms of action and is essentially involved in all stages of the wound healing process.More importantly,copper plays a key role in skin regeneration and angiogenesis and accelerates the healing process through induction of vascular endothelial growth factor(VEGF)and angiogenesis by hypoxia-induced factor-1-alpha(HIF-1α)action where copper enhances HIF-1αexpression and HIF-1αbinding to the critical motifs in the promoter and putative enhancer regions of HIF-1-regulated genes.

Gene-activated dermal equivalents to accelerate healing of diabetic chronic wounds by regulating inflammation and promoting angiogenesis

Diabetic chronic wound,characterized by prolonged inflammation and impaired angiogenesis,has become one of the most serious challenges in clinic and pose a significant healthcare burden worldwide.Although a great variety of wound dressings have been developed,few of encouraged achievements were obtained so far.In this study,the gene-activated strategy was applied to enhance sustained expression of vascular endothelial growth factor(VEGF)and achieve better healing outcomes by regulating inflammation and promoting angiogenesis.The gene-activated bilayer dermal equivalents(Ga-BDEs),which has good biocompatibility,were fabricated by loading the nano-sized complexes of Lipofectamine 2000/plasmid DNA-encoding VEGF into a collagen-chitosan scaffold/silicone membrane bilayer dermal equivalent.The DNA complexes were released in a sustained manner and showed the effective transfection capacities to up-regulate the expression of VEGF in vitro.To overcome cutaneous contraction of rodents and mimic the wound healing mechanisms of the human,a reformative rat model of full-thickness diabetic chronic wound was adopted.Under the treatment of Ga-BDEs,speeding wound healing was observed,which is accompanied by the accelerated infiltration and phenotype shift of macrophages and enhanced angiogenesis in early and late healing phases,respectively.These proved that Ga-BDEs possess the functions of immunomodulation and pro-angiogenesis simultaneously.Subsequently,the better regeneration outcomes,including deposition of oriented collagen and fast reepithelialization,were achieved.All these results indicated that,being different from traditional pro-angiogenic concept,the up-regulated expression of VEGF by Ga-BDEs in a sustained manner shows versatile potentials for promoting the healing of diabetic chronic wounds.

Cellular senescence is a promising target for chronic wounds:a comprehensive review

Chronic wounds include,but are not limited to,radiation ulcers,pressure ulcers,vascular ulcers and diabetic foot ulcers.These chronic wounds can persist for years without healing and severe ulcers may lead to amputation.Unfortunately,the underlying pathologies of refractory chronic wounds are not fully characterized,and new treatments are urgently needed.Recently,increasing evidence has indicated that cell senescence plays an important role in the development of chronic wounds,and preventing cell senescence or removing senescent cells holds promise as a new therapeutic strategy.In this review,we aim to probe these latest findings to promote the understanding of cellular senescence in the pathological process and potential management of chronic wounds.