Wound Repair and Regeneration最新文献

Hard-to-heal arterial leg ulcers in older adults are a challenging and complex condition. In this quasi-experimental study, three treatment approaches were compared. The purpose was to investigate (1) the healing time of arterial leg ulcers in older adults (≥ 70 years) who underwent photobiomodulation, revascularisation, or conservative treatment; (2) the importance of factors associated with impaired healing; and (3) ulcer recurrence after healing with photobiomodulation. Participants who received photobiomodulation (n = 51) were frail older adults recruited from municipal home healthcare and matched with participants who received revascularisation (n = 71) or conservative treatment (n = 153). The latter two groups were retrieved from the Swedish Quality Registry RiksSår for ulcer treatment. Photobiomodulation was performed at wavelengths of 635 and 904 nm twice weekly. The results showed that the photobiomodulation group had a significantly shorter healing time (p < 0.001) and a higher proportion of healed ulcers; photobiomodulation 66.7%, revascularized 50.7% and conservatively treated group 41.2%. The median healing times for the photobiomodulation group were 135 days (confidence interval 95-175), compared to 252 (confidence interval 181-323) and 316 (confidence interval 192-440) in revascularized and conservatively treated groups, respectively. Neither ulcer duration nor other pretreatment factors exerted clinically relevant effects on healing time. In this study, recurrence within 24 months of healing with photobiomodulation was < 12%. In conclusion, photobiomodulation has the potential to heal hard-to-heal arterial ulcers markedly faster than revascularisation or conservative treatment. It could be a suitable treatment alternative for frail older adults, including those with previous substantial ulcer duration.

Skin wound healing is a complex biological process that involves various cell types, molecular signals, and intricate regulatory networks. The specific cellular composition and dynamic characteristics during wound healing remain poorly understood despite their significant importance. Single-cell sequencing (SCS) emerges as a transformative tool in this context, enabling the exploration of cellular heterogeneity, underlying molecular mechanisms, and cell-to-cell interactions in wound healing. This paper reviews advancements in SCS technology and elucidates the critical role of macrophages in the healing process. Macrophages are essential for restoring tissue homeostasis by removing cellular debris, remodelling the extracellular matrix, and secreting key cytokines and growth factors. Importantly, SCS highlights that macrophages exhibit heterogeneity, functional diversity, and dynamic variation throughout the various stages of wound healing. Notably, they can differentiate into rare subtypes, including CD301b⁺ macrophages, monocyte-derived macrophages, and tissue-resident macrophages. Moreover, this review summarises key marker genes identified in SCS-based studies of skin wound healing. Overall, these insights enhance our understanding of the roles of macrophages in wound healing at the single-cell level.

Pressure injuries are a major source of morbidity in critically ill patients, and early recognition is particularly difficult in patients with darker skin tones where erythema may be missed. This prospective study evaluated thermographic imaging with the Wound Scout in 32 patients (40 wound encounters) admitted to the ICU. Abnormal temperature, defined as > ±1.1°C, was significantly associated with deep tissue pressure injury (DTPI) diagnosis, with an odds ratio of 6.1 (95% CI 1.2-36.6), sensitivity of 83% and positive predictive value of 74%. Wound Scout changed the diagnosis in 25% of encounters, most often in sacral wounds where visual inspection is limited. Performance was consistent across Fitzpatrick skin types, supporting its utility in skin of colour. Longitudinal data from a small subset (n = 10) did not show predictive value for progression. Thermography offers an objective, equitable adjunct to clinical assessment that may improve early detection of pressure injuries.

Bullous pemphigoid is the most common autoimmune subepidermal blistering disease. Yet, despite its significant impact on patient morbidity and quality of life, the role of wound care in disease management is not well documented in the literature and there is an overall lack of consensus regarding optimal wound care strategies. This systematic review and meta-analysis aimed to critically appraise the available evidence on wound practices in bullous pemphigoid with the goal of identifying interventions that enhance clinical outcomes, including healing time, infection control, and pain management. A comprehensive literature review was performed on the National Institute of Health (Pubmed), Embase, and Web of Science. Two independent reviewers conducted the screening, with discrepancies resolved by consensus. Of 1087 total articles extracted, five articles met the inclusion criteria. Among them, two studies were eliminated due to their incomplete or terminated status, and three articles were included in this review, assessing ozone liquid dressing (OLD), recombinant human type XVII collagen (RHCXVII), and berberine-based dressings. OLD was associated with faster wound healing, decreased infection rates, and improved pain control. Application of RHCXVII hydrogel led to faster healing, blister regression time, and greater patient satisfaction. A single case of berberine 'stamp therapy' showed symptomatic benefit as a topical adjunct in bullous pemphigoid wound care. These findings highlight the emerging, yet underrepresented, role of wound care in bullous pemphigoid, as well as the need for large-scale, multicentre randomised controlled trials to critically evaluate wound care modalities in its management with the goal of constructing standardized guidelines.

TTAX01/Neox 1K are cryopreserved ultra-thick human amniotic membrane products derived from umbilical cord (cUC) that have been assessed for clinical effectiveness in complex diabetic foot ulcers (DFUs). Herein, a randomised controlled trial was conducted to assess the safety and efficacy of cUC versus standard of care (SOC) for DFUs with exposed bone, tendon, muscle and/or joint capsule and controlled osteomyelitis. A total of 220 eligible patients were enrolled and randomised to receive cUC + SOC (n = 118) or SOC alone (n = 102), which included debridement, bone resection, wound dressings, offloading and a 6-week course of systemic antibiotics. cUC was applied at baseline and reapplied at a minimum of 4-week intervals if healing was stalled throughout a 16-week treatment period, for a maximum of four applications. The mean baseline wound area for the cUC and SOC groups was 5.64 ± 5.5 cm² and 5.30 ± 4.6 cm², respectively. By 26 weeks, 139 patients achieved complete healing in the intent-to-treat population (66.1% cUC group vs. 59.8% SOC group; p = 0.40). An average of 1.67 ± 0.87 applications were required to achieve wound closure in the cUC group. By 50 weeks, 77.1% of patients treated with cUC achieved complete healing compared to 71.6% in the SOC group (p = 0.29). Adverse event rates, i.e., 89.8% and 87.3%, were comparable between cUC and SOC groups. While there were no significant differences in healing rates or adverse events between the two treatment arms at any time point, this study demonstrates that adjunctive cUC is safe and helps achieve a high healing rate at 50 weeks with less than four applications for complex DFUs that are often excluded in clinical trials.

Chronic wound infections pose significant healthcare challenges due to persistent biofilms, antibiotic resistance, and impaired healing pathways. These wounds are characterised by prolonged inflammation, microbial colonisation, and disrupted tissue regeneration, leading to substantial morbidity and healthcare costs. This article reviews current knowledge on chronic wound types, their pathophysiology, and the mechanisms underlying biofilm formation to examine the latest advancements in antimicrobial-based strategies aimed at addressing these challenges. It highlights how diverse materials and technologies have been engineered to improve infection management, enhance tissue regeneration, and overcome the limitations of traditional treatments as well as advances that leverage innovations such as nanotechnology, advanced drug delivery systems, and bioactive components. Furthermore, the review explores how biomaterials can be tailored to interact with the wound microenvironment, mitigating infection risks while accelerating healing. By analysing the strengths and limitations of these emerging strategies, the review provides insights into the future of chronic wound care by integrating infection biology, biofilm dynamics, diagnostic challenges, and biomaterial-based interventions into a unified framework, highlighting the need for interdisciplinary and strategically layered treatment approaches.

Pig skin represents the best analogue for human skin both anatomically and physiologically, with this model used extensively for pre-clinical testing of therapeutics and biomaterials. However, the molecular processes underlying re-epithelialisation in pigs are still not well described compared to murine models. Our objective was to characterise the re-epithelialisation process in porcine full-thickness excisional wounds in Yorkshire pigs. Immunohistochemistry markers for keratinocyte differentiation, activation and oxidative stress were used at 7 days and 28 days post-wounding, and in healthy control skin to characterise protein expression. We show at day 7, re-epithelialisation is associated with reduced cytokeratin 10, E-cadherin and filaggrin and an increase in cytokeratin 14, cytokeratin 16 and cytokeratin 17. At day 28, cytokeratin 16 remained expressed, but cytokeratin 14 only associated with basal keratinocytes and cytokeratin 10 with suprabasal keratinocyte layers. At day 7, both phospho-nuclear factor kappa B and the antioxidant transcription factor nuclear factor-erythroid 2-related factor 2 show nuclear translocation at the wound edge, which is attenuated by day 28. Concomitant with these observations, we show that re-epithelialisation is associated with guanosine oxidation, protein nitration, and lipid peroxidation at both day 7 and 28. Our observations confirm the baseline expression profile of keratinocytes during normal healing of full-thickness excisional wounds in Yorkshire pigs. Characterisation of similar markers in human healing will improve our understanding of the validity of the Yorkshire pig model for use in the testing of therapeutics for impaired skin healing in humans.

Though Traumatic Brain Injury (TBI) and skin trauma often occur together, it is unresolved whether TBI changes the healing of skin wounds. We here explored whether TBI impacts the sequence of events during skin wound healing. Incisional skin wounds from mice subjected to TBI were assessed employing unbiased transcriptome analysis and immunostaining. Transcriptome analysis at day 1 after combined trauma detects a significant enrichment of genes involved in macrophage and T cell recruitment and activation in contrast to skin wounds without TBI. At day 7 after combined trauma, genes in pathways of re-epithelialisation including cornification and keratinisation and of anti-inflammatory responses were highly enriched. These findings were confirmed by immunostaining with increased re-epithelialisation and cornification and an increased number of macrophages and T cells resolving inflammation. Moreover, the number of dermal myofibroblasts is highly increased in skin wounds after combined trauma. Collectively, TBI induces a robust defence response characterised by early onset of enhanced immunity, faster epidermal barrier formation, and myofibroblast-driven acceleration of wound closure, which may together help counteract systemic infection.