Wound Repair and Regeneration最新文献

Diabetic foot ulcer (DFU) is a kind of refractory wound, with elevated miR-155 impeding the healing process. Platelet-rich fibrin (PRF) enhances tissue regeneration after injury, yet its therapeutic role and mechanisms in DFU remain unclear. The miR-155 levels in wound margin tissues from 20 DFU and 20 non-diabetic patients were compared. Sixty DFU patients meeting the inclusion criteria were divided into the control group (n = 36) and the PRF group (n = 24) after receiving basic treatment. Baseline clinical characteristics and healing progress were analysed between groups. The correlation between miR-155 levels in wound margin tissues and baseline clinical data were analysed, and the independent influencing factors of wound healing were explored by COX regression analysis. The effect of PRF on the miR-155, hypoxia inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF), and vascular density in the wound margin tissue was measured. Elevated miR-155 expression was observed in DFU compared to non-diabetic wounds. The miR-155 levels were positively associated with Wagner grading (R = 0.578). Accelerated wound healing was demonstrated in the PRF group versus controls via Kaplan-Meier analysis. Multivariate Cox regression found that miR-155 (HR = 0.87, 95% CI: 0.79-0.97) and PRF intervention (HR = 3.21, 95% CI: 1.70-6.06) were statistically significant for wound healing time. After 15-day PRF interventions, miR-155 levels were suppressed, while HIF-1α and VEGF expression and vascular density were increased in PRF-treated wound margin tissues. PRF promotes the DFU healing via decreasing miR-155 levels in the wound margin tissue, enhancing the expression of HIF-1α and VEGF, and accelerating angiogenesis. These findings provide new evidence from evidence-based medicine and mechanistic insights for the application of PRF in treating DFU.

Split-thickness skin graft donor site wounds present significant challenges in pain management and healing optimization. This intra-individual comparative study evaluated the efficacy and safety of a novel topical solution containing tranexamic acid, adrenaline and bupivacaine versus standard paraffin-chlorhexidine dressings, with side allocation determined by computer randomisation after graft harvesting. Twelve patients received standardised solution application on one donor site and standard treatment on the contralateral site, with each side's dressing changes performed according to protocol. The treatment group demonstrated significantly lower mean pain scores across all time intervals (1.1 vs. 5.3 at 24 h, p < 0.001). Mean epithelialization rates at Days 10-14 were higher in the treatment group (97.1% vs. 94.8%, p < 0.05), with faster time to complete healing (median 12 vs. 16 days, p = 0.002). No significant hemodynamic changes occurred following solution application, with only one case of transient tachycardia reported. Vancouver Scar Scale scores at eight weeks showed a trend favouring the treatment (3.8 vs. 4.2, p = 0.15), although this difference was not statistically significant. No infections were observed in either group. These findings suggest that this novel topical solution with transparent film dressing effectively reduces pain and accelerates healing in donor site wounds without compromising safety, providing a promising new option for managing these challenging surgical wounds.

Surgical debridement is a common treatment for complex wounds but can present risks for patients. Negative pressure wound therapy with instillation and dwell (NPWTi-d) using reticulated open cell foam dressings with 1 cm holes (ROCF-CC) provides hydromechanical wound cleaning and preparation and can be applied outside the operating room at the bedside. This systematic literature review examined the effectiveness of NPWTi-d with ROCF-CC in removing nonviable tissue and infectious material, promoting granulation tissue, and reducing surgical debridements. A systematic search was conducted utilising PubMed, Embase, and ClinicalTrials.gov to identify studies conducted from 1 January 2015-31 August 2022. Study outcomes related to nonviable tissue, granulation tissue, and debridement were summarised and analysed using descriptive statistics. Twenty-one studies including 178 patients who received NPWTi-d with ROCF-CC were included. Evidence of reduction in necrotic and infected tissue following treatment was observed in 97.9% of wounds across 17 studies. Formation of granulation tissue after NPWTi-d with ROCF-CC was reported in 99.2% of wounds across 14 studies. Over 63% of patients avoided surgical debridements in 8 studies, and a statistically significant decrease in surgical debridements was noted in 2 comparative studies. This systematic review provides real-world evidence demonstrating the effectiveness of NPWTi-d with ROCF-CC in the hydromechanical removal of infectious materials, non-viable tissue, and wound debris; reduction of surgical debridements; and promotion of granulation tissue. Thus, NPWTi-d with ROCF-CC may potentially reduce or eliminate the need for surgical debridement by removing non-viable tissue through hydromechanical action.

Activation of fibroblasts and formation of myofibroblasts are essential for granulation tissue formation following injury. In fibrotic reactions, excessive deposition of ECM by the activated fibroblasts determines scar formation and functional failure. Although these events critically depend on the activity of a plethora of growth factors and cytokines, TGFβ1 is a unique player controlling the immune response and proliferation of many cell types. Different cell types contribute to its release and activation, which is also regulated by the interaction with the ECM and by mechanical forces. The aim of this study was to elaborate whether fibroblast-derived TGFβ1 plays a critical role during these processes. The data demonstrate a dynamic expression of TGFβ1 during tissue repair. Cell-specific ablation of Tgfb1 in fibroblasts revealed that deletion of TGFβ1 attenuates bleomycin-induced skin fibrosis and perturbs maturation of granulation tissue in skin wounds. Absence of fibroblast-derived TGFβ1 induced vascular alterations (less vascular density and branching, haemorrhage) in early wound healing. This was associated with alterations in the formation of stable ECM structure. This can be explained by paracrine regulation of endothelial cells or pericytes by fibroblast-released TGFβ1 and by impaired expression of pro-angiogenic factors in TGFβ1-deficient fibroblasts. Our findings provide novel mechanistic insights into the central role of fibroblast-derived TGFβ1 for early stages of tissue repair and fibrosis in the skin.

Diabetic foot infection (DFI) is a major complication of diabetes, causing significant morbidity and mortality. Host factors and microorganisms in DFI can disrupt healing processes, leading to chronic, non-healing wounds. The aim of this study was to characterise the microbiome of DFIs and contralateral healthy foot skin (CHFS). Thirty-two diabetic patients were enrolled in this study. Samples were obtained from DFIs and CHFS from the same patient. The microbiome was profiled using metagenomic shotgun sequencing. All the samples were polymicrobial, with a predominance of the obligate anaerobes belonging to Bacteroidetes in PEDIS 4. While PEDIS 3 and 2 were dominated by Proteobacteria. CHFS showed similar bacterial composition across all grades of severity, and the most abundant genera detected were Corynebacterium, Staphylococcus, Pseudomonas, and Cutibacterium. The CHFS was more diverse than DFIs in PEDIS 3 and 4. However, DFIs and CHFS in PEDIS 2 present similar diversity. In addition, DFIs of this grade exhibited a high proportion of Corynebacterium as well as CHFS. PCoA analysis demonstrated that the community structure of DFIs was different from that of CHFS, with Prevotella, Bacteroides, and Porphyromonas the main contributors to the clustering. Neighbour-Net analyses revealed that DFIs exhibited lower diversity compared to CHFS and harboured a more homogeneous dominant bacterial community. Our study revealed a high abundance of obligate anaerobes, including Bacteroides, Prevotella, Morganella, and Porphyromonas, in more severe infections; along with a decrease in microbial diversity. Additionally, there was a decrease in the abundance of key bacteria from the normal skin microbiota.

Pressure ulcers pose a significant health challenge, requiring effective management strategies. Nutrition, particularly arginine and glutamine, supports collagen synthesis and tissue repair. This review evaluates the role of enteral glutamine and arginine supplementation on wound healing outcomes, addressing gaps in previous research. A PRISMA-guided systematic search of five databases identified studies published between 2004 and 2024 on adults with pressure ulcers receiving these supplements. Outcomes assessed included healing time, wound size reduction, local infection, recurrence, and pain. A narrative synthesis was performed due to heterogeneity, with bias assessed via Cochrane RoB2 and JBI checklists. Fifteen studies involving 1085 participants were included. Findings indicated a trend toward improved healing with arginine or combined arginine/glutamine supplements, with relative wound size reductions of 18.6% to 98.2% over 2 to 20 weeks. However, inconsistencies were noted, with seven studies showing non-significant or unreported differences in wound size, and six studies with similar issues for healing time. Glutamine was examined only in combination with arginine, limiting insights into its isolated effects. None of the studies reported on recurrence or pain outcomes. While arginine shows potential for enhancing healing, evidence remains inconclusive. Future research should emphasise follow-up until complete wound closure and explore the independent effects of glutamine on wound healing outcomes.

Venous ulcers are among the most common chronic wounds, considerably impacting quality of life and causing substantial economic burden. This study aimed to determine if race and ethnicity are predictors for ulceration among ambulatory patients with venous insufficiency. Physician-reported data were extracted from the National Ambulatory Medical Care Survey (NAMCS) collected between 2014 and 2019. An estimated 42.7 (95% Confidence Interval (CI) 39.9-45.5) million outpatient visits with a diagnosis of venous insufficiency, unspecified chronic wound, or varicose veins were included in the analysis. Patient race and ethnicity were not associated with differences in the likelihood of ulceration. However, venous ulceration was associated with the male sex (Adjusted Odds Ratio (aOR) 2.5; 95% CI 1.2-5.2, p = 0.02) and was more likely among visits with surgical specialties (aOR 5.2; 95% CI 2.1-13.4, p = 0.0005). While prior studies report greater chronic wound treatment rates among non-White racial minority patients, these findings do not demonstrate differences in ambulatory care for venous ulceration within nationally representative data.

This study investigates the potential of wound bed temperature, measured using an IR camera, to aid in the clinical assessment of chronic wounds. The study captured thermal images from 267 patients with chronic wounds (diabetic foot ulcers, pressure ulcers, venous leg ulcers and arterial ulcers) with corresponding photographic images and clinical data. Temperature measurements were extracted from thermal images, focusing on both the centre of the wound and the surrounding periwound skin. Statistical analyses were employed to evaluate the relationship between wound temperature distribution and clinical diagnosis. The results showed a strong correlation between wound centre temperature and the average temperature across the entire wound (R² = 0.977). This indicates that a single-point measurement is representative of the entire wound, simplifying wound temperature assessment. A fair correlation was found between the temperature difference between the wound and periwound and the clinician's assessment of infection status (Pearson coefficient = 0.32). The study concludes that thermal imaging holds promise as a supplementary tool for clinicians in assessing chronic wound status, especially in cases where infection is unclear. It is a low-cost, non-contact, and easy-to-use technique.

This study examines immune and inflammatory responses in draining wound fluid over the course of the early stages of wound healing in patients recovering from spinal fusion surgery. The inflammatory phase of wound healing is essential for setting the stage for successful tissue repair and preventing chronic or poorly healing wounds. Scoliosis can be idiopathic or occur secondary to neuromuscular disorders, which are known to be associated with poor wound healing outcomes. We hypothesised that neuromuscular scoliosis patients would exhibit differences in inflammatory wound healing markers compared to idiopathic scoliosis patients. Comparison of the cellular and cytokine contents of draining wound fluid revealed that several inflammatory cytokines were elevated in the neuromuscular scoliosis patient group compared to idiopathic, whereas the leukocyte contents were the same between groups. This study shows that draining wound fluid is a good source of cellular and soluble biomarkers for acute wound healing and can be used to determine changes in individuals at risk for wound healing complications.