Antimicrobial Wound Dressing Containing Silver Sulfadiazine With High Biocompatibility: In Vitro Study

Many patients all over the world suffer from acute wounds caused by traumas or burns. In most crucial cases, skin regeneration cannot be promoted spontaneously, and skin grafts are applied as the main treatment. However, this therapy has some drawbacks which motivate researchers to develop wound dressings. In this study, electrospun mats consisting of polycaprolactone (PCL) and polyvinyl alcohol (PVA) incorporated with silver sulfadiazine (SSD) are proposed to be used as antimicrobial wound dressings with the capability of cell seeding. Various amounts of SSD were loaded into PVA nanofibers, and the effects of SSD particles on the morphological characteristics of nanofibers, mechanical behaviors, and physical properties of the mats were studied for the first time. The cellular viability, antimicrobial properties of the scaffolds, and release behavior of silver were also examined. Finally, the best concentration of SSD was determined based on the quality of nanofibers, antibacterial features, and the ability of cellular attachment and proliferation. Fibronectin was also coated to enhance the biocompatibility of the selective scaffold. It was shown that the mats have appropriate mechanical properties with good handling ability in wet environment and also have a hydrophilic surface to adhere to the wound bed. Results indicate that SSD particles increase the fiber diameter and hydrophilic properties, while they weaken the mechanical characteristics of the mats. Furthermore, 5 wt% SSD/PVA was determined as the best concentration of SSD as it results in a desirable fiber quality for the mats with enough antimicrobial properties and acceptable cell proliferation on the surface. Coating fibronectin was also introduced as an effective method to increase the biocompatibility of the scaffolds incorporated with SSD particles.     

Comparison of silver nylon wound dressing and silver sulfadiazine in partial burn wound therapy

The study aims to perform a comparative assessment of two types of burn wound treatment. To do the assessment, patients with partial thickness burn wounds with total body surface area <40% were simple randomised to treat with nanocrystalline silver nylon wound dressing or silver sulfadiazine cream. Efficacy of treatment, use of analgesics, number of wound dressing change, wound infection and final hospitalisation cost were evaluated. The study showed silver nylon wound dressing significantly reduced length of hospital stay, analgesic use, wound infection and inflammation compared with silver sulfadiazine.     

负压封闭引流术联合银离子敷料治疗难愈性烧伤创面的临床效果

的 探究负压封闭引流术联合银离子敷料在难愈性烧伤创面治疗中的应用效果。方法 选择2021年8月-2023年2月京山市人民医院收治的80例难愈性烧伤患者为研究对象,以随机数字表法分为对照组和试验组,每组40例。对照组接受负压封闭引流术（VSD）治疗,试验组接受负压封闭引流术联合银离子敷料治疗,比较两组创面恢复情况、临床指标、疼痛程度、创面分泌物细菌检出率及并发症发生率。结果 试验组创面红期时间、创面愈合时间及敷料维持时间均优于对照组（P＜0.05）;试验组换药次数、住院时间及治疗总费用均优于对照组（P＜0.05）;试验组治疗后VAS评分低于对照组（P＜0.05）;两组治疗后创面分泌物细菌检出率均低于治疗前,且试验组低于对照组（P＜0.05）;试验组并发症发生率为2.50%,低于对照组的15.00%（P＜0.05）。结论 采用负压封闭引流术联合银离子敷料治疗难愈性烧伤创面的效果良好,可有效促进创面愈合,提高敷料使用率,减轻疼痛,同时可降低创面分泌物细菌检出率和并发症发生几率,有利于促进患者快速康复出院,减少治疗费用,减轻患者的经济负担。     

Assessment of the Effectiveness of Silver-Coated Dressing,Chlorhexidine Acetate (0.5%), Citric Acid (3%), and Silver Sulfadiazine (1%) for Topical Antibacterial Effects Against the Multi-Drug Resistant Pseudomonas Aeruginosa Infecting Full-Skin Thickness Burn Wounds on Rats

The aim of this study was to compare the effects of four different topical antimicrobial dressings on a multi-drug resistant Pseudomonas aeruginosa contaminated full-thickness burn wound rat model. A total of 40 adult male Wistar albino rats were used. The control group (group 1), silver sulfadiazine (1%) group 2, chlorhexidine acetate (0.5%) group 3, citric acid (3%) group 4, and silver-coated dressing group 5 were compared to assess the antibacterial effects of a daily application to a 30% full-skin thickness burn wound seeded 10 minutes earlier with 10⁸ CFU (colony forming unit)/0.5 mL of a multi-drug resistant Pseudomonas aeruginosa strain. Five groups (1 control group and 4 treatment groups) were compared. The administration of third-degree burns to all rats was confirmed based on histopathologic data. The tissue cultures from groups 2 and 5 exhibited significant differences compared to those of the other 3 groups, whereas no significant differences were observed between groups 1, 3, and 4. The effectiveness of the treatments was as follows: 1% silver sulfadiazine > silver-coated dressing > 3% citric acid > 0.5% chlorhexidine acetate > control group. Our results supported the efficacy of topical therapy by silver sulfadiazine and silver-coated dressing on infections caused by multi-drug resistant Pseudomonas spp.     

A Prospective Randomized Study to Compare the Effectiveness of Honey Dressing vs. Povidone Iodine Dressing in Chronic Wound Healing

To compare the healing of chronic wounds with honey dressing vs. Povidone iodine dressing in adult subjects with chronic wounds of ≥6 weeks of duration, attending wound care clinic in Surgical Out Patient Department of All India Institute of Medical Sciences, Surgical Out Patient Department of Jai Prakash Narayan Apex Trauma center, New Delhi. Forty five subjects were randomized into two groups i.e., Honey & Povidone iodine dressing group. Dressing was done on alternate day basis for 6 weeks of followup period. Main outcome measure was complete healing at 6 weeks. Wound healing status was assessed at 2 weekly intervals till 6 weeks. Seven out of 22 subjects in honey treated group achieved complete healing as compared to none out of 20 subjects in Povidone iodine treated group. There was a significant decrease in the wound surface area, pain score & increase in comfort score in Honey dressing group in comparison to the Povidone Iodine group at 0.05 level of significance. Honey dressing is highly effective in achieving healing in chronic wounds as compared to Povidone iodine dressing.     

A systematic review of silver-containing dressings and topical silver agents (used with dressings) for burn wounds

Silver preparations are commonly used for burns, but evidence of their effectiveness remains poorly defined. The aim of the study was to evaluate the effectiveness of silver-containing dressings and topical silver for preventing infection and promoting healing in burns wounds through a meta-analysis of the available evidence. The Cochrane Central Register of Controlled Trials and relevant databases were searched. Drug companies and experts in this field were also contacted. Randomised controlled trials (RCTs) of silver dressings or topical silver (used with dressings) compared with non-silver dressings were eligible for inclusion. We identified 14 RCTs involving 877 participants. One small trial of a silver-containing dressing showed significantly better healing time compared to the control [MD -3.6; 95% CI -4.94 to -2.26 for partial thickness burns and MD -3.9; 95% CI -4.54 to -3.26 for superficial burns]. Topical silver showed significantly worse healing time compared to the non-silver group [WMD 3.96; 95% CI 2.41-5.51] and showed no evidence of effectiveness in preventing wounds infection [WMD 2.48; 95% CI 0.39-15.73]. Our review suggests that silver-containing dressings and topical silver were either no better or worse than control dressings in preventing wound infection and promoting healing of burn wounds.     

纳米晶体银敷料治疗烧伤后残余创面的多中心临床研究

目的观察纳米晶体银敷料在治疗烧伤后残余创面、控制感染方面的疗效和安全性, 从而评价其临床应用价值。方法入选患者98例166个残余创面,采用随机、盲法、多中心、阳性平行对照的试验设计。在常规治疗的基础上,试验组(83处创面)参照伤口形状剪切大小合适的纳米晶体银敷料覆盖创面,对照组(83处创面)常规外用磺胺嘧啶银。观察至创面完全愈合或用药20d 时终止试验。比较两组患者创面愈合时间、愈合率及药物抗感染效果。结果试验组创面愈合时间为(12±5)d,较对照组(16±6)d明显缩短(P=0．005<0．01)。治疗总显效率试验组为97．05％, 较对照组的94．17％有升高趋势(P>0．05)。试验组用药后6、12 d累计细菌清除率分别为21．7％、 43．5%,较对照组明显增高(P<0．05)。用药后两组患者均未见明显不良反应。结论纳米晶体银敷料用于治疗烧伤后残余创面疗效确切,并可为进一步促进伤口愈合提供良好的基底。     

新型湿性敷料在高位肛瘘术后创面中的应用

为探讨新型湿性敷料联合应用对促进高位肛瘘术后创面愈合的疗效,将35例高位肛瘘手术患者随机分为治疗组（新型湿性敷料）和对照组（传统方法）,进行创面愈合疗效的比较。结果显示,治疗组在减轻创面疼痛、渗出及创面愈合率方面均明显优于对照组（P〈0．01）。结果表明,新型湿性敷料联合应用在肛瘘术后的创面,能较好地控制局部感染,促进肉芽组织增生,加速上皮生长,并能缩短创面愈合时间,具有临床应用价值。     

软组织扩张术对烧伤整形患者创面愈合情况的影响

目的 探讨烧伤整形患者采用软组织扩张术对创面愈合情况的影响。方法 选取我院2019年 7月-2022年6月收治的30例烧伤整形患者为研究对象,根据随机数字表法分成研究组与对照组,每组15例。 对照组采用复合皮瓣移植术,研究组采用软组织扩张术,比较两组临床疗效、创面愈合情况、疼痛程度、 生命质量、瘢痕修复效果及并发症发生情况。结果 研究组治疗总有效率为93.33%,高于对照组的60.00% （P＜0.05）;研究组创面愈合时间、皮肤血运恢复时间短于对照组（P＜0.05）;两组术后24 h VAS评分均 低于术前,且研究组低于对照组（P＜0.05）;两组术后3个月BSHS-B评分均高于术前,且研究组高于对 照组（P＜0.05）;两组术后3个月外观、质地、弹性评分均高于术前,且研究组高于对照组（P＜0.05）;研 究组并发症总发生率为6.67%,低于对照组的46.67%（P＜0.05）。结论 对烧伤整形患者行软组织扩张术可提 高临床疗效,改善创面愈合情况,缓解疼痛程度,提高生活质量及瘢痕修复效果,减少并发症发生几率。     

Healing,Inflammation, and Fibrosis: Wound Healing: A Comprehensive Review

Wound healing is an intricate, tightly regulated process that is critical to maintaining the barrier function of skin along with preserving all other skin functions. This process can be influenced by a variety of modifiable and nonmodifiable factors. As wound healing takes place in all parts of the human body, this review focuses on cutaneous wound healing and highlights the classical wound healing phases. Alterations in any of these phases can promote chronic wound development and may impede wound healing.     

水胶体敷料在大面积烧伤患者中的应用效果及促进创面愈合机制探讨

目的:分析水胶体敷料在大面积烧伤患者中的应用效果及其促进创面愈合机制。方法:选择笔者医院2018年1月-2019年6月收治的200例大面积烧伤患者,以随机数表法分为采取纱布加压包扎的对照组以及采取水胶体敷料包扎的观察组,各100例,两组均接受Meek植皮术治疗,对两组创面愈合时间、创面细菌定量、炎性细胞因子(C反应蛋白、白介素6、转化生长因子-β1)、血管新生指标(血管内皮生长因子、碱性成纤维细胞生长因子)进行比较。结果:观察组创面愈合时间(19.85±1.15)d,短于对照组(25.50±1.50)d,创面细菌定量(420.25±15.20)cfu/g小于对照组(877.50±15.35)cfu/g,差异有统计学意义(t=29.893、211.667,P均=0.000)。治疗后观察组C反应蛋白(9.25±1.05)mg/L、白介素6(71.10±12.10)ng/L、转化生长因子-β1(9.33±1.17)μg/L,低于对照组(12.11±1.08)mg/L、(84.88±12.82)ng/L、(12.14±1.12)μg/L,差异有统计学意义(t=18.987、77.245、17.349,P均=0.000)。观察组血管内皮生长因子(140.29±1.61)ng/L、碱性成纤维细胞生长因子(88.92±1.18)ng/L,高于对照组(124.38±1.52)ng/L、(79.86±1.24)ng/L,差异有统计学意义(t=71.856、52.929,P均=0.000)。结论:在大面积烧伤患者治疗中水胶体敷料能够通过抑制炎症反应、促进血管新生来促进创面愈合,值得在今后临床治疗工作中推广使用。     

Effects of Oriental Sweet Gum Storax on Porcine Wound Healing

ABSTRACT

Purpose: The objective of the present study was to assess the effects of oriental sweet gum (Liquidambar orientalis Mill.) storax on partial-thickness and full-thickness wounds compared to conventional wound dressings in a porcine model. Methods: Six young Yorkshire pigs were used. Sixteen square excisional wounds measuring 3 × 3 cm were performed per animal. The wounds were allocated to one of the four treatment modalities: storax, hydrocolloid dressing, silver sulfadiazine, and control groups. Partial-thickness wounds were created in two pigs, and tissue samples were harvested on days 4 and 8, respectively. Full-thickness wounds were created in four pigs, and tissue samples were taken on days 4, 8, 14, and 21, respectively. Histologically, all wounds were examined for re-epithelialization and granulation tissue formation. Tissue hydroxyproline content and wound contraction areas were measured. Results: In storax-applied group, there was a greater depth of granulation tissue at 4 and 8 days compared to all other groups (p < .0125), and there was a faster re-epithelialization at 21 days compared to both hydrocolloid dressing and control groups in full-thickness wounds (p < .0125). Tissue hydroxyproline content and wound contraction did not differ significantly between the groups. Conclusion: The results of this study indicate that topical application of storax enhanced both re-epithelialization and granulation tissue formation in full-thickness wounds. Further studies are indicated in this important area of wound healing research to evaluate the clinical efficacy of this storax and search for the mechanisms that explain its effects.     

A comparative study of the in vitro permeation characteristic of sulphadiazine across synthetic membranes and eschar tissue

Infections of burn wounds are the source of significant problems in burn patients. Early excision of eschar tissue is an ideal solution to avoid sepsis. When early excision is not feasible, the application of topical antimicrobial formulations may be used to control burn wound sepsis. An understanding of the barrier properties of eschar tissue is essential for optimal design of topical antimicrobial formulations. To date, little research has been conducted on the permeability of eschar. Silver sulphadiazine (SSD) is the most frequently used topical agent in burn management. In this study, the permeation of sulphadiazine from aqueous saturated solutions of SSD through human full‐thickness burn eschar tissue was studied and compared with permeability through silicone and Carbosil as model membranes. The permeation of sulphadiazine through eschar tissue was significantly higher than that through silicone and Carbosil membranes (P < 0·05). Deconvolution of the data showed that the apparent sulphadiazine diffusion coefficient was much higher in eschar tissue and was comparable to transport through an aqueous protein gel. Further studies on a greater number of compounds are suggested to elucidate the utility of such membranes as predictive models of drug permeability through eschar tissue.     

Comparative study of Silver Sulfadiazine with other materials for healing and infection prevention in burns: A systematic review and meta-analysis

The aim of this systematic review with meta-analysis was to compare the effect of Silver Sulfadiazine (SSD) with other new dressings, with or without silver, on healing and infection prevention in burns. The electronic search was carried out in the electronic databases of Pubmed, ScienceDirect, Lilacs and BVS. The articles included were randomized clinical trials about burn treatment with SSD, which evaluated the healing and infection of burn wounds in humans. The exclusion criteria included articles, editorials and letters published in the form of abstracts, unpublished reports and case series, cross-sectional, observational experimental studies, and the use of sulfadiazine for other types of wounds. The search identified 873 references, and 24 studies were included in accordance with the eligibility criteria. The results showed a statistically favorable difference related to the time of healing for silver dressings (p < 0.0001; MD 3.83; 95% CI 2.03–5.62) and dressings without silver (p < 0.007; MD 2.9; 95% CI 0.81–5.00) in comparison with SSD. The rate of infection showed no difference in the group treated with SSD compared with the group treated with dressings containing silver (p > 0.05). The rate of infection was significantly higher in the SSD group compared with the group treated with dressings without silver (p < 0.005; MD 25.29% and MD 12.97%). Considering the clinical trials conducted up to the present time, the authors concluded that new dressings with and without silver show better results than SSD for wound healing, and burns treated with dressings without silver are less likely to become infected than burns with SSD. No differences between SSD and new silver materials were observed in relation to infection prevention.     

A New Dressing System for Wound in Enhanced-Recovery Total Hip Arthroplasty: A Randomized and Controlled Trial

BackgroundCurrently, there is a paucity of recommendations in regards to dressing selection within the enhanced recovery after surgery protocol. We devised a new dressing system to accelerate the recovery after total hip arthroplasty (THA). We aimed to present our experience with this new dressing system as an adjunct to wound management in THA and to evaluate its performance.MethodsFrom September 2020 to August 2021, we prospectively enrolled 124 patients who underwent a primary THA. The patients were randomly assigned to the intervention (the new dressing system group) or the control (the traditional gauze dressing) group. The primary outcome measures of this study were numbers of dressing changes, postoperative lengths of stay, wound scores including the Stony Brook Scar Evaluation Scale and ASEPSIS scores and wound-related complications. The secondary outcomes include satisfaction scores, dressing-related costs, and pain and functional recovery scores.ResultsThe intervention group numbers of dressing changes and postoperative lengths of stay were significantly less than the control group (P < .001, P < .001). During the one-month follow-up, the Stony Brook Scar Evaluation Scale in the intervention group was significantly better than that in the control group (P < .001). The intervention group satisfaction was significantly higher than that in the control group (P < .001). There were no statistically significant differences between the two groups in terms of dressing-related costs and pain and function scores.ConclusionThe new dressing system could significantly reduce the number of dressing changes and postoperative lengths of stay and increase patient satisfaction scores, which can be an ideal adjunct to wound management in enhanced-recovery THA.     

银离子联合水凝胶敷料对术后感染伤口治疗效果的前瞻性研究

目的研究银离子联合水凝胶敷料和传统敷料对术后感染伤口的治疗作用。方法对我院普外科行手术治疗后伤口发生感染的患者进行前瞻性研究,随机纳入新型敷料组(银离子联合水凝胶)和传统敷料组,收集患者一般基线资料,比较2组的创面愈合率、创面愈合时间及换药费用。结果根据纳入和排除标准,最终新型敷料组纳入42例患者,传统敷料组纳入58例患者,2组患者基线资料一致(P>0.05)。治疗6 d后的创面愈合率新型敷料组明显高于传统敷料组(P<0.05);创面愈合时间新型敷料组明显短于传统敷料组(P<0.05);换药费用2组间比较差异无统计学意义(P>0.05)。结论银离子联合水凝胶敷料具有较好的控制伤口感染、促进伤口的生长及促进伤口愈合的作用。     

复方桐叶烧伤油促进糖尿病足皮肤创面愈合及通过p38 MAPK信号通路调节糖尿病足大鼠皮肤组织AQP3表达

探讨复方桐叶烧伤油通过p38信号通路调节激酶（MAPK）信号通路对糖尿病足大鼠皮肤组织水通道蛋白3表达的影响。方法 选取60只SD大鼠随机分为正常对照组（A组）、糖尿病足溃疡组（B组）、复方桐叶烧伤油组（C组）、复方桐叶烧伤油+S B 2 0 3 5 8 0组（D组）,各15只。B组、C组、D组45只大鼠腹腔注射链脲佐菌素诱导糖尿病后构建糖尿病足溃疡模型;比较各组研究指标。结果 C组创面愈合率显著高于B组,D组创面愈合率显著低于C组（P ＜0.001）;B组、C组、D组组织中TNF -α、I L - 6、CRP水平均显著高于A组,C组组织中TNF -α、I L - 6、CRP水平均显著低于B组,D组组织中TNF-α、IL-6、CRP水平显著高于C组（P ＜0.001）;B组、D组组织中APQ3、p38蛋白表达量均低于A组（P ＜0.001）;C组组织中APQ3表达量低于A组（P ＜0.001）,而p38蛋白表达量显著高于B组,D组APQ3、p38蛋白表达量均极显著低于C组（P ＜0.001）。结论 复方桐叶烧伤油促进糖尿病足皮肤创面愈合,通过激活p38 MAPK信号通路磷酸化上调糖尿病足大鼠皮肤组织中APQ3表达。     

Silver serum levels in burned patients treated with silver sulfadiazine and its toxicity on inflammatory cells

BackgroundSilver sulfadiazine (SSD) has been widely used in burned patients for the prevention of local infections. To be biologically active and exert antimicrobial properties, silver needs to be present in the form of silver ions (Ag¹⁺) that bind to negatively charged proteins, namely, the RNA and DNA in microorganisms. However, previous published studies conducted with SSD in the 1990s reported a high level of silver absorption through damaged skin and noted the potential cytotoxicity of Ag¹⁺ to human cells. SSD toxicity, however, had been described in cell cultures using arbitrary silver concentrations. In the present study, we determined the serum silver levels in burned patients treated with SSD and, taking into account the molar Ag¹⁺ concentrations found in these patients, we evaluated the Ag¹⁺ toxicity effects on inflammatory cells (ROS and cytokine production) in vitro.MethodsTwenty patients with an average burned body surface area of 27.68% were included in this study.ResultsPatients’ Ag¹⁺ serum levels reached up to 558 times those of the unexposed controls. Ag¹⁺ was then added to inflammatory cells in vitro at levels up to 2000 times the level of the control, and there was no effect on the viability of the cells nor on the rate of apoptosis. We observed a decrease in reactive oxygen species production by mononuclear (MN) and polymorphonuclear (PMN) cells, as well as a substantial decrease in cytokines IL-1β, IL-6, IL-8, IL-10, and TNF-α production by leukocytes (MN and PNM).ConclusionThese findings suggest that Ag¹⁺ may contribute to negative outcomes after burns, decreasing the primary defense mechanism (respiratory burst) and altering cytokine production.     

The effects of honey compared to silver sulfadiazine for the treatment of burns: A systematic review of randomized controlled trials

Evidence from animal studies and trials suggests that honey may accelerate wound healing. The objective of this review was to assess the effects of honey compared with silver dressings on the healing of burn wounds. Relevant databases for randomized controlled trials (RCTs) of honey compared with silver sulfadiazine (SSD) were searched. The quality of the selected trials was assessed using the Cochrane Risk of Bias Assessment Tool. The primary endpoints considered were wound healing time and the number of infected wounds rendered sterile. Nine RCTs met the inclusion criteria. Based on moderate quality evidence there was a statistically significant difference between the two groups, favoring honey in healing time (MD ?5.76 days, 95% CI ?8.14 to ?3.39) and the proportions of infected wounds rendered sterile (RR 2.59; 95% CI 1.58–2.88). The available evidence suggests that honey dressings promote better wound healing than silver sulfadiazine for burns.