Evaluation of a two-stage antibacterial hydrogel dressing for healing in an infected diabetic wound

Abstract

Various types of wound dressings have been used to treat complex infections in diabetes mellitus. This study is the first to evaluate the healing effects using a two-stage dressing in infected diabetic wounds. A two-stage antibacterial hydrogel dressing (two-stage dressing) was established with two time phases, an antibacterial phase and a drug release phase. We established each phase by using a swelling and rate of drug release test. These results suggested that the antimicrobial phase is activated as soon as the two-stage dressing attaches to the skin. The drugs in the drug release layer of the dressing were released to a greater extent than expected 20-36 h after attachment to the skin, likely due to extensive water absorption. Histological analysis and measurement of vascular endothelial growth factor expression through in vivo testing suggested that the benefits of a two-stage dressing include rapid antibacterial properties, sustained drug release, and promotion of wound healing through cell proliferation as compared with the traditional composite antibacterial hydrogel dressing. Further in vivo tests confirmed that separation of the antibacterial and drug-releasing properties, along with biocompatibility and rapid wound closure rates made two-stage dressings suitable for healing of infected wounds. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1808-1817, 2017.

Nanotechnology‐driven advances in the treatment of diabetic wounds

“…It is believed that Ag rarely induces resistance due to the low cytotoxicity. Its safety threshold is wider than many other antimicrobial agents, reducing the risk of harmful side effects to humans [3, 12, 74]. AgNPs can be easily synthesized in various shapes and sizes.…”

“…A two‐stage dressing (two times of antibacterial phase and drug release phase) of CMC, nano‐Ag, polyacrylic acid sodium (PAAS), and Calculus bovis was evaluated on S. aureus ‐infected diabetic wounds and showed a significantly higher wound closure rate. In vivo testing proved the advantages of sustained drug release, rapid antibacterial activity, and improved wound healing by complete closure at day 14 for two‐stage dressing [3].…”

“…According to the World Health Organization, there are currently 422 million people with diabetes (8.5% prevalence among adults), most of them in low and middle‐income countries. 1.6 million deaths each year have made diabetes as one of the most deadly diseases and it is reported to be the 7th cause of death by 2030 [3–5]. Diabetes affects both the health and life quality in patients, with a high risk of developing serious damages to many organs including blood vessels, nerves, and eyes.…”

“…Although most of these dressings have shown good effects in repairing normal wounds, their effect on diabetic wounds should be further investigated. Disadvantages of such dressings include inadequate flexibility and mechanical strength, lack of blood clotting activity, nonbiodegradable nature, and high costs [3, 25]. Considering the mentioned limitations, the development of novel dressings for DFU is still a great challenge.…”

Functional Biomaterials for Treatment of Chronic Wound

“…Drug release experiments showed that the antibacterial phase occurred earlier than the long-duration drug release phase. Thus, the drug-loading system achieved rapid anti-infection, continuous reduction of inflammatory response, and accelerated healing of S. aureus-infected wounds (He et al, 2017).…”