Evolution of the Chronic Venous Leg Ulcer Microenvironment and Its Impact on Medical Devices and Wound Care Therapies

Abstract

Studies have reported that the constituents of the wound microenvironment are likely to have critical roles in the degradation and fate of the polymeric matrix and the compounds dissolved in the wound dressing matrix. Thus, chronic wound assessment and the design of effective medical devices and drug products for wound care partly rely on an in-depth understanding of the wound microenvironment. The main aim of this review is to identify and discuss the different stages of chronic wound progression, focusing on the changes in the biochemical composition of the wound microenvironment, with particular attention given to venous leg ulcers (VLUs), as they are one of the most prevalent chronic wound aetiologies. The pathophysiology of venous ulcers is detailed, followed by a thorough review of what is known about the VLU microenvironment and its changes as a function of the evolution of the VLU. Simulating conditions for VLU are then discussed with the view of highlighting potentially relevant simulating media as a function of VLU evolution for a better assessment of biological safety, in particular medical devices intended to be in contact with these wounds.

Cytotoxicity and concentration of silver ions released from dressings in the treatment of infected wounds: a systematic review

“…A better understanding of the wound microenvironment is essential for the creation of innovative wound dressings specifically crafted to enhance the healing process ( 42 ).…”

Advanced Dressings for Chronic Wound Management

“…Diabetic foot ulcers, venous ulcers, and pressure ulcers often present complex challenges when monitoring wound repair. Some advanced smart dressings constitute a closed-loop system for wound management, incorporating sensors for wound biomarkers, microprocessors for translating the wound information, and drug delivery systems …”

“…Smart dressings have the capacity to release therapeutic agents from the formulated preparations such as films, hydrocolloids, hydrofibers, foams, hydrogels, and self-healing hydrogels, minimizing the risk of systemic side effects and ensuring optimal medication concentrations at the affected area. Moreover, incorporation of microprocessors within smart dressing allows dynamic adjustment of drug release based on the wound status, adapting to changing conditions and promoting a more effective healing process …”

“…Some advanced smart dressings constitute a closed-loop system for wound management, incorporating sensors for wound biomarkers, microprocessors for translating the wound information, and drug delivery systems. 104 Embedded biosensors in smart dressings as shown in Figure 4 enable monitoring of various parameters such as temperature, pH levels, and bacterial load, offering healthcare professionals valuable insights into the healing progress of the wound. Smart dressings have the capacity to release therapeutic agents from the formulated preparations such as films, hydrocolloids, hydrofibers, foams, hydrogels, and self-healing hydrogels, minimizing the risk of systemic side effects and ensuring optimal medication concentrations at the affected area.…”

“…Moreover, incorporation of microprocessors within smart dressing allows dynamic adjustment of drug release based on the wound status, adapting to changing conditions and promoting a more effective healing process. 104 5.1. Connectivity Devices for Real-Time Wound Monitoring.…”