The external microenvironment of healing skin wounds

Kruse, Carla; Nuutila, Kristo; Lee, Cameron C. Y.; Kiwanuka, Elizabeth; Singh, Mansher; Caterson, Edward J.; Eriksson, Elof; Sørensen, Jens Ahm

doi:10.1111/wrr.12303

Cited by 99 publications

(83 citation statements)

References 105 publications

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“…Wound microenvironment plays a major role in the process of wound healing. It is influenced by various external and internal factors that participate in wound pathophysiology . The pH is an important factor that influences wound healing by changing throughout the healing process .…”

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confidence: 99%

“…For this reason, alkaline dressings, with peroxide and bleach, and acidic wound dressings, containing citric acid, boric acid or acetic acid, have been used to treat infected wounds. These treatments aim at affecting pathogens as well as the function of the cells and enzymes in the wound . Although both acidic and alkaline dressings have been used in the clinic, wound pH is not regularly monitored and treated in clinical practice and it is still not completely clear how an increase or decrease in the pH level affect the wound microenvironment and the healing process.…”

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confidence: 99%

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The effect of pH on cell viability, cell migration, cell proliferation, wound closure, and wound reepithelialization: In vitro and in vivo study

Kruse

Singh

Targosinski

et al. 2017

Wound Repair Regeneration

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186

111

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Wound microenvironment plays a major role in the process of wound healing. It contains various external and internal factors that participate in wound pathophysiology. The pH is an important factor that influences wound healing by changing throughout the healing process. Several previous studies have investigated the role of pH in relation to pathogens but studies concentrating on the effects of pH on wound healing itself are inconclusive. The purpose of this study was to comprehensively and in a controlled fashion investigate the effect of pH on wound healing by studying its effect on human primary keratinocyte and fibroblast function in vitro and on wound healing in vivo. In vitro, primary human keratinocytes and fibroblasts were cultured in different levels of pH (5.5-12.5) and the effect on cell viability, proliferation, and migration was studied. A rat full-thickness wound model was used to investigate the effect of pH (5.5-9.5) on wound healing in vivo. The effect of pH on inflammation was monitored by measuring IL-1 α concentrations from wounds and cell cultures exposed to different pH environments. Our results showed that both skin cell types tolerated wide range of pH very well. They further demonstrated that both acidic and alkaline environments decelerated cell migration in comparison to neutral environments and interestingly alkaline conditions significantly enhanced cell proliferation. Results from the in vivo experiments indicated that a prolonged, strongly acidic wound environment prevents both wound closure and reepithelialization while a prolonged alkaline environment did not have any negative impact on wound closure or reepithelialization. Separately, both in vitro and in vivo studies showed that prolonged acidic conditions significantly increased the expression of IL-1 α in fibroblast cultures and in wound fluid, whereas prolonged alkaline conditions did not result in elevated amounts of IL-1 α.

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confidence: 99%

mentioning

confidence: 99%

The effect of pH on cell viability, cell migration, cell proliferation, wound closure, and wound reepithelialization: In vitro and in vivo study

Kruse

Singh

Targosinski

et al. 2017

Wound Repair Regeneration

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186

111

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“…Burn damages the skin and exposes a large portion of tissue to infectious agents in a long time and as a more sustainable source of infection is a suitable place for opportunistic microorganisms to reside, afterwards colonization and bacterial products increase inflammation and infection (3,4). Treatment of wound infections is a challenge due to the biofilms formation and resistance to antibiotics (5). Also, inadequate initial therapy is associated with poor clinical outcomes, longer hospital stays and higher costs (6).…”

Section: Introductionmentioning

confidence: 99%

Phenotypic and Molecular Detection of Metallo-Beta-Lactamase Genes Among Imipenem Resistant Pseudomonas aeruginosa and Acinetobacter baumannii Strains Isolated From Patients with Burn Injuries

Tarashi

Goudarzi

Erfanimanesh

et al. 2016

Arch Clin Infect Dis

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Background: Pseudomonas aeruginosa and Acinetobacter baumannii are the common causes of nosocomial infections especially among patients with burn injuries. Objectives: The current study aimed to determine the frequency of blaIMP, blaVIM, blaDIM, blaAIM, blaGIM and blaNDM genes among P. aeruginosa and A. baumannii strains isolated from patients with burn injuries hospitalized in Shahid Motahari hospital, Tehran, Iran. Methods:The current cross-sectional study evaluated a total of 309 nonduplicate isolates of P. aeruginosa and 189 isolates of A. baumannii collected from different clinical samples of patients with burn injuries in Shahid Motahari hospital in Tehran, Iran, from 2012 to 2015. Antibiotic susceptibility tests were conducted by Kirby-Bauer disc diffusion and broth microdilution methods according to the clinical and laboratory standards institute (CLSI) guidelines. The frequency of metallo-beta-lactamase (MBL) producers was evaluated by the combination disk diffusion test (CDDT). The blaIMP, blaVIM, blaDIM, blaAIM, blaGIM and blaNDM genes were detected by polymerase chain reaction (PCR) and sequencing techniques. Results: The most effective agent against the studied isolates was colistin. By CDDT, it was found that among 278 imipenem resistant P. aeruginosa strains, 178(64.02%) were MBL producers. The blaIMP-1 and blaVIM-1 genes were detected in 30(16.8%) and 52(29.2%) of P. aeruginosa isolates, respectively. Result of 187 imipenem resistance A. baumannii strains showed that 85(45.4%) were MBL producers. The blaOXA-51, blaIMP-1 and blaVIM-1 genes were detected in 187(100%), 10(5.3%) and 34(18.18%) of A. baumannii isolates, respectively. Conclusions: The high prevalence of MBLs-producing P. aeruginosa and A. baumannii strains in the study were one of the major concerns.

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“…Other animal species have also been used as models for wound healing studies, such as mice, rats, and rabbits . Kruse et al have reviewed many animal models to discuss the major role played by the external microenvironment of a wound (temperature, hydration, oxygen content, pH, and microbial load) in the healing process.…”

Section: Discussionmentioning

confidence: 99%

In vivo methods to evaluate a new skin protectant for loss of skin integrity

Been¹,

Bernatchez²,

Conrad‐Vlasak³

et al. 2016

Wound Repair Regeneration

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A new skin protectant was developed for use on conditions involving partial-thickness skin loss such as severe incontinence-associated dermatitis. This new formulation is based on a cyanoacrylate chemistry designed to polymerize in situ and create a breathable film able to protect the skin surface from external irritants. This film provides an environment favorable for healing to occur beneath the film. To evaluate the characteristics of the novel chemistry, we devised a preclinical testing strategy comprising three different animal models. The data from all three models was considered collectively to create an overall assessment of effectiveness. A guinea pig model was used to evaluate the barrier efficacy of the new product in protecting intact skin from irritation. A porcine partial-thickness wound model was used to evaluate the efficacy of the product in helping control minor bleeding and exudate. A similar model was also used to assess the process of reepithelialization in the continued presence of an irritant. In the first model, untreated sites had 8.5 times more irritation than sites covered with the new product (p < 0.001). In the second model, a single application of the new product successfully attached to intact peri-wound skin and to denuded, weepy skin. It significantly reduced the amount of fluid weeping from the wounds (p 0.001) and continued to perform throughout a 96 hours experiment. In the third model, the percent of reepithelialization was significantly greater for the wounds covered with the new product than for the control wounds (p 5 0.003; on average, 18.3% greater, with a 95% confidence interval of 9.2% to 27.5%). These results suggest that the new skin protectant protects intact and denuded skin from irritants and provides an environment favorable to healing, offering promise for the management of various conditions involving loss of epidermis. Wound healing is a complex biological process with several steps involved to restore skin integrity (hemostasis, inflammation, granulation tissue formation, and remodel-ing). The biological events involved and how they can be modulated using current knowledge and technology have been recently reviewed by Wong et al. 1 The context of the wound impacts the sequence of events that will follow and the successful resolution of the wound. A variety of products are available to manage wounds. Dressings are typically used for acute (surgical or traumatic) and chronic wounds (recently reviewed by Sood et al. 2); however, severe skin damage such as that seen in incontinence-associated dermatitis (IAD) requires a different approach due to the location on the body and the necessity for frequent cleaning caused by incontinence episodes. In mild cases of IAD (skin is red and macerated but epidermis is still present), barrier films can be used. These products are applied as liquids, either in a spray formulation, a wipe, or a wand applicator, and polymerize to form a film in situ and protect the skin. In severe cases of IAD, however , the epidermis is breached...

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The external microenvironment of healing skin wounds

Cited by 99 publications

References 105 publications

The effect of pH on cell viability, cell migration, cell proliferation, wound closure, and wound reepithelialization: In vitro and in vivo study

The effect of pH on cell viability, cell migration, cell proliferation, wound closure, and wound reepithelialization: In vitro and in vivo study

Phenotypic and Molecular Detection of Metallo-Beta-Lactamase Genes Among Imipenem Resistant Pseudomonas aeruginosa and Acinetobacter baumannii Strains Isolated From Patients with Burn Injuries

In vivo methods to evaluate a new skin protectant for loss of skin integrity

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