Treating a ‘Silent Pandemic’: More Effective Dressing for Chronic Wounds on the Horizon, Researchers Say

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Millions of patients have chronic wounds, which are hard to treat and can lead to amputation. Now researchers say they have found a better treatment.

A new antibiotic- and silver ion-free dressing that has shown promising results in trials is good news for patients with chronic wounds. Researchers from Australia and the UK recently showed that a new treatment using a plasma-activated hydrogel can effectively kill bacteria, avoiding issues with current treatment methods for non-healing wounds.

Chronic wounds are wounds that fail to heal in an orderly and timely fashion or do not heal within a specific period, usually a month to three months. These wounds, which are at high risk of repeated infections, are frequently found in patients with diabetes.

Statistics estimate that there will be 578 million people with diabetes by 2030—a 36 percent increase from 2020. More than 30 percent of those patients will experience an ulcer at some point, while 60 percent of those ulcers will become infected. When those infections don’t respond to antibiotic treatment, amputation may be necessary.

Wounds may be caused by trauma, such as bumps and scratches, by mechanical impacts like persistent pressure, or by pathologies, such as diabetes or vascular deficits. Chronic wounds are quickly colonized by bacteria, which are also an important factor in their failure to heal. Thus antibiotic therapy is an important part of chronic wound treatment.

The treatment of chronic wounds is a longtime headache for the health care industry. Wound healing is a complex process that involves hemostasis, anti-inflammation, the prevention of regeneration, and remodeling. In the United States, Medicare costs for wound treatments are in the billions of dollars, with surgical wounds and diabetic ulcers being the most expensive to treat.

In addition to cleaning, anti-inflammatories, and often specialized dressings to protect the wound and promote healing, patients may need to undergo the often painful process of debridement—removal of decayed tissue. Other treatments may include compression bandages, hyperbaric oxygen therapy, or skin grafts. In addition, successful treatment of chronic wounds must be accompanied by treatment to regulate glucose in diabetic patients.

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In a collaborative research effort by teams from the University of Sheffield, UK, and the University of South Australia, scientists used a plasma-activated hydrogel to kill harmful bacteria in wounds without using antibiotics and silver ions. Although diabetic foot ulcers were the focus of the study, the technology could be useful for other wounds and chronic infections.
The method used by the study, also known as plasma-activated hydrogel therapy (PAHT), shows promise for controlling serious infections in wounds. The research results were published on Feb. 12 in the journal Advanced Functional Materials.

PAHT, which uses cold plasma ionized gas, has shown encouraging results in previous studies, but researchers faced the challenge of loading hydrogels with sufficient concentrations of reactive oxygen and nitrogen species (RONS) to be effective in clinical use. To meet this challenge, the recent study used a new electrochemical method that enhanced hydrogel activation, resulting in an unprecedented concentration of the hydrogel’s major antibacterial agent, hydrogen peroxide.

In vitro experiments showed that the hydrogel was found to effectively control E. coli and P. aeruginosa, two bacteria frequently found in diabetic foot ulcers. It was mildly effective against the common human pathogen S. aureus.

According to the researchers, it’s not necessary for the plasma-treated hydrogels to directly kill all wound bacteria. It is expected that they will also kill bacteria indirectly by activating immune cells.

One of the major benefits of the plasma-activated hydrogel is that it can be tailored to the phase of healing, the study noted. For example, a hydrogel treated with a higher dose of active agent may be needed initially to control infection but can be replaced with a less potent dose as healing progresses.

The team still needs to validate the new PAHT dressing in vivo. Clinical trials in human patients and live mammals are necessary to ensure that the process is effective and safe for wound treatment, and to evaluate the effects of the environment on treatment.

‘An Urgent Need for Innovation’

The University of Sheffield’s Professor Rob Short, who co-authored the study, told Science Daily: “More than 540 million people are living with diabetes worldwide, of which 30 percent will develop a foot ulcer during their lifetime. This is a neglected global pandemic which is set to increase further in the coming years due to a rise in obesity and lack of exercise.

“There is an urgent need for innovation in wound management and treatment and it is a real privilege to be part of the international team who have been working on this alternative treatment for over 10 years.”

University of South Australia professor Endre Szili, who led the study, noted that two commonly used treatments for chronic wound care—antibiotics and silver-infused dressings—are increasingly problematic due to antibiotic resistance and concerns over silver-induced toxicity.

“Chronic wound infections are a silent pandemic threatening to become a global healthcare crisis,” he said. “It is imperative that we find alternative treatments to antibiotics and silver dressings because when these treatments don’t work, amputations often occur.

“A major advantage of our PAHT technology is that it can be used for treating all wounds. It is an environmentally safe treatment that uses the natural components in air and water to make its active ingredients, which degrade to non-toxic and biocompatible components. The active ingredients could be delivered over a lengthy period, improving treatment,” he said.

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