Therapeutic and pro-healing potential of advanced wound dressings loaded with bioactive agents
Abstract
Chronic skin wound infections are inextricably linked with high mortality rates. With the rise in the aging population and the threat of diabetes, obesity and lifestyle-based diseases, the risk incurred from invasive wound pathogens has been ever escalating. Thus, more efficacious wound care management is necessary to cope with such morbid illnesses. A plethora of bioactive agents, such as antibiotics, phytochemicals, essential oils, phages among others, has been exploited to develop wound dressings, raising tremendous interest in their prospective use as wound care products. The present review critically focuses on the therapeutic implications of advanced wound dressings that have assisted in the expansion of regenerative medicine and also discusses the practical concerns that have limited their bench-to-market entry.
Papers of special note have been highlighted as: • of interest; •• of considerable interest
References
- 1. . Understanding the structure and function of the skin. Nurs. Times 99(31), 46–48 (2003).
- 2. . Ramakrishna wound dressings: current advances and future directions. J. Appl. Polym. Sci. 136(27), 47738 (2019).
- 3. . Burn injury. Nat. Rev. Dis. Primers 6, 11 (2020).
- 4. . National programme for prevention of burn injuries. Indian J. Plast. Surg. 43, S6–S10 (2010).
- 5. . The roles of physical therapists in wound management, part II: patient and wound evaluation. J. Am. Col. Certif. Wound Spec. 1(2), 49–50 (2009).
- 6. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 17(6), 763–771 (2009).
- 7. . Human wounds and its burden: an updated compendium of estimates. Adv. Wound Care 8(2), 39–48 (2019).
- 8. . Wound healing: time to look for intelligent, ‘natural’ immunological approaches? BMC Immunol. 18(S1), 23 (2017).
- 9. An economic evaluation of the impact, cost, and medicare policy implications of chronic nonhealing wounds. Value Health 21(1), 27–32 (2018).
- 10. The humanistic and economic burden of chronic wounds: a systematic review. Wound Repair Regen. 27(1), 114–125 (2019).
- 11. . Challenges in the treatment of chronic wounds. Adv. Wound Care 4(9), 560–582 (2015).
- 12. . First Pass Effect. Cynthia Santos StatPearls Publishing Treasure Island, FL (2022).
- 13. . Advances in topical drug-delivery system: micro to nanofibrous structures. J. Nanosci. Nanotechnol. 14(1), 853–867 (2014).
- 14. Element. Topical drug-delivery systems: an overview (2022). www.element.com/nucleus/2022/topical-drug-delivery-systems-overview (Accessed 2 June 2022).
- 15. PM360. A Robust market rich with opportunities: advanced wound dressings (2015). www.pm360online.com/a-robust-market-rich-with-opportunities-advanced-wound-dressings (Accessed 2 June 2022).
- 16. Financeswire.Wound Closure Products Market Share 2018 Industry analysis, growth, and forecast to 2022 (2018). www.financeswire.com/wound-closure-products-market-share-2018-industry-analysis-growth-and-forecast-to-2022 (Accessed 2 June 2022).
- 17. Bisresearch. Global Advanced Wound Care Market–Analysis and Forecast, 2018–2024 (2019). bisresearch.com/industry-report/advanced-wound-care-market.html (Accessed 2 June 2022).
- 18. Mordor Intelligence. India Wound Care Management Market–Growth, Trends, COVID-19 Impact, and Forecasts (2022–2027) (2022). www.mordorintelligence.com/industry-reports/india-wound-care-management-devices-market (Accessed 2 June 2022).
- 19. Cision. India Wound Care Market 2017–2022–Johnson and Johnson Leads the Market (2017). www.prnewswire.com/news-releases/india-wound-care-market-2017-2022—johnson-and-johnson-leads-the-market-300565349.html (Accessed 2 June 2022).
- 20. . Acute cutaneous necrosis: a guide to early diagnosis and treatment. J. Cutan. Med. Surg. 21(5), 425–437 (2017).
- 21. Selection of appropriate wound dressing for various wounds. Front. Bioeng. Biotechnol. 8 (182), (2020).
- 22. . Skin wound-healing process and new emerging technologies for skin wound care and regeneration. Pharmaceutics 12(8), 1–30 (2020). • Highlights the importance of multifactorial wound-healing process.
- 23. . Models of wound healing: an emphasis on clinical studies. Skin Res. Technol. 23(1), 3–12 (2017).
- 24. . The wound-healing process: an overview of the cellular and molecular mechanisms. Int. J. Med. Res. 37(5), 1528–1542 (2009).
- 25. . The wound healing assay revisited: a transport phenomena approach. Chem. Eng. Sci. 160, 200–209 (2017).
- 26. . Disclosure of the culprits: macrophages-versatile regulators of wound healing. Adv. Wound Care 2(7), 357–368 (2013).
- 27. Physiology, granulation tissue. Amandeep Goyal StatPearls Publishing, Treasure Island, FL (2021).
- 28. . Keratinocyte–fibroblast interactions in wound healing. J. Investig. Dermatol. 127(5), 998–1008 (2007).
- 29. . Wound repair and regeneration. Nature 453(7193), 314–321 (2008).
- 30. . Emerging progress on the mechanism and technology in wound repair. Biomed. Pharmacother. 117, 109191 (2019).
- 31. . Skin wound healing: an update on the current knowledge and concepts. Eur. Surg. Res. 58(1–2), 81–94 (2017).
- 32. . Immunology of acute and chronic wound healing. Biomolecules 11(5), 1–25 (2021).
- 33. . Microbial biofilms and chronic wounds. Microorganisms 5(1), 1–15 (2017).
- 34. Healing of chronic wounds: an update of recent developments and future possibilities. Tissue Eng. Part B Rev. 25(5), 429–444 (2019).
- 35. . Development and use of biomaterials as wound healing therapies. Burns Trauma 7, 2 (2019).
- 36. . A dressing history. Int. Wound J. 1(1), 59–77 (2004).
- 37. . Wound dressings: principles and practice. Surgery (Oxford) 32(9), 462–467 (2004).
- 38. . Wound dressings–a review. BioMedicine 5(4), 24–28 (2015).
- 39. . Recent advances in topical wound care. Indian J. Plast. Surg. 45(02), 379–387 (2019).
- 40. . Moist wound healing with occlusive dressings: a clinical focus. Dermatol. Surg. 27(2), 175–181 (2001).
- 41. . Adsorption of serum-derived proteins by primary dressings: implications for dressing adhesion to wounds. J. Wound Care 8(8), 403–406 (1999).
- 42. . Wound healing and antimicrobial effect of active secondary metabolites in chitosan-based wound dressings: a review. Carbohydr. Polym. 233, 1–16 (2020).
- 43. . Physico-mechanical properties of wound dressing material and its biomedical application. J. Mech. Behav. Biomed. Mater. 4(7), 1369–1375 (2011).
- 44. . Modifications of wound dressings with bioactive agents to achieve improved pro-healing properties. Appl. Sci. 11(9), 4114 (2021). •• Presents various bioactive agent-loaded wound dressings.
- 45. . Emerging innovative wound dressings. Ann. Biomed. Eng. 47(3), 659–675 (2018). • Presents various emerging and innovative wound dressings.
- 46. Synthetic polymeric biomaterials for wound healing: a review. Prog. Biomater. 7(1), 1–21 (2018).
- 47. . Wound dressings. StatPearls Publishing, Treasure Island, FL (2022).
- 48. . A review on polymeric hydrogel membranes for wound dressing applications: PVA-based hydrogel dressings. J. Adv. Res. 8(3), 217–233 (2017).
- 49. . Exploring the therapeutic potential of staphylococcal phage formulations: current challenges and applications in phage therapy. J. Appl. Microbiol. 132(5), 3515–3532 (2022).
- 50. . A novel wound dressing consisting of PVA-SA hybrid hydrogel membrane for topical delivery of bacteriophages and antibiotics. Int. J. Pharm. 572, 118779 (2019). • An important research paper based on a novel hydrogel preparation for the delivery of phages.
- 51. . Wound dressings–a review. Biomedicine 5(4), 22 (2015).
- 52. . Preparation and characterization of chitosan/gelatin/PVA hydrogel for wound dressings. Carbohydr. Polym. 146, 427–434 (2016).
- 53. . Hydrocolloid Dressings Promote Granulation Tissue on Exposed Bone. Dermatol. Surg. 39(1), 123–125 (2013).
- 54. . Biomaterials and nanotherapeutics for enhancing skin wound healing. Front. Bioeng. Biotechnol. 4, 1–20 (2016).
- 55. . Choosing a wound dressing based on common wound characteristics. Adv. Wound Care 5(1), 32–41 (2016).
- 56. . Alginate in wound dressings. Pharmaceutics 10(2), 42 (2018).
- 57. . Alginate: properties and biomedical applications. Prog. Polym. Sci. 37(1), 106–126 (2012).
- 58. Chitosan-calcium alginate dressing promotes wound healing: a preliminary study. Wound Repair Regen. 28(3), 326–337 (2019).
- 59. . Silver-containing foam dressings with Safetac: a review of the scientific and clinical data. J. Wound Care 26(Sup6a), S1–S32 (2017).
- 60. . A review on wound dressings with an emphasis on electrospun nanofibrous polymeric bandages. Polym. Adv. Technol. 21(2), 77–95 (2010).
- 61. Biodegradable and biocompatible high elastic chitosan scaffold is cell-friendly both in vitro and in vivo. Oncotarget 8(22), 35583–35591 (2017).
- 62. Enhanced antibacterial and wound healing activities of microporous chitosan-Ag/ZnO composite dressing. Carbohydr. Polym. 156, 460–469 (2017).
- 63. Chitosan-coated liposomes loaded with butyric acid demonstrate anticancer and anti-inflammatory activity in human hepatoma HepG2 cells. Oncol. Rep. 41(3), 1476–1486 (2019).
- 64. Mechanical, barrier and antioxidant properties of chitosan films incorporating cinnamaldehyde. J. Polym. Environ. 26(2), 452–461 (2017).
- 65. . The integrin–collagen connection–a glue for tissue repair? J. Cell Sci. 129(6),653–64 (2016).
- 66. . Keratin-based wound dressings: from waste to wealth. Int. J. Biol. Macromol. 211, 183–197 (2022).
- 67. A novel bilayer wound dressing composed of a dense polyurethane/propolis membrane and a biodegradable polycaprolactone/gelatin nanofibrous scaffold. Sci. Rep. 10(1), 1–15 (2020).
- 68. Photocatalytic quantum dot-armed bacteriophage for combating drug-resistant bacterial infection. Adv. Sci. 9(17), 1–8 (2022).
- 69. Transparent ciprofloxacin-povidone antibiotic films and nanofiber mats as potential skin and wound care dressings. Eur. J. Pharm. Sci. 104, 133–144 (2017).
- 70. . Curcumin incorporation into an oxidized cellulose nanofiber-polyvinyl alcohol hydrogel system promotes wound healing. Mater. Des. 186, 108313 (2020).
- 71. . Antibacterial bi-layered polyvinyl alcohol (PVA)-chitosan blend nanofibrous mat loaded with Azadirachta indica (neem) extract. Int J. Biol. Macromol. 138, 13–20 (2019).
- 72. Synthesis and characterization of PVA/starch hydrogel membranes incorporating essential oils aimed to be used in wound dressing applications. J. Polym. Environ. 29(1), 156–174 (2020).
- 73. . A review of medicinal plant-based bioactive electrospun nano fibrous wound dressings. Mater. Des. 209, 109942 (2021). •• Highlights the importance of plant extracts as effective wound-healing agents.
- 74. . Preparation and characterization of ampicillin-incorporated electrospun polyurethane scaffolds for wound healing and infection control. Polym. Eng. Sci. 55(3), 541–548 (2015).
- 75. Antibacterial activity of chitosan nanofiber meshes with liposomes immobilized releasing gentamicin. Acta Biomater. 18, 196–205 (2015).
- 76. Covalently antibacterial alginate-chitosan hydrogel dressing integrated gelatin microspheres containing tetracycline hydrochloride for wound healing. Mater. Sci. Eng. C Mater. Biol. Appl 70(Pt 1), 287–295 (2017).
- 77. . Construction of silver sulfadiazine loaded chitosan composite sponges as potential wound dressings. Carbohydr. Polym. 157, 1963–1970 (2017).
- 78. . Recent advances on antimicrobial wound dressing: a review. Eur. J. Pharm. Biopharm. 127, 130–141 (2018).
- 79. Bioadhesive and biocompatible films as wound dressing materials based on a novel dendronized chitosan loaded with ciprofloxacin. Carbohydr. Polym. 175, 75–86 (2017).
- 80. . Ciprofloxacin-intercalated layered double hydroxide-in-hybrid films as composite dressings for controlled antimicrobial topical delivery. Mater. Sci. Eng. C Mater. Biol. Appl. 111, 110859 (2020).
- 81. . Poly(N-isopropylacrylamide)/poly(l-lactic acid-co-varepsilon-caprolactone) fibers loaded with ciprofloxacin as wound dressing materials. Mater. Sci. Eng. C Mater. Biol. Appl. 79, 245–254 (2017).
- 82. . Collagen-based wound dressing for doxycycline delivery: in-vivo evaluation in an infected excisional wound model in rats. J. Pharm. Pharmacol. 61(12), 1617–1623 (2009).
- 83. Efficacy of tigecycline for the treatment of complicated skin and soft-tissue infections in real-life clinical practice from five European observational studies. J. Antimicrob. Chemother. 68(Suppl. 2), ii15–24 (2013).
- 84. . Skin and muscle permeating antibacterial nanoparticles for treating Staphylococcus aureus infected wounds. J Biomed. Mater. Res. B Appl. Biomater. 104(4), 797–807 (2016).
- 85. . Anti-staphylococcal activity of injectable nano tigecycline/chitosan-PRP composite hydrogel using Drosophila melanogaster model for infectious wounds. ACS Appl. Mater. Interfaces 8(34), 22074–22083 (2016).
- 86. Synthesis and characterization of a novel controlled release zinc oxide/gentamicin-chitosan composite with potential applications in wounds care. Int. J. Pharm. 463(2), 161–169 (2014).
- 87. . Construction of silver sulfadiazine loaded chitosan composite sponges as potential wound dressings. Carbohydr. Polym. 157, 1963–1970 (2017).
- 88. Silver sulfadiazine loaded chitosan/chondroitin sulfate films for a potential wound dressing application. Mater. Sci. Eng. C Mater. Biol. Appl. 33(2), 588–595 (2013).
- 89. Development of silver sulfadiazine loaded bacterial cellulose/sodium alginate composite films with enhanced antibacterial property. Carbohydr. Polym. 132, 351–358 (2015).
- 90. Silver sulfadiazine nanosuspension-loaded thermosensitive hydrogel as a topical antibacterial agent. Int. J. Nanomed. 14, 289–300 (2019).
- 91. Montmorillonite-chitosan-silver sulfadiazine nanocomposites for topical treatment of chronic skin lesions: in vitro biocompatibility, antibacterial efficacy and gap closure cell motility properties. Carbohydr. Polym. 102, 970–977 (2014).
- 92. Cefuroxime-loaded hydrogels for prevention and treatment of bacterial contamination of open wounds. Int. J. Polym. Sci. 2021, 1–7 (2021).
- 93. . Essential Microbiology. Chapter 17: Antimicrobial Agents John Wiley & Sons (2013).
- 94. . Subinhibitory concentrations of nalidixic acid alter bacterial physiology and induce anthropogenic resistance in a commensal strain of Escherichia coli in vitro. Lett. Appl. Microbiol. 73(5), 623–633 (2021).
- 95. . Natural products in drug discovery: advances and opportunities. Nat. Rev. Drug Discov. 20(3), 200–216 (2021).
- 96. . Antioxidant and antiinflammatory activities of curcumin on diabetes mellitus and its complications. Curr. Pharm. Des. 19(11), 2101–2113 (2013).
- 97. . Designing and fabrication of curcumin loaded PCL/PVA multi-layer nanofibrous electrospun structures as active wound dressing. Prog. Biomater. 6(1–2), 39–48 (2017).
- 98. Production and characterisation of bacterial cellulose hydrogels loaded with curcumin encapsulated in cyclodextrins as wound dressings. Eur. Polym. J. 118, 437–450 (2019).
- 99. Wound healing potential of curcumin cross-linked chitosan/polyvinyl alcohol. Int. J. Biol. Macromol. 140, 871–876 (2019).
- 100. . Designing and fabrication of curcumin loaded PCL/PVA multi-layer nanofibrous electrospun structures as active wound dressing. Prog. Biomater. 6(1–2), 39–48 (2017).
- 101. . Investigation on curcumin nanocomposite for wound dressing. Int. J. Biol. Macromol. 98, 366–378 (2017).
- 102. . Curcumin-loaded electrospun PHBV nanofibers as potential wound-dressing material. J. Drug Deliv. Sci. Technol. 43, 185–193 (2018).
- 103. . Development of biodegradable electrospun gelatin/aloe-vera/poly(ε-caprolactone) hybrid nanofibrous scaffold for application as skin substitutes. Mater. Sci. Eng. C 93, 367–379 (2018).
- 104. . Starch nanoparticle as a vitamin E-TPGS carrier loaded in silk fibroin-poly(vinyl alcohol)-Aloe vera nanofibrous dressing. Colloids Surf. B Biointerfaces 166, 9–16 (2018).
- 105. . Morphology, drug release, antibacterial, cell proliferation, and histology studies of chamomile-loaded wound dressing mats based on electrospun nanofibrous poly(ε-caprolactone)/polystyrene blends. J. Biomed. Mater. Res. Part B Appl. Biomater. 102(5), 977–987 (2014).
- 106. Chitosan/essential oils formulations for potential use as wound dressing: physical and antimicrobial properties. Materials (Basel) 12(14), 1–21 (2019). • Highlights the prospective role of essential oils in wound care.
- 107. . A mini-review of thymol incorporated materials: applications in antibacterial wound dressing. J. Drug Deliv. Sci. Technol. 60, 101904 (2020). • Presents the application of thymol-based dressings as antibacterial agents.
- 108. . Thymol enriched bacterial cellulose hydrogel as effective material for third degree burn wound repair. Int. J. Biol. Macromol. 122, 452–460 (2019).
- 109. . Evaluation of electrospun poly (vinyl alcohol)-based nanofiber mats incorporated with Zataria multiflora essential oil as potential wound dressing. Int. J. Biol. Macromol. 125, 743–750 (2019).
- 110. . Electrospun nanofibrous membranes with essential oils for wound dressing applications. Fibers Polym. 21(5), 999–1012 (2020).
- 111. . Topical application of bacteriophages for treatment of wound infections. Transl. Res. 220, 153–166 (2020).
- 112. . A novel sustained-release matrix based on biodegradable poly(ester amide)s and impregnated with bacteriophages and an antibiotic shows promise in management of infected venous stasis ulcers and other poorly healing wounds. Int. J. Dermatol. 41(7), 453–458 (2002).
- 113. The use of a novel biodegradable preparation capable of the sustained release of bacteriophages and ciprofloxacin, in the complex treatment of multidrug-resistant Staphylococcus aureus-infected local radiation injuries caused by exposure to Sr90. Clin. Exp. Dermatol. 30(1), 23–26 (2005).
- 114. Efficacy of phage cocktail AB-SA01 therapy in diabetic mouse wound infections caused by multidrug-resistant Staphylococcus aureus. BMC Microbiol. 20(1), 1–10(2020).
- 115. . Apitherapeutics and phage-loaded nanofibers as wound dressings with enhanced wound healing and antibacterial activity. Nanomedicine 12(17), 2055–2067 (2017). • Highlights the role of phage-loaded dressings in chronic wound healing.
- 116. Production-scale fibronectin nanofibers promote wound closure and tissue repair in a dermal mouse model. Biomaterials 166, 96–108 (2018).
- 117. Soy protein/cellulose nanofiber scaffolds mimicking skin extracellular matrix for enhanced wound healing. Adv. Healthc. Mater. 7(9), e1701175 (2018).
- 118. . Assessment of chicken-egg membrane as a dressing for wound healing. Adv. Skin Wound Care 29(3), 131–134 (2016).
- 119. In situ functionalized nanobiocomposites dressings of bamboo cellulose nanocrystals and silver nanoparticles for accelerated wound healing. Carbohydr. Polym. 155, 152–162 (2017).
- 120. In vivo diabetic wound healing potential of nanobiocomposites containing bamboo cellulose nanocrystals impregnated with silver nanoparticles. Int. J. Biol. Macromol. 105(Pt 1), 45–55 (2017).
- 121. . Smart bandage with wireless connectivity for optical monitoring of pH. Sens. Actuators B Chem. 246, 455–460 (2017).
- 122. . The pH of the skin surface and its impact on the barrier function. Skin Pharmacol. Physiol. 19(6), 296–302 (2006).
- 123. . Influence of pH on wound-healing: a new perspective for wound-therapy? Arch. Dermatol. Res. 298(9), 413–420 (2007).
- 124. Stretchable Hydrogel Electronics and Devices. Adv. Mater. 28(22), 4497–4505 (2016).
- 125. Prototype development of the intelligent hydrogel wound dressing and its efficacy in the detection of model pathogenic wound biofilms. ACS Appl. Mater. Interfaces 8(24), 14909–14919 (2016).
- 126. . Wound dressing products: a translational investigation from the bench to the market. Engineered Regeneration 3(2), 182–200 (2022).
- 127. . Recent advances in dermal wound healing: biomedical device approaches. Expert Rev. Med. Devices 7(1), 143–154 (2014).
- 128. . Preparation and characterization of ceftazidime loaded electrospun silk fibroin/gelatin mat for wound dressing. Fibers Polym. 17(5), 744–750 (2016).
- 129. . Poly (vinyl alcohol)-alginate physically crosslinked hydrogel membranes for wound dressing applications: characterization and bio-evaluation. Arab J. Chem. 8(1), 38–47 (2015).
- 130. . Development and characterization of cefazolin loaded zinc oxide nanoparticles composite gelatin nanofiber mats for postoperative surgical wounds. Mater. Sci. Eng. C 58, 242–253 (2016).
- 131. . Porous dressings of modified chitosan with poly(2-hydroxyethyl acrylate) for topical wound delivery of levofloxacin. Carbohydr. Polym. 143, 90–99 (2016).
- 132. . Curcumin-loaded electrospun polycaprolactone/montmorillonite nanocomposite: wound dressing application with anti-bacterial and low cell toxicity properties. J. Biomater. Sci. Polym. Ed. 31(2), 169–187 (2020).
- 133. . Honey/chitosan nanofiber wound dressing enriched with allium sativum and cleome droserifolia: enhanced antimicrobial and wound-healing activity. ACS Appl. Mater. Interfaces 8(10), 6379–6390 (2016).
- 134. Antibacterial activity of honey/chitosan nanofibers loaded with capsaicin and gold nanoparticles for wound dressing. Molecules 25(20), 1–16 (2020).
- 135. . Development of chitosan-based hydrogel containing antibiofilm agents for the treatment of Staphylococcus aureus–infected burn wound in mice. AAPS PharmSciTech 21, 43 (2020).
- 136. A hybrid injectable hydrogel from hyperbranched PEG macromer as a stem cell delivery and retention platform for diabetic wound healing. Acta Biomater. 75, 63–74 (2018).
- 137. Generation of two biological wound dressings as a potential delivery system of human adipose-derived mesenchymal stem cells. ASAIO J. 61(6), 718–725 (2015).
- 138. . Wound dressing model of human umbilical cord mesenchymal stem cells-alginates complex promotes skin wound healing by paracrine signaling. Stem Cells Int. 2016, 1–8 (2016).
- 139. A textile dressing for temporal and dosage controlled drug delivery. Adv. Funct. Mater. 27(41), 1702399 (2017).
- 140. Effects of structurally stabilized EGF and bFGF on wound healing in type I and type II diabetic mice. Acta Biomater. 66, 325–334 (2018).
- 141. Multifunctional self-assembled films for rapid hemostat and sustained anti-infective delivery. ACS Biomater. Sci. Eng. 1(3), 148–156 (2015).
- 142. A novel wound dressing based on a Konjac glucomannan/silver nanoparticle composite sponge effectively kills bacteria and accelerates wound healing. Carbohydr. Polym. 183, 70–80 (2018).
- 143. 3M. 3M™ Tegaderm™ Transparent Film Dressing Frame Style 1624W, 2 3/8 in x 2 3/4 in (6cm×7cm) (2022). www.3mindia.in/3M/en_IN/p/d/v000058079/ (Accessed 2 June 2022).
- 144. 3M+KCl .Bioclusive™ Plus Transparent Film Dressing (2020). www.acelity.com/healthcare-professionals/global-product-catalog/catalog/bioclusive-plus-dressing (Accessed 2 June 2022).
- 145. Wound source. Procellera™ Composite Antibacterial Wound Dressing (2021). www.woundsource.com/product/procellera-composite-antibacterial-wound-dressing (Accessed 2 June 2022).
- 146. Wound source. Silverlon® Wound Pad Dressing (2021). www.woundsource.com/product/silverlon-wound-pad-dressing (Accessed 2 June 2022).
- 147. L&R global. Vliwasorb® Pro (2012). www.lohmann-rauscher.com/en/products/wound-care/specialty-wound-care/vliwasorb-pro/ (Accessed 2 June 2022).
- 148. Convatec. Aquacel® Ag Extra™ (2022). www.convatec.co.in/products/pc-wound-burns/dd439fea-a0be-4328-b544-f430ee87f97a#https://www.convatec.co.in/wound-skin/foamlite-dressings/ (Accessed 2 June 2022).
- 149. Convatec. FoamLite™ ConvaTec Dressing (2022). www.convatec.co.in/wound-skin/foamlite-dressings/ (Accessed 2 June 2022).
- 150. Wound source. Lyofoam® Max Polyurethane Foam Sterile Dressing (2021). www.woundsource.com/product/lyofoam-max-polyurethane-foam-sterile-dressing (Accessed 2 June 2022).
- 151. Medical dressings. Hydrosorb Hydrogel Dressings (Hartmann) (2022). https://medicaldressings.co.uk/hydrosorb-hydrogel-dressings-hartmann/ (Accessed 2 June 2022).
- 152. Pearson surgical supply. Sof-Foam® Foam Dressing (2022). www.pearsonsurgical.com/catalog/product.asp?majcatid=79&catid=289&subcatid=2191&pid=18272 (Accessed 2 June 2022).
- 153. Smith+Nephew. Allevyn Ag Advanced Foam Wound Dressings (2016). www.smith-nephew.com/key-products/advanced-wound-management/allevyn/allevyn-gentle-border-ag/ (Accessed 2 June 2022).
- 154. Allegro Medical. Curasorb Calcium Alginate Dressing (2022). www.allegromedical.com/products/curasorb-calcium-alginate-dressing-4-x-4/ (Accessed 2 June 2022).
- 155. Southwest Medical. Tegagel Hydrogel Wound Filler (2022). www.southwestmedical.com/Hydrogels/Tegagel-Hydrogel-Wound-Filler-15gm/2798p (Accessed 2 June 2022).
- 156. Smith+Nephew. ActicoatAntimicrobial Barrier Silver Dressing (2016). www.smith-nephew.com/professional/products/advanced-wound-management/acticoat/ (Accessed 2 June 2022).
- 157. RevMedx. Revolutionizes the treatment of gunshot and knife wounds (2022). www.revmedx.com/xstat/ (Accessed 2 June 2022).