wound healing

Right. Thanks, Daniel. OK, hello, everyone. As you have seen from the title on screen, today we're going to talk about wound dressing, wound uh, another session tomorrow where we talk about exam and anything and everything to do with the course. I'll follow up on there. So today I have Fatima with me. We already know from the course, she has been helping me throughout the semester and you have interacted with. So Fatima is one of our PhD students and she is working on, and she will tell more about her project in addition to patients. So I hand over to Fatima and she should take it from. Alright. Thank you for confirming that, Daniel. So welcome to the lecture on wounded and wound dressings preparation. I have the lightest light is not moving. OK. So in this lecture, we are going to look into the backgrounds of the wound. And before we can talk about the wound by itself, we should understand the structure of the skin because wound is a result of any greed in the integrity of the lining of the skin layers. And we will also look into what's the difference between an acute wound and chronic wounds. And we'll further look into the healing status of bone, which involves chemo status and coagulation. Inflammation, proliferation and remodeling stages and there are various factors that affect the even of these stages of which are classified either as local vectors or systemic vectors. And after that, we will have an overview on the current treatment, both the marketed treatments and also the latest research which is ongoing on the area of phone dressing. And in the end, I would also address about my research, what I am doing in the area of developing a novel formulation. So before we can talk about the research aspects of wound treatments, I would like to give an overview on the statistics around the wound itself. So it's a very big topic and worldwide as well. Or we can talk about the research aspect of. I would like to give an overview on the statistics around the. It's a, so it's a very big topic and uh, worldwide as well, there are a number of people who are actually suffering from this, uh, point itself. So in Australia, different statistics actually report that there are more than 400° thousand patients in Australia who are affected by chronic wounds. And most of these wounds, they are related to diabetic wounds where you can say the diabetes related wounds and among those patients were suffering from these chronic wounds. 23 hours, there is almost 1 Australian who is actually losing their lower limb and 50% of those patients were undergoing through those amputations. They actually end up losing their lives within five years. So you can't actually portrays the significance of this area that how serious this condition is and one of the reasons that why it has been a big problem is attributed towards lack of adequate treatments that are available to treat or directly target. Chronic phones and as a result of that, there is an estimated loss of nearly 2.85 billion Australian dollars annually, which is a result of the failures of those treatments. It's important to understand the structure of the world because whenever we are designing the wound treatments it actually has we have to specify that how deep the wound is and what type of wound is created. So skin is actually one of the largest organ which all of you might be aware of and it is actually designed in a very beautiful way. So it has got two major skin layers which are defined as epidermis and dermis. So the outermost layer is epidermis which you can see on the structure over here. Embedded in the first layer of the skin and this epidermal layer which is keratinized is made-up of five substructures for sub layers and each layer has a different composition and the structure of the cell is also different. Then we have the underlying tissue layers which is classified as thermal layer and the dermal layer is further sub categorized into two layers which is. Earlier and the recognizer and the last layer is of the hypodermis which is composed of those simultaneous tissues so as i said that each one of these layers they vary in terms of the structure and the composition and when we talk about process which is ongoing whenever there is a boot and after the information is over, the refrigeration starts and it takes the next few weeks are actually taken over by the proofation phase and remodeling can take up to months which can result into the formation of a star and the closure or we can say the replacement of the new skin in that area. So inflammation is composed of hemostasis where there is the gathering of the tickets formation of. First of all that there is a lot of that tissue formation which is known as the bone diplomat and the role of macrophages is in again to allow or attract more of the sales wide web sales to fight through the process and then it also. Initial pathogens or those emitting Michael? $0.14 and there's a release of cytokines and protector that for the. Process under proliferation we can see that there is skin servicing which is initiated by creating a site which is a type of sales found in the skin structure. They initiate reapplication and the German restoration which is the restoration of the underlying dermal tissues. It is initiated by endothelial cells that promote angiogenesis and formation of new blood vessels and then fibroblasts again they try to create the fibrin that is a meshwork of the different product vectors and then in. Remodeling phase all of these cells that were linked initial parts in the initial cases of healing, they work together and make sure that there is the construction of the and. Hard is that that would say that there is no more moon in that area. So it's a quite long process, but we're going to look into each one of these stages once again. So as I said, separate stages and regulation. It occurs rapidly as soon as the work is formed. And the different factors that are involved in that base are tickets, which are the initial phase and they initiate plot permission and regulation by releasing the file. I think and the purpose of this phase is actually to prevent excessive fluid loss because as you know whenever there is a formation and they have been satisfied into local vectors or systemic vector. So the local vectors that are included over here are infections 3 radicals, oxygenations, we have moisture content. It can also impair healing process and the weekends which are important, there are different elections, different middle sectors which are important base. But if there is insufficiency of these patients then it is specified as a little factor that can impair here and under system effectives the factors in 2K gender genetics. Because I can start with the information of the radicals. Nutrition again is a systemic factor as well obesity, medications and different diseases that can implement process. So talking about the first factor in under local vectors we have oxygenation. So oxygen is an important for approaching vector for initiation of healing mechanisms. So whenever there is a bone hypoxic conditions are formed or they are found and as a result of that there is a disruption of the local vascular supply and oxygen, what does it do is that it is important for people metabolism and secondly for information because in the presence of oxygen there would be a rabbit for speedy recovery. And as a result of impairment of the optimization process, the bones are not and similarly we have different free radical or the reactical student species that are found in whenever there is a wound and these are classified as super oxides, peroxide and hydroxyl species. And the non radical oxidants which are found which can impair the healing mechanisms are hydrogen peroxide. Therefore it's important that there is a balance between all of these species, the reactive oxygen species. Present the oxygen only that can actually do the repairment or the incision of the mechanism in order manner. Then we have infections. So infections there are a number of microorganisms which are part of carnomic flora and these are residing naturally on our skin. So whenever there is a breach of the lining of the epithelial cells, the organisms which are residing on your skin surface, they get the access to the underlying tissues and cause infection and. Infection is actually generated whenever there is material contamination. They start to grow and from:ies and the system. And the one of the major vector under infections which actually impairs feeling is the formation of the biofilms which is a strong shield which is formed by the bacteria around their around themselves. So whenever their formation of gloomies, the biosphere created by those bacteria which is the. Nobody supplied metrics that were mixed with the data itself from any other treatments we are going to like to the healing area. So as a result of the Commission of the Biosynth introduces or minimizes the FTSE of the antibiotics or the antimicrobial agents we are trying to treat those ones for. So this is considered as a physical protective barrier against the uncritical environment. And another factor that can impair healing is nutrition. So as I mentioned earlier that. Different vitamins and different fingers that are needed for and that are essential for the healing phases. It includes vitamin A, vitamin E, omega-3 fatty acids and. So whenever there's an imbalance between the availability of these different nutrition for nutrients, there's prolonged inflammatory phase, it inhibits the migration of keratinocytes and fibroblasts, the cycle feelings and there is little synthesis and as a result there is reduced formation of blood vessels that can promote process. Now amongst the systemic factors each other is one of the factors that can impair healing mechanisms. So people who are over 60, the natural healing ability of people starts to slow down. And the second factor is that the academic layer is very thin. As you age, there is loss of elastin and collagen in the structure of the skin that can further easily cause information open and other than that the migratory operation. This or those, uh, phases of verification and remoting effort to slow down the reason because there is no inflammatory response for generated suppose of any uh, information. And this further leads to a delayed feeling process. And then the gender and genetics. So males that it has been found that there is delayed feeling uh, process found in terms of acute wounds, whereas in terms of females, there is a release of accident. And these estrogens actually promote the healing mechanism it. Found that it has a positive effect on the migration mechanisms of these five. These are different hormones and genes which are associated with the matrix production through the inhibition of the migration and epidemic function information. There are certain things that are associated with the process of regeneration and the expression of the genes between different ages and different genders is also different that can further impair the release of the estrogen which are responsible for regulating the healing. Stress, stress is related to the relief of, uh, reactive oxygen species. And secondly, whenever there is a destruction in the immune response, there is an equilibrium that is created and this down regulates your immune system. So different means originally and adenylene, these are different neurons which are possible in the release of or they're responsible of those responses whenever there is a information and they allow the healing processes by causing these. So that there is not a lot of integrity permission or lots of like from the site of injury. And they also decrease the revision of the tissues at the side of injury. And then there are different conditions like immunosuppression and chronic diseases that can impair the healing mechanisms because it further lower down or suppresses your immune response. And these include diseases like HIV, cancer or different cardiovascular predecessor and these different immunosuppressions diseases and chronic diseases they further. Oxygenation phase which can further impact the supply of the nutrients through the tissues where is important and different medications that can impair the protein factors are including. And steroids, chemotherapeutic drugs and they inhibit cellular metabolism and also the television process which should be very rapid at the cycle healing, it is also impaired and it also there's more supply presence of oxygen and the supply of matrix at the side of injury. So currently there are a number of different, you know, treatments available for healing mechanisms. They are classified under advanced wound dressings and dimensional. So the dressings include the same clusters, bandages and important food. So the difference between dimension and advanced is that the conventional are not impregnated with any antimicrobial agents or they do not provide extra. Or to the, uh, process. So they only provide a protective layer as an initial primary support to avoid loss of blood from the area of, uh, point. So and they secondly, they don't have good adoption capacity because as you know, whenever there is a Commission of a booth, there's a lot of activate, which is the wound fluid excluded from the cycle injury. So these images, wound dressings, they don't have the capacity to absorb those. So they become easily moistened and it's not a good idea to promote healing. So they only provide a physical barrier. There is they are classified into different modern combinations like fields, hydrochloroids, hydrogels forms, hydro fibers, impregnated pause and antimicrobial agents. So these different. To actually allow the exclusive inequality non exclusive as well. So they provide permission to water vapor and carbon dioxide across the moon from the itself and secondly, because they are impregnated, that means it just does not provide any physical support, but they also provide additional support in maybe and secondly to promote area. So here is a list of different segments that are found in the market. So you can see they are trying to present 10 seconds for each one of these different supplies. So you can see that each one of these products, their function is how much of the food they can be supported with. So they have a particular partial fitness moon and each one of these different primary. In the market they have different application for different type of foods and for full thickness. Again, each type of phones can be subclassified into the level of thickness that is a partial phones or it's a thickness that is caused in the integrity caused in all of the layers of the skin and these type of food that it could be, it could have different levels, it could. It would be likely exhibiting phones or it could be heavily exhibiting. So each type of it has 30° and therefore based on the different types of own depth and levels, we have got different. And we can see their application that for minimum moisture there is deodorant and you do not need any secondary questions to support this dressing. And similarly, if you look into the minimum moisture for the same application, but it's for the full thickness we have for the hydraulic gel. And for this one there there's also a secondary dressing reply, which is named as the tutor. So the second contact with your moon and the secondary doesn't provide a second protection or a second layer on top of that. So for example, if you are using an appointment, yeah, it's kind of an evaluator. So if you are using a boss which is not impregnated with anything, so you need according to wrap it to keep it safe on the cycle so that. So once I think again we are going to look into one of these ones. So we have got the bio depressings which are implemented with factors like both vectors. We have hydrofluoric dressings, one of the most commonly used dressings in the area of healing. We have hydrogels, traditional dressing that we have talked about them as dimensional dressings, foam dressings, LGNA dressings and semi permeable. So this is a pro classification of the so we have to make sure if the moon is not completely dry or it is not only activated. So to ensure that the excess activities that's all we have to make sure that doesn't have the best of good absorption won't changing. Because as you know, whenever there is a formation of a voice, there's a lot of material secreted from the area of wood, especially when there is a bacterial border infection found and there's a lot of tissues. The dead microorganisms and the dead particles as well. So there's a need for changing that area. So those will present to have the capacity to perform good cleaning action as well. Gestures exchange is important for oxygenation and also to promote epithelialization and angiogenesis or information of blood vessels. So a good wound vessel should have this with gaseous exchange capacity then it should definitely provide a protective barrier against the information mediators as well. And then it should also improve the blood flow as well by providing the thermal regulation. So it should be it should have a good thermal insulation and adherence is another important factor in terms of the you have to make sure that it is not too much to the other side of the wound. You know it's very painful area whenever there is enough to stay at the site of the moon rather than sitting there and it will be painful procedure to. Whenever you have to change the dressing and lastly definitely should be false perfected because in terms of because your business change is a lot and you have to make sure it's effective so they can improve the efficacy of application. So traditional dressing, so this is the subcategory of different types of traditional dressings that are found in the market. OK. And in practice, all of these functions have a question that in practice all of these functions are met. So ideally it should. But in fact there's not much because you can actually come up with things which can provide most of these goods in that combined in one. But it's really hard to come up with all of those, but most of them they do and talking about the traditional dressing. So we have, uh, they provide different degree of absorbency. So we have what we will call this link and bandages. So again, they provide the primary protection against the loss of like and uh, the most important issue. They have the best to absorb some of the accidents and they are actually provided over on top of the family boot dressings to make sure those are there staying at or they are in contact with them in itself and processing. Classified under the poster dressings and for antimicrobial agents which you can apply onto the primary dressings can include, but we don't already or see where it's are still in the market and they are considered as traditional. The disadvantage is that they do not provide a lot of exclusion and there's not a lot, a lot of gashes exchange by the use of these traditional systems and they also allow evaporation, which makes that the wound it gets dry instantly. Which is not the political you need some type of moisture present in the area.nutrients. So there is deficiency of nutrients.healing. For these bills are say right they have very thin pills and they have different layers as you can see up it has up here back in here which is exposed on external surface and there is a drug reservoir from where this is the area from where those impregnated drugs are released. And then it it is directly coming through or exposed to the area of you need some moisture so moisture and do different things. So we do not need a lot of activates which include the extras cylinder fluid which is leaked from. Information for representative We don't need that, but we need some moisture that will allow the changes or exchange of the exchange of the gases across the dressing. And secondly, moisture is important as it will allow the, you know, the production phases and allow the cells and the migration phase to stay and promote team. So we do not need completely dry phase because in that area. So yes, we need moisture but not. A lot of mystery and then so these are really important with hypoallergenic acrylic emphasis. So it is as I said is needed so that it can stay on the side of wound and it should be permeable both the water and the gases, particularly for carbon dioxide and oxygen. They are flexible because if it's brittle, it wouldn't stay in the left and the advantage that they provide moisture and also for more Commission under bread from the granular. And the disadvantage is that it's because as I said, it's very thin formulation, so it's very hard to handle. So it's very dedicated. And another thing, it does not absorb accidents a lot. And as a result of that, because actually this thing in the area, so there could be skin maceration because there's a lot of fluid thing staying there, not coming out and just before the bacteria. Let me have the form dressings which you can see in this picture how the form dressing looks like. So it has advantages over the previous present we have talked about. So it is better than the dressings. It has good absorption capacity. It also tries to maintain moist environment at the side of itself and it also provides insulation at the side. Insulation is needed for the angiogenesis phase and it has particular thickness. Thickness is important for maintaining moisture. And the four sides you can see over here. So these different microbores, they allow that option that you do proceed faster. Denby had alternated dressings. So these alternate dressings are composed of calcium salts or the sodium salts of alginate acid. So these different salts, they allow deformation of these gels and the upper needle and their soluble in water. So that's why most likely we use these different sorts of alginate acid and the different forms in which the alginate dressings are found or available, they are in the form of dry oven fiber snacks and sheets which you can see here in the picture. And these dressings that directly interact with the book and the most of the blood itself, they form a protective layer of them or gel from the area of wounds. They maintain occlusion. They don't stick too much to the side of education and they also allow the gaseous exchange and maintain the moisture content as well. So alginate dressings, they are very good selling agents. So whenever the allows the ease of application on the site of information and secondly, the presence of these. Audience also the ions, they also try to help them out the maintain the moisture content in the area of course. So the advantages is ease of application and is ease of changing the person itself. And secondly, they have very good absorption capacity. So whenever you apply an alternate gel, it absorbs in a very nice way and that's why the engineer dressings up a pretty good for negativity. Then we have hydrogel dressing, so hydrogels, we can see how a hydrogel looks like. So these are very strong gels which do not solidize in water. They are amorphous and they are saturated forces and you can also find them in the form of beads. They try to maintain hydration. As you can see that it's kind of a Jelly. This hydrogel, it has a lot of hydration. It provides to the type of injury and allows the exchange. Evaporation as well, they are insoluble so they will not dissolve when they come in contact with them actually so they maintain their structure and different cross linkers are used for the formation of hydrogels. So it could be polyethylene and 70 to 95% of the composition of hydrogen is based on water as a ingredient. The advances are it provides moisture or a moist environment to the healing. It promotes rehabilitation, absorbs moderate accidents. It's not for it's not good for heavily exiting moods as the reason is because it contains a lot of moisture by itself. So it does not have very high absorption capacity. So those type of wounds which release at today's inner moderate quantity for those the hydrogen business are good and the disadvantages are similar to the other some of the other dimensional dressings. It's because as I said, it does not absorb a lot of. Accident and as a result of that if they need to have a lot of water, consensus water is very good media for the bacterial group. So for infected wounds hydrogels are not good and secondly for heavy aggregating wounds it's not application. And then we have hydrochloride living. So these are used for the formation of hydrofluid dressings. These include TMC, carbonate, cellulose, cellulose, gelatin and alginated cells. They can be formed in different shapes and size and in different phones. As you can see different these pictures which are provided on this slide, you can see how you can treat the sizes and shape for the hydrochloride dressings. They vary in their thickness and transparency that further allows the exchange of. And they also have got good phone adoption that the activate adoption capacity and the permission of the moisture and flipper and they also maintain the fluid retention at the cycle injury. And these are some of the basic advantages that hydrochlorothiazines have got over the previous Wednesday and these are the most as well in the area. Then we had bio active dressing. So bio active dressing means that they contained the bio active ingredients such as prospectors and some of the growth expectors. I have already told you earlier that we have epidemic growth sector. We also have data drive growth sector, transforming growth sectors. So these different types of growth factors, they are impregnated in the dressing and that's why they call them as bio active dressings. So their function is actually to deliver these active compounds to the wounds. There are different biopolymers which are used for the delivery of these bio active ingredients. So these include chicosign, LGNS, elastin, hydronic acid and collagen. And you can also use these bio active dressings to deliver proteins as well as different stem cells. And the advantages is that because we are using all these natural biopolymer so they are biocompatible with the wound and they are bio degradable. So you do not have to change the dressing each time so. Itself overtime. So no matter what type of one dressing we are using or we are developing. So each when it comes to the market, we have to make sure that there's certain evaluation criteria which is linked by USB is met. It includes the uniformity of the dosage units. We have to make sure that if it is a bio active containing, so we have to make sure that it is uniformly distributed. Then we have to also ensure the microbial limits for the wound dressing the particle size if again for example. By living, we have been short about the size of those different silver molecules. We have to ensure the responsibility if it is a gel or a hydrogel field addition test because we have seen in terms of our film in particular, you have to make sure it can easily feel open, it can inject and then we have a lead test which is important when you come towards the storage conditions of the. So now those are the things we have talked about about the application of the. But there are different technologies that are also used instead of applying. So these include screen graphing. So in skin graph we remove the section of our healthy skin and we try to transplant that new skin to the cycle. And then we have got different methods or technologies that are used for promoting. Which includes medical glue or a super glue. So on application, it can promote or it can speak the two exposes together. And then there is the sutras. There's another method for promoting healing or to ensure that there is not a lot of injury. And there are different advantages with these different technologies as well. They are biodegradable. So you don't have to remove procedures. Secondly, they are biodegradable. Any response? But they are not impregnated with any active ingredients or they are not suitable for infected wounds, so they only provide a physical protection to the area. So now I would like to talk about my research. So in my PhD I am focusing on the application of pH on healing mechanisms. So pH is one of the very important factor for healing phase. So whenever there is a information the pH of the skin surface, it changes. So normally the normal skin pH or the pH of the epithelial lining is specific which is ranged between somewhere 5.4 to 5.9 but. Of abort, the pH is actually it jumps to the outline pH which is around 8 and above. So my aim is actually to make sure to create other combination which can maintain the pH in the acidic media in the pH rather than keeping it somewhere in the neutral 7.4 pH which is underneath. So other thing is that whenever there is a formation of a chronic pain and there's invasion of the microorganisms again, the pH is jumped to 8:00 and 9:00. Mechanism. So by maintaining a pH of the wound environment, it will first promote the healing. Second, it will also inhibit the invision of the bacteria or the growth of the bacterial organisms at the site of. So for this I'm trying to develop an old formulation which will have the capacity to maintain the pH in the city site. So just summarizing the lecture, so we have talked about how the structure of the skin that what is the composition of the skin is composed of epidemic and Germans and their cell players And what different type of wounds are found that could be either specified as acute and chronic based on the healing places. If it's less than seven days, it's classified as a coupon. More than seven days is called as a chronic wound. Different stages of wounds feeling are found, which includes penicillin. Information for efficient and remodeling and based on the type of food each one of these phases they actually haven't been organized manner. Then we have we talk about different vectors that can impair or promote feelings that have been classified as local and systemic vectors, different things which are available in the market, different research around the traditional and the modern dressings and we talk about the functions of each one of those hydrogen hydrofluidoids or the hydrogen. So thank you everyone for the lecture. If you have any questions, please feel free to ask.

Lecture on Wound Dressing Preparation

Overview of Wounds

Wounds result from a breach in skin integrity.
Skin Structure:
- Epidermis: Outermost layer, keratinized with five sublayers.
- Dermis: Contains two layers (papillary and reticular) and the hypodermis with subcutaneous tissue.

Types of Wounds

Acute Wounds: Heal in less than 7 days.
Chronic Wounds: Heal in more than 7 days.

Healing Stages:

Hemostasis
Inflammation
Proliferation
Remodeling

Factors affecting healing are classified as local (e.g., oxygenation, infections) or systemic (e.g., age, gender, nutrition).

Current Treatments:

Traditional Dressings: Provide a protective barrier but lack active components.
Advanced Dressings: Include hydrocolloids, hydrogels, alginates, and bioactive dressings.
Importance of moisture, gas exchange, and metabolic support in healing.

Statistics (Australia):

Over 400,000 patients with chronic wounds.
23% lose lower limbs; 50% of amputees die within 5 years.
Annual costs due to treatment failures: approximately 2.85 billion AUD.

Fatima’s Research Focus:

Investigating the role of pH in healing; aims to maintain acidic pH to promote healing and inhibit bacterial growth.

Summary:

Understanding skin structure and the healing process is critical for developing effective wound treatments. Questions?