Bioactive wound dressings for the management of chronic non healing ulcers (CNHU) – A review of clinical and translational studies

Abstract

Chronic non healing ulcers (CNHU) can be designated as a silent pandemic affecting a large segment of the world population. It is estimated that 6% of the global population are afflicted by chronic wounds. The International Diabetes Federation predicts that a lower limb is amputated every 30 s, globally. Moreover, recently the National Institutes of Health's (NIH) Research Portfolio Online Reporting Tool (RePORT) has enlisted wounds as a distinct disease category. Tremendous global health burden associated with CNHU warrants more holistic and integrated material systems for wound management. Recent advancements in tissue engineering and regenerative medicine have led to the emergence of advanced bioactive dressings capable of re-correcting the course in non-healing wounds. In that regard, the mainstay of this comprehensive review focuses on the vast array of emerging bioactive dressings under clinical evaluation, or in regular clinical use. These include cellular and acellular matrix products such as dermal substitutes, amnion grafts, 3D bioprinted constructs and newer bioactive dressings under trial. This review strives to serve as a reference point for the wound care practitioners with an up-to-date understanding of the prevalent bioactive dressings and disruptive technology platforms with major data based clinical trial findings, their material science and clinical efficacy, for incorporation in the chronic wound management regime. The review also highlights that acellular dermal matrices and amnion based bioactive dressings offer faster wound resolution and cost effectiveness in comparison to the established standard of care.