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Wound Healing Dressings and Drug Delivery Systems: A Review

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ABSTRACT

The variety of wound types has resulted in a wide range of wound dressings with new products frequently introduced to target different aspects of the wound healing process. The ideal dressing should achieve rapid healing at reasonable cost with minimal inconvenience to the patient. This article offers a review of the common wound management dressings and emerging technologies for achieving improved wound healing. It also reviews many of the dressings and novel polymers used for the delivery of drugs to acute, chronic and other types of wound. These include hydrocolloids, alginates, hydrogels, polyurethane, collagen, chitosan, pectin and hyaluronic acid. There is also a brief section on the use of biological polymers as tissue engineered scaffolds and skin grafts. Pharmacological agents such as antibiotics, vitamins, minerals, growth factors and other wound healing accelerators that take active part in the healing process are discussed. Direct delivery of these agents to the wound site is desirable, particularly when systemic delivery could cause organ damage due to toxicological concerns associated with the preferred agents. This review concerns the requirement for formulations with improved properties for effective and accurate delivery of the required therapeutic agents. General formulation approaches towards achieving optimum physical properties and controlled delivery characteristics for an active wound healing dosage form are also considered briefly. © 2007 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 97: 2892–2923, 2008

Section snippets

INTRODUCTION

Wound dressings and devices form an important segment of the medical and pharmaceutical wound care market worldwide. In the past, traditional dressings such as natural or synthetic bandages, cotton wool, lint and gauzes all with varying degrees of absorbency were used for the management of wounds. Their primary function was to keep the wound dry by allowing evaporation of wound exudates and preventing entry of harmful bacteria into the wound. It has now been shown however, that having a warm

WOUNDS

A wound can be described as a defect or a break in the skin, resulting from physical or thermal damage or as a result of the presence of an underlying medical or physiological condition. According to the Wound Healing Society, a wound is the result of ‘disruption of normal anatomic structure and function’.3 Based on the nature of the repair process, wounds can be classified as acute or chronic wounds. Acute wounds are usually tissue injuries that heal completely, with minimal scarring, within

WOUND DRESSINGS

Wound dressings have developed over the years from the crude applications of plant herbs, animal fat and honey to tissue engineered scaffolds. Many traditional medicinal plants used in Africa to treat wounds exhibit antibacterial activity.57 The leaves of Guiera senegalensis used in Senegal and Nigeria for treating wounds and inflammatory swelling, show antibacterial and anti radical effects.58 Ghanaian researchers have reported that extracts of Commelina diffusa herb and Spathodea campanulata

MEDICATED DRESSINGS FOR DRUG DELIVERY

The active ingredients used in wound management have evolved alongside the pharmaceutical agents and dressings used to deliver them. The use of topical pharmaceutical agents in the form of solutions, creams and ointments to wound sites have already been described. For example solutions such as thymol and hydrogen peroxide106 used commonly for cleansing and debridement, also possess antiseptic and antibacterial actions.

A new generation of medicated dressings incorporate new chemicals which have

CONTROLLED DRUG DELIVERY TO THE WOUND

Controlled release of drugs to a given target generally involves prolonging the action of the active drug over time by allowing continual release from a polymeric dosage form.193 There is however, little literature on the controlled delivery of drugs from polymeric wound dressings. The use of hydrophilic polymers as controlled release dressings has great promise because of the potential advantages they offer.

PHYSICAL CHARACTERISATION OF WOUND DRESSINGS

The physical properties of all pharmaceutical formulations including wound dressings influence their ultimate performance and contribute to satisfying the desirable properties of dressings (see Tab. 2). The specific property to be characterised will depend on both the type of wound dressing, the nature of the surface to which the dressing will be applied and any secondary dressings that may be involved.56 As for controlled drug delivery from polymeric dressings, there is very little literature

CONCLUDING REMARKS

This review has considered many classes of wound dressings including topical pharmaceutical agents, traditional wound dressings and modern dressings such as hydrocolloids, alginates, hydrogels, polyurethane film and foam and novel biomaterials such as collagen, chitosan and hyaluronic acid used directly or as tissue engineered matrices for skin replacement.

Polymeric dressings designed as vehicles to deliver therapeutic agents directly to the surface of wounds have also been discussed. These

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