New wound healing and wound management strategies including SiRNA delivery, and targeting mRNA molecules and receptors in the wound microenvironment, are emerging. Stem cells isolated from different tissues such as bone marrow, adipose, and umbilical cord Wharton's jelly also have high potential to use in acute and chronic wound healing. In addition, to reduce the enormous costs associated with these materials has pushed new research endeavors to focus on wound and graft environment sensors as a means of decreasing cost and improving care (82).
Best practice for wound care involves regular inspection of the wound site, maintenance of nutritional status and an in-depth analysis of the patient’s history and lifestyle. As the wound progresses through the stages of healing, these requirements change and so should the materials used. In progress is the development of next generation of wound dressings such as smart dressings which look to incorporate biosensors that respond to known biomarkers such as pH or to release growth factors and antimicrobial agents in a controlled manner (45).
Research is also focused on improving dressing materials already in use, such as modifying cotton gauze so that it selectively captures excess neutrophil elastase within a chronic wound. Plant- and animal-derived products for use in modern wound healing strategies are also being explored. Substances known to ancient and indigenous cultures is examined with a modern eye; that is, traditional Chinese herbal formulae F1 and F2 were recently investigated in relation to their traditional use with diabetic ulcers. The plant extracts used in these formulations were found to promote fibroblast viability in vitro and liquorice is being investigated for its ability to assist dermal wound healing. Papaya is another ‘old remedy’ that has undergone scrutiny as a topical treatment for burns and wounds (45).
Extracts of unripe papaya peel and papaya latex are high in antioxidants, exhibit antibacterial properties and have been shown to enhance wound healing in diabetic rodents. As technology and engineering processes become increasingly sophisticated, the development of complex materials on the nano-scale provides dressings such as hydrogels which provide a biologically appropriate treatment for hard to heal wounds and other complex wounds. Another expanding field is the investigation of natural agents such as plant- and animal-derived polymers for use in scaffolds and gels as well as a return to natural antimicrobial agents that were known to ancient cultures such as silver, honey and iodine (45).
