Polyhexanide-Releasing Membranes for Antimicrobial Wound Dressings: A Critical Review

Abstract

The prevalence of chronic, non-healing skin wounds in the general population, most notably diabetic foot ulcers, venous leg ulcers and pressure ulcers, is approximately 2% and is expected to increase, driven mostly by the aging population and the steady rise in obesity and diabetes. Non-healing wounds often become infected, increasing the risk of life-threatening complications, which poses a significant socioeconomic burden. Aiming at the improved management of infected wounds, a variety of wound dressings that incorporate antimicrobials (AMDs), namely polyhexanide (poly(hexamethylene biguanide); PHMB), have been introduced in the wound-care market. However, many wound-care professionals agree that none of these wound dressings show comprehensive or optimal antimicrobial activity. This manuscript summarizes and discusses studies on PHMB-releasing membranes (PRMs) for wound dressings, detailing their preparation, physical properties that are relevant to the context of AMDs, drug loading and release, antibacterial activity, biocompatibility, wound-healing capacity, and clinical trials conducted. Some of these PRMs were able to improve wound healing in in vivo models, with no associated cytotoxicity, but significant differences in study design make it difficult to compare overall efficacies. It is hoped that this review, which includes, whenever available, international standards for testing AMDs, will provide a framework for future studies.

Alginate-Based Materials Loaded with Nanoparticles in Wound Healing

“…Direct use of such agents as hydrogen peroxide [57], ethacridine lactate [58], ethanol [59], or gentian violet is not recommended, as it can lead to serious irritation. It is worth choosing an agent that is safe, stimulates healing, and does not destroy the forming granulation tissue and, at the same time, is effective, killing bacteria, viruses, and fungi [60]. Both at the beginning and throughout the healing process, the wound should be properly moisturized, as it enables migration of fibroblasts and proper reconstruction of the wound.…”

Poly(hexamethylene biguanide) hydrochloride (PHMB)-based materials: synthesis, modification, properties, determination, and application

“…13,19 It can be incorporated into a variety of types of wound dressings such as gauze, bandages, sponges, foams, and surgical sutures. [211][212][213][214][215][216] Notwithstanding, numerous studies are being conducted to develop more efficient, multifunctional, and user-friendly PHMB-based wound dressings. 211 Generally, wound dressings can be classified into two categories.…”

“…[211][212][213][214][215][216] Notwithstanding, numerous studies are being conducted to develop more efficient, multifunctional, and user-friendly PHMB-based wound dressings. 211 Generally, wound dressings can be classified into two categories. The first one was developed based on the traditional type by coating PHMB and/or additives onto the substrates such as gauze via either immersion or chemical modification.…”

“…139 Generally speaking, the commonly used methods for preparing such PHMB-loaded wound dressings include non-weaving, electrospinning, wet-spinning, phase inversion, and free-radical polymerization, depending on the specific materials used. 211,212,214 PHMB also found applications in the fabrication of biomedical scaffolds for infected wound healing in combination with biomaterials such as poly(ε-caprolactone) (PCL), polylactide (PLA), and collagen. [223][224][225][226] Depending on the biomaterials, the scaffolds could be fabricated via layer-by-layer self-assembly or electrospinning.…”

“…139 Generally speaking, the commonly used methods for preparing such PHMB-loaded wound dressings include non-weaving, electrospinning, wet-spinning, phase inversion, and free-radical polymerization, depending on the specific materials used. 211,212,214…”