Advertisement

Chitosan-Based Dressing Materials for Problematic Wound Management

  • Ji-Ung Park
  • Eun-Ho Song
  • Seol-Ha Jeong
  • Juha Song
  • Hyoun-Ee KimEmail author
  • Sukwha KimEmail author
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1077)

Abstract

Wound healing is a complex mechanism involving a variety of factors and is a representative process of tissue growth and regeneration in our body. Surface-based interactions between the dressing material and the wound may significantly influence the healing phase. Advances in understanding the mechanism of wound healing have led to the development of numerous dressing materials that can accelerate the healing process. However, these materials have a passive role in wound healing. It is therefore necessary to develop novel wound dressing materials, especially effective for clinically problematic wounds. Chitosan-based dressing materials are considered suitable for clinically problematic wounds as they exhibit several characteristic features, such as facilitating hemostasis, enhanced wound healing during the inflammatory and proliferative phases, antimicrobial effect, etc. Here, we review the current status of clinically available dressing materials and studies on the biological characteristics of chitosan, and discuss the potential applications of chitosan in multi-functional dressing materials for accelarated wound healing.

Keywords

Wound healing Dressing materials Chitosan 

References

  1. 1.
    Abdelgawad AM, Hudson SM, Rojas OJ (2014) Antimicrobial wound dressing nanofiber mats from multicomponent (chitosan/silver-NPs/polyvinyl alcohol) systems. Carbohydr Polym 100:166–178.  https://doi.org/10.1016/j.carbpol.2012.12.043CrossRefPubMedGoogle Scholar
  2. 2.
    Abu-Elala NM, Attia MM, Abd-Elsalam RM (2017) Chitosan-silver nanocomposite in goldfish aquaria: new prospective for Lernaea cyprinacea control. Int J Biol Macromol.  https://doi.org/10.1016/j.ijbiomac.2017.12.133CrossRefGoogle Scholar
  3. 3.
    Ali GW, El-Hotaby W, Hemdan B, Abdel-Fattah WI (2018) Thermosensitive chitosan/phosphate hydrogel-composites fortified with Ag versus Ag@ Pd for biomedical applications. Life Sci 194:185–195CrossRefGoogle Scholar
  4. 4.
    Augustin M, Mayer G, Wild T (2016) Challenges of aging skin: care and therapy using the example of venous ulcers. Hautarzt 67(2):160–168.  https://doi.org/10.1007/s00105-015-3756-0CrossRefPubMedGoogle Scholar
  5. 5.
    Azad AK, Sermsintham N, Chandrkrachang S, Stevens WF (2004) Chitosan membrane as a wound-healing dressing: characterization and clinical application. J Biomed Mater Res B Appl Biomater 69B(2):216–222.  https://doi.org/10.1002/jbm.b.30000CrossRefGoogle Scholar
  6. 6.
    Beanes SR, Dang C, Soo C, Ting K (2004) Skin repair and scar formation: the central role of TGF-[beta]. Expert Rev Mol Med 5(08).  https://doi.org/10.1017/s1462399403005817
  7. 7.
    Behera SS, Das U, Kumar A, Bissoyi A, Singh AK (2017) Chitosan/TiO2 composite membrane improves proliferation and survival of L929 fibroblast cells: application in wound dressing and skin regeneration. Int J Biol Macromol 98:329–340.  https://doi.org/10.1016/j.ijbiomac.2017.02.017CrossRefPubMedGoogle Scholar
  8. 8.
    Berry DP, Harding KG, Stanton MR, Jasani B, Ehrlich PH (1998) Human wound contraction: collagen organization, fibroblasts, and myofibroblasts. Plast Reconstr Surg 102(1):124–131CrossRefGoogle Scholar
  9. 9.
    Biagini G, Bertani A, Muzzarelli R, Damadei A, DiBenedetto G, Belligolli A, Riccotti G, Zucchini C, Rizzoli C (1991) Wound management with N-carboxybutyl chitosan. Biomaterials 12(3):281–286.  https://doi.org/10.1016/0142-9612(91)90035-9CrossRefPubMedGoogle Scholar
  10. 10.
    Boateng J, Catanzano O (2015) Advanced therapeutic dressings for effective wound healing—a review. J Pharm Sci 104(11):3653–3680.  https://doi.org/10.1002/jps.24610CrossRefPubMedGoogle Scholar
  11. 11.
    Boateng JS, Matthews KH, Stevens HNE, Eccleston GM (2008) Wound healing dressings and drug delivery systems: a review. J Pharm Sci 97(8):2892–2923.  https://doi.org/10.1002/jps.21210CrossRefPubMedGoogle Scholar
  12. 12.
    Burd A, Kwok CH, Hung SC, Chan HS, Gu H, Lam WK, Huang L (2007) A comparative study of the cytotoxicity of silver-based dressings in monolayer cell, tissue explant, and animal models. Wound Repair Regen 15(1):94–104.  https://doi.org/10.1111/j.1524-475X.2006.00190.xCrossRefPubMedGoogle Scholar
  13. 13.
    Chan LW, Kim CH, Wang X, Pun SH, White NJ, Kim TH (2016) PolySTAT-modified chitosan gauzes for improved hemostasis in external hemorrhage. Acta Biomater 31:178–185.  https://doi.org/10.1016/j.actbio.2015.11.017CrossRefPubMedGoogle Scholar
  14. 14.
    Chen J-P, Chang G-Y, Chen J-K (2008) Electrospun collagen/chitosan nanofibrous membrane as wound dressing. Colloids Surf A Physicochem Eng Asp 313:183–188.  https://doi.org/10.1016/j.colsurfa.2007.04.129CrossRefGoogle Scholar
  15. 15.
    Dai M, Zheng X, Xu X, Kong X, Li X, Guo G, Luo F, Zhao X, Wei YQ, Qian Z (2009) Chitosan-alginate sponge: preparation and application in curcumin delivery for dermal wound healing in rat. Biomed Res Int 2009:1.  https://doi.org/10.1155/2009/595126CrossRefGoogle Scholar
  16. 16.
    Dai T, Tanaka M, Huang Y-Y, Hamblin MR (2011) Chitosan preparations for wounds and burns: antimicrobial and wound-healing effects. Expert Rev Anti-Infect Ther 9(7):857–879.  https://doi.org/10.1586/eri.11.59CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Dissanaike S, Ha D, Mitchell D, Larumbe E (2017) Socioeconomic status, gender, and burn injury: a retrospective review. Am J Surg 214(4):677–681.  https://doi.org/10.1016/j.amjsurg.2017.06.012CrossRefPubMedGoogle Scholar
  18. 18.
    Dreifke MB, Jayasuriya AA, Jayasuriya AC (2015) Current wound healing procedures and potential care. Mater Sci Eng C 48:651–662.  https://doi.org/10.1016/j.msec.2014.12.068CrossRefGoogle Scholar
  19. 19.
    Englehart MS, Cho SD, Tieu BH, Morris MS, Underwood SJ, Karahan A, Muller PJ, Differding JA, Farrell DH, Schreiber MA (2008) A novel highly porous silica and chitosan-based hemostatic dressing is superior to HemCon and gauze sponges. J Trauma Acute Care Surg 65(4):884–892.  https://doi.org/10.1097/TA.0b013e318187800bCrossRefGoogle Scholar
  20. 20.
    Falanga V (2000) Classifications for wound bed preparation and stimulation of chronic wounds. Wound Repair Regen 8(5):347–352.  https://doi.org/10.1111/j.1524-475x.2000.00347.xCrossRefPubMedGoogle Scholar
  21. 21.
    Gok NS, Kim HK, Kim SH, Kim WS, Bae TH, Kim MK (2007) Comparative study of Acticoat (R) & Allevyn (R) on infected full-thickness wound of the rat skin. J Korean Soc Plast Reconstr Surg 34(2):169–175Google Scholar
  22. 22.
    Gosain A, DiPietro LA (2004) Aging and wound healing. World J Surg 28(3):321–326.  https://doi.org/10.1007/s00268-003-7397-6CrossRefPubMedGoogle Scholar
  23. 23.
    Han F, Dong Y, Song A, Yin R, Li S (2014) Alginate/chitosan based bi-layer composite membrane as potential sustained-release wound dressing containing ciprofloxacin hydrochloride. Appl Surf Sci 311:626–634.  https://doi.org/10.1016/j.apsusc.2014.05.125CrossRefGoogle Scholar
  24. 24.
    Hiro ME, Pierpont YN, Ko F, Wright TE, Robson MC, Payne WG (2012) Comparative evaluation of silver-containing antimicrobial dressings on in vitro and in vivo processes of wound healing. Eplasty 12:e48PubMedPubMedCentralGoogle Scholar
  25. 25.
    Howling GI, Dettmar PW, Goddard PA, Hampson FC, Dornish M, Wood EJ (2001) The effect of chitin and chitosan on the proliferation of human skin fibroblasts and keratinocytes in vitro. Biomaterials 22(22):2959–2966.  https://doi.org/10.1016/S0142-9612(01)00042-4CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hultman CS, van Duin D, Sickbert-Bennett E, DiBiase LM, Jones SW, Cairns BA, Weber DJ (2017) Systems-based practice in burn care. Clin Plast Surg 44(4):935–942.  https://doi.org/10.1016/j.cps.2017.06.002CrossRefPubMedGoogle Scholar
  27. 27.
    Jayakumar R, Prabaharan M, Kumar PS, Nair S, Tamura H (2011) Biomaterials based on chitin and chitosan in wound dressing applications. Biotechnol Adv 29(3):322–337.  https://doi.org/10.1016/j.biotechadv.2011.01.005CrossRefPubMedGoogle Scholar
  28. 28.
    Kasiewicz LN, Whitehead KA (2017) Recent advances in biomaterials for the treatment of diabetic foot ulcers. Biomater Sci 5(10):1962–1975.  https://doi.org/10.1039/C7BM00264ECrossRefPubMedGoogle Scholar
  29. 29.
    Kim GH, Im JN, Kim TH, Lee GD, Youk JH, Doh SJ (2017) Preparation and characterization of calcium carboxymethyl cellulose/chitosan blend nonwovens for hemostatic agents. Text Res J..  https://doi.org/10.1177/0040517517712101CrossRefGoogle Scholar
  30. 30.
    Kojima K, Okamoto Y, Kojima K, Miyatake K, Fujise H, Shigemasa Y, Minami S (2004) Effects of chitin and chitosan on collagen synthesis in wound healing. J Vet Med Sci 66(12):1595–1598.  https://doi.org/10.1292/jvms.66.1595CrossRefPubMedGoogle Scholar
  31. 31.
    Labrude P, Becq C (2003) Pharmacist and chemist Henri Braconnot. Rev Hist Pharm 51(337):61–78.  https://doi.org/10.3406/pharm.2003.5479CrossRefGoogle Scholar
  32. 32.
    Lan G, Lu B, Wang T, Wang L, Chen J, Yu K, Liu J, Dai F, Wu D (2015) Chitosan/gelatin composite sponge is an absorbable surgical hemostatic agent. Colloids Surf B Biointerfaces 136:1026–1034.  https://doi.org/10.1016/j.colsurfb.2015.10.039CrossRefPubMedGoogle Scholar
  33. 33.
    Lazarus GS, Cooper DM, Knighton DR et al (1994) Definitions and guidelines for assessment of wounds and evaluation of healing. Arch Dermatol 130(4):489–493.  https://doi.org/10.1001/archderm.1994.01690040093015CrossRefPubMedGoogle Scholar
  34. 34.
    Lazic T, Falanga V (2011) Bioengineered skin constructs and their use in wound healing. Plast Reconstr Surg 127:75S–90S.  https://doi.org/10.1097/PRS.0b013e3182009d9fCrossRefPubMedGoogle Scholar
  35. 35.
    Lee EJ, Kim HE (2016) Accelerated bony defect healing by chitosan/silica hybrid membrane with localized bone morphogenetic protein-2 delivery. Mater Sci Eng C Mater Biol Appl 59:339–345.  https://doi.org/10.1016/j.msec.2015.10.001CrossRefPubMedGoogle Scholar
  36. 36.
    Lee EJ, Shin DS, Kim HE, Kim HW, Koh YH, Jang JH (2009) Membrane of hybrid chitosan-silica xerogel for guided bone regeneration. Biomaterials 30(5):743–750.  https://doi.org/10.1016/j.biomaterials.2008.10.025CrossRefPubMedGoogle Scholar
  37. 37.
    Lee JH, Chae JD, Kim DG, Hong SH, Lee WM, Ki M (2010) Comparison of the efficacies of silver-containing dressing materials for treating a full-thickness rodent wound infected by methicillin-resistant Staphylococcus aureus. Korean J Lab Med 30(1):20–27.  https://doi.org/10.3343/kjlm.2010.30.1.20CrossRefPubMedGoogle Scholar
  38. 38.
    Li X, Nan K, Li L, Zhang Z, Chen H (2012) In vivo evaluation of curcumin nanoformulation loaded methoxy poly (ethylene glycol)-graft-chitosan composite film for wound healing application. Carbohydr Polym 88(1):84–90.  https://doi.org/10.1016/j.carbpol.2011.11.068CrossRefGoogle Scholar
  39. 39.
    Lu Z, Gao J, He Q, Wu J, Liang D, Yang H, Chen R (2017) Enhanced antibacterial and wound healing activities of microporous chitosan-Ag/ZnO composite dressing. Carbohydr Polym 156:460–469.  https://doi.org/10.1016/j.carbpol.2016.09.051CrossRefPubMedGoogle Scholar
  40. 40.
    Lyder CH (2003) Pressure ulcer prevention and management. JAMA 289(2):223–226.  https://doi.org/10.1001/jama.289.2.223CrossRefPubMedGoogle Scholar
  41. 41.
    Mauricio D, Jude E, Piaggesi A, Frykberg R (2016) Diabetic foot: current status and future prospects. J Diabetes Res 2016:2.  https://doi.org/10.1155/2016/5691305CrossRefGoogle Scholar
  42. 42.
    Millner RWJ, Lockhart AS, Bird H, Alexiou C (2009) A new hemostatic agent: initial life-saving experience with Celox (Chitosan) in cardiothoracic surgery. Ann Thorac Surg 87(2):e13–e14.  https://doi.org/10.1016/j.athoracsur.2008.09.046CrossRefPubMedGoogle Scholar
  43. 43.
    Mohandas A, Anisha B, Chennazhi K, Jayakumar R (2015) Chitosan–hyaluronic acid/VEGF loaded fibrin nanoparticles composite sponges for enhancing angiogenesis in wounds. Colloids Surf B: Biointerfaces 127:105–113.  https://doi.org/10.1016/j.colsurfb.2015.01.024CrossRefPubMedGoogle Scholar
  44. 44.
    Nussbaum SR, Carter MJ, Fife CE, DaVanzo J, Haught R, Nusgart M, Cartwright D (2018) An economic evaluation of the impact, cost, and medicare policy implications of chronic nonhealing wounds. Value Health 21(1):27–32.  https://doi.org/10.1016/j.jval.2017.07.007CrossRefPubMedGoogle Scholar
  45. 45.
    Ogura K, Kanamoto T, Itoh M, Miyashiro H, Tanaka K (1980) Dynamic mechanical behavior of chitin and chitosan. Polym Bull 2(5):301–304CrossRefGoogle Scholar
  46. 46.
    Ozkaynak MU, Atalay-Oral C, Tantekin-Ersolmaz SB (2005) Güner FS polyurethane films for wound dressing applications. In: Macromolecular symposia, vol 1. Wiley Online Library, pp 177–184.  https://doi.org/10.1002/masy.200551016CrossRefGoogle Scholar
  47. 47.
    Pan M, Tang Z, Tu J, Wang Z, Chen Q, Xiao R, Liu H (2018) Porous chitosan microspheres containing zinc ion for enhanced thrombosis and hemostasis. Mater Sci Eng C 85:27–36.  https://doi.org/10.1016/j.msec.2017.12.015CrossRefGoogle Scholar
  48. 48.
    Park CJ, Clark SG, Lichtensteiger CA, Jamison RD, Johnson AJW (2009) Accelerated wound closure of pressure ulcers in aged mice by chitosan scaffolds with and without bFGF. Acta Biomater 5(6):1926–1936.  https://doi.org/10.1016/j.actbio.2009.03.002CrossRefGoogle Scholar
  49. 49.
    Park J-U, Jeong S-H, Song E-H, Song J, Kim H-E, Kim S (2018) Acceleration of the healing process of full-thickness wounds using hydrophilic chitosan–silica hybrid sponge in a porcine model. J Biomater Appl 0(0):0885328217751246.  https://doi.org/10.1177/0885328217751246CrossRefGoogle Scholar
  50. 50.
    Park JU, Jung HD, Song EH, Choi TH, Kim HE, Song J, Kim S (2016) The accelerating effect of chitosan-silica hybrid dressing materials on the early phase of wound healing. J Biomed Mater Res B Appl Biomater 105:1828.  https://doi.org/10.1002/jbm.b.33711CrossRefPubMedGoogle Scholar
  51. 51.
    Raghav A, Khan ZA, Labala RK, Ahmad J, Noor S, Mishra BK (2018) Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always. Ther AdvEndocrinol Metab 9(1):29–31.  https://doi.org/10.1177/2042018817744513CrossRefGoogle Scholar
  52. 52.
    Rasero L, Simonetti M, Falciani F, Fabbri C, Collini F, Dal Molin A (2015) Pressure ulcers in older adults: a prevalence study. Adv Skin Wound Care 28(10):461–464.  https://doi.org/10.1097/01.ASW.0000470371.77571.5dCrossRefPubMedGoogle Scholar
  53. 53.
    Ren D, Yi H, Wang W, Ma X (2005) The enzymatic degradation and swelling properties of chitosan matrices with different degrees of N-acetylation. Carbohydr Res 340(15):2403–2410.  https://doi.org/10.1016/j.carres.2005.07.022CrossRefPubMedGoogle Scholar
  54. 54.
    Ricardi NC, de Menezes EW, Valmir Benvenutti E, da Natividade Schöffer J, Hackenhaar CR, Hertz PF, Costa TMH (2018) Highly stable novel silica/chitosan support for β-galactosidase immobilization for application in dairy technology. Food Chem 246:343–350.  https://doi.org/10.1016/j.foodchem.2017.11.026CrossRefPubMedGoogle Scholar
  55. 55.
    Riches DWH (1988) Macrophage involvement in wound repair, remodeling, and fibrosis. In: RAF C (ed) The molecular and cellular biology of wound repair. Springer US, Boston, pp 95–141.  https://doi.org/10.1007/978-1-4899-0185-9_3CrossRefGoogle Scholar
  56. 56.
    Romić MD, Klarić MŠ, Lovrić J, Pepić I, Cetina-Čižmek B, Filipović-Grčić J, Hafner A (2016) Melatonin-loaded chitosan/Pluronic® F127 microspheres as in situ forming hydrogel: an innovative antimicrobial wound dressing. Eur J Pharm Biopharm 107:67–79.  https://doi.org/10.1016/j.ejpb.2016.06.013CrossRefPubMedGoogle Scholar
  57. 57.
    Santos TC, Marques AP, Silva SS, Oliveira JM, Mano JF, Castro AG, Reis RL (2007) In vitro evaluation of the behaviour of human polymorphonuclear neutrophils in direct contact with chitosan-based membranes. J Biotechnol 132(2):218–226.  https://doi.org/10.1016/j.jbiotec.2007.07.497CrossRefPubMedGoogle Scholar
  58. 58.
    Siafaka PI, Zisi AP, Exindari MK, Karantas ID, Bikiaris DN (2016) Porous dressings of modified chitosan with poly (2-hydroxyethyl acrylate) for topical wound delivery of levofloxacin. Carbohydr Polym 143:90–99.  https://doi.org/10.1016/j.carbpol.2016.02.009CrossRefPubMedGoogle Scholar
  59. 59.
    Smith JK, Bumgardner JD, Courtney HS, Smeltzer MS, Haggard WO (2010) Antibiotic-loaded chitosan film for infection prevention: a preliminary in vitro characterization. J Biomed Mater Res B Appl Biomater 94B(1):203–211.  https://doi.org/10.1002/jbm.b.31642CrossRefGoogle Scholar
  60. 60.
    Song JM, Shin SH, Kim YD, Lee JY, Baek YJ, Yoon SY, Kim HS (2014) Comparative study of chitosan/fibroin-hydroxyapatite and collagen membranes for guided bone regeneration in rat calvarial defects: micro-computed tomography analysis. Int J Oral Sci 6(2):87–93.  https://doi.org/10.1038/ijos.2014.16CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Stone CA, Wright H, Devaraj VS, Clarke T, Powell R (2000) Healing at skin graft donor sites dressed with chitosan. Br J Plast Surg 53(7):601–606.  https://doi.org/10.1054/bjps.2000.3412CrossRefPubMedGoogle Scholar
  62. 62.
    Sullivan TP, Eaglstein WH, Davis SC, Mertz P (2001) The pig as a model for human wound healing. Wound Repair Regen 9(2):66–76.  https://doi.org/10.1046/j.1524-475x.2001.00066.xCrossRefPubMedGoogle Scholar
  63. 63.
    Sun X, Tang Z, Pan M, Wang Z, Yang H, Liu H (2017) Chitosan/kaolin composite porous microspheres with high hemostatic efficacy. Carbohydr Polym 177(Suppl C):135–143.  https://doi.org/10.1016/j.carbpol.2017.08.131CrossRefPubMedGoogle Scholar
  64. 64.
    Ueno H, Yamada H, Tanaka I, Kaba N, Matsuura M, Okumura M, Kadosawa T, Fujinaga T (1999) Accelerating effects of chitosan for healing at early phase of experimental open wound in dogs. Biomaterials 20(15):1407–1414.  https://doi.org/10.1016/S0142-9612(99)00046-0CrossRefPubMedGoogle Scholar
  65. 65.
    Vimala K, Mohan YM, Sivudu KS, Varaprasad K, Ravindra S, Reddy NN, Padma Y, Sreedhar B, MohanaRaju K (2010) Fabrication of porous chitosan films impregnated with silver nanoparticles: a facile approach for superior antibacterial application. Colloids Surf B: Biointerfaces 76(1):248–258.  https://doi.org/10.1016/j.colsurfb.2009.10.044CrossRefPubMedGoogle Scholar
  66. 66.
    Wiegand C, Winter D, Hipler UC (2010) Molecular-weight-dependent toxic effects of Chitosans on the human keratinocyte cell line HaCaT. Skin Pharmacol Physiol 23(3):164–170CrossRefGoogle Scholar
  67. 67.
    Yan T, Cheng F, Wei X, Huang Y, He J (2017) Biodegradable collagen sponge reinforced with chitosan/calcium pyrophosphate nanoflowers for rapid hemostasis. Carbohydr Polym 170:271–280.  https://doi.org/10.1016/j.carbpol.2017.04.080CrossRefPubMedGoogle Scholar
  68. 68.
    Zhao R, Li X, Sun B, Zhang Y, Zhang D, Tang Z, Chen X, Wang C (2014) Electrospun chitosan/sericin composite nanofibers with antibacterial property as potential wound dressings. Int J Biol Macromol 68:92–97.  https://doi.org/10.1016/j.ijbiomac.2014.04.029CrossRefPubMedGoogle Scholar
  69. 69.
    Zheng L-Y, Zhu J-F (2003) Study on antimicrobial activity of chitosan with different molecular weights. Carbohydr Polym 54(4):527–530.  https://doi.org/10.1016/j.carbpol.2003.07.009CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgerySeoul National University Boramae HospitalSeoulSouth Korea
  2. 2.Department of Materials Science and EngineeringSeoul National UniversitySeoulSouth Korea
  3. 3.School of Chemical and Biomedical EngineeringNanyang Technological UniversitySingaporeSingapore
  4. 4.Biomedical Implant Convergence Research Center, Advanced Institutes of Convergence TechnologySuwonSouth Korea
  5. 5.Department of Plastic and Reconstructive SurgerySeoul National University College of MedicineSeoulSouth Korea

Personalised recommendations