How Effective are Nano-Based Dressings in Diabetic Wound Healing? A Comprehensive Review of Literature

Figures & data

Scheme 1 Schematic diagram of this review.

Figure 1 Stages of wound healing and pathophysiological changes in different stages.³³

Notes: Reproduced from Przekora A. A Concise Review on Tissue Engineered Artificial Skin Grafts for Chronic Wound Treatment: Can We Reconstruct Functional Skin Tissue In Vitro? Cells 2020, 9 (7), 1622. Creative Commons Attribution License.³³

Figure 2 Factors affecting wound healing.

Figure 3 Differences of wound healing between diabetic and non-diabetic patients.

Notes: Reprinted from Bao P, Kodra A, Tomic-Canic M, Golinko MS, Ehrlich H P, Brem H. The role of vascular endothelial growth factor in wound healing. J Surg Res 2009, 153 (2), 347–58, Copyright 2009, with permission from Elsevier.⁵⁸

Figure 4 Development of wound dressings and characteristics. The advantages and disadvantages of different dressings are shown in green and red squares, respectively.

Table 1 Different Kinds of Material Combinations of AgNPs and Their Therapeutic Effect

Material	Dressing Form	Results	Ref.
KGM	Sponge	Excellent antibacterial activity No obvious cytotoxicity Promote wound healing	[^Citation121]
Hyaluronic acid, alginate	Membrane	Antibacterial activity to planktonic bacteria Stimulate wound healing	[^Citation124]
γ-glutamate	Hydrogel	Continuous release of antibacterial factors Promote collagen deposition	[^Citation125]
Sericin, chitosan	Hydrogel	Significantly increase antibacterial activity Promote fibroblast growth Accelerate epithelial reformation	[^Citation122]
Hydroxyapatite, polyurethane	Foam	Antibacterial effect of four kinds of bacteria Promote collagen deposition Promote scar-free wound healing	[^Citation126]
Chitosan, PVP	Membrane	Wound healing can be observed directly Enhanced antibacterial activity	[^Citation127]
Polyvinyl alcohol, cellulose	Hydrogel	Significant antibacterial effect Promotes angiogenesis Accelerate wound healing	[^Citation128]
Chitosan, PEG	Hydrogel	Antibacterial and antioxidant activities Promote chronic wound healing	[^Citation129]
AGAR, fumaric acid	Hydrogel	Synergistic antibacterial action Promote wound collagen deposition Accelerate angiogenesis	[^Citation130]
Aloe, silk fibroin	Hydrogel	Significantly enhance antibacterial properties Promote cell proliferation and migration Accelerate chronic wound healing	[^Citation123]
rhEGF, polyurethane	Foam	Promote cell growth Accelerate diabetic wound healing Good absorption and antibacterial ability	[^Citation131]
bFGF, chitosan	Hydrogel	Obvious bacteriostatic effect Promote granulation Promote regeneration of infected wounds	[^Citation132]
EGF, chitosan	Hydrogel	Good sustained release capability Significantly enhanced antibacterial activity Accelerate diabetic wound healing	[^Citation133]
Bamboo cellulose nanocrystals	Hydrogel	Promote growth factor release Increases blood vessel formation Accelerate collagen deposition	[^Citation134]

Table 2 Different Kinds of Material Combinations of AuNPs and Their Therapeutic Effect

Material	Dressing Form	Results	Ref.
Dextran, sericin	Cotton Fabric	Accelerate wound healing Reduce scar formation	[^Citation138]
Pig diaphragm	Scaffold	Enhanced cell proliferation Lower ROS levels Promote wound healing	[^Citation141]
Collagen	Scaffold	Reduce inflammation Promote granulation tissue formation	[^Citation142]
Gentamicin, KGM, gelatin	Sponge	Enhance antibacterial effect Good water retention Deadly to super bacteria	[^Citation140]
Dextran, polyvinyl alcohol	Cotton Fabric	Good biocompatibility Accelerate wound healing	[^Citation143]
Ag, chitosan	Sponge	Significantly enhance antibacterial effect Low cytotoxicity Significantly promote wound healing	[^Citation139]
Poloxamer 407, PEG, PAH	Hydrogel	Obvious antibacterial and antifungal ability Good biocompatibility Enhanced reepithelialization Promote collagen deposition	[^Citation144]
KGF, gelatin	Hydrogel	Promotes keratinocyte proliferation Good biocompatibility Promote wound reepithelialization	[^Citation145]
Chitosan, arginine	Membrane	Accelerate wound healing Promote collagen deposition	[^Citation146]

Table 3 Different Kinds of Material Combinations of CuNPs and Their Therapeutic Effect

Material	Dressing Form	Results	Ref.
PDA, calcium silicate	Hydrogel	Inhibit drug-resistant bacteria growth Promote angiogenesis	[^Citation153]
Chitosan, polyvinyl alcohol	Membrane	Inhibit Gram-positive bacteria growth Promote wound healing	[^Citation154]
Chitosan, gallic acid	Membrane	Significant antibacterial properties Promote healing of infected wounds	[^Citation155]
GelMA, BACA	Hydrogel	Promote angiogenesis Reduce the level of inflammation Significant antibacterial properties	[^Citation156]
Chitosan, CDs, GO	Hydrogel	Inhibit bacterial growth Promote wound healing	[^Citation157]
GO, chitosan, hyaluronic acid	Sponge	Good biocompatibility Reduce inflammation Speed up the healing process	[^Citation158]
PDA, hydroxyapatite	Hydrogel	Promote angiogenesis Promote collagen deposition Good antibacterial properties	[^Citation159]
Alginate	Hydrogel	Promote blood clotting in the wound Significant antibacterial properties	[^Citation160]

Figure 5 The corresponding wound photographs (A) and the recovery progress of the wounds (B) of control group and different concentration Ag/AgBr/MSNs (**p<0.01; ***p<0.001).

Notes: Republished with permission of Royal Society of Chemistry from Jin C, Liu XM, Tan L et al. Ag/AgBr-loaded mesoporous silica for rapid sterilization and promotion of wound healing. Biomaterials Science 2018, 6 (7), 1735–1744, permission conveyed through Copyright Clearance Center, Inc.¹⁷⁶

Figure 6 Design strategy of the SCDs-AP hydrogel. (A) Synthesis of cationic antibacterial CDs starting from (B) assembly of the fluorescent antibacterial CDs hydrogel through pectin, acrylic acid, CDs, APS, and PEGDA. (C) Scheme of molecular structure and applications of fluorescent antibacterial hydrogel.

Notes: Reprinted from Cui FC, Sun JD, Ji J et al. Carbon dots-releasing hydrogels with antibacterial activity, high biocompatibility, and fluorescence performance as candidate materials for wound healing. Journal of Hazardous Materials 2021, 406. Copyright 2021, with permission from Elsevier.¹⁸²

Table 4 Different Kinds of Combinations of Natural Polymer and Their Therapeutic Effect

Material	Supplementary Materials	Results	Ref.
Chitosan	Alginate	Significant antibacterial activity Regulate ROS formation Promote angiogenesis	[^Citation192]
Chitosan	Alginate	Promote granulation tissue formation Reduce inflammation	[^Citation193]
Chitosan	Rosmarinic acid	Good biocompatibility Promote wound healing	[^Citation194]
Chitosan	Curcumin, collagen, alginate	Reduce inflammatory cell infiltration Promote granulation tissue formation Accelerate wound healing	[^Citation195]
Alginate	Polymyxin, lidocaine, chitosan	Accelerate wound contraction Inhibit bacterial growth	[^Citation196]
Alginate	Ag, chitosan, fresh blood	Broad-spectrum antibacterial properties Promotes cell proliferation Promote neovascularization Accelerate diabetic wound healing	[^Citation197]
Hyaluronic acid	Vitamin E, lecithin	Keep releasing vitamin E Reduce water loss from the wound	[^Citation198]

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