中国药学杂志

Type	Advantages	Disadvantage	Application
Film dressings	Transparent & well-ventilated	Poor ability to absorb liquids^[25]	Minor burn & ulcer wound^[14]
Foam dressings	Keep warm & antibiosis	Opacification^[26]	Infected wound^[27]
Hydrocolloid dressings	Good ability to absorb liquids^[18]	High cost & secondary damage^[19]	Exudate wound
Hydrogel dressings	Clear necrotic tissue^[28]	Increased risk of infection^[29]	Burn wound^[30]& operative wound

Type	Advantages	Disadvantage	Application
Film dressings	Transparent & well-ventilated	Poor ability to absorb liquids^[25]	Minor burn & ulcer wound^[14]
Foam dressings	Keep warm & antibiosis	Opacification^[26]	Infected wound^[27]
Hydrocolloid dressings	Good ability to absorb liquids^[18]	High cost & secondary damage^[19]	Exudate wound
Hydrogel dressings	Clear necrotic tissue^[28]	Increased risk of infection^[29]	Burn wound^[30]& operative wound

Feature	Materials	Advantages	Disadvantage	Research progress	Application
Hemostasis	Zeolite^[39]	Massive hemorrhage	Burn the surrounding tissue	Clinical application	First aid in battle
	Chitosan^[40]	Deep hemorrhage	Poor mechanical properties	Clinical application	Surgery
	Chitosan derivative			Application for registeration	-
	Alginate^[41]	Biocompatibility & Degradability^[42]	High cost & short action time	Clinical application	Dental treatment
Antibiosis	Metals and oxides^[43-44]	Long action time	Metal toxicity	Clinical application	Nano silver dressing
	Natural polymer^[45]	Biocompatibility	Poor mechanical properties	Preclinical study	-
	Antibiotic^[46-47]	Good effect	Bacterial resistance	Clinical application	Emergency local antibacterial
	Synthetic polymer^[48]	Biocompatibility & degradability	Poor mechanical properties	Preclinical study	-
Promote healing	Exogenous growth factors^[49-50]	Biocompatibility & good effect	High cost	Preclinical study	-

Feature	Materials	Advantages	Disadvantage	Research progress	Application
Hemostasis	Zeolite^[39]	Massive hemorrhage	Burn the surrounding tissue	Clinical application	First aid in battle
	Chitosan^[40]	Deep hemorrhage	Poor mechanical properties	Clinical application	Surgery
	Chitosan derivative			Application for registeration	-
	Alginate^[41]	Biocompatibility & Degradability^[42]	High cost & short action time	Clinical application	Dental treatment
Antibiosis	Metals and oxides^[43-44]	Long action time	Metal toxicity	Clinical application	Nano silver dressing
	Natural polymer^[45]	Biocompatibility	Poor mechanical properties	Preclinical study	-
	Antibiotic^[46-47]	Good effect	Bacterial resistance	Clinical application	Emergency local antibacterial
	Synthetic polymer^[48]	Biocompatibility & degradability	Poor mechanical properties	Preclinical study	-
Promote healing	Exogenous growth factors^[49-50]	Biocompatibility & good effect	High cost	Preclinical study	-

Type	Technology	Advantage	Complication	Research progress
Adjuvant therapy technique	Negative pressure wound therapy^[58]	Tissue regeneration	Bleeding & infection	Clinical application
	Topical hyperbaric oxygen therapy^[59]	Reduce inflammation	Slow down tissue nutrient transport^[60]	Clinical application
	Shock wave therapy^[61]	Precise energy transfer^[62]	Pain & hematoma	Clinical application
	Photobiomodulation^[63]	Penetrate superficial tissue	Patient tolerance decreased^[64]	Clinical application
Manufacturing technology	3D Printing technology^[65]	Simulate the three-dimensional structure of biology^[66]& altered drug release	Low cell activity	Preclinical study

Type	Technology	Advantage	Complication	Research progress
Adjuvant therapy technique	Negative pressure wound therapy^[58]	Tissue regeneration	Bleeding & infection	Clinical application
	Topical hyperbaric oxygen therapy^[59]	Reduce inflammation	Slow down tissue nutrient transport^[60]	Clinical application
	Shock wave therapy^[61]	Precise energy transfer^[62]	Pain & hematoma	Clinical application
	Photobiomodulation^[63]	Penetrate superficial tissue	Patient tolerance decreased^[64]	Clinical application
Manufacturing technology	3D Printing technology^[65]	Simulate the three-dimensional structure of biology^[66]& altered drug release	Low cell activity	Preclinical study

医用湿性敷料在创面修复的应用及研究进展

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林锦涛 , 韩晓璐 , 洪晓轩 , 王增明 , 娄经虎 , 唐志强 , 张慧 ^* , 高翔 ^* , 郑爱萍

中国药学杂志 | 综述 2025,60(4): 319-325

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中国药学杂志 | 综述 2025, 60(4): 319-325

医用湿性敷料在创面修复的应用及研究进展

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林锦涛, 韩晓璐, 洪晓轩, 王增明, 娄经虎, 唐志强, 张慧^*, 高翔^*, 郑爱萍

作者信息

军事医学研究院, 北京 100850

林锦涛,男,硕士研究生研究方向:纳微缓控药物关键技术及其递送机制

通讯作者:

^*张慧,女,博士,副研究员,硕士生导师研究方向:纳微缓控药物关键技术及其递送机制 Tel:(010)66874665;

高翔,男,博士,副研究员,硕士生导师研究方向:新型药物递释系统 Tel:(010)66874665

Application and Research Progress of Medical Wet Dressing in Wound Repair

Jintao LIN, Xiaolu HAN, Xiaoxuan HONG, Zengming WANG, Jinghu LOU, Zhiqiang TANG, Hui ZHANG^*, Xiang GAO^*, Aiping ZHENG

Affiliations

Academy of Military Medical Sciences, Beijing 100850, China

出版时间: 2025-02-22 doi: 10.11669/cpj.2025.04.002

文章导航

摘要

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皮肤作为机体第一道免疫屏障,常遭受多种致伤因素破坏,造成皮肤创伤,皮肤创伤修复愈合已成为严重的健康问题。医用湿性敷料可在伤口周围形成持续湿润环境,刺激细胞因子释放和细胞增殖,以及增强炎症细胞功能,在促进伤口愈合领域具有广泛应用前景。随着医疗技术进步,多功能创面治疗策略及辅助治疗技术与医用湿性敷料结合,为皮肤创伤修复愈合提供了更优的治疗方案。本文通过总结医用湿性敷料的类型及应用情况,对功能型医用湿性敷料及相关辅助治疗技术研究进展进行了阐述和归纳,为研究人员开发新型医用湿性敷料提供思路。

关键词

创面敷料 / 湿性敷料 / 医用敷料 / 创面愈合 / 湿性愈合

Abstract

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Skin, as the first line of defense of the body, is often damaged by various factors, causing skin trauma. Skin wound repair has become a serious health problem. Medical wet dressings can create a sustained moist environment around the wound, stimulating the release of cytokines and cell proliferation, as well as enhancing the function of inflammatory cells, which have broad prospects in promoting wound healing. With the advancement of medical technology, multifunctional wound treatment strategies and auxiliary treatment technologies combined with medical wet dressings have provided better treatment options for skin wound repair and healing. This article summarizes the types and applications of medical wet dressings, elucidates and generalizes the research progress on functional medical wet dressings and related auxiliary treatment technologies, providing insights for researchers to develop new types of medical wet dressings.

Key words

wound dressing / wet dressing / medical dressing / wound healing / wet healing

引用本文

林锦涛, 韩晓璐, 洪晓轩, 王增明, 娄经虎, 唐志强, 张慧, 高翔, 郑爱萍. 医用湿性敷料在创面修复的应用及研究进展. 中国药学杂志, 2025 , 60 (4) : 319 -325 . DOI: 10.11669/cpj.2025.04.002

Jintao LIN, Xiaolu HAN, Xiaoxuan HONG, Zengming WANG, Jinghu LOU, Zhiqiang TANG, Hui ZHANG, Xiang GAO, Aiping ZHENG. Application and Research Progress of Medical Wet Dressing in Wound Repair[J]. Chinese Pharmaceutical Journal, 2025 , 60 (4) : 319 -325 . DOI: 10.11669/cpj.2025.04.002

正文

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皮肤是人体最大的器官和第一道免疫屏障,具有体温调节、体液平衡和维生素D合成等功能,但易遭受各种致伤因素破坏,如光、电、热及辐射等,从而造成皮肤创伤。据统计,在发达国家约1%~2%人口正在经历慢性创伤侵害^[1],治疗费用占卫生总预算2%~4%,且随着人口老龄化、糖尿病和肥胖等致伤因素增加,治疗负担不断增加。在发展中国家,皮肤烧伤创面已成为影响生活质量和致残、导致身体畸形的主要因素之一^[2]。创伤愈合修复给患者及家庭造成严重的负担。

创伤愈合修复是一个漫长且复杂的过程,包括止血、炎症、增殖和细胞外基质(extracellular matrix,ECM)重塑^[3]四个阶段(图1)。修复过程中受损组织得到清理,相应区域皮肤完整性恢复^[4]。创伤愈合修复从止血和炎症反应开始,依靠募集血小板和免疫细胞控制血液流失并清除异物,并进入增殖阶段。增殖过程将发生肉芽组织的发育(临时ECM的形成)、血管生成和再上皮化(表皮层形成),此时伤口开始收缩。最后是重构阶段,即先前形成的基质缓慢变形,形成功能性皮肤或无功能性瘢痕组织^[5]。在修复过程中,敷料可发挥良好促愈合作用,可以加速炎症细胞的聚集和功能性皮肤的形成。

传统愈合理论中,保持创面干燥是愈合关键因素。然而在1962年,Winter^[6]发现伤口在湿润环境下愈合速度较干燥环境下更为迅速,并提出了“湿性愈合及湿性敷料”理念。湿性愈合是指利用伤口湿润环境,加速坏死组织溶解和上皮化的发生,从而促进创伤愈合的方式。湿性敷料是指通过密封伤口,在伤口周围形成持续湿润微环境、加速伤口愈合的一类敷料。近期研究表明,湿润环境促进细胞因子释放和细胞增殖、提高表皮细胞迁移速率,并增强白细胞的功能^[7]。在一项对照、随机和部分单盲平行研究中^[8],比较了湿性敷料与传统纱布对长期住院压疮患者皮肤创伤的治疗效果。在第6周时,湿性敷料组已完全愈合,而生理盐水纱布治疗组中为 31%(P=0.016)。在长期的临床应用中,换药时使用的传统敷料存在一些限制:它们可能会在更换过程中导致新生的肉芽组织脱落,进而影响伤口的愈合进程^[9]。针对渗出液较多的伤口如烧伤,理想敷料应具有适度湿润、清除伤口渗出物及坏死组织、透气性好、抗菌、无细胞毒性等特性^[10]。

本文围绕医用湿性敷料在创面修复的应用现状和研究进展进行综述,对比不同类型医用湿性敷料的结构特点、优缺点、适应证及临床应用等方面进行阐述,对功能性医用湿性敷料、辅助治疗技术进行总结,为加速医用湿性敷料的研发及应用提供新思路。

1 医用湿性敷料的分类

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在临床上,为达到缓解患者痛苦、节省护理时间、降低更换频率和促进愈合的目的,格乐思(GLYCO cell)、欣敷等多款湿性敷料已完成上市,并在临床上得到了广泛运用。从国家药品监督管理局(National Medical Products Administration, NMPA)^[11]和美国食品药品监督管理局(Food and Drug Administration, FDA)^[12]新注册的敷料类产品统计可知,两国申请注册的前100项敷料产品可分为干性敷料和湿性敷料两大类。两国注册的新型湿性敷料数量均超过半数,其中美国有51项,而中国有75项。根据调研可知,现有医用湿性敷料基本可分为薄膜型、泡沫型、水胶体型和水凝胶型4种类型。

1.1 薄膜型敷料(film dressings)

薄膜型敷料是由透明高分子材料与脱敏医用黏胶组合而成的湿性敷料,它主要是通过半透性来维持伤口的湿润环境。制造薄膜型敷料的高分子材料大多是透明弹性体,如聚乙烯、聚丙烯腈、聚乳酸、聚四氟乙烯、聚氨酯和聚乙烯醇等材料,其中聚氨酯类应用较为广泛。薄膜型敷料具有良好的隔菌及贴附性能,可以减少伤口二次污染的发生。敷料弹性及透明度较好,便于医护人员监护伤口。Atay等^[13]用薄膜型敷料固定患者外周静脉导管,可以便捷地观察静脉导管的位置。与纱布组对比,实验组静脉导管并发症发病率从63.6%降至52.7%,且导管滞留时间从24 h延长至7 d。但薄膜型敷料几乎没有吸收渗液能力,仅通过蒸发作用转运水分,水分转运的速度与敷料的结构及厚度有关。这易造成渗出液在伤口周围蓄积,进而引发感染,所以薄膜型敷料适用于渗出液较少的轻度烧伤或溃疡伤口^[14]。将薄膜型敷料和消炎镇痛药物组合形成新型药物递送系统,减少伤口的渗出已经成为了新的研究热点。

1.2 泡沫型敷料(foam dressings)

泡沫型敷料是利用发泡工艺对高分子材料进行特殊处理形成的多孔湿性敷料,具有防粘连层、泡沫层、背衬层三层结构。防粘连层接触伤口,避免创面与泡沫层接触,减少二次伤害,背衬层起到防水作用。泡沫层在愈合中起重要作用,既提供屏障又保证透气性^[15]。泡沫层能吸收渗出液,减少换药频率,适用中重度烧伤和压疮。Beeckman等^[16]用泡沫型敷料进行一项预防医院获得性压疮的试验,在配合标准临床护理情况下,使用泡沫型敷料的住院患者压疮及严重脓液渗出的发生率从6.3%降低至4.3%(P=0.04)。但泡沫型敷料的不透明外层限制了对伤口的观察监护^[17]。为观察伤口情况需要频繁撕贴敷料,从而影响伤口愈合。在烧伤等大面积渗出的伤口应用中,渗出液过多会影响泡沫型敷料防粘连层功能。在泡沫型敷料中加入抗菌剂,是预防感染的新研究方向。

1.3 水胶体型敷料(hydrocolloid dressings)

水胶体型敷料是一种由弹性高分子聚合物、合成橡胶及黏结材料组合而成的交互式敷料^[18]。水胶体型敷料具有隔绝外界因素、清创和防粘连的优点,可以提供保护性覆盖,隔离病原体,防止感染。敷料贴敷后患者可以正常进行清洗或淋浴等活动。敷料具有良好黏附力,在儿童及运动员等活动强度较高的伤口应用广泛^[19]。水胶体型敷料中的弹性高分子如羧甲基纤维素,能吸收渗液并膨胀多达12倍,紧贴创口边缘皮肤。

水胶体型敷料的应用受成本及副作用局限。首先是成本昂贵,尽管医生对水胶体敷料使用频率及范围做出严格控制,但是应用成本仍高于其他类型敷料。其次,合成橡胶及黏结材料的使用不仅会产生不愉快的气味^[20],还可能对部分患者伤口会造成二次损伤(接触性皮炎等)。野外环境下,对伤口的防水、隔绝外界环境应用需求迫切^[21],可以扩大水胶体型敷料的应用范围。

1.4 水凝胶型敷料(hydrogel dressings)

水凝胶型敷料是利用特殊工艺,将亲水高分子材料制备成具有三维结构且不溶于水的胶状敷料。根据合成方法的不同,可分为2种:一种是通过共价键化学交联的不可逆型水凝胶;另一种是通过二级键物理交联的可逆型水凝胶^[22]。水凝胶型敷料不仅可以利用如聚乙烯醇、聚丙烯酰胺等进行合成;还可以利用海藻酸盐、壳聚糖、透明质酸等天然生物材料^[23]进行合成。

目前水凝胶型敷料的开发应用呈现多功能趋势,许多在研的敷料具备调控药物释放、抗氧化、抗菌等功能。Chen等^[24]设计了一款抗氧化水凝胶型敷料。这款敷料可以去除伤口中的活性氧,减少氧化应激对伤口愈合的影响,促进伤口胶原沉淀以及再上皮化的过程,从而促进伤口愈合。将来,水凝胶型敷料不仅可以为伤口提供物理屏障和湿润环境,还可通过影响伤口微环境,从而改善伤口愈合。尽管水凝胶型敷料应用前景广泛,仍有一些应用局限,如敷料中水的体积占总体积的70%~90%,仅适用于处理渗出物少的伤口。且在高温、高湿等复杂环境下,伤口感染风险增高,局部过度液体积累将加剧伤口发生感染的概率。

以上四类医用湿性敷料的情况见表1。

2 医用湿性敷料的研究进展

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结合临床创伤修复的多种需求,为解决皮肤创伤的出血、感染,以及愈合延缓等问题,在医用湿性敷料的基础上,添加多种活性成分兼具多功能治疗策略,已经成为研究领域的新趋势。

2.1 功能性医用湿性敷料研究进展

2.1.1 具有止血功能的湿性敷料

伤口出血通常发生在接触致伤因素瞬间,血管连续性缺损导致大量血液丢失,甚至出现休克和死亡等严重情况。出血现象较为普遍,尤其在交通事故意外及战争等情况,所以止血型湿性敷料具有广泛的应用范围。止血作用主要依靠提供促凝因子、促进凝血因子富集或作为黏附剂3种机制实现^[31]。

根据止血作用机制,将止血型湿性敷料分为被动交互型和主动止血型两类。被动交互型湿性敷料是敷料覆盖伤口、仅通过压力压迫伤口封闭血管的湿性敷料。传统被动交互型敷料的材料有棉纱布、棉垫和薄纱等。目前,被动交互型湿性敷料的研究主要集中在氧化纤维素、氧化再生纤维素和非晶体水凝胶等材料改进及开发^[32]。由于止血作用温和,仅适用于出血轻微及康复后期的伤口。

主动止血型湿性敷料是含有参与或促进生物凝血级联生理止血过程的湿性敷料,当敷料接触伤口时,活性成分释放并主动参与到机体的级联止血反应,从而产生止血作用。主动止血型湿性敷料的材料主要有壳聚糖、海藻酸盐和α-氰基丙烯酸酯等,这些材料可以通过刺激体内外的凝血通路产生效果,适用于出血量较大的场景,例如车祸、手术出血及战场大出血等情况。主动止血型湿性敷料已经成为缓解战场上严重出血的新方案。美军装备的第三代速效止血敷料正是以壳聚糖为基质的湿性敷料,它同时具有壳聚糖的生物级联止血效果和纱布的柔韧性质,在大面积出血伤口应用广泛。该类敷料不仅装备于美军部队使用,还广泛运用在地方院前急救等领域^[33]。

2.1.2 具有抗菌功能的湿性敷料

感染是伤口愈合中较为常见的问题,条件致病菌可在伤口中入侵、定植并增殖,甚至引发局部感染,延长伤口愈合时间。情况严重时,常伴有残疾及死亡等不良预后发生^[34]。近期数据表明,全球每年约有五十万人死于感染性伤口,导致经济损失高达940亿美元^[35]。目前,仅有少数敷料具抗菌功能,所以增强湿性敷料抗菌性能成为解决伤口感染的新方案。目前主要有增加抗菌剂及使用改性材料2种策略。

在湿性敷料中添加抗生素、金属粒子,以及天然聚合物等抗菌剂已经成为增强敷料抗菌性能的常用策略。尽管这种方式增加了湿性敷料的抗菌能力,但是研究发现频繁使用抗生素将产生耐药菌,增加患者二次感染风险;金属粒子的蓄积会引发机体毒性反应,以及天然聚合物的抗菌效果不佳等问题。所以使用改性材料成为了新趋势,开发新型抗菌聚合物不仅可以提高湿性敷料的抗菌能力,还可以减少耐药菌的产生。新聚合物如壳聚糖衍生物、细菌纤维素复合材料以及聚赖氨酸等,已用于增强湿性敷料的抗菌能力^[36]。这些聚合物具有良好的生物相容性、低细胞毒性等优点,可以减少创面二次损伤风险。

2.1.3 具有促愈合功能的湿性敷料

生长因子作为一类生物活性多肽参与细胞生长、分化、增殖、迁移和代谢。研究表明,在未愈合的急慢性伤口中,一些生长因子的表达水平呈现降低趋势,如血小板源性生长因子(platelet-derived growth factor,PDGF)、成纤维细胞生长因子(fibroblast growth factor,FGF)和表皮生长因子(epidermal growth factor,EGF)。利用医用湿性敷料搭载外源性生长因子促进伤口愈合已成为新研究热点。Peng等^[37]利用原位水凝胶型敷料搭载肝素及碱性成纤维细胞生长因子,并作用于大鼠急性皮肤创伤模型。研究发现,搭载细胞生长因子的敷料有利于血管生成及细胞增殖分化。与空白凝胶组相比,载有生长因子的实验组创伤愈合面积从47%增长至69%。但是生长因子造价昂贵、储存条件苛刻限制了临床应用^[38],目前仅在大面积皮肤缺损等少数患者使用。降低生长因子的使用成本、提高其常温下在湿性敷料中的稳定性,或许将成为未来搭载生长因子的湿性敷料新的研究热点。功能性医用湿性敷料的研究进展情况见表2。

2.2 辅助治疗及制造技术研究进展

近年来,制造业水平不断提升,医用湿性敷料功能化需求不断增高,伤口愈合的辅助治疗技术及医用湿性敷料制造技术得到发展。在伤口原位贴敷医用湿性敷料后,结合包括局部高压氧、冲击波、负压伤口及光动力治疗技术在内的多项辅助治疗技术^[51],可有效地改变伤口周围微环境、促进组织增生并缩短伤口愈合的时间。

2.2.1 局部高压氧技术

局部高压氧技术是利用湿性敷料及相关器械,在伤口周围形成一个局部富氧、封闭环境的技术。因为局部富氧可以改善新生血管和ECM的形成、减少炎症反应,有效促进了伤口愈合。研究表明对于不愈合伤口进行局部氧疗后,32%的患者伤口完全闭合,在治疗超过25 d时,溃疡伤口闭合率可达50%^[52]。局部高压氧技术运用广泛,已被FDA批准运用于脓疮、烧伤、静脉功能不全、术后感染、坏疽病变、皮肤移植、冻伤和截肢等伤口^[53]。但是,仅仅伤口局部暴露在富氧环境中,成纤维细胞的胶原蛋白产量较低,ECM的形成不够完全,与全身氧疗相比治疗效果仍有差距。

2.2.2 冲击波技术

冲击波技术是利用设备在伤口局部形成瞬时微机械力的技术,通过微机械力的传递可以实现细胞的机械传导和免疫调节。临床前研究表明,该技术在糖尿病伤口、皮瓣坏死及烧伤愈合方面具有重要作用。由于肉芽组织较为脆弱,利用湿性敷料传递冲击波不仅可以缓解伤口的疼痛,还可以维持肉芽组织基本形态。冲击波疗法具有可精准地将高剂量的能量传递到不同皮肤层次的优点,从而达到不同皮肤层次损伤的修复。但其过分依赖于操作者的经验,无法形成固定的治疗方案^[54],将影响治疗的效果及治疗方案的推广。

2.2.3 负压伤口技术

负压伤口技术,也称作真空辅助闭合技术,是利用湿性敷料及负压泵在伤口局部形成一个密闭负压环境的技术。局部负压环境的形成有利于渗出液排出、增加组织间连接并促进血管的生成,这使得伤口愈合的时间大大缩短。目前,负压伤口技术已经广泛应用于各类伤口,例如,植皮后、感染性以及炎症性伤口^[55]。尽管负压伤口技术得到广泛应用,但仍存在一些潜在的风险及并发症,例如二次出血的发生、感染的加重及伤口周围材料的滞留等问题。所以,在使用负压伤口技术前需要对伤口开展全面评估。

2.2.4 光动力治疗技术

光动力治疗技术是利用透明的湿性敷料及光源设备,对于伤口局部进行照射治疗的技术。透明湿性敷料允许光子穿透组织,并与部分细胞的发光基团发生反应,从而引发伤口周围的免疫调节作用,改善伤口愈合。研究表明,光动力治疗技术对治疗腿部静脉溃疡、糖尿病足溃疡及压疮等慢性伤口有良好的治疗效果,约有47%的患者实现了伤口闭合,该方法较为安全,患者的耐受性和依从性均较高^[56]。

2.2.5 3D打印技术

3D打印技术也称为增材制造技术,是通过预先设置的数字程序,经过一定的顺序,有层次地添加材料生产预先设计好的产品。该技术不仅可以设计和控制敷料特定的孔隙、尺寸以及形状,还能通过改变生物墨水组成达到控制敷料溶胀、载药量、降解曲线和药物释放的能力。这为创面提供与皮肤的原生环境相似的愈合环境^[57],促进细胞更快地贴附生长(图2)。辅助治疗及制造技术研究进展见表3。辅助技术的运用,主要是通过物理及化学的方式改变伤口微环境,从而达到促愈合作用,但是无法改变医用湿性敷料的微观结构特点。3D打印技术主要是通过特殊工艺方法改变医用湿性敷料的微观结构,可以为医用湿性敷料的研究及应用提供新的方案。

3 展望

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近年来,医用湿性敷料的广泛研究和应用,推动了皮肤创伤修复愈合领域快速发展。本综述全面阐述了几种常见医用湿性敷料的结构特点、优缺点及临床应用情况,并对其在止血、抗感染和促进伤口愈合等伤口治疗方面的进展进行了归纳,结合新型的治疗技术及制备手段,总结了湿性敷料在皮肤创伤方面的最新发展现状。总体来看,薄膜型敷料和水胶体型敷料根据吸收渗液能力的差异,在临床应用场景上存在差异。透气性好、吸收力弱的薄膜型敷料,适用于导管、引流管固定,轻度烧伤和溃疡型伤口,且易于与抗菌止血等活性成分复合,构建新型给药系统并拓宽其运用范围。吸收渗液能力强的水胶体型敷料则偏向于严重渗出伤口的应用,其防水、防菌、防脱落的特性也有利于其在野外复杂条件下的应用。〗泡沫型敷料由于其泡沫型的结构特点,常常搭配负压伤口技术进行使用。水凝胶型敷料具有保湿、清除坏死组织的能力,可应用于各类急慢性伤口。改变敷料结构、增加物理响应能力可能成为水凝胶型敷料研究新热点。随着3D打印等多种制造技术的更新和快速发展,湿性敷料的层级及微观结构可调性增加、物理化学响应能力显著提升,结合局部高压氧、冲击波、负压伤口及光动力治疗技术在内的多项辅助治疗技术^[51],也可进一步改变伤口周围微环境、促进组织增生并缩短伤口愈合的时间。

经过多年的发展,众多类型的医用湿性敷料上市供医生和患者选择使用,但仍存在着部分制约因素,主要包括新型敷料高昂成本及患者的可负担性、敷料选择与患者诊疗适配性的选择,以及新型特种敷料储存和供应链发展的必要性等。首先,湿性敷料相较于传统敷料制造成本的高昂是不可避免的,并且随着功能性叠加可能会进一步提高制造成本。在临床使用过程中,使用者需开展一些成本效益分析,以期获得长期伤口管理中更佳的经济优势;第二,不同类型的皮肤创伤与不同特点的医用湿性敷料的适配性仍需更多的临床数据的验证,选择及操作不当,可能直接导致不良的治疗效果。这需要医院提供针对医疗专业人员和患者开展培训及科普工作,以提高对湿性愈合和湿性敷料使用的认识;第三,一些新型的医用湿性敷料(如搭载各类生长因子的湿性敷料)可能需要特殊的储存条件,以保持其稳定性和治疗效果,这可能对供应链和存储提出了更高的要求。所以改进供应链管理和敷料存储条件,确保产品质量和可用性成为了医用湿性敷料推广应用的又一难点。开发更为稳定及可靠的改性聚合物和生物活性因子,加强供应链管理可能将推动医用湿性敷料的临床应用。皮肤创伤愈合已经成为了困扰临床较为严重的健康问题,创伤愈合具有过程的复杂性和患者特异性,希望通过对医用湿性敷料研究进展的总结,为医生及患者提供参考,为研究人员在医用湿性敷料的设计及开发过程中提供新的思路。

参考文献

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文献

收起

参考文献引证文献

排序方式：

[1]

GAINZA

, VILLULLAS

, PEDRAZ

J L

, et al. Advances in drug delivery systems (DDSs) to release growth factors for wound healing and skin regeneration[J]. Nanomedicine, 2015, 11(6): 1551-1573.

[2]

PECK

M D

. Epidemiology of burns throughout the World. Part Ⅱ: intentional burns in adults[J]. Burns, 2012, 38(5): 630-637.

[3]

LIANG

, ZHAO

, HU

, et al. Adhesive hemostatic conducting injectable composite hydrogels with sustained drug release and photothermal antibacterial activity to promote full-thickness skin regeneration during wound healing[J]. Small, 2019, 15(12): e1900046.

[4]

WILKINSON

H N

, HARDMAN

M J

. Wound healing: cellular mechanisms and pathological outcomes[J]. Open Biol, 2020, 10(9): 200223.

[5]

ROUSSELLE

, MONTMASSON

, GARNIER

. Extracellular matrix contribution to skin wound re-epithelialization[J]. Matrix Biol, 2019, 75-76: 12-26.

[6]

WINTER

G D

. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig[J]. Nature, 1962, 193: 293-294.

[7]

TAVAKOLIAN

, MUNGUIA-LOPEZ

J G

, VALIEI

, et al. Highly absorbent antibacterial and biofilm-disrupting hydrogels from cellulose for wound dressing applications[J]. ACS Appl Mater Interfaces, 2020, 12(36): 39991-40001.

[8]

ALM

, HORNMARK

A M

, FALL

P A

, et al. Care of pressure sores: a controlled study of the use of a hydrocolloid dressing compared with wet saline gauze compresses[J]. Acta Derm Venereol Suppl (Stockh), 1989, 149: 1-10.

[9]

J Y

, SU

, JIN

Z M

, et al. Effects of Natural Brown Cotton Bleached Gauze on Wound Healing[J]. Materials (Basel), 2022, 15(6): 2070.

[10]

, ZHAO

, LIANG

Y P

, et al. Antibacterial adhesive injectable hydrogels with rapid self-healing, extensibility and compressibility as wound dressing for joints skin wound healing[J]. Biomaterials, 2018, 183: 185-199.

[11]

NATIONAL MEDICAL PRODUCTS ADMINISTRATION. 2024. dressing. Domestic Medical Devices (Registration)[DB/OL]. [2024-05-15]. https://www.nmpa.gov.cn/datasearch/search-result.html. https://www.nmpa.gov.cn/datasearch/search-result.html

[12]

FOOD AND DRUG ADMINISTRATION. 2024. dressing. Domestic Medical Devices (Registration)[DB/OL]. [2024-05-15]. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRL/rl.cfm. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRL/rl.cfm

[13]

ATAY

, YILMAZ KURT

. Effectiveness of transparent film dressing for peripheral intravenous catheter[J]. J Vasc Access, 2021, 22(1): 135-140.

[14]

FERNANDES DE CARVALHO

, PAGGIARO

A O

, ISAAC

, et al. Clinical trial comparing 3 different wound dressings for the management of partial-thickness skin graft donor sites[J]. J Wound Ostomy Cont Nurs, 2011, 38(6): 643-647.

[15]

KHIL

M S

, CHA

D I

, KIM

H Y

, et al. Electrospun nanofibrous polyurethane membrane as wound dressing[J]. J Biomed Mater Res B Appl Biomater, 2003, 67(2): 675-679.

[16]

BEECKMAN

, FOURIE

, RAEPSAET

, et al. Silicone adhesive multilayer foam dressings as adjuvant prophylactic therapy to prevent hospital-acquired pressure ulcers: a pragmatic noncommercial multicentre randomized open-label parallel-group medical device trial[J]. Br J Dermatol, 2021, 185(1): 52-61.

[17]

DAVIES

, MCCARTY

, HAMBERG

. Silver-containing foam dressings with Safetac: a review of the scientific and clinical data[J]. J Wound Care, 2017, 26(Sup6a): S1-S32.

[18]

GAN

J E

, CHIN

C Y

. Formulation and characterisation of alginate hydrocolloid film dressing loaded with gallic acid for potential chronic wound healing[J]. F1000Res, 2021, 10: 451.

[19]

ROLDAN-VASQUEZ

, CANELOS

, CAICEDO

, et al. Conservative management of giant omphaloceles with hydrocolloid dressings[J]. J Pediatr Surg Case Rep, 2021, 64: 101700.

[20]

KONG

D N

, ZHANG

Q C

, YOU

, et al. Adhesion loss mechanism based on carboxymethyl cellulose-filled hydrocolloid dressings in physiological wounds environment[J]. Carbohydr Polym, 2020, 235:115953.

[21]

BISHT

, LOHANI

U C

, KUMAR

, et al. Edible hydrocolloids as sustainable substitute for non-biodegradable materials[J]. Crit Rev Food Sci Nutr, 2022, 62(3): 693-725.

[22]

AZAM

, AHMAD

, et al. Preparation and Characterization of Alginate Hydrogel Fibers Reinforced by Cotton for Biomedical Applications[J]. Polymers (Basel), 2022, 14(21).

[23]

XIANG

J X

, SHEN

, HONG

Y L

. Status and future scope of hydrogels in wound healing: Synthesis, materials and evaluation[J]. Eur Polym J, 2020, 130:109609.

[24]

CHEN

, QIN

, WU

, et al. Glucose-responsive antioxidant hydrogel accelerates diabetic wound healing[J]. Adv Healthc Mater, 2023, 12(21): e2300074.

[25]

LEE

S J

, HEO

D N

, MOON

J H

, et al. Chitosan/polyurethane blended fiber sheets containing silver sulfadiazine for use as an antimicrobial wound dressing[J]. J Nanosci Nanotechnol, 2014, 14(10): 7488-7494.

[26]

TEOT

, OHURA

. Challenges and Management in Wound Care[J]. Plast Reconstr Surg, 2021, 147(1S-1): 9S-15S.

[27]

SILLMON

, MORAN

, SHOOK

, et al. The use of prophylactic foam dressings for prevention of hospital-acquired pressure injuries: a systematic review[J]. J Wound Ostomy Cont Nurs, 2021, 48(3): 211-218.

[28]

AHMAD

, SALMAN

, KHAN

S A

, et al. Versatility of hydrogels: from synthetic strategies, classification, and properties to biomedical applications[J]. Gels, 2022, 8(3): 167.

[29]

CHENG

, SHI

, YUE

, et al. Sprayable hydrogel dressing accelerates wound healing with combined reactive oxygen species-scavenging and antibacterial abilities[J]. Acta Biomater, 2021, 124: 219-232.

[30]

QIAN

, ZHENG

, JIN

, et al. Immunoregulation in diabetic wound repair with a photoenhanced glycyrrhizic acid hydrogel scaffold[J]. Adv Mater, 2022, 34(29): e2200521.

[31]

BOULTON

A J

, LEWIS

C T

, NAUMANN

D N

, et al. Prehospital haemostatic dressings for trauma: a systematic review[J]. Emerg Med J, 2018, 35(7): 449-457.

[32]

ZIMNITSKY

D S

, YURKSHTOVICH

T L

, BYCHKOVSKY

P M

. Multilayer adsorption of amino acids on oxidized cellulose[J]. J Colloid Interface Sci, 2005, 285(2): 502-508.

[33]

YANG

, LIU

, LI

, et al. Design and development of polysaccharide hemostatic materials and their hemostatic mechanism[J]. Biomater Sci, 2017, 5(12): 2357-2368.

[34]

ZHOU

, WANG

, CAO

, et al. Genipin-crosslinked polyvinyl alcohol/silk fibroin/nano-hydroxyapatite hydrogel for fabrication of artificial cornea scaffolds-a novel approach to corneal tissue engineering[J]. J Biomater Sci Polym Ed, 2019, 30(17): 1604-1619.

[35]

WOLCOTT

R D

, RHOADS

D D

, BENNETT

M E

, et al. Chronic wounds and the medical biofilm paradigm[J]. J Wound Care, 2010, 19(2): 45-46, 48-50, 52-53.

[36]

WAHID

, HUANG

L H

, ZHAO

X Q

, et al. Bacterial cellulose and its potential for biomedical applications[J]. Biotechnol Adv, 2021, 53: 107856.

[37]

PENG

, ZHAO

, TU

, et al. In situ hydrogel dressing loaded with heparin and basic fibroblast growth factor for accelerating wound healing in rat[J]. Mater Sci Eng C Mater Biol Appl, 2020, 116: 111169.

[38]

MORETTI

, STALFORT

, BARKER

T H

, et al. The interplay of fibroblasts, the extracellular matrix, and inflammation in scar formation[J]. J Biol Chem, 2022, 298(2): 101530.

[39]

SAMADIAN

, VAHIDI

, SALEHI

, et al. Hydrogel nanocomposite based on alginate/zeolite for burn wound healing: In vitro and in vivo study[J]. Iran J Basic Med Sci, 2023, 26(6): 708-716.

[40]

SONG

, KONG

, SHAO

, et al. Chitosan-based multifunctional flexible hemostatic bio-hydrogel[J]. Acta Biomater, 2021, 136: 170-183.

[41]

LIN

, DUAN

, LAN

, et al. Alginate-based cryogels for combined chemo/photothermal antibacterial therapy and rapid hemostasis[J]. ACS Omega, 2023, 8(5): 4889-4898.

[42]

DING

, WANG

, MAN

, et al. Antibacterial and hemostatic polyvinyl alcohol/microcrystalline cellulose reinforced sodium alginate breathable dressing containing Euphorbia humifusa extract based on microfluidic spinning technology[J]. Int J Biol Macromol, 2023, 239: 124167.

[43]

SAKTHI DEVI

, GIRIGOSWAMI

, SIDDHARTH

, et al. Applications of gold and silver nanoparticles in theranostics[J]. Appl Biochem Biotechnol, 2022, 194(9): 4187-4219.

[44]

CHOUDHURY

, PANDEY

, LIM

Y Q

, et al. Silver nanoparticles: Advanced and promising technology in diabetic wound therapy[J]. Mater Sci Eng C Mater Biol Appl, 2020, 112: 110925.

[45]

NEGUT

, GRUMEZESCU

A M

. Treatment strategies for infected wounds[J]. Molecules, 2018, 23(9):2392.

[46]

NDLOVU

S P

, FONKUI

T Y

, NDINTEH

D T

, et al. Dissolvable wound dressing loaded with silver nanoparticles together with ampicillin and ciprofloxacin[J]. Ther Deliv, 2022, 13(5): 295-311.

[47]

OLIVEIRA

, SIMÕES

, ASCENSO

, et al. Therapeutic advances in wound healing[J]. J Dermatol Treat, 2022, 33(1): 2-22.

[48]

ALVEN

, ADERIBIGBE

B A

. Chitosan and cellulose-based hydrogels for wound management[J]. Int J Mol Sci, 2020, 21(24):9656.

[49]

DAS

, MANNA

, ROY

, et al. Polymeric biomaterials-based tissue engineering for wound healing: a systemic review[J]. Burns Trauma, 2023, 11: tkac058.

[50]

SHPICHKA

, BUTNARU

, BEZRUKOV

E A

, et al. Skin tissue regeneration for burn injury[J]. Stem Cell Res Ther, 2019, 10(1): 94.

[51]

BENSON

H A E

, GRICE

J E

, MOHAMMED

, et al. Topical and transdermal drug delivery: from simple potions to smart technologies[J]. Curr Drug Deliv, 2019, 16(5): 444-460.

[52]

KAUFMAN

, GUREVICH

, TAMIR

, et al. Topical oxygen therapy stimulates healing in difficult, chronic wounds: a tertiary centre experience[J]. J Wound Care, 2018, 27(7): 426-433.

[53]

PASEK

, SZAJKOWSKI

, OLE

Ś P

, et al. Local hyperbaric oxygen therapy in the treatment of diabetic foot ulcers[J]. Int J Environ Res Public Health, 2022, 19(17): 10548.

[54]

SHI

, LI

, WANG

, et al. Irritant contact dermatitis following extracorporeal shockwave therapy: a case report[J]. Ann Palliat Med, 2021, 10(6): 7083-7087.

[55]

WANG

, LI

, FAN

, et al. Negative pressure wound therapy promoted wound healing by suppressing inflammation via down-regulating MAPK-JNK signaling pathway in diabetic foot patients[J]. Diabetes Res Clin Pract, 2019, 150: 81-89.

[56]

ROMANELLI

, PIAGGESI

, SCAPAGNINI

, et al. Evaluation of fluorescence biomodulation in the real-life management of chronic wounds: the EUREKA trial[J]. J Wound Care, 2018, 27(11): 744-753.

[57]

SEOANE-VIANO

, JANUSKAITE

, ALVAREZ-LORENZO

, et al. Semi-solid extrusion 3D printing in drug delivery and biomedicine: personalised solutions for healthcare challenges[J]. J Controlled Release, 2021, 332: 367-389.

[58]

NORMAN

, GOH

E L

, DUMVILLE

J C

, et al. Negative pressure wound therapy for surgical wounds healing by primary closure[J]. Cochrane Database Syst Rev, 2020, 6(6): CD009261.

[59]

HUANG

, LIANG

, JIANG

, et al. Hyperbaric oxygen potentiates diabetic wound healing by promoting fibroblast cell proliferation and endothelial cell angiogenesis[J]. Life Sci, 2020, 259: 118246.

[60]

ORTEGA

M A

, FRAILE-MARTINEZ

, GARCIA-MONTERO

, et al. A general overview on the hyperbaric oxygen therapy: applications, mechanisms and translational opportunities[J]. Medicina (Kaunas), 2021, 57(9):864.

[61]

AUERSPERG

, TRIEB

. Extracorporeal shock wave therapy: an update[J]. EFORT Open Rev, 2020, 5(10): 584-592.

[62]

AGUILERA-SAEZ

, MUNOZ

, SERRACANTA

, et al. Extracorporeal shock wave therapy role in the treatment of burn patients. a systematic literature review[J]. Burns, 2020, 46(7): 1525-1532.

[63]

FEEHAN

, BURROWS

S P

, CORNELIUS

, et al. Therapeutic applications of polarized light: tissue healing and immunomodulatory effects[J]. Maturitas, 2018, 116: 11-17.

[64]

JENG

S F

, CHEN

J A

, CHANG

L R

, et al. Beneficial effect of intense pulsed light on the wound healing in diabetic rats[J]. Lasers Surg Med, 2020, 52(6): 530-536.

[65]

NAM

S Y

, PARK

S H

. ECM based bioink for tissue mimetic 3D bioprinting[J]. Adv Exp Med Biol, 2018, 1064: 335-353.

[66]

DOS SANTOS

, DE OLIVEIRA

R S

, DE OLIVEIRA

T V

, et al. 3D Printing and nanotechnology: a multiscale alliance in personalized medicine[J]. Adv Funct Mater, 2021, 31(16):2009691.

2025年第60卷第4期

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doi: 10.11669/cpj.2025.04.002

接收时间：2024-01-31
首发时间：2025-11-07
出版时间：2025-02-22

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收稿日期：2024-01-31

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军事医学研究院, 北京 100850

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^*张慧,女,博士,副研究员,硕士生导师研究方向:纳微缓控药物关键技术及其递送机制 Tel:(010)66874665;

高翔,男,博士,副研究员,硕士生导师研究方向:新型药物递释系统 Tel:(010)66874665

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
				栓菌属 Trametes	5	2.39

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Type	Advantages	Disadvantage	Application
Film dressings	Transparent & well-ventilated	Poor ability to absorb liquids^[25]	Minor burn & ulcer wound^[14]
Foam dressings	Keep warm & antibiosis	Opacification^[26]	Infected wound^[27]
Hydrocolloid dressings	Good ability to absorb liquids^[18]	High cost & secondary damage^[19]	Exudate wound
Hydrogel dressings	Clear necrotic tissue^[28]	Increased risk of infection^[29]	Burn wound^[30]& operative wound

Type

Advantages

Disadvantage

Application

Film dressings

Transparent & well-ventilated

Poor ability to absorb liquids^[25]

Minor burn & ulcer wound^[14]

Foam dressings

Keep warm & antibiosis

Opacification^[26]

Infected wound^[27]

Hydrocolloid dressings

Good ability to absorb liquids^[18]

High cost & secondary damage^[19]

Exudate wound

Hydrogel dressings

Clear necrotic tissue^[28]

Increased risk of infection^[29]

Burn wound^[30]& operative wound

Feature	Materials	Advantages	Disadvantage	Research progress	Application
Hemostasis	Zeolite^[39]	Massive hemorrhage	Burn the surrounding tissue	Clinical application	First aid in battle
	Chitosan^[40]	Deep hemorrhage	Poor mechanical properties	Clinical application	Surgery
	Chitosan derivative			Application for registeration	-
	Alginate^[41]	Biocompatibility & Degradability^[42]	High cost & short action time	Clinical application	Dental treatment
Antibiosis	Metals and oxides^[43-44]	Long action time	Metal toxicity	Clinical application	Nano silver dressing
	Natural polymer^[45]	Biocompatibility	Poor mechanical properties	Preclinical study	-
	Antibiotic^[46-47]	Good effect	Bacterial resistance	Clinical application	Emergency local antibacterial
	Synthetic polymer^[48]	Biocompatibility & degradability	Poor mechanical properties	Preclinical study	-
Promote healing	Exogenous growth factors^[49-50]	Biocompatibility & good effect	High cost	Preclinical study	-

Feature

Materials

Advantages

Disadvantage

Research progress

Application

Hemostasis

Zeolite^[39]

Massive hemorrhage

Burn the surrounding tissue

Clinical application

First aid in battle

Chitosan^[40]

Deep hemorrhage

Poor mechanical properties

Clinical application

Surgery

Chitosan derivative

Application for registeration

Alginate^[41]

Biocompatibility & Degradability^[42]

High cost & short action time

Clinical application

Dental treatment

Antibiosis

Metals and oxides^[43-44]

Long action time

Metal toxicity

Clinical application

Nano silver dressing

Natural polymer^[45]

Biocompatibility

Poor mechanical properties

Preclinical study

Antibiotic^[46-47]

Good effect

Bacterial resistance

Clinical application

Emergency local antibacterial

Synthetic polymer^[48]

Biocompatibility & degradability

Poor mechanical properties

Preclinical study

Promote healing

Exogenous growth factors^[49-50]

Biocompatibility & good effect

High cost

Preclinical study

Type	Technology	Advantage	Complication	Research progress
Adjuvant therapy technique	Negative pressure wound therapy^[58]	Tissue regeneration	Bleeding & infection	Clinical application
	Topical hyperbaric oxygen therapy^[59]	Reduce inflammation	Slow down tissue nutrient transport^[60]	Clinical application
	Shock wave therapy^[61]	Precise energy transfer^[62]	Pain & hematoma	Clinical application
	Photobiomodulation^[63]	Penetrate superficial tissue	Patient tolerance decreased^[64]	Clinical application
Manufacturing technology	3D Printing technology^[65]	Simulate the three-dimensional structure of biology^[66]& altered drug release	Low cell activity	Preclinical study

Type

Technology

Advantage

Complication

Research progress

Adjuvant therapy technique

Negative pressure wound therapy^[58]

Tissue regeneration

Bleeding & infection

Clinical application

Topical hyperbaric oxygen therapy^[59]

Reduce inflammation

Slow down tissue nutrient transport^[60]

Clinical application

Shock wave therapy^[61]

Precise energy transfer^[62]

Pain & hematoma

Clinical application

Photobiomodulation^[63]

Penetrate superficial tissue

Patient tolerance decreased^[64]

Clinical application

Manufacturing technology

3D Printing technology^[65]

Simulate the three-dimensional
structure of biology^[66]& altered drug release

Low cell activity

Preclinical study