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International Journal of Bioprinting 3D printed bioactive dressings for burn wound treatment

promotes moist wound healing for longer time periods, immense need to develop advanced wound dressings
and the non-adhesive porous texture of the 3D-printed for second-degree burn wound treatment with desired
dressings with increased wound-dressing interactions. features, such as bioactive formulation, soothing effect,
Our findings provided proof of concept for the synergistic tunable water absorption/release, non-adhesive contact,
effect of bioactive formulation and the porous texture and skin-like mechanical properties [6,16,23,24] .
of the 3D-printed hydrogel dressings incorporated with Bioactive glass materials are a class of bioceramics that
BBG on continuous water release and, consequently, on have the ability to bond with living tissues and promote
second-degree burn wound healing. specific biological responses when exposed to body fluids.
These materials have been studied extensively for their
Keywords: Hydrogel wound dressing; Burn wound potential use in hard tissue engineering and implant
healing; 3D printing; Bioactive borate glass; coating [25,26] . Bioactive glass materials comprise a mixture
Continuous water release of oxides from biologically active elements, such as Si, B,
Ca, Mg, Ag, Ce, Cu, and Zn, among others. The multiple
therapeutic ions released from bioactive glass can react
with proteins and enzymes to stimulate the proliferation
1. Introduction and differentiation of cells involved in wound healing, such
as mesenchymal stem cells, fibroblasts, and endothelial
Burn wound healing is a complex and delicate molecular- cells [26,27] . There are three major types of bioactive glass
cellular process to restore skin functions and repair which are classified based on the dominant network
[1]
tissue damage . Burn injuries represent a major public forming oxide in the glass formulation: silicate glass,
health issue and are among the most severe injuries , phosphate glass, and borate glass, among which the latter
[2]
with approximately 10,000 annual deaths in the United has the fastest degradation rate . Recently, the US Food
[28]
States . Each year approximately 1.1 million patients and Drug Administration (FDA) has cleared a bioactive
[3]
suffering from burn wounds are admitted to hospitals in borate glass (BBG) product (Mirragen, ETS Wound Care,
the United States, and approximately 660,000 among them Missouri, USA) for treatment of chronic wound healing .
[29]
are diagnosed with second-degree burn wounds [4-6] . In addition to its ability to promote cellular activity, BBG
Second-degree burn is characterized by damage to the can enhance wound healing by (i) regulating the secretion
integrity of the entire epidermis and varied depths of the of essential growth factors and matrix metalloproteinase
[7]
dermis that typically require immediate medical care . (MMPs) to promote angiogenesis and extracellular
The current standard of care in clinical practice for second- matrix (ECM) remodeling [30-37] , (ii) preventing bacterial
degree burn wound treatment includes topical antimicrobial growth [32,38,39] , and (iii) alleviating the adverse inflammatory
agents and advanced dressings such as contact dressing response by scavenging the reactive oxygen species [40,41] .
and hydrogel dressings. The primary goal of the advanced Several studies showed that boron in BBG positively affects
dressings is to promote optimal wound healing while different stages of wound healing. It has been shown that
providing pain relief and protection from infection [8,9] . boron can promote angiogenesis by stimulating tissues to
Although the existing advanced wound dressings cover secrete specific growth factors and modulate keratinocytes
a broad range of moderate to high exuding wounds, a and endothelial cellular responses [26,31,36,42,43] . One of the
small number of wound care products are specifically key advantages of using BBG over other additives is its
designed for low exuding wounds, e.g., second-degree potential for incorporating a wide variety of dopants,
burns. Despite good clinical outcomes for wet wounds, the including copper and zinc to promote the release kinetics
majority of these products end up with inadequate healing of bioactive ions, regulate degradation rate, and potentially
[44]
and poor hydration in second-degree burn wounds [10,11] . impart additional therapeutic properties to the glass .
Topical agents, such as silver sulfadiazine, are typically Copper has been shown to stimulate the proliferation of
associated with pain and prolonged healing due to wound endothelial cells by inducing local hypoxia to stimulate
dehydration, poor re-epithelialization, traumatic removal, the expression of vascular endothelial growth factor
[33,45]
and non-transparent appearance [10-22] . Hydrogel dressings (VEGF) . Several studies have reported the positive
provide a moist environment for the second-degree wound effect of zinc dopant on the antimicrobial activity and
[46-48]
and help with pain relief. However, frequent changes of inflammatory response .
hydrogel dressings in second-degree burn wounds can Despite the good clinical outcome for wet wounds,
be time-consuming, potentially traumatic to the healing however, BBG alone is ineffective in treating dry wounds,
tissue, and may lead to complications such as dehydration e.g., burn wounds, due to the wound dehydration and
or maceration if poorly managed. Hence, there is an lack of reacting medium. Besides, the fast degradation

Volume 9 Issue 6 (2023) 133 https://doi.org/10.36922/ijb.0118