72 These nanofiber webs have unique properties, such as a high ratio of surface area to volume, small pore size, and high porosity.73 and 74 These nanofibers impregnated with silver nanoparticles are very efficient for topical drug administration and wound healing because of their high ratio of surface area to volume.75 and 76 Maneerung et al.77 has impregnated silver nanoparticles into bacterial cellulose for antimicrobial

wound dressing. Bacterial cellulose is an interesting material for use as a wound dressing since it provides a moist environment to a wound, resulting in better wound healing. However, bacterial cellulose itself has no antimicrobial activity to prevent wound infection. To achieve antimicrobial activity,

silver nanoparticles were impregnated into bacterial cellulose by immersing bacterial check details cellulose in a silver nitrate solution. The freeze-dried silver nanoparticle–impregnated bacterial cellulose exhibited strong the antimicrobial activity against E coli (gram-negative) and S aureus (gram-positive). In a study by Miller et al., 78 the effect of nano-crystalline silver on the healing Autophagy inhibitor datasheet of leg ulcers was studied. The silver dressing did not increase the overall healing rate, but it was associated with quicker healing in larger and older ulcers. An extensive metastudy by Storm-Versloot et al. 79 confirmed these findings in that most studies on silver dressings for nonhealing PDK4 wounds did not

show a significant reduction of infection when silver sulfadiazine cream or silver dressings were used. Wound healing was found to vary among the different studies reviewed, depending on the type of wounds included in the study and the exact dressing used. 79 A chitosan-nanocrystalline silver dressing showed superior healing rates (89%) compared with silver sulfadiazine dressings (68%) and chitosan film (74%). 80 In addition, the chitosan-nanocrystalline silver dressing deposited far less silver than did conventional silver sulfadiazine, 80 thus demonstrating that the use of silver nanoparticles may be safer in reducing the incidence of argyria and argyremia (elevated silver concentration in the blood). The inflammatory response is an important part of wound healing. The various inflammatory mediators are secreted to adjust the healing process within wounds. In usual wound healing, the possibility of proinflammatory and anti-inflammatory cytokines is present, and the inflammatory response is totally appropriate. To achieve successful wound repair and tissue regeneration, the inflammatory response must be securely regulated in vivo. A vital mediator in this anti-inflammatory cascade appears to be interleukin 10 (IL-10), which can be produced by keratinocytes as well as inflammatory cells involved in the healing process, including T lymphocytes, macrophages, and B lymphocytes88 (Figure 5).