ترمیم زخم

Treatment of some wounds, such as bedsores, diabetic foot ulcers, and other chronic wounds, requires hospitalization and imposes significant costs on society.
Therefore, there is a need to expand research into new methods for healing such wounds. The purpose of this review is to compare classic and modern methods in managing infectious treatments.

This narrative review is the result of searching and analyzing studies in printed texts and published in reliable databases such as Google Scholar, PubMed (MEDLINE), Scopus and Cochrane Library (CENTRAL) between the years 2000 until February 2024. The main Latin keywords used in the search were "probiotics", "wound treatment", "wound dressing" and "wound" in free text and medical subject headings (MeSH).

Various methods for wound management including classical dressings, ozone therapy, vacuum therapy, larval therapy, laser therapy and new dressings (including blocking dressings, films, hydrocolloid dressings, foam dressings, hydrogels, dressings containing calcium alginate, dextranomer granules, photodynamic therapy, biological dressings, the dressing contains probiotics and post-biotic dressings). there is great potential for significant healing of wounds with the introduction of new wound healing treatments,

The effort to gain knowledge about the basic mechanisms in wound healing and the appropriate applications of existing dressings facilitates the approach of choosing the best dressing. It seems necessary to choose a suitable and efficient method Considering the existence of types of wounds and the challenges related to each one, Therefore, further research is very important to find an advanced treatment option and wound healing dressings for wound healing to help patients and physicians.

Wound healing is the body's natural repair process after injury. Due to its high antioxidant capacity and many effective components, this study aimed to assess the impact of topically applied Heracleum persicum extract on rat full-thickness incisional cutaneous wound healing.

After induction the wound, sixty male rats were divided into four groups: control, basal cream, H. persicum 5% and 10% and were treated daily with saline, basal cream, H. persicum 5% and H. persicum 10% for 14 days, respectively. The animals were euthanized at 7, 14 and 21 days post-injury, and samples were collected for histopathological and biochemical analysis.

A prominent decrease in the wound area was observed in the treatment groups, particularly H. persicum 10% compared to the control group. Additionally, treatment with H. persicum decreased the number of lymphocytes and improved the number of fibroblasts at the earlier stages and increased the number of fibrocytes at the later stages of wound healing. Also, re-epithelization, tissue alignment, higher maturity of the collagen fibers and large capillary-sized blood vessels revealed significant changes in the treatment groups, especially H. persicum 10% compared to the control group. H. persicum extracts increased hydroxyproline and glycosaminoglycans contents and elevated total antioxidant capacity, while decreased malondialdehyde compared to the control group.

This study showed that H. persicum promotes wound healing activity. This property can be attributed to its action on blood vessels, modulation of inflammation, its role in initiating more collagen and glycosaminoglycan production and decreasing oxidative stress.

Impaired wound healing following significant tissue damage such as severe burns, trauma, or surgery can result in scarring and skin fibrosis. Pathological scarring leads to changes in the natural shape of the wound and, in addition to cosmetic problems, may be accompanied by pain and even limit the person's normal movement. The immune response plays a very important role in the wound healing process. Activation of immune cells and factors initiates the inflammatory process, facilitates wound cleansing, and tissue repair and regeneration. However, disruption of the immune system during the wound healing process leads to persistent inflammation and delayed healing, ultimately leading to the development of chronic wounds. The microenvironment of a chronic wound contains a large number of immune cells, including proinflammatory macrophages, and high expression of inflammatory mediators such as TNF-α and IL-1β is observed in it. Among them, macrophages, as innate immune cells, play a key role in promoting the immune response and activating adaptive immunity. These cells are also key factors in the transition from the inflammatory phase to the tissue repair phase. As a result, dysregulation of macrophage function will have consequences such as scarring. Therefore, knowledge of the exact mechanism of the inflammatory process during wound healing, the inflammatory and anti-inflammatory mediators produced, and the effect of macrophages on this process can promise the achievement of new strategies in scarless wound healing. Therefore, this article discusses the mechanism of the immune system during the inflammatory process, and the key role of macrophages in this process, as well as scar formation.

Bacteria are natural sources of metabolites that exhibit diverse bioactive properties, including wound healing, antioxidative, antibacterial, antifungal, anti-inflammatory, antidiabetic, and anticancer activities. Two important groups of bacteria with wound healing potential are polysaccharides and peptides. In addition to cellulose, bacteria produce various polysaccharides (such as exopolysaccharides) with wound healing potential. The most common bacterial peptides used in wound healing studies are bacteriocins and lipopeptides. The aim of this article is to review recent literature on the potential of wound healing in vitro and in vivo by polysaccharides and peptides derived from bacteria (Actinobacteria, Bacteroides, Cyanobacteria, Firmicutes, and Proteobacteria). For this reason, a search was conducted in scientific research databases such as Web of Science, Google Scholar, Wiley, Elsevier, Taylor and Francis, BMC Springer and MDPI with the keywords polysaccharide, peptide, bacteriocins, lipopeptides, streptomyces, bacteria, lactic acid bacteria, cyanobacteria and wound healing. The overall results showed that polysaccharides and peptides and peptides derived from bacteria show wound healing power both in vitro and in vivo. In living models, including animals and humans, these metabolites have a positive effect on wound healing by inhibiting pathogens, antioxidant activity, modulating the inflammatory response, moisturizing the wound environment, promoting the proliferation and migration of fibroblasts and keratinocytes, increasing collagen synthesis, remodeling, epithelialization and angiogenesis. Therefore, peptides and polysaccharides derived from bacteria play a significant role in wound healing.

Bacteria are natural sources of metabolites that exhibit diverse bioactive properties, including wound healing, antioxidative, antibacterial, antifungal, anti-inflammatory, antidiabetic, and anticancer activities. Two important groups of bacteria with wound healing potential are polysaccharides and peptides. In addition to cellulose, bacteria produce various polysaccharides (such as exopolysaccharides) with wound healing potential. The most common bacterial peptides used in wound healing studies are bacteriocins and lipopeptides. The aim of this article is to review recent literature on the potential of wound healing in vitro and in vivo by polysaccharides and peptides derived from bacteria (Actinobacteria, Bacteroides, Cyanobacteria, Firmicutes, and Proteobacteria). For this reason, a search was conducted in scientific research databases such as Web of Science, Google Scholar, Wiley, Elsevier, Taylor and Francis, BMC Springer and MDPI with the keywords polysaccharide, peptide, bacteriocins, lipopeptides, streptomyces, bacteria, lactic acid bacteria, cyanobacteria and wound healing. The overall results showed that polysaccharides and peptides and peptides derived from bacteria show wound healing power both in vitro and in vivo. In living models, including animals and humans, these metabolites have a positive effect on wound healing by inhibiting pathogens, antioxidant activity, modulating the inflammatory response, moisturizing the wound environment, promoting the proliferation and migration of fibroblasts and keratinocytes, increasing collagen synthesis, remodeling, epithelialization and angiogenesis. Therefore, peptides and polysaccharides derived from bacteria play a significant role in wound healing.

Dysfunction of pancreatic beta cells causes a decrease in insulin and an increase in serum glucose, resulting in diabetes. Diabetes has caused dysfunction by damaging various organs, including tissues that are at risk of diabetes. So we've looked at the effect of Vicia sativa on skin wounds caused by high blood sugar.

In this study, 48 male mouse heads of the wistar breed with a weight range of 220 to 250 grams were divided into 4 control groups, Shem, experimental one (diabetic group+ oserin), experimental two(diabetic+ V. sativa). At the same time as the mice became diabetic with a dose of 50 mg/kg streptosotocin, the rest of the groups received the citrate buffer intra-peritoneal. After the rats were unconscious with the anesthetic and their back hair was shaved in the 3 cm long test groups on the left side of the spine, and the treated groups were treated with 14 days of MG/kg200 dose of mascara extract on the wounds. The wound healing process was examined macroscopically and microscopically on days 7 and 14.

The wound of diabetic groups treated with streptozocin showed a later repair compared to the control group, and the wound healing was faster in experimental groups treated with alcoholic extract of the mascara than in the control group.

The results indicated that the alcoholic extract of the mascara accelerated the healing of skin wounds of healthy and diabetic samples.

Diabetes is a metabolic disorder characterized by high blood glucose levels and insulin resistance. Pioglitazone can lower insulin resistance and has anti-inflammatory properties. The aim of this work was to develop pioglitazone-loaded nanofibers and to evaluate their effect as a dermal implant device to lower blood glucose levels. The effect of pioglitazone-loaded nanofiber was investigated as a wound dressing in diabetic Wistar rats.

In this work, nanofibers were developed using the electrospinning method. The structure and characteristics of the fibers were evaluated using scanning electron microscopy and Fourier Transform Infrared Spectroscopy. The effect of nanofiber implants was evaluated on blood glucose levels , and their wound healing effect was investigated in diabetic wounds in a Wistar rat model.

The developed formulations did not show any effect in lowering blood glucose when used as an implant; however, they were able to accelerate the wound healing rate when used as a dressing in the wound model. This effect might be due to the anti-inflammatory properties of the drug. The developed wound dressing was able to accelerate the formation of the epidermis and dermis layers in the wound model.

Histological studies indicate that wounds treated with pioglitazone-loaded nanofibers exhibit an anti-inflammatory effect and therefore can increase the wound healing rate. These drug-loaded nanofibers enhanced the development of collagen and improved the formation of the epidermis and dermis while reducing the number of inflammatory cells. The developed drug delivery system was not able to significantly decrease blood glucose levels in the animal model. This effect may be due to the low drug loading capacity as well as its poor aqueous solubility.

A wound is a break in the skin. Oral wounds are among the most common reasons for patients to visit a dental clinic, manifesting as lesions with clear boundaries, often slightly sunken, accompanied by or with complete loss of epithelium, covered by a fibrinoleukocytic membrane. Various factors can cause developing wound lesions, including trauma, infection, disease, medication, malignancy, and non-specific causes. Zinc plays a role in cell proliferation, protein synthesis, and wound healing following injury. Given the contradictions and potentials of zinc, and the lack of a study on the effect of zinc on oral wounds, conducting such a study became necessary. This study aimed to investigate the effect of zinc sulfate gel on the healing process of intraoral wounds in rats and compare it with triamcinolone.

This experimental study was conducted in the animal laboratory of the Oral and Dental Diseases Research Center of Kerman University of Medical Sciences. In this study, rats with an approximately 2 x 2 mm wound created using a 2-mm punch in the hard palate were used. The animals were randomly divided into 3 groups (14 rats in each group). Group A (0.1% triamcinolone acetonide gel), Group B (5% zinc sulfate gel), and Group C (placebo) received the respective treatments. Each group was divided into two subgroups based on microscopic evaluation of wound healing: A1, B1, and C1 for one week, and A2, B2, and C2 for two weeks of treatment. The wound sizes were measured along the largest diameter on days 1, 3, 7, and 14 using a Williams periodontal probe. Histological samples were prepared on days 7 and 14 and sent to the pathology laboratory for evaluation. The histopathological criterion for the wounds was based on tissue inflammation. The wounds were also divided into grades 1-5 for re-epithelialization. Finally, the data were analyzed using SPSS 20 software.

Regarding the severity of inflammation in the three study groups on days 7 and 14, there was no significant difference (P=0.538). Evaluation of the extent of re-epithelialization in the three study groups on days 7 and 14 showed that the mean extent of re-epithelialization was not significantly different between the triamcinolone and zinc sulfate groups (P=0.18), but the mean extent of re-epithelialization in the triamcinolone group was significantly greater than the placebo group (P=0.001). Also, in terms of wound size on days 1, 3, 7, and 14, the trend of wound size change was the same in the groups, and the mean wound size in the triamcinolone and zinc sulfate groups was less than the placebo group, although the mean of the triamcinolone group was slightly lower, the difference was not significant (P=0.118), indicating that the zinc sulfate group performed as well as the triamcinolone group.

The use of zinc sulfate gel resulted in a decrease in inflammation, an increase in re-epithelialization, and a decrease in wound size. Although the triamcinolone gel performed better in reducing inflammation, increasing re-epithelialization, and decreasing wound size, the difference was not significant. The prolonged use of triamcinolone can lead to adverse effects in some oral ulcers, such as candidiasis and hyperpigmentation. Additionally, zinc supplementation has fewer undesirable effects. Therefore, further research is needed to consider replacing triamcinolone with zinc sulfate.

Except for the palms and soles, the majority of the human skin surface is covered by hair follicles (HF). Hair follicles mostly produce thin and tiny hair stalks that are hardly visible to the naked eye and have a diameter of less than 30 micrometers, which are called unwanted hairs. Other human HFs, which have a lower percentage than the previous type, produce thicker hair shafts with a diameter of 60 µm, known as terminal hairs, and are located in androgen-dependent areas such as the scalp, armpits, and pubic areas. Unlike other mammals, the role of human hair in thermal and shock insulation is insignificant, and the most likely main role of hair follicles in human skin is not the production of hair stems, but participation in functions such as skin homeostasis and wound healing response to surface skin damage. Easy access to hair follicles in humans and their unique feature in the cycle of self-destruction and self-renewal make this microorganism very valuable for stem cell biologists. Hair follicle stem cells (HFSCs) are located in the protruding region of the external root sheath and dermal papilla of the hair follicle and are considered slow cycle cells that have the potential of multilineage differentiation and high proliferation capacity. The normal morphology and periodic growth of HFSCs play an important role in normal skin function, wound healing and skin regeneration. Hair follicle is a powerful enhancer for wound healing, but the application of this new idea in clinical practice is still in its early stages.

Nowadays, there is a specific focus on the skin health issue specifically about acute and chronic wounds repairment. Up to day, many efforts have been done and some solutions have been introduced to amelioration of cutaneous wounds.
As one of the latest methods, extracellular vesicles such as exosomes presented to procedure of wound healing phases. Exosomes, the nanosized extracellular bilayer vesicles, secret from every cell type in body and could influence on many targeted cells via their cargo’s. So, they may be essential agents in various biological processes including Support the skin repairment. Because of blood importance in wound healing, in this study we reviewed the effects of blood cells derived exosome on chronic wound.

In order to obtain this information, all of articles related with exosomes derived from each of the blood cells are collected with a time limitation between 2005 to 2024years.

Overall, revealed that some exosomes secreted from some blood cells specially macrophages and platelets, can affect on wound healing and promote It, almost in earlier stages of wound incidence.

Among the accidents that threaten human life, burn accidents are one of the worst. Burns are the fourth most common trauma worldwide and cause death, disability, pain, and many other problems. Faster healing of burn wounds is one of the health priorities of countries and it's important as a principle in the science of treatment. This research aims to determine and compare the effectiveness of hydrogel dressings containing allantoin and silver nanoparticles in the treatment of second-degree burn wounds.

This study was designed as a randomized controlled clinical trial. A total of 86 patients were selected in the study based on the inclusion and exclusion criteria and were randomly divided into two groups: A=43 and B=43, using a block method of 4. Group A patients received hydrogel containing silver nanoparticles and allantoin with a thickness of 2 millimeters and then sterile gauze and bandage on top of it, and group B patients received the usual treatment (Vaseline gauze, 0.5% acetic acid and 1% betadine). Local treatment was performed every 48 hours, and dressing was applied after each treatment. The condition of the wounds, including the presence or absence of granulation tissue, bleeding, pain, infection, and other wound complications or healing factors, was recorded and evaluated by visiting and observing every 48 hours.

The average age in the intervention group was 10.2 years and in the control group was 9.9 years, and the difference was not statistically significant, P=0.456. 48% of the patients in the intervention group were male 52% were female, and in the control group, 44% were male and 56% were female, and the difference was not statistically significant, P=0.665. The average percentage of burns in the intervention group was 9.04% and in the control group was 9.58%, which was not statistically significant P=0.289. The type of burn in the intervention group was liquid 69% and flame 31%, and in the control group, liquid 65% and flame 34%, which was not statistically significant P=0.645.The intervention group had 55% of limbs and 45% of trunk and the control group had 63% of limbs and 37% of trunk, which difference was not statistically significant, P=0.510. In other words, the two groups were homogenous in age, sex, average burn percentage, burn mechanism, and location, and there were no significant differences. The average onset of epithelialization in the intervention group was 4.5 days (74% of patients on day 4 and 23% on day 6) and 6.4 days in the control group (60% of patients on day 6 and 30% on day 8), which was statistically significant P<0.001. The average intensity of pain in the intervention group was 5 out of 10 and in the control group was 7 out of 10, and this difference was statistically significant P<0.001.

The results of this study show that patients treated with a hydrogel dressing containing silver nanoparticles and allantoin had a statistically significant difference in the onset of wound epithelialization and pain intensity, compared to the usual dressing. This dressing can be used as a suitable alternative in the treatment of second-degree burn wounds compared to routine dressings. Therefore, offering it to the medical team, who play an essential role in the treatment of patients with burns, will reduce the length of hospitalization and the costs.

The skin, as the outer layer, protects the body against external factors. Wounds can negatively affect its performance. Wound healing includes three stages of inflammation, proliferation, and regeneration, which begin immediately after injury. Also, some factors such as infection, obesity and diabetes can disrupt the natural healing process that leads to chronic wounds. Various surgical and non-surgical treatments have been used to manage chronic wounds, including hyperbaric oxygen therapy, ultrasound therapy, laser therapy, and skin grafting. These treatments have advantages and disadvantages. Recently, stem cells have been used as a surgical treatment for chronic wound healing. Stem cells are highly proliferative cells that can maintain their ability to divide and regenerate for a long time. Among the different types of stem cells, MSCs have many advantages such as ease of harvest, availability, and multilineage differentiation capacity for cell therapy. In addition, they showed some properties that could be useful in the clinical application of ASCs, including angiogenesis, immune system modulation, and improved tissue regeneration. This study was conducted by collecting data from reliable scientific sources from April 1401 to January 1402 at the Research Institute of Neurosciences, Brain and Spinal Cord Injury Research Center of Tehran University of Medical Sciences. Several studies have shown that ASCs can be a suitable candidate for wound healing due to their special characteristics. The purpose of this review is to discuss the use of ASCs in wound repair and healing as a new strategy in the treatment of skin problems.

Burns are one of the most important and common causes for a person to suffer from skin lesions with partial thickness. The partial thickening site of the skin is very painful and has a discharge until the wound heals and it is prone to infection; therefore, to prevent physical injury and infection, a suitable dressing should be used on the spot. This study aimed to evaluate the effectiveness of some of the dressings that affect the wounds of the skin.

This narrative review study was conducted in 2020-2021.The printed and the electronic literature published in electronic database such as PubMed, Medline, Scopus, SID, and Cochrane Library between 2000 until 2021 in Persian and English were searched and assessed. Also, the Google Scholar search engine was used to search literature.

To accelerate the healing time without side effects is the most important aim of managing the skin removal site. Today, various dressings such as Vaseline, honey, plain moist gas, banana leaves, and a variety of modern dressings are used to repair wounds at the skin graft site with partial-thickness; but still one of the therapeutic challenges is finding the ideal dressing. Discussion and

To now, the role of modern dressings in improving the skin removal site cannot be ignored. However, any dressing that can accelerate the healing time of the skin donor with partial thickness and reduce the pain when removing the dressing and prevent complications such as infection and is also cost-effective is a good choice.

This study aimed to develop a liposomal silibinin formulation that would reduce healing time and improve wound healing.

A thin film method was used to prepare liposomal silibinin. They were characterized for their size, ζ-potential, drug encapsulation efficiency, and silibinin release kinetics in vitro. By using a scanning electron microscope, lipid nanoparticle morphology was determined. A MTT assay was then used to determine the cytotoxicity of liposomal silibinin for human skin fibroblasts. SPSS version 18 software was used to analyze the results using one-way analysis of variance (ANOVA).

The optimized liposomal silibinin with a size of 112 ± 9.07 nm, and ζ-potential value of -14.5 ± 2.2 mV exhibited a high silibinin encapsulation efficiency (84± 5.3%). Results of the MTT assay indicated that the liposomal silibinin formulation does not have cytotoxicity besides they promote the growth of fibroblast cells.

Liposomal silibinin promotes the therapeutic effect of silibinin for wound healing.

Considering that stress slows down wound healing, the main purpose of this study was to investigate the effects of acute and chronic restraint stress on inducible Nitric Oxide synthase (iNOS) and Nitric Oxide (NO) concentrations in wound tissue in rat.

48 male and female rats in 6 groups (n=8) including male control, male animals exposed to acute stress, male animals exposed to chronic stress, female control, female animals exposed to  acute stress and female animals exposed to chronic stress were used in this study. Tissue samples were collected on the 3rd and 7th days after wound creation. iNOS concentration were measured by ELISA method and the concentration of NO was measured by determining nitrite concentrations in the samples using Griess reagent.

Acute (P< 0.001) and chronic (P< 0.05) stress caused a significant increase in iNOS concentrations on the 3rd  and 7th days post wounding in male animals comparing to the control group. The concentration of iNOS was significantly increased in female animals only in the group exposed to the acute stress and on the 3rd day compared to the control group (P< 0.05). Acute and chronic stress caused a significant (P < 0.001) increase in NO concentrations in male animals when compared with the control group. NO concentrations was increased significantly in female animals exposed to acute stress comparing to the control group on 3rd day post wounding (P< 0.001).

Stress induced elevations in iNOS and NO concentrations could be one of the mechanisms underlying delayed wound healing by stress.

To treat wounds, various treatment methods are used,including chemical, herbal, homeopathic and laser treatments, the main goal of which is faster, less complication, and at the same time lower cost of wounds. Topical phenytoin also has a positive effect on wound healing.The aim of present study was to investigate the antimicrobial effect of topical 1% phenytoin on microbial contamination caused by microorganisms affecting oral ulcer infection in an animal model.

In this experimental animal experimental study in 2019, 36 male rafts were selected. After anesthetizing the rats, the mandibular gingiva was flapped. Three types of microbial microorganisms including Candida albicans, Staphylococcus aureus and Actinomycosis were prepared. An equal number of microorganisms was placed at the incision site. Rats were randomly divided into two groups. In 18 rats 1% topical phenytoin powder was applied to the wounds, and in the remaining 18 rats no drug was applied to the wound. Finally, 36 samples of incisal biopsy were cultured in specific media for each microorganism and transferred to the laboratory. Colonies counted in phenytoin groups were compared with non-phenytoin groups. Data were analysed by Mann-Whitney test  by means of SPSS 22 software.

Mean±sd and Pvalue colonies of Staphylococcus aureus case and control groups respectively(124827±301378) and(807±1209),(P=0.259), Candida albicans(1750±1339)and(2357±4679),(P=0.423) and Actinomyces (16088±36721)and(47±114)(P=0.049)were not statistically significant between the phenytoin and control groups.

 It seems that 1% topical phenytoin powder after one use had no effect on reducing the microbial contamination of oral ulcers in laboratory rat.

Episiotomy is one of the most common surgeries in midwifery. Episiotomy wound healing can lead to perineal infection and pain, and affects mothers' satisfaction with childbirth. Tea herb with analgesic and anti-inflammatory properties can be effective on mothers' satisfaction with wound healing process. Therefore, the present study was conducted with aim to investigate the effect of tea herb cream on wound healing satisfaction and episiotomy pain intensity in primiparous women.

This double blind randomized clinical trial study was conducted in 2014 on 100 eligible primiparous women referred to Noorani hospital of Talesh. The participants were randomly allocated into two groups: A (drug) and B (placebo). After delivery, the subjects used the creams on episiotomy site twice a day for 10 days. They completed the researcher's questionnaires about satisfaction with treatment on the 10th day after delivery. Data were analyzed by SPSS software (version 19) and Mann-Whitney, independent t test and fisher exact test. P< 0.05 was considered statistically significant.

 The level of satisfaction in the intervention group with mean rating of 73.93 was higher than the control group with mean rating of 25.07. According to the Mann-Whitney test, the relationship between the two groups in terms of the level of satisfaction was significant (P<0.001)

Tea herb cream is effective on the satisfaction of pain improvement and wound healing.

Wounds are common injuries, that promotion of healing, infection control, and reducing the complications of which are an issue in medicine. The present study was conducted to evaluate the types of wounds and factors affecting their healing from the perspective of Persian medicine compared to conventional medicine, in order to find potential new solutions to control wounds and their complications. This review study was conducted to investigate definition of wounds and their classification based on five original Persian medicine books, including Kāmil al-Sinā`a al-Tibbīya by Haly Abbas, Al-Qanun fi al-Tibb by Avicenna, Zakhireye Khwarazmshahi by Sayyid Isma'il Jurjani, Tibb-i Akbari by Muhammad Akbar Arzānī, and Exir-i Azam by Muhammad Azam Khan Chishti. PubMed/MEDLINE, Scopus, and Google Scholar databases were searched for relevant evidence in contemporary medicine and comparison between results was made. According to these results, wounds are divided into seven categories in Persian medicine based on the amount of damage caused to the skin and the process of repairing and treating them is different based on various factors like age, sex, weight and lifestyle. Wounds are categorized based on length, depth, volume and cleanliness in modern medicine. According to results of this study results, lifestyle and six essential principles of health from the perspective of Persian medicine can be effective in the wound healing process. The first step in wound management, is diagnosing the category. The healing process can be accelerated with methods of Persian medicine (six principles of health and treatment methods) as a complementary method to modern medicine and complications can thereby be reduced.

Buxus hyrcana Pojark. has been traditionally used for the treatment of skin disorders including wound injuries and recent studies have shown the therapeutic potential of some Buxus species in healing skin wounds. In this study, the effect of an ointment containing methanolic extract of B. hyrcana leaves was evaluated on the full-thickness wound healing in a rat model.

The full-thickness wound was made with a scalpel on the dorsum cervical area of 32 Wistar rats (weighing 250-300 g). The animals were randomly divided into four groups: I; control, II; ointment base (eucerin), III; 1 % phenytoin cream, and IV; 5 % B. hyrcana methanolic extract ointment. For histopathological assessment, wound criteria were evaluated on the 12th day of treatment according to the Abramov score method. The collagen fiber deposition in the skin tissue was determined using Masson’s trichrome staining. The spectrophotometric analysis was performed to evaluate the total phenol and total flavonoid content of the extract.

Based on macroscopic observations, herbal ointment increased wound closure in the treatment group compared to the control group. In this way, the collagen deposition, epidermal and keratin formation, neovascularization, and fibroblast maturation increased significantly (P<0.05) with the herbal ointment, the same as the phenytoin group. The extract did not show any antimicrobial effect using the disc agar diffusion method.

The observed wound-healing effect of B. hyrcana seems to be mainly due to the presence of flavonoid compounds in the plant extract.

One of the medical interventions in childbirth is episiotomy which is used to widen the pelvic outlet. Plantago is one of the oldest medicinal plants that have wound healing properties due to its flavonoids and phenolic compounds. The present study was performed aimed to determine the effect of plantago cream on intensity of pain and episiotomy wound healing in nulliparous women.

This triple-blind clinical trial study was performed in 2019 on 107 nulliparous women who had referred to Valiasr Hospital in Birjand for natural childbirth. The participants were randomly divided into two groups of placebo and drug. After delivery, mothers used 2-3 cm of prescribed cream on the sutures for 10 days and twice a day. The wound healing rate was evaluated on the third, seventh and tenth days after delivery using the Reda tool. Data were analyzed using SPSS 21 software and Chi-square and Mann-Whitney tests. P< 0.05 was considered statistically significant.

The mean of Reda score in the drug group was 3.433 ± 0.635 on the third day, and 0.773 ± 0.422 on the seventh day, but in the placebo group, it was 5.611 ± 0.492, 2.185 0 0.478, respectively. The two groups had significant difference on the third and seventh days in terms of wound healing (p<0.001).  The median McGill score in the drug group was 26 on the third day and 7 on the seventh day, but in the placebo group, it was 44 and 19, respectively, and the two groups had a statistically significant difference in terms of pain intensity on the third and seventh day (P<0.001)

The use of plantago cream in comparison with placebo increases the speed of improvement of pain intensity and episiotomy wound healing in nulliparous women.