Silk-Based Biomaterials in Cutaneous Wound Healing: A Systematic Review

OBJECTIVE: Effective wound dressings should promote healing through cellular migration, neovascularization, and re-epithelialization. Silk fibroin (SF) and silk sericin (SS) are reported to have very good biocompatibility, excellent mechanical properties, and controlled biodegradability. This review investigates the use and performance of silk-based biomaterials in cutaneous wounds within in vitro, in vivo, and randomized controlled studies. METHODS: Study authors conducted a comprehensive literature search on the use of silk-based dressings in cutaneous wound healing and investigated reports of the advantages and disadvantages of SF and SS along with these materials' methods of characterization, cell migration, neovascularization, wound closure, and cytotoxicity. RESULTS: In vitro and in vivo animal models have shown SF-based biomaterials promote good cellular adhesion and fibroblast proliferation in cutaneous wounds. The porosity and silk concentration of silk-based scaffolds are key determinants of biodegradation and plasmatic imbibition capabilities and can help promote wound healing. In reviewed studies, SF biomaterials promoted neovascularization as early as 7 days and better than common dressings, demonstrating low cytotoxicity and immunogenicity. That said, a concern with the use of SS is the tendency to cause a hypersensitivity reaction. CONCLUSIONS: The benefits of silk-based biomaterials seem evident based on promising preclinical studies. Both SF and SS have been shown to have excellent wound healing properties by promoting cell attachment, migration, and collagen deposition. The authors encourage the use of SF and SS in more trials for wound healing.