Comparative Study between Topical Application of Silver Nanoparticles Gel and Added Injection of Silver Nanoparticles Solution at Ulcer Base in Management of Induced Ulcers in a Rat Model

Background: Diabetic skin ulcers are a major public health issue due to their serious complications, including infection, sepsis, amputation, and long-term disability, all of which negatively impact quality of life. These chronic wounds affect a large proportion of diabetic patients, and conventional treatments are often insufficient. Silver nanoparticles (AgNPs), owing to their antimicrobial and anti-inflammatory properties, have emerged as a promising solution for enhancing wound healing. This study aims to evaluate the effectiveness of topical AgNPs alone and in combination with direct injection at the ulcer base in accelerating wound healing, with a focus on clinical outcomes, healing timeline, histological changes, and cost-effectiveness.Methods: An experimental study was conducted on 75 male Wistar rats at the Medical Ain Shams Research Institute, Faculty of Medicine, Ain Shams University. After induction of diabetes and creation of standardized full-thickness wounds, rats were divided into three equal groups: Group I received non-silver-based standard moist wound dressing; Group II received topical AgNPs gel; Group III received topical AgNPs gel with super-added AgNPs injection at the ulcer base. Wound healing was assessed using serial measurements of surface area and detailed histopathological examination.Results: Groups II and III showed significantly improved wound healing compared to the control group (Group I), with measurable improvements evident from day 5. By day 28, Group III demonstrated the most substantial healing. Histologically, Group III showed reduced inflammation, increased fibroblast and fibrocyte activity, more organized collagen fibers, and higher healing scores, especially at days 18 and 28. While Group II also showed improvement over the control, the combination treatment in Group III produced the most favorable cellular and tissue-level outcomes.Conclusion: Super-added injection of AgNPs combined with topical application significantly enhances wound healing in diabetic ulcers and may offer a more effective and economical alternative to conventional treatments.