Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Overall assessment

This narrative review addresses an interesting and clinically relevant topic, namely the treatment of burns and blast injuries in the patient's "own liquid medium" (OLM), as developed by Dr. V.A. Menzul. The historical experience and the proposed fibrin–leukocyte membrane (FLM) concept are potentially valuable to the international wound-care community. However, in its present form the manuscript is largely promotional rather than critically evaluative. The evidence base is not presented with sufficient rigor, the limitations and risks of the technique are not adequately discussed, and several key claims are not supported by controlled or comparative data. Major revision is required before the manuscript can be considered further.

Major comments

1.Abstract and conclusions overstate the evidence. The Abstract presents almost exclusively benefits, without indicating the level of evidence, the risk of bias, or the contraindications of the OLM technique. The single case of a patient with 97% total body surface area burns is presented in a way that could be read as a main conclusion. Please revise the Abstract and Conclusions so that the strength of the evidence is explicitly stated, the observational and single-center nature of most data is acknowledged, and the 97% case is described as an illustrative case rather than as proof of efficacy.

2.The 80-patient randomized study is insufficiently described and does not isolate the effect of OLM. The manuscript does not clearly state the source, setting, randomization method, allocation concealment, blinding, or primary endpoint of this study. More importantly, in the intervention group both the Menzul perforator and the occlusive polyethylene film dressing were changed simultaneously, so the specific contribution of the OLM/film component cannot be separated from that of the perforator. Please clarify the study design and either re-analyze the data or explicitly acknowledge this confounding.

3.Lack of comparison with established wound-care modalities. The manuscript does not compare OLM with standard modern alternatives, including foam dressings, hydrocolloids, hydrogels, negative-pressure wound therapy (NPWT), and early excision and grafting. Without such comparisons, the claim that OLM is superior or preferable cannot be substantiated. Please add a structured comparison with these modalities, or clearly downgrade the claims accordingly.

4.Infection-related risks are one-sided. The manuscript emphasizes the fibrin barrier and antimicrobial properties of fibrin, but does not discuss the possibility that the fibrin–leukocyte membrane may act as a bacterial reservoir, promote sub-membrane abscess formation, or mask deep infection. There is also no report of treatment failures, complications, or adverse events. Please add a balanced discussion of infectious and non-infectious complications, and include failure cases if available.

5.Outcome assessment is too subjective. The manuscript relies heavily on descriptive and cosmetic impressions. Objective and reproducible endpoints are needed, such as time to re-epithelialization, validated scar scales (e.g., Vancouver Scar Scale, Patient and Observer Scar Assessment Scale), validated pain scores, infection rates, graft take rates, and length of hospital stay with clear definitions. Please specify which outcomes were measured, how, and by whom.

6.Indications and contraindications are not defined. The manuscript does not specify the burn depth, blast-injury type, presence of deep cavities, contamination or infection status, or patient factors such as immunosuppression, diabetes, or pediatric age, for which OLM is indicated or contraindicated. Please provide explicit inclusion and exclusion criteria.

7.Antimicrobial photodynamic therapy is speculative. The proposal to combine OLM with antimicrobial photodynamic therapy is presented without preclinical or clinical data in the OLM context. The discussion also does not address hypoxia in the wound bed, reactive oxygen species (ROS) generation and diffusion, photosensitizer delivery, or the risk of phototoxicity to host cells. Please either provide supporting data or clearly label this section as a hypothesis and discuss its limitations.

8.Suggested references. The manuscript would benefit from citing the following three recent articles, which are directly relevant to the antimicrobial photodynamic strategy, stimulus-responsive hydrogel/membrane dressings, and ROS-related inflammatory regulation discussed in Sections 5, 12 and 13. The authors should integrate them into the revised discussion with a brief explanation of their relevance, rather than listing them without context.

Lyu, S.; Li, L.; Gao, J.; Liu, D.; Song, F. Metallo-Supramolecular Nanofibers Based on Type-I Photosensitizer for Synergistic Antibacterial Therapy. Smart Mol. 2024, 2, e20240037. https://doi.org/10.1002/smo.20240037

Kulbay, M.; Wu, K.Y.; Truong, D.; Tran, S.D. Smart Molecules in Ophthalmology: Hydrogels as Responsive Systems for Ophthalmic Applications. Smart Mol. 2024, 2, e20230021. https://doi.org/10.1002/smo.20230021

Zhao, Z.; Tong, X.; Sun, J.; Lu, J.; Zhang, G.; Wang, Q.; Yang, L. Curcumin Ameliorates Hyperuricemia and Gout-Induced Damage via Modulating the ROS-Dependent NEK7-NLRP3 Inflammasome Activation. Smart Mol. 2024, 2, e20250002. https://doi.org/10.1002/smo.20250002

Author Response

please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Available evidence indicates that Dr. Menzul’s wound management approach, known as treatment in the wound’s own liquid medium (OLM), may significantly enhance healing outcomes. The method has been associated with quicker wound closure, reduced pain and discomfort, and improved aesthetic results. It is also cost-effective, as it does not rely on expensive dressings, and can be applied to both burn wounds and blast-related injuries, which remain a growing clinical challenge.

The technique is based on supporting the body’s intrinsic healing mechanisms by maintaining a fibrin-leukocyte membrane (FLM) over the wound surface. Made up primarily of fibrin and immune cells, this naturally formed membrane serves as a protective biological covering and creates favorable conditions for tissue regeneration. Unlike many advanced dressings that attempt to replicate this environment artificially, OLM utilizes the wound’s own biological resources.

Although the results are promising, additional research is required to characterize the FLM in greater detail and refine the polyethylene film used in the technique.
Authors should add comparative work with other similar techniques being used.

how does this compares to using opsite film?

 

One important point that needs clarification is how this technique compares with conventional transparent film dressings, particularly OpSite. Both approaches aim to maintain a favourable moist environment for wound healing. The difference is that OLM preserves the wound’s natural fibrin-leukocyte membrane, whereas OpSite primarily acts as a protective, semi-permeable barrier.

The authors should explain whether preserving this biological membrane provides any additional benefit in terms of healing time, pain, infection rates, scar quality, or cost. A direct comparative study with OpSite or another established moist wound dressing would help establish whether OLM offers a meaningful clinical advantage over existing techniques.

Comments on the Quality of English Language

manuscript would benefit from stylistic editing to improve flow, reduce repetition, and adopt a more cautious scientific tone

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The author revised it accordingly. The manuscript is now recommended for acceptance.