Background: Pediatric hard-to-heal wounds are rare but clinically demanding due to skin immaturity, comorbidities, and infection risk. Methods: This prospective case series evaluated the feasibility, safety, and clinical outcomes of an injectable hyaluronic acid-amino acid complex administered to fifteen children and adolescents (aged 4–16 years) with chronic hard-to-heal wounds, treated between November 2022 and August 2025 within a standardized wound-hygiene protocol. The primary outcome was time to complete re-epithelialization; secondary outcomes included pain, tolerability, and safety. Results: Complete healing was achieved in most patients within a few weeks of treatment. The injectable therapy was well tolerated, with minimal discomfort and no serious adverse events observed. Conclusions: The injectable hyaluronic acid-amino acid complex appears to be a safe, feasible, and potentially effective therapy for pediatric hard-to-heal wounds. These preliminary findings support its integration into multidisciplinary wound-care strategies, although controlled multicenter studies are warranted to confirm efficacy and define optimal protocols.

Cleft palate is a congenital anomaly that causes functional and esthetic challenges, and the hard palate is essential for feeding, speech, and separation of the oral and nasal cavities. Yet, current reconstructive techniques do not restore its bony component. Building on previous in vitro work showing that decellularized palatal mucoperiosteum, microperforated with Quantum Molecular Resonance (QMR^®) technology and recellularized with mesenchymal stem cells, preserves the collagen microenvironment, supports engraftment, and shows osteoinductive potential, this study evaluated the early feasibility and regenerative potential of bioengineered mucoperiosteal scaffolds (BEMS) in Landrace pigs model. Bone marrow was collected from recipient pigs to isolate pBM-MSCs. Donor palatal mucoperiosteum was decellularized, microperforated, and recellularized with these cells to generate BEMS. After surgical creation of a cleft palate, four pigs received BEMS, and two controls underwent standard palatoplasty. At one month, scaffold-treated animals showed early mucosal and osseous regeneration, including neo-epithelium, connective tissue, and new bone formation, without clinical or routine histological signs of acute rejection. SPARC (Secreted protein acidic and rich in cysteine) expression supported osteogenic activity. Regenerated palates were stable and fracture-resistant, whereas controls showed incomplete repair and fractures. These findings suggest that BEMS may address limitations of conventional palatal reconstruction and support further investigation for human palatal bone regeneration.

Aim: To evaluate the feasibility, outcomes, and tolerability of an injectable hyaluronic acid plus amino acid (HA+AA) complex in children with hard-to-heal wounds. Background: Pedi-atric hard-to-heal wounds are rare but highly challenging due to skin immaturity, comorbidities, and the risk of infection. Hyaluronic acid (HA), a key extracellular matrix component, supports hydration, cell proliferation, and inflammation modulation. Its injectable formulation combined with amino acids (AA) essential for collagen and elastin synthesis may accelerate tissue repair in refractory lesions. Methods: A prospective observational case series was conducted in a special-ized pediatric wound care setting (November 2022–August 2025). Fifteen patients aged 4–16 years with wounds persisting >6 months were treated with HA+AA infiltrations, combined with stand-ardized wound hygiene and selected co-interventions (negative pressure wound therapy [NPWT], dialkylcarbamoyl chloride [DACC] dressings). The primary endpoint was time to complete re-epithelialization; secondary endpoints included pain and safety. Results: Complete healing was achieved in 14/15 patients (93.3%), with one patient censored at the end of follow-up. Median time to re-epithelialization was 6 weeks [IQR 5–12], with 50% healed by week 6 and >90% by week 12. The median number of infiltration sessions was 6 [IQR 5–12]; median follow-up was 14 months [IQR 8–24]. NPWT was required in 73.3% of cases, and DACC dressings in 20.0%. Treatment was well tolerated, with minimal procedural discomfort and no serious adverse events. Conclusions: Injectable HA+AA complex appears to be a safe, feasible, and potentially effective therapy for pe-diatric hard-to-heal wounds. While preliminary, these results support integrating HA+AA into multidisciplinary wound care strategies. Controlled multicenter trials are warranted to confirm efficacy and define optimal protocols.