Ethno Medicinal Plants Used for Wound Healing Properties in Tinsukia District, Assam: A Comprehensive Review

Wound healing is a vital physiological process that helps to retain the integrity of the skin after it has been damaged, whether by accident or by a deliberate operation. In Tinsukia district, Assam, tribal people and folklore traditions employ a wide variety of plants/plant extracts/decoctions or pastes to cure wounds. This study is designed to explore the ethnomedicinal plants used for the wound healing properties by the people of Tinsukia district, Assam. The Documentation of potential ethnobotanical information of traditionally used medicinal plant with wound healing activity will facilitates the scientific evaluation to look forward into a leading scientific prospect for the development of new herbal therapy for wound healing.


INTRODUCTION
A wound is a disruption of the skin's normal state as a result of damage to its continuity caused by a pathological process, whether internal or external. Wounds are common in everyday life, and they can lead to serious complications, If not treated properly, significant consequences can occur [1].
More than 1.2 million people have died in automobile accidents around the world, with 20-50 million individuals suffering non-fatal injuries such as wounds [2]. Trauma (48.00 percent), foot ulcers (28.00 percent), and pressure sores are the leading causes of acute and chronic injuries in the global population (21.00 percent) [3]. Acute wounds develop quickly and the healing process can be predicted. For instance, injuries sustained as a result of trauma or surgery. The healing process for persistent wounds, such as pressure ulcers, cancer-related lesions, and others, cannot be predicted [4]. In underdeveloped countries, it is estimated that 1-2 percent of the population may experience a chronic injury at some point in their lives [5].
Wound treatment and management are important for both acute and chronic wounds. But chronic wounds are a major source of concern for both patients and clinicians; chronic wounds impact a huge number of patients and significantly diminish their quality of life. According to current estimates, almost 6 million people worldwide suffer from chronic wounds [6].
Wound healing agents research is one of the burgeoning fields in modern biomedical science. Many traditional healers around the world, particularly in countries like India and China, have important knowledge of many lesserknown, previously undiscovered wild plants that are utilized by traditional healers to cure wounds. Several medications of plant, mineral, and animal origin are described in old texts of Indian systems of medicine like Ayurveda for their therapeutic characteristics as 'Vranaropaka.' In addition to the classical systems of Indian medicine, folk and tribal medicine uses a variety of herbs and animal products to treat cuts and wound. Some of these plants have been experimentally examined for wound healing action in various pharmacological models and human patients, but the potential of the majority of them has yet to be discovered [7].

WOUND HEALING PROCESS
All of the body's tissues and organs experience wound healing. Many of these repair mechanisms are found in all tissues of the body. While the healing process is continual, it is divided into stages at random to better explain the physiological processes occurring in the wound and surrounding tissue [8]. Healing is a dynamic procedure involving coordinated interactions between many immunological and biological systems. Various stages of the healing process necessitate a series of carefully and precisely managed processes and activities that correspond to the appearance of various cell types in the wound bed. The numerous processes that occur in acute tissue recovery as a result of tissue damage can be grouped into four time-dependent phases: hemostasis, inflammation, proliferation, and remodelling (

Hemostasis
When the skin is wounded, the body's natural reaction to stop bleeding is to constrict the artery walls. Following that, primary and secondary hemostasis are aided by two contemporaneous and mechanistically related mechanisms [8]. For primary hemostasis, platelet aggregation and the formation of platelet plugs inside the subendothelial matrix are required. The activation of the coagulation cascade, in which soluble fibrinogen is converted into insoluble strands that make up the fibrin mesh, is referred to as secondary hemostasis. The platelet plug and fibrin mesh unite to create a thrombus, which stops bleeding, releases accompaniments and growth factors, and acts as a temporary scaffold for infiltrating wound-healing cells [10].

Inflammation
The inflammatory process begins soon after the injury and can persist anywhere from 24 to 48 hours, with some cases lasting up to two weeks. The inflammatory phase quickly starts hemostatic pathways to control the bleeding at the wound site. As a result, clinically discernible cardinal indications of inflammation, skin redness, colour, tumour, pain, and functio-laesa appear [11]. This process is defined by vasoconstriction and platelet aggregation to cause blood clotting and, as a result, vasodilation and phagocytosis to cause inflammation at the wound site [12].

Proliferation
After persistent damage has stopped, hemostasis has been achieved, and an immune system has been successfully established, the acute wound advances toward tissue repair [13]. On the third day after the damage, the proliferative process begins and lasts for about two weeks. It is defined by fibroblast migration and the deposition of newly produced extracellular matrix, which acts as a replacement for the fibrin and fibronectin provisional network. The macroscopic stage of wound healing can be noticed as an abundance of granulation tissue formation [14].

Remodeling
In this final stage of wound healing, the granulation tissue goes through a steady decline. The epidermis of skeletal muscle, dermal vasculature, nerves, and myofibers are modified, resulting in the development of functional tissue [15]. The granulation tissue fibroblast and myofibroblast's vascular components are reduced, and PBMC cells die or leave the site. Similarly, the levels of structural and hydrationrelated glycosaminoglycans and proteoglycans are decreasing. Collagen metalloproteinases produced by fibroblasts and macrophages destroy Type III collagen in granulation tissue and replace it with Type I collagen, which is then rearranged into parallel fibrils, resulting in a lowcellularity scar. This final stage will take months to complete [16].

PHYSIOLOGY OF WOUND HEALING
Wound healing is a critical but difficult process in humans and animals, involving a diverse process driven by successive yet overlapping phases such as hemostasis/inflammation, proliferation, and remodelling [24]. Following a skin injury, the exposed sub-endothelium, collagen, and tissue factor activate platelet aggregation, resulting in degranulation and the release of chemotactic factors (chemokines) and growth factors (GFs) to form the clot, and all of the above procedures will achieve successful hemostasis [25]. The first cells to emerge at the injury site, neutrophils, sweep up debris and bacteria to provide a favourable environment for wound healing. Following this, macrophages amass germs and enhance phagocytosis, causing tissue injury. The hemostasis and inflammatory phases can take up to 72 hours to complete [26].
The first cells to emerge at the injury site, neutrophils, sweep up debris and bacteria to provide an ideal environment for wound healing. Macrophages collect germs and facilitate phagocytosis, causing tissue injury. The hemostasis and inflammatory phases usually take 72 hours to complete [27]. The transforming growth factor-b family (TGF-b, which includes TGF-b1, TGF-b2, and TGF-b3), the interleukin (IL) family, and angiogenesis factors (i.e., vascular epidermal growth factor) are all involved in this phase. This stage lasts for days or weeks [28].
The final stage of wound healing is the remodelling phase, which requires a precise balance of existing cell death and new cell creation [29]. In this phase, which lasts a few months or years, the gradual destruction of abundant ECM and immature type III collagen, as well as the formation of mature type I collagen, are crucial. Any deviations during this phase could result in excessive wound healing or chronic wounds [30].

WOUND HEALING MANAGEMENT BY MEDICINAL PLANTS
Classical systems of Indian medicine, particularly Ayurveda, Siddha, and Unani, a large number of medicinal plants were used for the treatment of skin diseases such as cuts and wounds. Medicinal plants have been used for centuries to treat a variety of skin and dermatological disorders, particularly cuts, and wounds [31]. The Indian epic Ramayana describes a traditional application of plant-based medicine in the treatment of injuries, When Lord Rama's brother Lakshman was mortally wounded on the battlefield in Lanka, medicinal plants from the Himalayas were used to treat him and return him to fighting strength [32].
People in developed countries are also seeking alternatives to modern wound healing therapies such as antibiotics, corticosteroids, and so on, owing to their side effects. In the case of chronic wound pathogenesis that does not heal, more understanding is required. Pathogenesis and failure to heal are two inseparable aspects that have guarded and heightened the use of herbal drugs as wound healing agent [33].
Various information regarding ethnomedicinal plants with wound healing activity is widely disseminated, with reports in leading journals devoted to ethnobotany and traditional medicine. In this review, we have presented plants that are widely used in traditional in Tinsukia District, Assam and have been reported in ethnobotanical literature for use in wound healing, classifying these plants based on their use in wounds, We have also indicated the same along with the part that have been reported to be used in the healing of the wound. The part used becomes even more important because, in order to provide ethnopharmacological evidence for these plants, researchers must ensure that they use the specific part mentioned in traditional medicines rather than random screening. Table 2 lists some lesser-known plants indigenous to Tinsukia District that are widely used in traditional medicine. It describes the plant, the part used, and the mode of preparation.

Malvaceae Paras pipal Fruits, leaves & roots
The paste is applied to wounds.

ETHNOPHARMACOLOGICAL VALIDATION
A number of plants such as Tagetes erecta, Ageratum conyzoides have been reported to offer wound-healing properties. The majority of these investigations include screening plants or extracts for wound healing efficacy on a random basis. We have tabulated (Table 3)

CONCLUSION
A number of plants used traditionally and by indigenous peoples have not been validated or examined in light of the traditional claim. The majority of plant/plant extract pharmacological reports test the organic soluble extracts of dried plants for their ability to heal wounds in rats and mice, but the main concern is that the most traditional claims of plants as wound healing agents involve the use of fresh plants as pastes in water. When it comes to wound healing medicines, this is a huge issue because the organic solvent extract of dry plant material is validated, while the aqueous extract of fresh plants is employed; the chemical components will be quite different in both circumstances. In this review, we found that leaf is the most commonly utilized in traditional and tribal medicine to treat wounds (51%), followed by bark and root (19%), flowers and seeds(2%) ( Table 1).
Another important issue with pharmacological validation is that the exact mechanism of the wound healing process is unknown; as a result, most researchers limit their plant screening to simple wound healing and do not get into the specifics. It's important to remember that a variety of factors play a role in wound healing, including epithelization, antioxidant defence, and metabolic changes (hydroxyproline). This review will assist pharmacologists in understanding the particular component of the plant and its exact function in traditional medicine, thereby bolstering Ethnopharmacological claims and increasing global acceptance of plant-based wound healing agents.
In addition, there hasn't been a concentrated attempt by researchers to investigate the concept of synergism in wound healing. The synergism of the prospective plants described in this analysis can be used to build a universally accepted wound healing formulation, if properly tested and proven scientifically, can operate as a substitute for or even replace modern wound healing medicines. As a result, the primary goal of this study is to identify and forecast plants, particularly those of Indian origin, that have the potential to become modern medication substitutes.

CONSENT AND ETHICAL APPROVAL
It is not applicable.