Professional Documents
Culture Documents
Environment DFU
Environment DFU
Environment DFU
1. Coagulation
2. Inflammation 3. Cellular proliferation 4. Remodelling
Haemostasis
Stop Bleeding
Platelet Degranulation
Provide Matrix for Cell Migration
Growth factors
Serotonin
Inflammation PNL
Phagocytose Microorgan.
Monocytes
Tissue Macrophage
phagocytosis
Proteol. Enz
GFs
Cellular Proliferation
Fibroblast EC matrix Deposition Endothelial cells Neovascularization Keratinocytes
Epithelialization
Remodelling
Provisional wound matrix
Mature scar
MMPs
consists predominately of fibrin and fibronectin
Lessons learned from acute wound healing cannot be applied to chronic wound.
So, for healing to occur, we need to change the environment of chronic wound toward that of acute wound.
Exudates from chronic wounds contain very high levels of inflammatory cytokines and proteases. Removal of the excess exudates can be accomplished by: 1. A foam or an alginate dressing 2. VAC (vacuum assisted closure) device.
Debridement
In microenvironmental terms we can think of Debridement as removal of old cells giving space to new cells to start wound healing.
The mechanisms of action of bioengineered skin might involve increased availability of growth factors, and perhaps recruitment of stem and progenitor cells to the wound site.
Some preliminary work suggests that topically applied autologous bone-marrow cultured cells can heal human chronic wounds.
Topical Phenytoin
The gingival hyperplasia appear during phenytoin therapy, raise interest in its use to prompt wound healing. Habibipour et al (2003) showed that phenytoin treated wounds had significant increase in collagen deposition and neovascularization. Shaw et al (2007) reviewed the effectiveness of topical phenytoin on wound healing and concluded that it had positive effect on wound healing in a variety of wounds including DFU
Inhibitors of MMPs
can
reduce
the
Supporting this concept, an initial report of a randomized controlled trial showed improved healing of chronic diabetic foot ulcers treated with a topical Doxycycline gel (Chin et al 2003) .
Metallic ions and citric acid e.g Poly Hydrated Ionogen positively restore MMP ratios within chronic wounds. Dressing consisting of metal ions and citric acid (Dermax) decrease MMP-2 production in vitro (van den Berg 2003)
Silver
Silver-containing dressings are effective in sequestering matrix metalloproteinase-2 and -9 (walker et al 2007).
Walker et al: In vitro studies to show sequestration of matrix metalloproteinases by silver-containing wound care products. Ostomy Wound Manage. 2007 Sep;53(9):18-25.
Growth factors
PDGF gel (Regranex) improved healing quality, enhanced angiogenesis, cell proliferation and epithelialization (Li et al 2007).
Recombinant human epidermal growth factor (REGEN-D 150) has been found to result in healthy granulation and stimulate epithelization (Mohan 2007).
VEFG
Successful in experimental animals (Galeano et al 2003) but clinical trials using VEGF therapy did not succeed in ameliorating healing as expected (YlaHerttuala 2006)
Conclusions
Optimum healing of a wound requires a well-orchestrated integration of complex cellular and molecular factors.
It is a complex process that need appropriate and precise cellular response to: inflammatory mediators, to growth factors and cytokines.
The chronic wound is not the acute wound In chronic wounds the progression of the healing process is impaired and the wound usually stuck in the inflammatory stage.
Enhanced understanding and correction of pathogenic factors, combined with stricter adherence to standards of care is giving new hope to the problem of impaired healing.
Successful Treatment of DFU depends on how we understand the complex and dynamic interaction of multiple factors that contribute to chronicity of the wound.
Thank you