Inhibitory effects of vitamin E on collagen synthesis and wound repair

Metabolic reprogramming in skin wound healing

Metabolic reprogramming refers to the ability of a cell to alter its metabolism in response to different stimuli and forms of pressure. It helps cells resist external stress and provides them with new functions. Skin wound healing involves the metabolic reprogramming of nutrients, such as glucose, lipids, and amino acids, which play vital roles in the proliferation, differentiation, and migration of multiple cell types. During the glucose metabolic process in wounds, glucose transporters and key enzymes cause elevated metabolite levels. Glucose-mediated oxidative stress drives the proinflammatory response and promotes wound healing. Reprogramming lipid metabolism increases the number of fibroblasts and decreases the number of macrophages. It enhances local neovascularization and improves fibrin stability to promote extracellular matrix remodelling, accelerates wound healing, and reduces scar formation. Reprogramming amino acid metabolism affects wound re-epithelialization, collagen deposition, and angiogenesis. However, comprehensive reviews on the role of metabolic reprogramming in skin wound healing are lacking. Therefore, we have systematically reviewed the metabolic reprogramming of glucose, lipids, and amino acids during skin wound healing. Notably, we identified their targets with potential therapeutic value and elucidated their mechanisms of action.

Evidence of Potential Natural Products for the Management of Hypertrophic Scars

Hypertrophic scarring is an aberrant wound-healing response to reestablish dermal integrity after an injury and can cause significant abnormalities in physical, aesthetic, functional, and psychological symptoms, impacting the patient's quality of life. There is currently no gold standard for preventing and treating hypertrophic scars. Therefore, many researchers have attempted to search for antihypertrophic scar agents with greater efficacy and fewer side effects. Natural therapeutics are becoming attractive as potential alternative anti-scarring agents because of their high efficacy, safety, biocompatibility, low cost, and easy accessibility. This review demonstrates various kinds of natural product-based therapeutics, including onion, vitamin E, Gotu kola, green tea, resveratrol, emodin, curcumin, and others, in terms of their mechanisms of action, evidence of efficacy and safety, advantages, and disadvantages when used as anti-scarring agents. We reviewed the literature based on data from in vitro, in vivo, and clinical trials. A total of 23 clinical trials were identified in this review; most clinical trials were ranked as having uncertain results (level of evidence 2b; n = 16). Although these natural products showed beneficial effects in both in vitro and in vivo studies of potential anti-scarring agents, there was limited clinical evidence to support their efficacy due to the limited quality of the studies, with individual flaws including small sample sizes, poor randomization, and blinding, and short follow-up durations. More robust and well-designed clinical trials with large-scale and prolonged follow-up durations are required to clarify the benefits and risks of these agents.

In-vitro and in-vivo evaluations of tocotrienol-rich nanoemulsified system on skin wound healing

Proper wound healing is vital for the survival of higher organisms. Responses to skin injury can lead to complications such as scar formation that can affect the quality of life. In this study, keratinocytes migration (scratch assay) and zebrafish tail regeneration experiments were used to evaluate the wound healing effect of a tocotrienol-based nanoemulsified (NE) system against ascorbic acid and phosphate-buffered saline (PBS) as positive and negative controls, respectively. MTT assay provided a concentration range of 0.35–8.75 μg/ml of nanoemulsion that produced cell viability more than 100%. After 24 hours of treatment, the wound closure of keratinocytes were found to be significantly faster by 73.76%, 63.37% and 35.56%, respectively when treated with 3.50 μg/ml and 1.75 μg/ml of NE compared to the blank. The lethal concentration at 50% (LC₅₀ value) obtained from acute and prolonged toxicity was almost similar, which was 4.6 mg/ml and 5.0 mg/ml, respectively. Growth of zebrafish tail regeneration treated with NE at a concentration of 2.5 mg/ml was significantly faster than the untreated zebrafish, which regenerated to 40% on the fifth day, more than 60% on the tenth day of treatment and fully recovered at the twentieth day. In conclusion, these results showed the potential of the tocotrienols-based nanoemulsified system in enhancing wound healing through accelerated wound closure.

Nutrition and cutaneous wound healing

Wound healing is a complex and energy-demanding process. The relationship between nutrition and wound healing has been recognized for many centuries. Several studies have indicated that nutritional deficiencies are more prevalent among patients with chronic wounds. Malnutrition may alter the inflammatory response, collagen synthesis, and wound tensile strength, all of which are crucial for wound healing. Although the specific role of nutrition and supplementation in wound care remains uncertain, it is necessary to identify and correct nutritional imbalances to avoid any potential deterioration of the healing process. It is also important to recognize the differences in pathophysiology between acute and chronic wounds. A burn, surgical, or a traumatic wound is different from a diabetic foot ulcer, which is different from a pressure ulcer. Chronic wounds are more prevalent in the aging population, and patients often have underlying comorbidities, such as diabetes mellitus, peripheral vascular disease, connective tissue disease, or other systemic illnesses that may alter energy metabolism and contribute to impaired healing. Management approaches to acute wound care may not apply universally to chronic wounds. In this review, we discuss the available data and possible roles for nutrition in wound healing.

Paradigms in Complex Facial Scar Management

The process of scar formation is a sequela of the healing following soft tissue injury extending to, or through, the reticular dermis. Scars, within the head and neck in particular, may be physically disfiguring with resultant psychosocial implications. Mitigation of excessive scar formation during the healing process following surgery, or in the setting of trauma, begins with meticulous soft tissue handling and reconstructive technique. The reconstructive surgeon's armamentarium must therefore include techniques that minimize initial scar formation and revision techniques that address unfavorable outcomes. With this in mind, this article reviews both conservative nonsurgical and surgical treatment modalities that mitigate scar formation or address mature scar formation.

The Physiological Mechanisms of Effect of Vitamins and Amino Acids on Tendon and Muscle Healing: A Systematic Review

Aims/Objectives: To evaluate the current literature via systematic review to ascertain whether amino acids/vitamins provide any influence on musculotendinous healing and if so, by which physiological mechanisms. Methods: EBSCO, PubMed, ScienceDirect, Embase Classic/Embase, and MEDLINE were searched using terms including “vitamins,” “amino acids,” “healing,” “muscle,” and “tendon.” The primary search had 479 citations, of which 466 were excluded predominantly due to nonrandomized design. Randomized human and animal studies investigating all supplement types/forms of administration were included. Critical appraisal of internal validity was assessed using the Cochrane risk of Bias Tool or the Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias Tool for human and animal studies, respectively. Two reviewers performed duel data extraction. Results: Twelve studies met criteria for inclusion: eight examined tendon healing and four examined muscle healing. All studies used animal models, except two human trials using a combined integrator. Narrative synthesis was performed via content analysis of demonstrated statistically significant effects and thematic analysis of proposed physiological mechanisms of intervention. Vitamin C/taurine demonstrated indirect effects on tendon healing through antioxidant activity. Vitamin A/glycine showed direct effects on extracellular matrix tissue synthesis. Vitamin E shows an antiproliferative influence on collagen deposition. Leucine directly influences signaling pathways to promote muscle protein synthesis. Discussion: Preliminary evidence exists, demonstrating that vitamins and amino acids may facilitate multilevel changes in musculotendinous healing; however, recommendations on clinical utility should be made with caution. All animal studies and one human study showed high risk of bias with moderate interobserver agreement (k = 0.46). Currently, there is limited evidence to support the use of vitamins and amino acids for musculotendinous injury. Both high-quality animal experimentation of the proposed mechanisms confirming the physiological influence of supplementation and human studies evaluating effects on tissue morphology and biochemistry are required before practical application.

Evidence-Based Scar Management: How to Improve Results with Technique and Technology

BACKGROUND

Scars represent the visible sequelae of trauma, injury, burn, or surgery. They may induce distress in the patient because of their aesthetically unpleasant appearance, especially if they are excessively raised, depressed, wide, or erythematous. They may also cause the patient symptoms of pain, tightness, and pruritus. Numerous products are marketed for scar prevention or improvement, but their efficacy is unclear.

METHODS

A literature review of high-level studies analyzing methods to prevent or improve hypertrophic scars, keloids, and striae distensae was performed. The evidence from these articles was analyzed to generate recommendations. Each intervention's effectiveness at preventing or reducing scars was rated as none, low, or high, depending on the strength of the evidence for that intervention.

RESULTS

For the prevention of hypertrophic scars, silicone, tension reduction, and wound edge eversion seem to have high efficacy, whereas onion extract, pulsed-dye laser, pressure garments, and scar massage have low efficacy. For the treatment of existing hypertrophic scars, silicone, pulsed-dye laser, CO2 laser, corticosteroids, 5-fluorouracil, bleomycin, and scar massage have high efficacy, whereas onion extract and fat grafting seem to have low efficacy. For keloid scars, effective adjuncts to excision include corticosteroids, mitomycin C, bleomycin, and radiation therapy. No intervention seems to have significant efficacy in the prevention or treatment of striae distensae.

CONCLUSION

Although scars can never be completely eliminated in an adult, this article presents the most commonly used, evidence-based methods to improve the quality and symptoms of hypertrophic scars, as well as keloid scars and striae distensae.

Cutaneous Wound Healing after Topical Application of Pistacia atlantica Gel Formulation in Rats

Objectives

This study has been undertaken to investigate the antioxidant activity of the gel formulation from Pistacia atlantica oil extraction on enzymatic antioxidants in experimental wound created in rats.

Materials and Methods

Under anesthesia, a square-shaped skin defect (2x2 cm) was created aseptically by surgical incision. Then, animals were randomly allocated to four groups (I- untreated controls, II- topically treated with base gel, III- topically treated with 5% gel, IV- topically treated with 10% gel).

Results

The results suggest that topical application of Pistacia atlantica oil gels improved reepithelialization with continuous stratum basalis and a mature granulation tissue and adnexa (hair follicles and sweat gland) compared with control and base gel groups. Treatment with 10% oil gel significantly enhanced the tensile strength, ultimate stress, yield strength and stiffness in this group compared with the control and base gel groups at 21 days post injury. The collagen fibers showed a more organized pattern and the tissue alignment was greater as compared to the control and base gel-treated groups at the same stage.

Conclusion

The results suggest that topical application of Pistacia atlantica oil gel improved the morphological, biochemical and biomechanical properties of experimentally-induced wound defects in rats.

Chronic Wound Healing: A Review of Current Management and Treatments

Wound healing is a complex, highly regulated process that is critical in maintaining the barrier function of skin. With numerous disease processes, the cascade of events involved in wound healing can be affected, resulting in chronic, non-healing wounds that subject the patient to significant discomfort and distress while draining the medical system of an enormous amount of resources. The healing of a superficial wound requires many factors to work in concert, and wound dressings and treatments have evolved considerably to address possible barriers to wound healing, ranging from infection to hypoxia. Even optimally, wound tissue never reaches its pre-injured strength and multiple aberrant healing states can result in chronic non-healing wounds. This article will review wound healing physiology and discuss current approaches for treating a wound.

Nutrients and Wound Healing: Still Searching for the Magic Bullet

Clinicians in nearly all practice areas are confronted with the challenges associated with delayed and impaired wound healing. Although nutrition plays a critical role in the healing process, controversy exists regarding the optimal nutrition regimen. This article reviews literature related to nutrition interventions that facilitate wound healing. The limitations of the research that forms the scientific basis of many nutrition recommendations are also examined. The limited availability of rigorously performed clinical studies to develop evidence-based guidelines for nutrition support in wound care emphasizes the need for further research and underscores the importance of individualizing the nutrition care plan for each patient.

Effects of nicotine in the presence and absence of vitamin E on morphology, viability and osteogenic gene expression in MG-63 osteoblast-like cells

BACKGROUND

Evidence shows that oxidative stress induced by nicotine plays an important role in bone loss. Vitamin E with its antioxidative properties may be able to reverse the effects of nicotine on bone. This study aimed to assess the effects of nicotine in the presence and absence of vitamin E on morphology, viability and osteogenic gene expression in MG-63 (osteosarcoma) human osteoblast-like cells.

METHODS

We treated the cells with 5 mM nicotine. The viability and morphology of cells were evaluated respectively using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium (MTT) and crystal violet assays. The effect of nicotine on osteogenic gene expression in MG-63 cells was assessed by real-time reverse-transcription polymerase chain reaction of osteoblast markers, namely, alkaline phosphatase, osteocalcin and bone sialoprotein.

RESULTS

The results revealed that survival and proliferation of MG-63 cells were suppressed following exposure to nicotine, and cytoplasm vacuolization occurred in the cells. Nicotine significantly down-regulated the expression of osteogenic marker genes. Such adverse effects on morphology, viability and osteogenic gene expression of MG-63 cells were reversed by vitamin E therapy.

CONCLUSIONS

In conclusion, vitamin E supplementation may play a role in proliferation and differentiation of osteoblasts, and vitamin E can be considered as an anabolic agent to treat nicotine-induced bone loss.

The Role of Topical Vitamin E in Scar Management: A Systematic Review

BACKGROUND

The practice of prescribing vitamin E after surgery for scar prevention and treatment is widespread and increasingly popular among both the public and clinicians. However, very little evidence exists for this "ritual."

OBJECTIVES

This review was undertaken to critically analyze the current literature about the effect of vitamin E on treating scars.

METHODS

The Cochrane, Medline, and PubMed databases were searched based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The studies and levels of recommendation were graded according to the American Society of Plastic Surgeons (ASPS) criteria. Only prospective studies were included.

RESULTS

Only six studies met the inclusion criteria. Of these six included studies, three reported a significant improvement in the cosmetic appearance of scars when using vitamin E: one study used topical vitamin E in white children as monotherapy, and two studies used vitamin E in an adult population as combination therapy. The other three selected studies showed no significant improvement in scar appearance when using topical vitamin E as monotherapy. Two of the six included studies reported adverse events of vitamin E application: contact dermatitis and increased incidence of itching and rash.

CONCLUSIONS

We conclude that there is not yet sufficient evidence that monotherapy with topical vitamin E has a significant beneficial effect on scar appearance to justify its widespread use. Further prospective studies with vitamin E monotherapy and/or combination therapy are warranted to draw better conclusions regarding the value of vitamin E in the management of scar healing.

LEVEL OF EVIDENCE

2 Therapeutic.

Keloids and Hypertrophic Scars: A Spectrum of Clinical Challenges

Since their earliest description, keloids and hypertrophic scars have beleaguered patients and clinicians alike. These scars can be aesthetically disfiguring, functionally debilitating, emotionally distressing, and psychologically damaging, culminating in a significant burden for patients. Our current understanding of keloid pathophysiology has grown and continues to advance while molecular biology, genetics, and technology provide ever-deepening insight into the nature of wound healing and the pathologic perturbations thereof. Greater understanding will lead to the development and application of refined therapeutic modalities. This article provides an overview of our current understanding of keloids, highlighting clinical characteristics and diagnostic criteria while providing a comprehensive summary of the many therapeutic modalities available. The proposed mechanism, application, adverse events, and reported efficacy of each modality is evaluated, and current recommendations are summarized.

Micronutrients after burn injury: a review

Supplementation of micronutrients after burn injury is common practice in order to fight oxidative stress, support the immune system, and optimize wound healing. Assessing micronutrient status after burn injury is difficult because of hemodilution in the resuscitation phase, redistribution of nutrients from the serum to other organs, and decreases in carrier proteins such as albumin. Although there are many preclinical data, there are limited studies in burn patients. Promising research is being conducted on combinations of micronutrients, especially via the intravenous route.

Vitamin E supplementation, superoxide dismutase status, and outcome of scaling and root planing in patients with chronic periodontitis: a randomized clinical trial

BACKGROUND

This study investigates the levels of superoxide dismutase (SOD) activity in serum and saliva of patients with chronic periodontitis (CP). In addition, the outcome of scaling and root planing (SRP) with and without vitamin E supplementation is evaluated in terms of changes in periodontal parameters and SOD activity in patients with CP.

METHODS

Serum and salivary SOD activity in 38 patients with CP were compared with those of 22 systemically and periodontally healthy individuals (control group). At periodontal examination, serum and saliva samples were obtained. Patients with CP were randomly divided into treatment groups 1 (TG-1) and 2 (TG-2). SRP was performed for both groups, and TG-2 also received 200 mg (300 IU) vitamin E every other day. Periodontal parameters and SOD activity were evaluated after 3 months. SOD activity was determined using an SOD assay and enzyme-linked immunosorbent assay reader at 450 nm.

RESULTS

SOD activity in both serum (P <0.05) and saliva (P <0.001) was lower in patients with CP compared with controls. After 3 months of follow-up, SOD activity improved in both treatment groups; however, the improvement in TG-2 was higher than in TG-1, along with more improvement in periodontal parameters. Serum SOD levels in TG-2 increased even above the level of the control group.

CONCLUSIONS

Systemic and local SOD levels are lowered in CP. Adjunctive vitamin E supplementation improves periodontal healing as well as antioxidant defense.

Topical modalities for treatment and prevention of postsurgical hypertrophic scars

There is no universally accepted treatment regimen and no evidence-based literature to guide management of hypertrophic scars. This article summarizes the existing literature regarding topical treatments such as silicone gel sheeting and ointment, onion extract, vitamin E, pressure garment therapy, massage therapy, and topical imiquimod 5% cream in the management of hypertrophic scars.

Vitamins and cutaneous wound healing

BACKGROUND

Vitamins have long been thought to modulate the various stages of wound healing through a variety of proposed mechanisms. Our goal was to investigate relevant studies examining the role of different vitamins in wound healing.

METHODS

MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched for basic science and clinical studies examining the role of vitamins as adjuncts in wound healing.

RESULTS

Mechanisms of action for each of the vitamins are reviewed. It was suggested by many of the studies that the major vitamins A, C, E, D, K, and B have demonstrated utility as adjuncts in wound care in basic science and clinical trials.

CONCLUSION

There is a vast amount of literature on the effect of vitamins on wound healing at the basic science level. Further understanding and controlled trials will help better understand how to utilize vitamins in wound care.

DECLARATION OF INTEREST

None.

Silicone-based scar therapy: a review of the literature

Hypertrophic and keloid scars still are among the banes of plastic surgery. In the treatment arsenal at the disposal of the plastic surgeon, topical silicone therapy usually is considered the first line of treatment or as an adjuvant to other treatment methods. Yet, knowledge concerning its mechanisms of action, clinical efficacy, and possible adverse effects is rather obscure and sometimes conflicting. This review briefly summarizes the existing literature regarding the silicone elastomer's mechanism of action on scars, the clinical trials regarding its efficacy, a description of some controversial points and contradicting evidence, and possible adverse effects of this treatment method. Topical silicone therapy probably will continue to be the preferred first-line treatment for hypertrophic scars due to its availability, price, ease of application, lack of serious adverse effects, and relative efficacy. Hopefully, future randomized clinical trials will help to clarify its exact clinical efficacy and appropriate treatment protocols to optimize treatment results.

A prospective, randomised, double-blinded trial to study the efficacy of topical tocotrienol in the prevention of hypertrophic scars

BACKGROUND

Despite widespread beliefs regarding the use of topical tocotrienol in the prevention of hypertrophic scars, there is very little evidence from well controlled and randomised clinical trials to justify its benefits for surgical scars.

OBJECTIVE

This study was conducted to evaluate the efficacy of topical tocotrienol in preventing the development of hypertrophic scars.

METHODS

A prospective, randomised, double-blinded study was performed on 122 patients with recently healed (<2 weeks) surgical scars, who were randomised into either a treatment group with 5% topical tocotrienol or a placebo group. The patients were required to apply the preparation to their scars twice a day for 6 weeks starting at 2 weeks after surgery. Assessments of the scars were performed at weeks 0, 2, 6 and 16 following the onset of topical application using three methods: a clinical assessment using the Patient and Observer Scar Assessment Scale (POSAS), a photographic scar assessment by two independent assessors using a visual analogue scale and laser Doppler imaging (LDI). Data analysis was performed on 85 patients (tocotrienol group: 45 patients; placebo group: 40 patients), who had completed four assessments.

RESULTS

There was no statistically significant difference in scar parameters between the tocotrienol and the placebo groups in the POSAS, photographic scar assessment or mean flux of LDI (p>0.05) categories. The mean LDI flux showed a decreasing trend over time, which was positively correlated with vascularity (correlation coefficient=0.325, p=0.008) and total scores (correlation coefficient=0.248, p=0.034) of the observer scar assessment scale on week 0. No significant adverse effect was observed.

CONCLUSIONS

Twice-daily application of 5% topical tocotrienol had no significant effect on the appearance and vascularity of scars over 4 months post-surgery. LDI has a promising role as a scar assessment tool.

Nutrition management of pressure ulcers

Despite our knowledge of how to prevent pressure ulcers, and improvements in treatment, pressure ulcers remain prevalent and impose a significant burden on financial and labor resources in the healthcare industry. Although there is no known role for specific nutrients in the prevention of pressure ulcers, undernutrition is a risk factor, and nutrition therapy plays a crucial role in pressure ulcer treatment. Limitations in research make it difficult to develop evidence-based nutrition guidelines, so it is important that clinicians conduct a comprehensive assessment that includes weight and intake history, biochemical data, and comorbidities as well as symptoms that may affect the intake, absorption, or excretion of nutrients. These data, combined with clinical judgment, must be used to estimate energy and protein needs, considering the size and severity of the pressure ulcer. Micronutriture is difficult to assess; usual intake, comorbidities and disease symptoms must be considered in addition to biochemical data. Micronutrients should be replaced if depleted, but routine supplementation of vitamins and minerals in all pressure ulcer patients is not warranted.

A prospective study in children: Pre- and post-surgery use of vitamin E in surgical incisions

BACKGROUND

One of the main problems of elective surgery is the cosmetic result.

OBJECTIVE

This prospective controlled study aims to determine the effects of topical vitamin E on cosmetic results in children.

METHODS

A single-blind study was carried out. Topical vitamin E was used on the intended incision site for at least 15 days, thrice daily, before surgery and for at least 30 days, twice daily, after surgery (group A). The control group received topical petrolatum-based ointment (group B).

RESULTS

No patients in group A developed keloids. A total of 96% of patients (or parents) considered the cosmetic results very good. No patients had wound infection. In the control group, only 78% of patients (or parents) considered the cosmetic results very good and 13 (6.5%) patients developed keloids after 6 months. There were no cases of wound infection.

CONCLUSION

Topical vitamin E before and after surgery improved surgical wound healing and improved cosmetic results.

Optimizing the patient for surgical treatment of the wound

Plastic surgeons are consulted often to close wounds that fail or are difficult to heal. Optimizing the patient's medical condition before surgical closure of a wound can mean the difference between a successful outcome and an undesirable one. It is imperative that plastic surgeons have an extensive knowledge of the modifiable risk factors affecting the wound-healing process and their subsequent complications. This knowledge allows the surgeon to tailor the treatment options and intervene when appropriate to optimize outcomes for successful surgical closure of a wound. Whether the impairments to wound healing and closure are local or systemic, they must be addressed appropriately.

A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management

Silicone elastomer sheeting is a medical device used to prevent the development of and improve the appearance and feel of hypertrophic and keloid scars. The precise mechanism of action of silicone elastomer sheeting has not been defined, but clinical trials report that this device is safe and effective for the treatment and prevention of hypertrophic and keloid scars if worn over the scar for 12 to 24 hours per day for at least 2 to 3 months. Some of the silicone elastomer sheeting products currently on the market are durable and adhere well to the skin. These products are an attractive treatment option because of their ease of use and low risk of adverse effects compared to other treatments, such as surgical excision, intralesional corticosteroid injections, pressure therapy, radiation, laser treatment, and cryotherapy. Additional controlled clinical trials with large patient populations may provide further evidence for the efficacy of silicone elastomer sheeting in the treatment and prevention of hypertrophic and keloid scars. The purpose of this article is to review the literature on silicone elastomer sheeting products and to discuss their clinical application in the treatment and prevention of hypertrophic and keloid scars.

Soft tissue wounds and principles of healing

Wound healing is a complex interchange, orchestrated between cellular components that play their respective parts signaled by and mediated by different cellular instruments of healing. When healing is performed well, the final product is a thing of beauty. When healing is delayed, interrupted, or excessive, then unsightly scars of chronic painful wounds that are frustrating to the patient and physician occur.

Nitrooxyethylation reverses the healing-suppressant effect of Ibuprofen

Nonsteroidal antiinflammatory drugs like ibuprofen impede tissue repair by virtue of retarding inflammation. The present study was undertaken to explore if linking of nitrooxyethyl ester to ibuprofen reverses its healing-depressant propensity. Nitrooxyethyl ester of ibuprofen (NOE-Ibu) was synthesized in our laboratory through a well-established synthetic pathway. NOE-Ibu was screened for its influence on collagenation, wound contraction and epithelialization phases of healing, and scar size of healed wound in three wound models, namely, incision, dead space, and excision wounds. Besides, its influence on the oxidative stress (levels of GSH and TBARS) was also determined in 10-day-old granulation tissue. NOE-Ibu was further screened for its antiinflammatory activity in rat paw edema model. NOE-Ibu promoted collagenation (increase in breaking strength, granulation weight, and collagen content), wound contraction and epithelialization phases of healing. NOE-Ibu also showed a significant antioxidant effect in 10-day-old granulation tissue as compared to ibuprofen. Results vindicate that the esterification of ibuprofen with nitrooxyethyl group reverses the healing-suppressant effect of ibuprofen. The compound also showed equipotent antiinflammatory activity as ibuprofen.

Palmar–plantar erythrodysesthesia due to docetaxel–capecitabine therapy is treated with vitamin E without dose reduction

Palmar-plantar erythrodysesthesia (PPE) is a distinctive and relatively frequent toxic reaction related to some chemotherapeutic agents. Doxorubicin, cytarabine, docetaxel, fluorouracil, and capecitabine are the most frequently implicated agents. Recently, taxanes, especially docetaxel, have been widely used in combination with capecitabine in patients with metastatic breast cancer (MBC). A high percentage of PPE has been seen in patients undergoing this combination therapy. PPE seems to be dose dependent and both peak drug concentration and total cumulative dose determine its occurrence. Withdrawal or dose reduction of the implicated drug usually gives rise to amelioration of the symptoms. Supportive treatments such as topical wound care, elevation, and cold compresses may help to relieve the pain. Use of systemic corticosteroids, pyridoxine (vitamin B6), blood flow reduction, and, recently, topical 99% dimethyl-sulfoxide have been used with variable outcomes. Vitamin E treatment has not been published before, especially without dose reduction of docetaxel-capecitabine therapy. Here we present five MBC patients treated with docetaxel-capecitabine combination therapy in whom PPE was observed during the clinical follow-up period. In all patients grade 2-3 PPE was observed. Vitamin E therapy was started at 300 mg/day p.o. without dose reduction of therapy and after 1 week of treatment PPE began to disappear. We suggest that it could be of interest to consider vitamin E as a preventive drug when drugs with a strong association with PPE are going to be administered.

Advances in the use of tocols as drug delivery vehicles

There has been increasing interest in recent years in the drug delivery applications of tocols and their derivatives. Their biocompatibility and potential to deliver both poorly soluble and water-soluble drugs make tocols attractive as drug delivery vehicles. This review article will focus primarily on topical, oral, and parenteral drug administration using tocols, although other routes of delivery such as pulmonary and nasal will also be discussed. After an overview of the tocol structures, physicochemical properties with emphasis on their solvent properties, functions, and metabolism, specific case studies will be discussed where tocols have been successfully used in topical, oral, and parenteral drug formulations and marketed drug products. Case studies will be extended to those where tocol-based formulations were administered pulmonarily and nasally. As more clinical data and marketed drug products emerge, the utility and therapeutic value of tocols will certainly increase.

Nutrition 2: a vital consideration in the management of skin wounds

The first part of this review focused on the essential biological features of human skin, their origins and cellular relationships as a basis for understanding nutritional requirements in health and disease (see Vol 13 (19; Tissue Viabil Suppl): S22-S28). The second part will discuss the importance of a good, well-balanced diet sufficient in proteins (amino acids), fats, carbohydrates, vitamins and minerals in the management of skin wounds. Evidence is drawn from clinical trials, case studies of patients with known genetic deficiencies affecting dietary metabolism and metabolic studies. Experimental studies in laboratory animals have provided limited information on the role of nutrient deficiencies in wound repair. There is still an urgent need for prospective controlled studies on the importance of key nutrients at principle phases in the wound-healing cascade and how uptake and metabolism is regulated by growth factors, cytokines and hormones.

Edema quantification by computerized morphometry as an evaluation parameter for the resistance of colon anastomoses

PURPOSE: This work had the objective of verifying the validity of using computerized morphometry as a method of quantitative analysis of the interference of edema in scar formation following colon anastomosis. METHODS: Forty-five adult female Wistar rats were utilized, divided into three groups of 15 animals according to whether sacrifice was performed on the first, second or seventh postoperative day. Each group was subdivided into a main group consisting of 10 animals, and a control group consisting of five animals. In the main group, in addition to the quantitative computerized morphometric analysis of the edema in the submucosal layer, the resistance of the colon anastomosis to bursting strength was verified. In the control group, edema quantification was studied alone. RESULTS: The results found via the computerized morphometry method showed that there is a 7% decrease in the presence of edema during the first postoperative week. They confirmed that there is an inverse statistically significant relationship (p< 0.001) between edema presence and the resistance of the anastomosis to bursting strength. CONCLUSION: The use of computerized morphometry is a reliable, fast, objective and low-cost methodology for the quantification of edema in colon anastomoses.

Effect of short-term and long-term antioxidant therapy on primary and secondary ageing neurovascular processes

Previous studies from our laboratory demonstrated an age-related functional decline in sensory neurones and their modulation of microvascular blood flow (primary ageing processes) that correlated with a deficiency in tissue repair (a secondary ageing process). We also raised the notion of a possible role for free radicals in these age-related changes. The aim of this study was to investigate the impact of antioxidant therapy on modulating sensory neurovascular function and tissue repair with age. Twenty-four-month-old Sprague-Dawley rats were treated with vitamin E for short-term (40 mg/kg, i.p., every other day for 2 weeks) or long-term (for 12 months in advance, 10 g/kg, incorporated in food). These treated rats were assessed for the effectiveness of treatment and tested for their sensory neurovascular function, repair of full-thickness burn, and recovery from hyperalgesia following nerve injury. The results indicate that both short- and long-term vitamin E treatments are effective in improving sensory neurovascular function and in reducing the time required for complete wound closure of full-thickness burn injury. Short-term vitamin E treatment was more effective in protecting against the development of hyperalgesia following nerve injury. An initial increase in wound size and in hyperalgesia was observed in the treated animals, and could reflect possible side effects of the antioxidant therapy and support the importance of free radicals in early stages of the repair process. The data, overall, support the notion that oxidative damage contributes to both primary and secondary ageing processes.

Nutritional and vitamin status of non-healing wounds in patients attending a tertiary hospital in India

Non-healing wounds are a common cause of morbidity worldwide. The wounds are the result of inadequate repair in an optimum period and are due to the presence of predisposing factors. The abnormalities of certain biochemical factors are important in impeding wound healing. One hundred patients with non-healing wounds of more than six weeks duration were studied for nutritional and vitamin status and their correlation with healing time. The healing time was significantly prolonged in patients with serum protein concentrations below 6 gram/dl, but the healing time was not correlated with the concentrations of vitamin C or vitamin E. Anemia also did not alter the healing time. Adequate protein intake is the most important prerequisite for good wound healing.

New acrylic bone cements conjugated to vitamin E: curing parameters, properties, and biocompatibility

Acrylic bone cement formulations with antioxidant character were prepared by incorporation of a methacrylic monomer derived from vitamin E (MVE). Increasing concentrations of this monomer provided decreasing peak temperature values, ranging from 62 to 36 degrees C, and increasing setting time with values between 17 and 25 min. Mechanical properties were evaluated by compression and tension tests. Compressive strength of the new formulations were superior to 70 MPa in all cases. The cement containing 25 wt % MVE, however, showed a significant decrease in tensile properties. Biocompatibility of the new formulations was studied in vitro. The analysis of the effect of leachables from cements into the media showed continued cell proliferation and cell viability with a significant increase for the cement containing 15 wt % MVE. This formulation also showed a significant increase in cellular proliferation over a period of 7 days as indicated by the Alamar Blue test. The cells were able to differentiate and express phenotypical markers in presence of all materials. A significant increase in alkaline phosphatase activity was observed on the cements prepared in presence of 15-25 wt % MVE compared with PMMA. Morphological assessment showed that the human osteoblast (HOB) cells were able to adhere, retain their morphology, and proliferate on all the cements.

Cicatrização de anastomoses colônicas na vigência de obstrução intestinal: Estudo experimental em ratos

INTRODUÇÃO: A cicatrização de anastomoses intestinais vem sendo estudada com ênfase às técnicas de sutura e materiais empregados na confecção das anastomoses, bem como à melhor compreensão dos efeitos de diversos fatores sobre a cicatrização. Observa-se número não desprezível de complicações nas anastomoses de cirurgias colorretais e a obstrução colônica é referida como um dos fatores determinantes. OBJETIVO: Estudar a cicatrização de anastomoses no cólon de ratos na vigência de obstrução intestinal. MÉTODOS: Os animais (n=39) foram divididos em: Grupo I (Submetidos à obstrução intestinal induzida quatro dias antes da anastomose, n=22) e Grupo II (Controles, n=22). As anastomoses colônicas foram confeccionadas por técnica padronizada e, sete dias após, os segmentos que as continham foram analisados e ressecados para dosagem de hidroxiprolina. RESULTADOS: As complicações foram mais frequentes nos animais com obstrução (11 ratos=50%) que nos controles (3 ratos=17,7%), p<0,05. A média dos valores de hidroxiprolina foi maior no grupo I (975,0 x 872,0), p>0,05. DISCUSSÃO: A anastomose no cólon de rato com obstrução intestinal está associada a maior número de complicações que podem ser explicadas pela presença de fatores como: maior dificuldade técnica na confecção da anastomose pela desproporção entre bocas, maior desnutrição, impactação de fezes à montante, translocação bacteriana e isquemia. A semelhança estatística entre os grupos quanto à dosagem de hidroxiprolina sugere que a cicatrização das anastomoses colônicas dos ratos com obstrução intestinal, na ausência de complicações, segue o mesmo processo de síntese de colágeno que a dos controles.

The future of nutrition and wound healing

Nutrition is vital to all bodily processes. During wound healing, it is essential that nutrients are available as they form the building blocks for tissue repair. Nutrition may therefore affect healing due to an overall deficiency of intake, either due to non-availability or due to inability of the patient to absorb sufficiently to meet their requirements. Alternatively, deficiencies of specific nutrients may also inhibit healing and on the converse some additives, not normally present in large quantity in the diet, may have beneficial effects. This review considers the nutritional factors affecting wound healing and some developments that may alter the future of therapy.

Patients with chronic leg ulcers show diminished levels of vitamins A and E, carotenes, and zinc

BACKGROUND

Nutrition plays an important role in the wound healing process, particularly in the elderly.

OBJECTIVE

Comparison of nutritional serum indices between patients with chronic leg ulcers and an age-matched control population.

METHODS

Seventeen patients with chronic leg ulcers (age range 47-90) were studied. A panel of vitamins (A, B1, B2, B6, B12, E), trace elements (zinc, copper, iron), folate, and carotene levels were screened on fasting blood samples. Study data were compared with data obtained from the nutritional status survey (NSS) in the greater Boston area.

RESULTS

Significantly lower levels of vitamin A (P < 0.0001), zinc (P < 0. 0001 men, P = 0.027 women) and carotenes (P = 0.0023 men, P = 0.0067 women) were found in chronic ulcer patients. Significantly lower levels of vitamin E (P < 0.009) were observed in the men with a tendency to lower levels in women.

CONCLUSION

Elderly Bostonian patients with chronic leg ulcers have low levels of vitamins A and E, carotenes, and zinc. Nutritional deficiency or increased consumption of nutritional elements in these patients may influence wound healing rates.

Keloids and hypertrophic scars: review and treatment strategies

Keloids and hypertrophic scars represent exuberant forms of scar formation that frequently are pruritic, painful, and occasionally form strictures. As well, they may result in significant cosmetic disfigurement. Recent years have seen an increased understanding in the molecular and biological mechanisms of keloidal scar formation, allowing for the development of more specific therapeutic options for these lesions. Despite these developments, keloids and hypertrophic scars remain difficult to manage. Clinical, histopathological, and biochemical features of keloids and hypertrophic scars, as well as treatment guidelines, are discussed.

Impediments to wound healing

Chronic wounds will often heal in a short period of time if factors that inhibit wound healing are identified and managed. Recombinant growth factor therapy may provide an added stimulus to healing in certain types of chronic wounds. However, there remains no substitute for a physiologic environment conducive to tissue repair and regeneration, without which the efficacy of growth factor therapy is questionable. Some of the most commonly encountered and clinically significant impediments to wound healing include wound hypoxia, infection, presence of debris and necrotic tissue, use of anti-inflammatory medications, a diet deficient in vitamins or minerals, or general nutritional deficiencies, tumors, environmental factors, and metabolic disorders, such as diabetes mellitus. Treatment of chronic wounds should be directed against the main etiologic factors responsible for the wound. Moreover, factors that may impede healing must be identified and, if possible, corrected, for healing to occur.

Care before and after laser skin resurfacing. A survey and review of the literature

BACKGROUND

The extent of the wound healing period and the final outcome of cutaneous laser resurfacing are influenced not only by the treatment protocol and type of laser used but also on care of the skin before and after the procedure.

OBJECTIVE

This project was conducted to determine the pre- and postresurfacing care protocols currently in practice and to research the literature in an effort to clarify which interventions can accelerate wound healing and improve efficacy of the treatment.

METHODS

Three hundred thirty-nine questionnaires were mailed to all dermatology and plastic surgery members of the American Society for Laser Medicine and Surgery (ASLMS). Questionnaires were completed anonymously to decrease respondent bias. Statistical analysis included calculation of percentages and means of the data.

RESULTS

Survey results are discussed and compared with data from the literature for the following interventions: tretinoin cream, glycolic acid cream, hydroquinone, oral prophylactic antibiotics, oral prophylactic antivirals, hydrogel dressings, semiocclusive ointments, topical antibiotics, topical corticosteroids, oral corticosteroids, and dilute acetic acid soaks.

CONCLUSIONS

Many options are appropriate, based on data from past studies, for pre- and postresurfacing skin care. Approximately 73% of the results of the survey correlate with information from the literature. Past studies do provide information to help us select interventions that can improve wound healing and the final cosmetic outcome. Further studies involving resurfacing patients may clarify some of the more complex wound care issues, such as oral prophylactic antibiotics, hydroquinone, and topical vitamins C and E.