Arterial insufficiency and ulceration: diagnosis and treatment options

Biocellulose-based hydrogel dressing as a strategy for the management of chronic arterial wounds

PURPOSE

To evaluate using a biocellulose-based hydrogel as an adjuvant in the healing process of arterial ulcers.

METHODS

A prospective single group quasi-experimental study was carried out with chronic lower limb arterial ulcer patients. These patients received biocellulose-based hydrogel dressings and outpatient guidance on dressing and periodic reassessments. The primary outcomes were the ulcer-healing rate and product safety, which were assessed by ulcer area measured in photographic records of pre-treatment and posttreatment after 7, 30, and 60 days. Secondary outcomes were related to clinical assessment by the quality-of-life scores (SF-36 and EQ-5D) and pain, evaluated by the visual analogue scale (VAS).

RESULTS

Seventeen participants were included, and one of them was excluded. Six patients (37%) had complete wound healing, and all patients had a significant reduction in the ulcer area during follow-up (233.6mm2 versus 2.7mm2) and reduction on the score PUSH 3.0 (p < 0.0001). The analysis of the SF-36 and EQ-5D questionnaires showed a statistically significant improvement in almost all parameters analyzed and with a reduction of pain assessed by the VAS.

CONCLUSIONS

The biocellulose-based hydrogel was safe and showed a good perspective to promoting the necessary conditions to facilitate partial or complete healing of chronic arterial ulcers within a 60-day follow-up. Quality of life and pain were positively affected by the treatment.

Acute and impaired wound healing: pathophysiology and current methods for drug delivery, part 1: normal and chronic wounds: biology, causes, and approaches to care

This is the first installment of 2 articles that discuss the biology and pathophysiology of wound healing, review the role that growth factors play in this process, and describe current ways of growth factor delivery into the wound bed. Part 1 discusses the latest advances in clinicians' understanding of the control points that regulate wound healing. Importantly, biological similarities and differences between acute and chronic wounds are considered, including the signaling pathways that initiate cellular and tissue responses after injury, which may be impeded during chronic wound healing.

Improving wound-healing outcomes in diabetic foot ulcers

The prevalence of diabetes is increasing worldwide and has been forecasted to double in the next 20 years. The major increase in morbidity and mortality of diabetes is due to the development of both macro- and microvascular complications, including failure of the wound-healing process. Foot ulcers occur in 15% of all patients with diabetes and precede 84% of all lower-leg amputations. The essential components of diabetic foot ulcer treatment are to reduce foot bearing pressure (in neuropathic ulcers) and to increase blood supply (in the case of vascular ulcers). Antibacterial therapy is also important. Despite optimized treatment, for reasons not completely understood, some ulcers fail to heal. Previous research studies have shown clearly that failure of healing eventually leads to deep-seated infection and amputation. Therefore, impaired wound healing is the pivotal event responsible for most of the morbidity (and mortality) of diabetic foot disease. Improving wound healing in diabetes requires a multidisciplinary approach in terms of clinical management as well as an increased effort aimed at better understanding the pathogenesis of poor wound healing in diabetes. Consequently, a detailed understanding of the wound-healing process in diabetes and how it can be improved is of great importance. However, efforts to develop new therapies are hampered by a lack of knowledge of the molecular mechanisms responsible for the pathologies, as well as a lack of suitable models for the study of chronic wounds. Therefore, this review will address both clinical and biochemical aspects of wound healing in diabetes.

Efficacy of concentrated autologous platelet-derived growth factors in chronic lower-extremity wounds

The efficacy of concentrated autologous platelet-derived growth factors in the healing and closure of chronic lower-extremity wounds was evaluated in 24 patients with 33 lower-extremity wounds treated previously for at least 6 months using traditional methods. Surgical wound debridement was performed to convert chronic ulcers into acute wounds. Concentrated autologous platelet-derived growth factors and thrombin were applied to the wound bases and protected with a nonadhering compression dressing that remained intact for 7 days. Wounds were evaluated and the concentrate was reapplied every 2 weeks. Wound closure and complete epithelialization was achieved in 20 wounds. Seventy-five percent or greater wound closure was obtained in three wounds, 50% to 74% closure in three wounds, and 25% to 49% closure in two wounds. Five wounds displayed no improvement. Mean time to complete closure was 11.15 weeks. The application of concentrated autologous platelet-derived growth factors and thrombin resulted in substantial wound healing and wound-diameter reduction. This technique constitutes a safe and effective treatment option and avoids lengthy treatment periods that increase the potential for infection.