Flor Macquhae

A Review of Cellular and Acellular Matrix Products: Indications, Techniques, and Outcomes

Background: Wound healing is a dynamic process whereby cells, growth factors (GFs), and the extracellular matrix (ECM) interact to restore the architecture of damaged tissue. Chronic wounds can be difficult to treat due to the increased presence of inflammatory cells that degrade the ECM, GF, and cells necessary for wound healing to occur. Cellular and acellular matrix products can be used in the management of a variety of chronic wounds including venous, diabetic, and pressure ulcers and other conditions such as burns, epidermolysis bullosa, pyoderma gangrenosum, and surgical wounds. These matrices provide cells, GF, and other key elements that act as a scaffold and promote reepithelialization and revascularization of the wound bed. Methods: This article focuses on cellular and acellular matrix products that have been well-studied clinically with positive results in randomized clinical trials and widely available matrices for chronic nonhealing wounds. We present trial results as well as their indications, techniques, and outcomes. Results: There are a variety of matrix products available on the market. Some of these products are used to treat chronic wounds, for example, diabetic foot ulcers, venous leg ulcers, pyoderma gangrenosum, and pressure ulcers. In this review, we found that wounds of different etiologies have been treated with a variety of matrices, with successful outcomes compared with standard wound care. Conclusions: Both cellular and acellular matrix products are useful in the management of a variety of chronic wounds. These matrices provide cells, GF, and other key elements that promote reepithelialization and revascularization of the wound bed while preventing degradation of the ECM. The treatment of chronic wounds with matrix products in combination with standard wound care has been proven to aid in wound healing when added to standard of care.

Epidermal skin grafting.

Autologous skin grafts, such as full‐ and split‐thickness, have long been part of the reconstructive ladder as an option to close skin defects. Although they are effective in providing coverage, they require the need for a trained surgeon, use of anaesthesia and operating room and creation of a wound at the donor site. These drawbacks can be overcome with the use of epidermal skin grafts (ESGs), which can be harvested without the use of anaesthesia in an office setting and with minimal to no scarring at the donor site. ESGs consist only of the epidermal layer and have emerged as an appealing alternative to other autologous grafts for the treatment of acute and chronic wounds. In this article, we provide an overview of epidermal grafting and its role in wound management.

Wound Dressings: A Comprehensive Review

Purpose of ReviewThis comprehensive review covers the advantage and limitations of some dressing materials and the current knowledge on wound dressings and emerging technologies to achieve proper wound healing.Recent FindingsTraditional and modern dressings are helpful in the wound healing process; however, they cannot substitute lost tissue. Human skin equivalents have been developed conceptually to fill this void as they do not only facilitate wound healing but also may replace lost tissue. Several studies have shown that the addition of mesenchymal stem cells, such as in human placenta, has promising results in wound healing.SummaryA wound is defined as a disruption in the continuity of the skin or mucosa due to physical or thermal damage, or an underlying medical condition. Wound healing is a complex, dynamic, and multistep process which occurs after skin damage leading to tissue repair. Although the skin normally undergoes repair after a disruption, the healing process can be affected in different conditions such as diabetes mellitus, infections, venous/arterial insufficiency, among others. To enhance healing, a wide range of wound dressings are available; however, a thorough wound assessment (e.g., wound type, size, depth, or color) is required to choose the appropriate dressing. The emergence of new dressings has brought a new perspective of wound healing, but there is no superior product yet to treat acute and/or chronic wounds. Therefore, wound dressing research studies need to be carried out in order to help improve wound healing.

Statins may be associated with six‐week diabetic foot ulcer healing

Diabetic foot ulcers (DFUs) affect 1.5 million Americans annually, of which only a minority heal with standard care, and they commonly lead to amputation. To improve care, investigations are underway to better understand DFU pathogenesis and develop more effective therapies. Some currently used medications may improve healing. One small, randomized clinical trial found statins improve DFU healing. In this secondary analysis of a large multisite prospective observational cohort of 139 patients with DFUs receiving standard care, we investigated whether there was an association between 6‐week DFU wound size reduction and use of a variety of medications including alpha‐blockers, beta‐blockers, angiotensin converting enzyme inhibitors (ACEi) and statins. We found no significant (p < 0.05) association between six‐week wound reduction and use of any of the evaluated drugs; however, statins did trend toward an association (p = 0.057). This suggests a potential benefit of statins on DFU healing, and larger, targeted studies are warranted.

Adalimumab treatment leads to reduction of tissue tumor necrosis factor-alpha correlated with venous leg ulcer improvement: a pilot study.

Venous leg ulcers (VLUs) have higher tumor necrosis factor‐α (TNF‐α) levels compared with normal skin. Refractory VLUs of long duration have higher TNF‐α levels compared with VLUs of shorter duration. As up to 75% of VLUs fail to heal with standard care, we sought to evaluate the role of anti‐TNF‐α therapy for patients with refractory VLUs. Evaluable data were obtained in four of five subjects with recalcitrant VLUs treated with 80 mg of subcutaneous adalimumab at week 0 and with 40 mg at week 2 along with compression therapy and were followed‐up for 6 weeks. Wound biopsies taken at weeks 0 and 4 were stained with anti‐TNF‐α antibodies. Average 4‐week percent wound size reduction was 20.5% ± 6.4%. Two patients had wound size reduction more than 25%, and their percent wound size reduction correlated to percent TNF‐α staining score reductions (P = 0.02, R2 = 0.999). VLU TNF‐α level decrease 4 weeks post‐adalimumab treatment correlated with wound healing.

Comment on Yang et al. Association of statin use and reduced risk of lower-extremity amputation among patients with diabetes: A nationwide population-based cohort observation. Diabetes Care 2016;39:e54-e55

It is estimated that 2 million Americans, two-thirds of whom have diabetes mellitus (DM), are currently living with a limb amputation (1). Patients with DM are at significant risk for limb amputation, as one in four will develop a diabetic foot ulcer (DFU) over their lifetime and nearly one in six will require amputation (2). In 2009, U.S. hospital costs due to amputation exceeded

Patients’ prediction of their wound healing time: Patients’ prediction of wound healing time

8.3 billion, and annual U.S. DFU treatment costs are approaching

Stress and wound healing

13 billion (1–3). With this in mind, we were pleased to read the study by Yang et al. (4) investigating the association between statin use and reduced risk of lower-limb amputation (LLA) in patients with DM. Yang et al. studied a population-based cohort …

Skin movement, wound repair and development of engineered skin.

Understanding and managing patients’ expectations can help improve their adherence to treatment for chronic wounds; however, little is known concerning about their expectations regarding healing time. Recruited subjects were asked to predict how long their wounds would take to heal and their charts were reviewed to retrieve real time of healing. We recruited 100 subjects from which 77% have healed. Fifty‐three subjects (68.8%) had a longer healing time than they predicted (underestimated), and 17 (22.1%) had a shorter healing time than they predicted (overestimated). Subjects with shorter wound duration history tended to predict shorter healing time than subjects with longer wound duration (p < 0.01). However, wound duration did not affect prediction accuracy (p = 0.65). Subjects with chronic wounds seem more often to underestimate their time of healing. Wound duration significantly influenced patients’ prediction time, although it did not make their prediction more accurate. Patient education about expectations may be important as patients often expect their wounds to heal faster than they actually do.

Opioids’ Effect on Healing of Venous Leg Ulcers

A wound can be defined as a disruption in the normal structure and function of the skin and soft tissues. Caused by a variety of different etiologies and mechanisms, wounds are further divided into acute or chronic wounds. A loop may ensue as these wounds may also create stress. For patients with diabetes mellitus, the fear of having a new ulcer generates anxiety and distress. Patients healing from burn wounds often suffer from post-traumatic stress disorder (7 % at discharge and 22 % at follow up). Moreover, stress and pain can result from wound care itself. Dressing changes are often painful for patients, doctor’s appointments and wound care visits can be taxing financially and time consuming, thus inducing anxiety and stress.