Challenges in the Treatment of Chronic Wounds

Abstract

Significance: Chronic wounds include, but are not limited, to diabetic foot ulcers, venous leg ulcers, and pressure ulcers. They are a challenge to wound care professionals and consume a great deal of healthcare resources around the globe. This review discusses the pathophysiology of complex chronic wounds and the means and modalities currently available to achieve healing in such patients.Recent Advances: Although often difficult to treat, an understanding of the underlying pathophysiology and specific attention toward managing these perturbations can often lead to successful healing.Critical Issues: Overcoming the factors that contribute to delayed healing are key components of a comprehensive approach to wound care and present the primary challenges to the treatment of chronic wounds. When wounds fail to achieve sufficient healing after 4 weeks of standard care, reassessment of underlying pathology and consideration of the need for advanced therapeutic agents should be undertaken. However, selection of an appropriate therapy is often not evidence based.Future Directions: Basic tenets of care need to be routinely followed, and a systematic evaluation of patients and their wounds will also facilitate appropriate care. Underlying pathologies, which result in the failure of these wounds to heal, differ among various types of chronic wounds. A better understanding of the differences between various types of chronic wounds at the molecular and cellular levels should improve our treatment approaches, leading to better healing rates, and facilitate the development of new more effective therapies. More evidence for the efficacy of current and future advanced wound therapies is required for their appropriate use.

Effects of the application of the amniotic membrane in the healing process of skin wounds in rats

“…We emphasize that the use of the HAM offers the advantages of high availability, ease of application, and good storability [12][13][14][15][16][17][18] . In this context, it is possible to affirm that by presenting properties that favor the re-structuring of the damaged portions of the tissues, the amniotic membrane could be used as a biological coverage of acute and chronic wounds [18][19][20][21][22][23][24][25][26] .…”

“…However, the histomorphometric analysis showed a considerable increase in the number of these cells in group T, which was probably related to the presence of several growth factors in the epithelium of the membrane. The HAM has the ability to stimulate skin repair and synthesize essential growth factors and cytokines that promote cell migration, proliferation, and metabolic activity in the cells and tissues [21][22] . It is evident that the repair process had an early initiation in the wounds protected compared with that in the fully exposed wounds because the membrane acts as a biological bandage protecting the injured tissues; this favors local hydration and avoids contamination by microorganisms and contaminated materials 5 .…”

Biochemical and Biophysical Cues in Matrix Design for Chronic and Diabetic Wound Treatment

“…189 Electrical stimulation is a biomimicry tool in tissue regeneration representing bioelectrical signals in the body and has been widely used in wound healing applications 190,191 and in the clinics. 192 Endogenous electric fields naturally arise after wounding and keratinocytes migrate in response to it, leading to wound closure. An external electrical stimulation aims to enhance the effect of naturally occurring electric fields on wound healing process.…”

“…209 Interaction of pulsed electromagnetic field with endogenous electric fields resulted in upregulation of multiple growth factors and NO, which regulated cell migration and angiogenesis. 192 Pulsed electromagnetic field increased the tensile strength of diabetic wounds in rat models. 210 The treatment significantly accelerated wound closure and reepithelialization after 10 days.…”

Application of 3d Printing in Electro Induced Drug Delivery Based on Wound Temperature

“…Meanwhile, a chronic wound is categorized as the one that fails to heal within four weeks, and which shows no sign of improvement within eight weeks though the cause may vary. Wound care and healing has common behaviors that carryout for all care and treatments 4 .…”