Chronic Wound Healing: A Review of Current Management and Treatments
DOI:
https://doi.org/10.22270/ajprd.v11i3.1262Keywords:
Biofilms, Chronic wounds, Growth factors, Hyperbaric oxygen, Negative pressure wound therapy, Skin infection, Skin substitutes, Wound dressings, Wound healingAbstract
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.
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References
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2. Brem H, Stojadinovic O, Diegelmann RF, et al. Molecular markers in patients with chronic wounds to guide surgical debridement. Mol Med. 2007;13(1–2):30–39
3. Sen CK, Gordillo GM, Roy S, et al. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009;17(6):763–771. Doi: 10.1111/j.1524-475X.2009.00543.x.
4. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26S–38S. doi: 10.1016/S0002-9610(98)00183-4.
5. Wynn TA, Barron L. Macrophages: master regulators of inflammation and fibrosis. Semin Liver Dis. 2010;30(3):245–257. Doi: 10.1055/s-0030-1255354.
6. Haukipuro K, Melkko J, Risteli L, Kairaluoma M, Risteli J. Synthesis of type I collagen in healing wounds in humans. Ann Surg. 1991;213(1):75–80. Doi: 10.1097/00000658-199101000-00013
7. Gurtner GC, Werner S, Barrandon Y, Longaker MT. Wound repair and regeneration. Nature. 2008;453(7193):314–321. Doi: 10.1038/nature07039.
8. Hunt TK, Hopf HW. Wound healing and wound infection. What surgeons and anesthesiologists can do. Surg Clin North Am. 1997;77(3):587–606. Doi: 10.1016/S0039-6109(05)70570-3
9. Sheffield PJ. Tissue oxygen measurements. In: Hunt TK, Davis JC, editors. Problem wounds: the role of oxygen. New York: Elsevier; 1988. Pp. 17–52.
10. Ruberg RL. Role of nutrition in wound healing. Surg Clin North Am. 1984;64(4):705–714. Doi: 10.1016/S0039-6109(16)43386-4.
11. Breslow RA, Hallfrisch J, Guy DG, Crawley B, Goldberg AP. The importance of dietary protein in healing pressure ulcers. J Am Geriatr Soc. 1993;41(4):357–362. Doi: 10.1111/j.1532-5415.1993.tb06940.x.
12. Ehrlich HP, Tarver H, Hunt TK. Inhibitory effects of vitamin E on collagen synthesis and wound repair. Ann Surg. 1972;175(2):235–240. Doi: 10.1097/00000658-197202000-00013.
13. MacKay D, Miller AL. Nutritional support for wound healing. Altern Med Rev. 2003;8(4):359–377.
14. Greenwald DP, Sharzer LA, Padawer J, Levenson SM, Seifter E. Zone II flexor tendon repair: effects of vitamins A, E, beta-carotene. J Surg Res. 1990;49(1):98–102. Doi: 10.1016/0022-4804(90)90117-K.
15. Galeano M, Torre V, Deodato B, et al. Raxofelast, a hydrophilic vitamin E-like antioxidant, stimulates wound healing in genetically diabetic mice. Surgery. 2001;129(4):467–477.
16. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–1053. Doi: 10.2337/diacare.27.5.1047.
17. Reiber GE, Vileikyte L, Boyko EJ, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999;22(1):157–162. Doi: 10.2337/diacare.22.1.157.
18. Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. J Clin Invest. 2007;117(5):1219–1222. Doi: 10.1172/JCI32169.
19. Christman AL, Selvin E, Margolis DJ, Lazarus GS, Garza LA. Hemoglobin A1c predicts healing rate in diabetic wounds. J Invest Dermatol. 2011;131(10):2121–2127. Doi: 10.1038/jid.2011.176
20. Peppa M, Stavroulakis P, Raptis SA. Advanced glycoxidation products and impaired diabetic wound healing. Wound Repair Regen. 2009;17(4):461–472. Doi: 10.1111/j.1524-475X.2009.00518.x
21. Trengove NJ, Stacey MC, McGechie DF, Mata S. Qualitative bacteriology and leg ulcer healing. J Wound Care. 1996;5(6):277–280. Doi: 10.12968/jowc.1996.5.6.277.
22. Armstrong DG, Liswood PJ, Todd WF. William J. Stickel Bronze Award. Prevalence of mixed infections in the diabetic pedal wound. A retrospective review of 112 infections. J Am Podiatr Med Assoc. 1995;85(10):533–537. Doi: 10.7547/87507315-85-10-533.
23. Schneider M, Vildozola CW, Brooks S. Quantitative assessment of bacterial invasion of chronic ulcers. Statistical analysis. Am J Surg. 1983;145(2):260–262. Doi: 10.1016/0002-9610(83)90075-2.
24. Murphy PS, Evans GR. Advances in wound healing: a review of current wound healing products. Plast Surg Int. 2012;2012:190436.
25. Warriner R, Burrell R. Infection and the chronic wound: a focus on silver. Adv Skin Wound Care. 2005;18(Suppl 1):2–12. Doi: 10.1097/00129334-200510001-00001.
26. Miller AC, Rashid RM, Falzon L, Elamin EM, Zehtabchi S. Silver sulfadiazine for the treatment of partial-thickness burns and venous stasis ulcers. J Am Acad Dermatol. 2012;66(5):e159–e165. Doi: 10.1016/j.jaad.2010.06.014.
27. Skog E, Arnesjo B, Troeng T, Gjores JE, Bergljung L, Gundersen J, et al. A randomized trial comparing cadexomer iodine and standard treatment in the out-patient management of chronic venous ulcers. Br J Dermatol. 1983;109(1):77–83. Doi: 10.1111/j.1365-2133.1983.tb03995.x.
28. Moberg S, Hoffman L, Grennert ML, Holst A. A randomized trial of cadexomer iodine in decubitus ulcers. J Am Geriatr Soc. 1983;31(8):462–465. Doi: 10.1111/j.1532-5415.1983.tb05117.x.
29. Lipsky BA, Hoey C. Topical antimicrobial therapy for treating chronic wounds. Clin Infect Dis. 2009;49(10):1541–1549. Doi: 10.1086/644732.
30. Draelos ZD, Rizer RL, Trookman NS. A comparison of postprocedural wound care treatments: do antibiotic-based ointments improve outcomes? J Am Acad Dermatol. 2011;64(3 Suppl):S23–S29. Doi: 10.1016/j.jaad.2010.11.010.
31. Taylor SC, Averyhart AN, Heath CR. Postprocedural wound-healing efficacy following removal of dermatosis papulosa nigra lesions in an African American population: a comparison of a skin protectant ointment and a topical antibiotic. J Am Acad Dermatol. 2011;64(3 Suppl):S30–S35. Doi: 10.1016/j.jaad.2010.11.009.
32. Langford JH, Artemi P, Benrimoj SI. Topical antimicrobial prophylaxis in minor wounds. Ann Pharmacother. 1997;31(5):559–563. Doi: 10.1177/106002809703100506.
33. Maddox JS, Ware JC, Dillon HC., Jr The natural history of streptococcal skin infection: prevention with topical antibiotics. J Am Acad Dermatol. 1985;13(2 Pt 1):207–212. Doi: 10.1016/S0190-9622(85)70160-0.
34. Rogers HD, Desciak EB, Marcus RP, Wang S, MacKay-Wiggan J, Eliezri YD. Prospective study of wound infections in Mohs micrographic surgery using clean surgical technique in the absence of prophylactic antibiotics. J Am Acad Dermatol. 2010;63(5):842–851. Doi: 10.1016/j.jaad.2010.07.029
35. Levender MM, Davis SA, Kwatra SG, Williford PM, Feldman SR. Use of topical antibiotics as prophylaxis in clean dermatologic procedures. J Am Acad Dermatol. 2012;66(3):445–451. Doi: 10.1016/j.jaad.2011.02.005.
36. Mulder G, Jones R, Cederholm-Williams S, Cherry G, Ryan T. Fibrin cuff lysis in chronic venous ulcers treated with a hydrocolloid dressing. Int J Dermatol. 1993;32(4):304–306. Doi: 10.1111/j.1365-4362.1993.tb04275.x.
37. Prete PE. Growth effects of Phaenicia sericata larval extracts on fibroblasts: mechanism for wound healing by maggot therapy. Life Sci. 1997;60(8):505–510. Doi: 10.1016/S0024-3205(96)00688-1.
38. Thomas S, Andrews A, Jones M, Church J. Maggots are useful in treating infected or necrotic wounds. BMJ. 1999;318(7186):807–808. Doi: 10.1136/bmj.318.7186.807.
39. Ke Q, Costa M. Hypoxia-inducible factor-1 (HIF-1) Mol Pharmacol. 2006;70(5):1469–1480. Doi: 10.1124/mol.106.027029.
40. Jones V, Grey JE, Harding KG. Wound dressings. BMJ. 2006;332(7544):777–780. Doi: 10.1136/bmj.332.7544.777.
41. Barnett SE, Varley SJ. The effects of calcium alginate on wound healing. Ann R Coll Surg Engl. 1987;69(4):153–155.
42. Cullen B, Smith R, McCulloch E, Silcock D, Morrison L. Mechanism of action of PROMOGRAN, a protease modulating matrix, for the treatment of diabetic foot ulcers. Wound Repair Regen. 2002;10(1):16–25. Doi: 10.1046/j.1524-475X.2002.10703.x.
43. Beele H, Meuleneire F, Nahuys M, Percival SL. A prospective randomised open label study to evaluate the potential of a new silver alginate/carboxymethylcellulose antimicrobial wound dressing to promote wound healing. Int Wound J. 2010;7(4):262–270. Doi: 10.1111/j.1742-481X.2010.00669.x.
44. Percival SL, Bowler P, Woods EJ. Assessing the effect of an antimicrobial wound dressing on biofilms. Wound Repair Regen. 2008;16(1):52–57. Doi: 10.1111/j.1524-475X.2007.00350.
45. Dziewulski P, et al. Acute management of facial burns. In: Jeschke MG, Kamolz L-P, Sjöberg F, Wolf SE, editors. Handbook of burns vol. 1: acute burn care, 1st edn. New York: Springer; 2011. Pp. 291–302.
46. Marston WA, Hanft J, Norwood P, Pollak R. The efficacy and safety of Dermagraft in improving the healing of chronic diabetic foot ulcers: results of a prospective randomized trial. Diabetes Care. 2003;26(6):1701–1705. Doi: 10.2337/diacare.26.6.1701.
47. Hanft JR, Surprenant MS. Healing of chronic foot ulcers in diabetic patients treated with a human fibroblast-derived dermis. J Foot Ankle Surg. 2002;41(5):291–299. Doi: 10.1016/S1067-2516(02)80047-3.
48. Newton DJ, Khan F, Belch JJ, Mitchell MR, Leese GP. Blood flow changes in diabetic foot ulcers treated with dermal replacement therapy. J Foot Ankle Surg. 2002;41(4):233–237.
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Published
2023-06-15
How to Cite
Kumar Jha, K., Raj, A., ., S., Bishnoi, H., Raj, M., & Thakur, V. (2023). Chronic Wound Healing: A Review of Current Management and Treatments. Asian Journal of Pharmaceutical Research and Development, 11(3), 95–102. https://doi.org/10.22270/ajprd.v11i3.1262
Issue
Section
Review Articles
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