ORIGINAL ARTICLES   

Acta Vulnologica 2009 June;7(2):75-83

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: Italian

The new frontier in the care of “difficult wounds”: use of growth factors

Ferraro G. A. ¹, Nebbioso G. ², Desiderio V. ², De Francesco F. ^{1, 3}, Rossano F. ², Caprarella E. ², Petrella F. ⁴, D’Andrea F. ¹

¹ Dipartimento di Scienze Ortopediche Traumatologiche, Riabilitative e Plastico-Ricostruttive Seconda Università di Napoli Napoli, Italia 2 Ambulatorio Chirurgia e Trattamento Lesioni Croniche Cutanee Dipartimentale di Patologia Cardiovascolare ASL Na1, Unità Operativa Semplice Napoli, Italia 3 Dipartimento di Medicina Sperimentale Sezione di Istologia ed Embriologia TESLAB, Seconda Università di Napoli Napoli, Italia 4 Ambulatorio di Riparazione Tessutale ASL Napoli5, Distretto 81, Portici, Napoli, Italia

The wound repair process unfolds in overlapping phases of hemostasis, inflammation, proliferation and tissue remodelling. In some circumstances, however, healing may be inhibited, resulting in a chronic skin wound. The causes may be systemic (the patient’s general condition, pharmacotherapy, severe malnutrition) or local (presence of necrotic tissue, infection, excessive exudate in the wound). But sometimes wounds may not respond to best practices in wound care, including debridement, control of bacterial colonization and excessive exudate. Also, alterations in cellular components or chemotactic mediators may interfere with healing: deceased cell mitosis and migration, augmented release of inflammatory cytokines and proteases, growth factor (GF) deficiency, senescent cells not responding to GF stimulation. GFs may be defined as agents that promote cell proliferation and metabolism by interacting with specific cell membrane receptors. These proteins induce cells (e.g., leukocytes and fibroblasts) to migrate to the wound. Because they are released at the wound site, many GFs or their transcripts have been identified in wound repair processes. In the past decades, there has been extensive research on the role and potential of GFs in the treatment of difficult wounds. One of the first applications of GFs in tissue repair was autologous platelet gel, which is rich in platelet GFs. But initial enthusiasm with autologous platelet gel in treating chronic skin wounds waned as results with single use did not match expectations owing to the vast variety of GFs involved in tissue repair processes, and it was speculated that some GFs are either not or not sufficiently produced by patients with chronic wounds. The aim of this study was to determine whether in chronic ulcers recalcitrant to general or local therapy there is a deficiency of GFs and of the GFs primarily responsible for cell stimulation in particular.