Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society
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Effective prevention and treatment of hypertrophic scars (HTSs), a dermal form of fibrosis that frequently occurs following thermal injury to deep dermis, are unsolved significant clinical problems. Previously, we have found that stromal cell-derived factor 1/CXCR4 signaling is up-regulated during wound healing in burn patients and HTS tissue after thermal injury. We hypothesize that blood-borne mononuclear cells are recruited into wound sites after burn injury through the chemokine pathway of stromal cell-derived factor 1 and its receptor CXCR4. ⋯ In this study, the inhibitory effect of CXCR4 antagonist CTCE-9908 on dermal fibrosis was determined in vivo using a human HTS-like nude mouse model, in which split-thickness human skin is transplanted into full-thickness dorsal excisional wounds in athymic mice, where these wounds subsequently develop fibrotic scars that resemble human HTS as previously described. CTCE-9908 significantly attenuated scar formation and contraction, reduced the accumulation of macrophages and myofibroblasts, enhanced the remodeling of collagen fibers, and down-regulated the gene and protein expression of fibrotic growth factors in the human skin tissues. These findings support the potential therapeutic value of CXCR4 antagonist in dermal fibrosis and possibly other fibroproliferative disorders.
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Randomized Controlled Trial Multicenter Study Comparative Study
Efficacy of intralesional recombinant human epidermal growth factor in diabetic foot ulcers in Mexican patients: a randomized double-blinded controlled trial.
The healing process in diabetic foot ulcer (DFU) is hindered by factors such as chronic inflammation, defects in fibroblast function, poor angiogenesis, and lack of cell migration. Recombinant human epidermal growth factor (rhEGF) has been shown to enhance extracellular matrix formation, cellular proliferation, and angiogenesis. Therefore, intralesional application of rhEGF in DFU could accelerate wound healing. ⋯ Mild transitory dizziness was the only side effect that was more frequently noted in the rhEGF group. Our results showed that in patients with DFU who received standard care, intralesional rhEGF application resulted in complete healing in more patients, promoted the epithelialization of the wound bed, and significantly reduced the area of the DFU treated. Therefore, rhEGF resulted in better outcomes for patients suffering from DFU.
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No universally accepted standard for evaluation, prevention, and treatment of scars, hypertrophic scars, and keloids exists. Following development of a questionnaire, we performed a closed Web-based survey among burn centers. ⋯ We noted a low penetration for the use of objective evaluation tools in our poll and detected differences in surgical approaches to keloids. Based on the results of our survey and the power of currently available clinical recommendations, we expect future guidelines to gain more evidence-based power, especially when more high-quality clinical trials with objective evaluation support, clearly defined disease entities, and therapeutic outcome factors have become available.
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Review Meta Analysis Comparative Study
Nonsilver treatment vs. silver sulfadiazine in treatment of partial-thickness burn wounds in children: a systematic review and meta-analysis.
The evidence for application of silver-containing dressings and topicals in the treatment of partial-thickness burns in pediatric patients is largely based on clinical trials involving adult patients despite the important differences between the skin of children and adults. A systematic review and meta-analysis was performed of all randomized controlled trials comparing nonsilver treatment with silver-containing dressings and silver topical agents in children with partial-thickness burns in the acute stage. Endpoints were wound healing, grafting, infection, pain, number of dressing changes, length of hospital stay, and scarring. ⋯ Most trials were of moderate quality with high risk of bias. Use of nonsilver treatment led to shorter wound healing time (weighted mean difference: -3.43 days, 95% confidence interval: -4.78, -2.07), less dressing changes (weighted mean difference: -19.89 dressing changes, 95% confidence interval: -38.12, -1.66), and shorter length of hospital stay (weighted mean difference: -2.07 days, 95% confidence interval: -2.63, -1.50) compared with silver sulfadiazine treatment, but no difference in the incidence of wound infection or grafting was found. In conclusion, nonsilver treatment may be preferred over silver sulfadiazine, but high-quality randomized controlled trials are needed to validly confirm the effectiveness of silver containing preparations, in particular silver-containing dressings, above nonsilver treatments.
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The intrasynovial flexor tendons of the hand are critical for normal hand function. Injury to these tendons can result in absent finger flexion, and a subsequent loss of overall hand function. ⋯ In spite of these advances, intrasynovial flexor tendon repairs continue to be plagued by postoperative scar formation, which limits tendon gliding and prevents a full functional recovery. This paper describes the current challenges of flexor tendon repair, and evaluates the most recent advances and strategies for achieving an excellent functional outcome.