Problems of healing chronic wounds
DOI:
https://doi.org/10.34287/MMT.3(58).2023.10Abstract
Aim. The work aimed to analyze and highlight the problems of chronic wound healing and modern methods of stimulation of reparative processes according to literature sources.
An analysis of the scientific literature was carried out, in which views on the problems of wound healing are presented, taking into account the factors affecting the formation and healing of chronic wounds, and modern methods that stimulate reparation processes. Identifying the problems of wound healing will allow a comprehensive approach to the assessment of the wound process, taking into account the factors affecting the healing of injuries.
Modern scientists are actively discussing the problems of wound healing, researching factors influencing the reparative process, including the high prevalence of chronic wounds, diagnosis and treatment of wound infections, age of patients, and state of immunity. In the case of systemic diseases, such as diabetes, cardiovascular pathology, etc., there is a violation of microcirculation, and as a result, there are violations of the phasing of reparative processes at the cellular level. As a result, the alteration process does not end and the process becomes chronic.
In case of a mechanical injury, when adaptation reserves are reduced, primarily of the neurohumoral system, a key role is played by the disruption of regulatory mechanisms at the cellular level. Wound treatment requires surgical treatment, stimulation of angiogenesis, and other reparative processes at the systemic and local levels.
In recent years, various methods of stimulating reparative processes have been used in clinical practice to treat wounds: local administration of recombinant growth factors, use of platelet-rich plasma, biotechnological wound dressings, and artificial skin substitutes. One of the most promising areas of wound treatment is the development of methods for targeted activation of stem cells. However, there are still insufficient data for the practical application of this method. Clinically effective and safe methods are still being developed. Physical methods are promising for improving the healing of chronic wounds. However, the selection of optimal parameters for physical action continues to be an urgent task. Despite the positive results obtained using the methods described above, there is a need for additional experimental studies and randomized controlled trials.
Conclusions. Chronic wounds develop as a result of severe systemic diseases, and major mechanical injuries against the background of a decrease in physiological reserves due to emotional and psychological stress, obesity, etc. Choosing the right method of influencing the reparative process, taking into account the leading mechanism of damage repair, becomes very important to ensure the best chance for optimal wound healing.
References
Wilkinson HN, Hardman MJ. Wound healing: cellular mechanisms and pathological outcomes. Open Biol. 2020;10(9):200223. doi: 10.1098/rsob.200223.
Martinengo L, Olsson M, Bajpai R, Soljak M, Upton Z, Schmidtchen A, et al. Prevalence of chronic wounds in the general population: systematic review and meta-analysis of observational studies. Ann Epidemiol. 2019;29:8-15. doi: 10.1016/j.annepidem.2018.10.005.
Sen CK. Human wound and its burden: updated 2020 compendium of estimates. Adv Wound Care. 2021;10(5):281-92. doi: 10.1089/ wound.2021.0026.
Lo ZJ, Lim X, Eng D, Car J, Hong Q, Yong E, et al. Clinical and economic burden of wound care in the tropics: a 5-year institutional population health review. Int Wound J. 2020;17(3):790-803. doi: 10.1111/iwj.13333.
Rodrigues M, Kosaric N, Bonham CA, Gurtner GC. Wound Healing: A Cellular Perspective. Physiol Rev. 2019;99(1):665-706. doi: 10.1152/ physrev.00067.2017.
Kolimi P, Narala S, Nyavanandi D, Youssef AAA, Dudhipala N. Innovative Treatment Strategies to Accelerate Wound Healing: Trajectory and Recent Advancements. Cells. 2022;11(15):2439. doi: 10.3390/cells11152439.
Song R, Wu Z, Ma J, Yin S, Liu C, Sun R, et al. Research status and hot topics of the effects of skin innervation on wound healing from 1959 to 2022: A bibliometric analysis. Front Surg. 2022;9:966375. doi: 10.3389/ fsurg.2022.966375.
Nowak NC, Menichella DM, Miller R, Paller AS. Cutaneous innervation in impaired diabetic wound healing. Transl Res. 2021;236:87-108. doi: 10.1016/j. trsl.2021.05.003.
Veith AP, Henderson K, Spencer A, Sligar AD, Baker AB. Therapeutic strategies for enhancing angiogenesis in wound healing. Adv Drug Deliv Rev. 2019;146:97-125. doi: 10.1016/j.addr.2018.09.010.
Farooq M, Khan AW, Kim MS, Choi S. The Role of Fibroblast Growth Factor (FGF) Signaling in Tissue Repair and Regeneration. Cells. 2021;10(11):3242. doi: 10.3390/cells10113242.
Pavlov S, Babenko N, Kumetchko M, Litvinova O, Mikhaylusov R. Experimental Study of the Effect of Photobiomodulation Therapy on the Regulation of the Healing Process of Chronic Wounds. Int J Photoenergy. 2021;2021:110. doi: 10.1155/2021/3947895.
Kolesnyk Y, Sheiko V, Dereka T. Comparison of indicators of cellular and humoral immunity in acquired myopia mild and high degree. Zdravotnicke listy. 2020;8(4); 36-42.
Schilrreff P, Alexiev U. Chronic Inflammation in Non-Healing Skin Wounds and Promising Natural Bioactive Compounds Treatment. Int J Mol Sci. 2022;23(9):4928. doi: 10.3390/ijms23094928.
Ding X, Tang Q, Xu Z, Xu Y, Zhang H, Zheng D, et al. Challenges and innovations in treating chronic and acute wound infections: from basic science to clinical practice. Burns Trauma. 2022;10:tkac014. doi: 10.1093/ burnst/tkac014.
Raziyeva K, Kim Y, Zharkinbekov Z, Kassymbek K, Jimi S, Saparov A. Immunology of Acute and Chronic Wound Healing. Biomolecules. 2021;11(5):700. doi: 10.3390/biom11050700.
Sartelli M, C Hardcastle T, Catena F, Chichom-Mefire A, Coccolini F, Dhingra S, et al. Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery. Antibiotics (Basel). 2020;9(8):497. doi: 10.3390/antibiotics9080497.
Pavlov SB, Tamm TI, Komisova TY, Babenko NM, Kumechko MV, Litvinova OB. The nature of changes in endocrine and immune factors at the initial stage of the formation of chronic wounds. Modern Medical Technology. 2023;(2):34-9. doi: 10.34287/MMT.2(57).2023.6.
Pavlov SB, Litvinova OB, Babenko NM. Features of skin wound healing in rats with experimental chronic kidney disease. Regul Mech Biosyst. 2021;12(4):594-8. doi: 10.15421/022181.
Mieczkowski M, Mrozikiewicz-Rakowska B, Kowara M, Kleibert M, Czupryniak L. The Problem of Wound Healing in Diabetes-From Molecular Pathways to the Design of an Animal Model. Int J Mol Sci. 2022;23(14):7930. doi: 10.3390/ijms23147930.
Pavlov SB, Babalyan VO, Valilshchikov MV, Babenko NM, Kumetchko MV, Litvinova OB, et al. The role of cytokines in the mechanisms of regulation of reparative processes in modeling fractures of the proximal femur secondary to the correction of concomitant arterial hypertension. Minerva Orthop 2022;73(3):287-93. doi: 10.23736/S0394-3410.21.04126-6.
U.S. Census Bureau. Older People Projected to Outnumber Children [Internet]. Census. Gov; 2018 [cited 2023 Jul 15]. Available from: https:// www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html
Herberger K, Müller K, Protz K, Zyriax BC, Augustin M, Hagenström K. Nutritional status and quality of nutrition in chronic wound patients. Int Wound J. 2020;17(5):1246-54. doi: 10.1111/iwj.13378.
Beyene RT, Derryberry SL Jr, Barbul A. The Effect of Comorbidities on Wound Healing. Surg Clin North Am. 2020;100(4):695-705. doi: 10.1016/j. suc.2020.05.002.
Frasca D, Strbo N. Effects of Obesity on Infections with Emphasis on Skin Infections and Wound Healing. J Dermatol Skin Sci. 2022;4(3):5-10. doi: 10.29245/2767-5092/2022/3.1157.
Thomas AL, Alarcon PC, Divanovic S, Chougnet CA, Hildeman DA, Moreno-Fernandez ME. Implications of Inflammatory States on Dysfunctional Immune Responses in Aging and Obesity. Front Aging. 2021;2:732414. doi: 10.3389/fragi.2021.732414.
Gethin G, van Netten JJ, Probst S, Touriany E, Sobotka L. The impact of patient health and lifestyle factors on wound healing. Part 2: Physical activity and nutrition. J Wound Management. 2022;23:S1-24. doi: 10.35279/ jowm2022.23.01.sup01.02.
Jenkins DA, Mohamed S, Taylor JK, Peek N, van der Veer SN. Potential prognostic factors for delayed healing of common, non-traumatic skin ulcers: A scoping review. Int Wound J. 2019;16(3):800-12. doi: 10.1111/iwj.13100.
Wynn M, Holloway S. The impact of psychological stress on wound healing: a theoretical and clinical perspective. Wounds UK. 2019;15(3):20-7.
Grada A, Phillips TJ. Nutrition and cutaneous wound healing. Clin Dermatol. 2022;40(2):103-13. doi: 10.1016/j.clindermatol.2021.10.002.
Wolcott RD, Rhoads DD, Dowd SE. Biofilms and chronic wound inflammation. J Wound Care. 2008;17(8):333-41. 10.12968/jowc.2008.17.8.30796.
Gushiken LFS, Beserra FP, Bastos JK, Jackson CJ, Pellizzon CH. Cutaneous Wound Healing: An Update from Physiopathology to Current Therapies. Life (Basel). 2021;11(7):665. doi: 10.3390/life11070665.
Tan SH, Ngo ZH, Sci DB, Leavesley D, Liang K. Recent Advances in the Design of Three-Dimensional and Bioprinted Scaffolds for Full-Thickness Wound Healing. Tissue Eng Part B Rev. 2022;28(1):160-81. doi: 10.1089/ ten.TEB.2020.0339.
Verdolino DV, Thomason HA, Fotticchia A, Cartmell S. Wound dressings: curbing inflammation in chronic wound healing. Emerg Top Life Sci. 2021;5(4):523-37. doi: 10.1042/ETLS20200346.
Vlasov OO, Kovalov GO, Myroshnychenko MS. Morphological features of a cold skin wound under the influence of an extract of cryopreserved skin fragments of piglets (experimental study). Wiad Lek. 2020;73(2):306-11. doi: 10.36740/WLek202002119.
Pogozhykh O, Prokopyuk V, Figueiredo C, Pogozhykh D. Placenta and Placental Derivatives in Regenerative Therapies: Experimental Studies, History, and Prospects. Stem Cells Int. 2018;2018:4837930. doi: 10.1155/2018/4837930.
Vaidyanathan L. Growth Factors in Wound Healing – A Review. Biomed Pharmacol J. 2021;14(3). doi: 10.13005/bpj/2249.
Xu P, Wu Y, Zhou L, Yang Z, Zhang X, Hu X, et al. Platelet-rich plasma accelerates skin wound healing by promoting re-epithelialization. Burns Trauma. 2020;8:tkaa028. doi: 10.1093/burnst/tkaa028.
Zhou C, Zhang B, Yang Y, Jiang Q, Li T, Gong J, et al. Stem cell-derived exosomes: emerging therapeutic opportunities for wound healing. Stem Cell Res Ther. 2023;14(1):107. doi: 10.1186/s13287-023-03345-0.
Monika P, Chandraprabha MN, Rangarajan A, Waiker PV, Chidambara Murthy KN. Challenges in Healing Wound: Role of Complementary and Alternative Medicine. Front Nutr. 2022;8:791899. doi: 10.3389/fnut.2021.791899.
Rajendran SB, Challen K, Wright KL, Hardy JG. Electrical Stimulation to Enhance Wound Healing. J Funct Biomater. 2021;12(2):40. doi: 10.3390/ jfb12020040.
Pavlov S, Babenko N, Kumetchko M, Litvinova O, Valilshchykov M. Features of cellular and molecular mechanisms of regulation of reparative processes in chronic wounds using photobiomodulation therapy. Folia Med (Plovdiv). 2022;64(2):260-6. doi: 10.3897/folmed.64.e61539.
Pasek J, Szajkowski S, Oleś P, Cieślar G. Local Hyperbaric Oxygen Therapy in the Treatment of Diabetic Foot Ulcers. Int J Environ Res Public Health. 2022;19(17):10548. doi: 10.3390/ijerph191710548.
Kirsner R, Dove C, Reyzelman A, Vayser D, Jaimes H. A prospective, randomized, controlled clinical trial on the efficacy of a single-use negative pressure wound therapy system, compared to traditional negative pressure wound therapy in the treatment of chronic ulcers of the lower extremities. Wound Repair Regen. 2019;27(5):519-29. doi: 10.1111/wrr.12727.
Lv H, Liu J, Zhen C, Wang Y, Wei Y, Ren W, et al. Magnetic fields as a potential therapy for diabetic wounds based on animal experiments and clinical trials. Cell Prolif. 2021;54(3):e12982. doi: 10.1111/cpr.12982.
Michaylusov RN, Negoduyko VV. [Results of surgical magnetic instruments application for survey of wounds and removal of ferromagnetic foreign bodies]. Klin Khir. 2016;(7):58-60. Ukrainian.
Myronov P, Bugaiov V, Holubnycha V, Sikora V, Deineka V, Lyndin M, et al. Low-frequency ultrasound increase effectiveness of silver nanoparticles in a purulent wound model. Biomed Eng Lett. 2020;10(4):621-31. doi: 10.1007/ s13534-020-00174-5.
