碱性成纤维细胞因子促进创面修复的临床疗效

目的:观察碱性成纤维细胞因子(bFGF)对创面修复的疗效及毒副作用.方法:173例患者分为治疗组89例,其中急性创面55例,慢性难愈合创面34例,采用bFGF局部外用,每平方厘米150活性单位,qd,7 d为1个疗程;对照组84例,其中急性创面50例,慢性难愈合创面34例,除未用bFGF外,其他疗法同治疗组.结果:治疗组较对照组创面修复质量显著提高,创面愈合时间缩短,且无明显毒副作用.结论:bFGF具有促进创面修复作用,有很大临床应用价值.     

Wound healing: a new approach to the topical wound care

Cutaneous wound healing is a complex and well-coordinated interaction between inflammatory cells and mediators, establishing significant overlap between the phases of wound healing. Wound healing is divided into three major phases: inflammatory phase, proliferative phase, and remodeling phase. Unlike the acute wound, the nonhealing wound is arrested in one of the phases of healing, typically the inflammatory phase. A systematic approach to the management of the chronic nonhealing wound emphasizes three important elements of wound bed preparation in chronic wounds: debridement, moisture, and countering bacterial colonization and infection. In this article, wound-healing process and new approaches to the topical wound care have been reviewed.     

Polymicrobial wound infections: Pathophysiology and current therapeutic approaches

Acute and chronic wounds represent a very common health problem in the entire world. The dermal wounds are colonized by aerobic and anaerobic bacterial and fungal strains, most of them belonging to the resident microbiota of the surrounding skin, oral cavity and gut, or from the external environment, forming polymicrobial communities called biofilms, which are prevalent especially in chronic wounds. A better understanding of the precise mechanisms by which microbial biofilms delay repair processes together with optimizing methods for biofilm detection and prevention may enhance opportunities for chronic wounds healing. The purpose of this minireview is to assess the role of polymicrobial biofilms in the occurrence and evolution of wound infections, as well as the current and future preventive and therapeutic strategies used for the management of polymicrobial wound infections.     

The role of topical growth factors in chronic wounds

Chronic wounds display aberrant wound healing or wound healing that deviates from normal. The term 'chronic wounds', implies that these wounds do not heal in a timely fashion. They are often predisposed to infection, and not uncommonly result in amputation. Growth factors and cytokines play a pivotal role in cutaneous wound healing. It has been noted that some growth factors are deficient in chronic wounds, therefore it has been suggested that local or topical application of these factors may compensate for any deficiency and allow normal wound healing to progress. This paper reviews current work on the application of topical growth factors to wounds. Some potential problems are identified and suggestions are made for future areas where research may improve the effectiveness of this form of therapy.     

Recent patents on topical application of honey in wound and burn management

Topical application of honey to burn and wounds has been found to be effective in controlling infection and producing a clean granulating bed. It is suggested that the wound healing effect of honey may in part be related to the release of inflammatory cytokines from surrounding tissue cells, mainly monocytes and macrophages. It has been reported that honey hastens wound healing by accelerating wound contractions. Microscopic evaluation demonstrated that there was a significant acceleration of dermal repair in wound treated with honey. Macroscopic and microscopic observations under in vivo assessment suggested that the topical application of honey might have favourable influences on the various phases of burn and wound healing hence accelerating the healing process. The regulatory effects of honey are related to components other than the sugars. However, the mechanisms by which honey affects the release of anti inflammatory agents and growth factors from monocytic cells are as yet unclear. Whether honey affects other cell types, particularly endothelial cells and fibroblasts, involved in wound healing also needs to be clarified. The present article is a short review of recent patents on the healing effect of honey in wound and burn management.     

The growth receptors and their role in wound healing

Abnormal wound healing is a major problem in healthcare today, with both scarring and chronic wounds affecting large numbers of individuals worldwide. Wound healing is a complex process involving several variables, including growth factors and their receptors. Chronic wounds fail to complete the wound healing process, while scarring is considered to be an overzealous wound healing process. Growth factor receptors and their ligands are being investigated to assess their potential in the development of therapeutic strategies to improve wound healing. This review discusses potential therapeutics for manipulating growth factors and their corresponding receptors for the treatment of abnormal wound healing.     

美宝湿润烧伤膏在创面修复中的应用研究进展

近年来,对创面的管理及治疗成为临床研究热点,除了对创面换药及必要时手术治疗,促进创面愈合的药物也越来越被重视。美宝湿润烧伤膏（MEBO）近年被越来越多的文献报道应用在治疗烧伤及慢性创面中具有较好的抗感染及促进创面愈合效果;因此,本文就MEBO对创面修复愈合及抗炎效果的影响作综述,旨在对临床上指导优化用药以促进创面愈合。...     

Delivery of Therapeutics from Layer-by-Layer Electrospun Nanofiber Matrix for Wound Healing: An Update

Increasing incidences of chronic wounds urge the development of effective therapeutic wound treatment. As the conventional wound dressings are found not to comply with all the requirements of an ideal wound dressing, the development of alternative and effective dressings is demanded. Over the past few years, electrospun nanofiber has been recognized as a better system for wound dressing and hence has been studied extensively. Most of the electrospun nanofiber dressings were fabricated as single-layer structure mats. However, this design is less favorable for the effective healing of wounds mainly due to its burst release effect. To address this problem and to simulate the organized skin layer's structure and function, a multilayer structure of wound dressing had been proposed. This design enables a sustained release of the therapeutic agent(s), and more resembles the natural skin extracellular matrix. Multilayer structure is also referred to layer-by-layer (LbL), which has been established as an innovative method of drug incorporation and delivery, combines a high surface area of electrospun nanofibers with the multilayer structure mat. This review focuses on LbL multilayer electrospun nanofiber as a superior strategy in designing an optimal wound dressing.     

Adenosine receptor agonists for promotion of dermal wound healing

Wound healing is a dynamic and complex process that involves a well-coordinated, highly regulated series of events including inflammation, tissue formation, revascularization and tissue remodeling. However, this orderly sequence is impaired in certain pathophysiological conditions such as diabetes mellitus, venous insufficiency, chronic glucocorticoid use, aging and malnutrition. Together with proper wound care, promotion of the healing process is the primary objective in the management of chronic poorly healing wounds. Recent studies have demonstrated that A_2A adenosine receptor agonists promote wound healing in normal and diabetic animals and one such agonist, Sonedenoson, is currently being evaluated as a prospective new therapy of diabetic foot ulcers. We will review the mechanisms by which adenosine receptor activation affects the function of the cells and tissues that participate in wound healing, emphasizing the potential beneficial impact of adenosine receptor agonists in diabetic impaired healing.     

Management of acute and chronic open wounds: the importance of moist environment in optimal wound healing

The history of wound care and management closely parallels that of military surgery which has laid down the principles and dictated the practices of wound cleansing, debridement and coverage. From a treatment standpoint, there are essentially two types of wounds: those characterized by loss of tissue and those in which no tissue has been lost. In the event of tissue loss it is critical to determine whether vital structures such as bone, tendons, nerves and vessels have been exposed. It is also important to determine the amount of soft tissue contusion and contamination. In any case primary wound healing by early closure either primarily or with the help of grafts or flaps is preferred to secondary healing and wound contraction with subsequent contractures which interfere with range of motion and function. Whether the wound is acute or chronic, essential principles of wound care must be observed in order to avoid wound sepsis and achieve rapid and optimal wound healing. - Tissues must be handled gently. - Caustic solutions capable of sterilizing the skin should never be applied to the wound. It is desirable never to put anything in the wound that cannot be tolerated comfortably in the conjunctival sac. - All devitalized tissues must be debrided either hydrodynamically, chemically, mechanically or surgically. - All dead space must be obliterated. - Exposed vital structures must be covered by well vascularized tissues. An essential part of any wound management protocol is wound dressing. It cannot be too strongly emphasized that a wound dressing may have a profound influence on healing particularly of secondary type healing, a critical feature being the extent to which such dressing restricts the evaporation of water from the wound surface. A review of available dressing materials is reported with emphasis on the newly developed concept of moist environment for optimal healing. a practical guide for dressing selection is also proposed.     

Ischemic wound healing and possible treatments

The present review describes the major steps in wound healing, the factors that clinically cause ischemia including the changes found in diabetes mellitus and the possible interventions and treatments of ischemic wounds. The number of randomized, double-blind, controlled clinical trials is scarce, especially on the healing of chronic ischemic soft tissue wounds. Experimental and clinical studies to date have demonstrated that hyperbaric oxygen may be an effective treatment of chronic hypoxic wounds and that certain growth factors (e.g., recombinant platelet-derived growth factor-BB) are likely to enhance the healing of such wounds. Other treatments are discussed, among them vasoactive drugs (e.g., pentoxifylline), occlusive dressings and surgical treatment, including delayed primary closure of acute ischemic wounds.     

湿润暴露疗法/湿润烧伤膏对慢性创面组织中MMP-2和MMP-9表达的影响

目的探讨湿润暴露疗法/湿润烧伤膏(MEBT/MEBO)作用MMP-2和MMP-9促进慢性创面愈合的机制。方法90只Wistar大鼠随机分为5组:MEBO组、贝复新组、慢性组、急性组和空白组,每组18只,构建慢性难愈合创面模型。采用ELISA、Western blot和qRT-PCR技术,检测d 3、14创面组织中MMP-2和MMP-9表达变化。结果(1)与慢性组相比,MEBO组和贝复新组创面愈合时间明显缩短且愈合率升高(P<0.05);且生长情况及病理形态学改变更好;(2)与慢性组相比,d 3标本匀浆中,MEBO组和贝复新组MMP-2和MMP-9表达均增高(均P<0.05);而d 14,MEBO组和贝复新组MMP-2和MMP-9均降低(P<0.05);(3)与慢性组相比,d 3标本,MEBO组和贝复新组MMP-2和MMP-9表达量均增高(P<0.05);而d 14,MEBO组和贝复新组MMP-2和MMP-9表达均降低(P<0.05)。结论MEBT/MEBO促进慢性创面愈合可能与调控MMP-2和MMP-9,来参与ECM的降解与重塑相关。     

rhFGF与rhEGF分期使用修复深Ⅱ度烧伤创面的临床观察

目的:观察分期使用重组牛碱性成纤维细胞生长因子(rhFGF)与重组人表皮细胞生长因子(rhEGF)治疗深Ⅱ度烧伤创面愈合的临床疗效。方法:随机选择同一患者4处深度相同、部位相应的创面进行自身对照,4处创面分别标记为A、B、C、D,20例深Ⅱ度烧伤患者共80个创面,相应归为A、B、C、D组:A组创面采用rhEGF治疗,B组创面采用rhFGF治疗,C组创面先使用rhFGF,10d后使用rhEGF治疗,D组创面为0.9%氯化钠对照组。观察创面完全愈合所需要的时间、创面愈合质量,以及全身和局部反应。结果:A组的平均愈合时间为(18.20±1.67)d,B组为(19.15±2.01)d,C组为(16.45±1.57)d,D组为(23.65±2.41)d。A、B、C组的平均愈合时间较D组短,C组的平均愈合时间较A、B组短,差异均具有统计学意义(P<0.05);A组与B组相比,愈合时间无显著性差异(P>0.05)。A、B、C组的平均愈合质量比D组好。各组治疗期间未见明显的全身或局部不良反应。结论:分期使用rhFGF和rhEGF能有效促进深Ⅱ度烧伤创面的愈合和修复,缩短愈合时间。     

Wound healing profile of Septilin

Septilin, a proprietary preparation claimed to be useful in inflammatory conditions was tested for anti-inflammatory and wound healing effects in albino rats. It significantly enhanced gain in tensile strength in incision wounds and wound contraction and epithelization in excision wounds. It also suppressed acute inflammation (rat paw edema) significantly without affecting chronic inflammation (cotton pellet granuloma).     

Age-related changes in wound healing

Evidence for age-related effects on wound healing have been derived for the most part from empirical observations without adjustment for confounders other than age. Age-related changes in the structure and function of the skin do occur. Some of these changes result from chronic solar radiation exposure rather than chronological age per se. The tensile strength of wounds, accumulation of wound healing factors and rate of wound closure have all been examined in relation to chronological aging. However, the clinical impact of these changes in acute wound healing appears to be small. Poor healing in chronic wounds is more often related to comorbid conditions rather than age alone. Since the majority of these chronic wounds occur in elderly populations, this has contributed to the conclusion that aging itself may influence healing. Progress in understanding the role that growth factors play in wound healing and the ability to synthesise adequate quantities of these factors for clinical use has led to clinical trials evaluating their use in wound healing. The results of these studies, with the possible exception of those in diabetic wounds, have been disappointing. Insight into the wound healing process indicates that growth factors interact during wound healing in a sequential and orderly process. Improved wound healing may require different clinical designs or the use of these factors in a precisely timed sequential administration.     

Wound healing: a new approach to the topical wound care

Cutaneous wound healing is a complex and well-coordinated interaction between inflammatory cells and mediators, establishing significant overlap between the phases of wound healing. Wound healing is divided into three major phases: inflammatory phase, proliferative phase, and remodeling phase. Unlike the acute wound, the nonhealing wound is arrested in one of the phases of healing, typically the inflammatory phase. A systematic approach to the management of the chronic nonhealing wound emphasizes three important elements of wound bed preparation in chronic wounds: debridement, moisture, and countering bacterial colonization and infection. In this article, wound-healing process and new approaches to the topical wound care have been reviewed.     

Impact of sidestream whole smoke solutions on the outcome of wound repair and related angiogenesis

Wound angiogenesis is essential to support the regenerating tissue and any setback in angiogenesis may result in retarded wound repair. Cigarette smoking causes numerous adverse effects, some of which are associated with poor healing. The current experiment was carried out to elucidate the possible detrimental effects of sidestream whole smoke solutions (SSWSS) on wound healing and related angiogenesis, using a well-defined chicken dorsum excision wound assay. Gross, histopathologic, SEM and computer based 3D image-probing modalities were utilized to quantify different detrimental effects of SSWSS on the fundamental processes of wound healing. A total of 160 chicks, aged 1 week, divided in eight groups were topically exposed for 8 days to SSWSS with different nicotine concentrations. At day 6 and day 8 post-wounding, very highly significant reduction (P < 0.001) in wound closure was observed among all SSWSS treated groups. Histological and SEM evaluation of SSWSS treated wounds unveiled deteriorated dermal matrix, delayed re-epithelialization and retarded neovascularization. Moreover, image-probing exploration of SSWSS treated wounds also divulge a very highly significant decrease (P < 0.001) in angular spectrum, Sa, Sy and Sci, at day 6 post-wounding. Our study suggests that the cumulative effect of different components of SSWSS has a negative impact on wound healing and related angiogenesis. Furthermore, our study demonstrates the effects that can contribute to abnormal healing and may explain why people who are consistently exposed to sidestream smoke suffer from slow healing and excessive scarring of wounds, much like the smokers themselves.     

Investigation of the permeability characteristics of peri-ulcer and whole ischaemic skin tissue

Excessive wound exudate in chronic wounds can cause skin maceration to occur around a wound, which may delay healing and lead to other complications. In order to assess possible treatment options with topical therapy there is a need to characterize the permeability of wound and peri-ulcer tissue. Previously we have reported the permeability of a range of chemicals with differing physicochemical properties in human ulcerated and peri-ulcer ischaemic tissue. The findings suggested that wound tissue and peri-ulcer tissue were not representative of normally functioning skin barriers. In the present work we have investigated the permeability of tritiated water in peri-ulcer and whole skin human tissue obtained from clinically diagnosed diabetic ischaemic patients. Permeability data for peri-ulcer tissue was generally higher and more variable than for normal tissue. Histological examination confirmed the breakdown of the skin tissue in the peri-ulcer area and also in the normal skin tissue samples taken from diabetic ischaemic patients. The impaired skin barrier function both in the peri-ulcer and normal tissue may offer opportunities for dermal and transdermal therapies for management of diabetes-related complications.     

腹腔镜下腹膜代阴道成形术创面愈合的影响因素探讨

目的探讨腹腔镜下腹膜代阴道成形术创面愈合的影响因素，以促进术后创面愈合。方法回顾分析13例先天性无阴道患者腹腔镜下腹膜代阴道成形术的临床资料，了解术后创面愈合时间、愈合情况、及愈合过程中阴道分泌物性状并进行效果评估。结果13例患者术后创面完全愈合时间为（26±17．8）天，术后阴道创面完全上皮化过程中有8例出现少量阴道流血，1例有阴道炎发生，除3例患者仅随访2个月外，10例患者随访性生活均满意。结论影响腹腔镜下腹膜代阴道成形术创面愈合的因素可能有术中腹膜游离的程度、术后创面的处理、佩戴模具的选择及佩戴模具的时间。