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Chronic Skin Wounds – New Insights in Underlying Pathophysiological Processes, Current Treatment Strategies and Advanced Clinical Approaches

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dermatology".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 16588

Special Issue Editor

Dr. Sandra Franz

E-Mail Website
Guest Editor
Department of Dermatology, Venereology and Allergology, University Leipzig Johannisallee 30, 04103 Leipzig, Germany
Interests: skin inflammation; physiology and pathomechanisms of skin wound healing; immunmodulation; advanced therapeutic concepts for wound healing disorders

Special Issue Information

Dear Colleagues,

Chronic wounds are an ulcerative skin defect that fails to proceed through the normal skin repair response. Demographically, the incidence of chronic wounds has reached epidemic levels. On the other hand, current clinical strategies are still limited and often less effective. This highlights the urgent need for new treatment options that require a further understanding of the underlying pathophysiological processes of poor wound healing.

Skin wound healing is a multistage and tightly regulated process. The healthy skin repair response requires spatio-temporal communication between skin-resident cells, invading immune cells and its surrounding extracellular compartment. Failures within this complex communication network results in poor wound healing. Various clinical condition, including vascular diseases and diabetes, compromised immunological status, advanced age or mechanical stress and pressure effects are associated with poor wound healing. However underlying cellular and molecular mechanisms which link these conditions with failures in the various phases of the wound healing response are far from being understood.   

This Special Issue of the Journal of Clinical Medicine on chronic skin wounds is intended to present cutting-edge original research and topical reviews on concepts of chronic wound healing, on existing strategies and on emerging advanced clinical approaches for the prevention and therapy of chronic wounds. Clinical studies on current management strategies of chronic wounds but also dermatoepidemiological studies and lab-based and pre-clinical translational research that increase the knowledge on molecular pathogenesis of chronic wounds and/or may shed light on new therapeutic approaches are welcome.

Dr. Sandra Franz
Guest Editor

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Keywords

  • Chronic skin wounds
  • CVU
  • DFU
  • Pressure ulcer
  • Chronic wounds and comorbidities
  • Pathomechanisms of chronic wound healing
  • Current management of chronic wounds
  • Immunmodulation
  • Cell-based therapies
  • Combination of therapies
  • Personalizing wound-healing therapies

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Published Papers (4 papers)

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Research

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21 pages, 1854 KiB  
Article
Healing of Chronic Wounds with Platelet-Derived Growth Factors from Single Donor Platelet-Rich Plasma following One Freeze-Thaw Cycle. A Cross-Sectional Study
by Julia Vidán-Estévez, Sergio Sánchez-Herráez, Fernando Escalante-Barrigón and Jesús Seco-Calvo
J. Clin. Med. 2021, 10(24), 5762; https://doi.org/10.3390/jcm10245762 - 9 Dec 2021
Cited by 5 | Viewed by 2864
Abstract
Chronic non-healing wounds (CNHWs) may be associated with trauma or idiopathic in nature and are difficult to treat. Our objective was to assess the use of platelet-derived growth factor (PDGF) from single-donor platelets (al-PRP), using one freeze-thaw cycle, for treating CNHWs. We conducted [...] Read more.
Chronic non-healing wounds (CNHWs) may be associated with trauma or idiopathic in nature and are difficult to treat. Our objective was to assess the use of platelet-derived growth factor (PDGF) from single-donor platelets (al-PRP), using one freeze-thaw cycle, for treating CNHWs. We conducted a cross-sectional study. A total of 23 CNHWs being treated with al-PRP. The al-PRP treatment can be considered successful in well over half (n = 13, 56.5%) of the wounds. We found that all the wounds treated for up to 7 weeks showed partial or complete healing, while those treated for between 8 and 12 weeks did not show healing, healing again being successful in cases in which treatment was extended to more than 13 weeks (85.7%). Using chi-square tests, this relationship was found to be highly significant (p < 0.001, chi2 = 19.51; p value = 0.00006). Notably, Cramer’s V coefficient was very high (0.921), indicating that the effect size of PRP treatment duration on healing is very large (84.8%). We could suggest that the use of al-PRP in the healing of CNHWs is a promising approach. Further studies with larger sample sizes and long follow-ups are needed to obtain multivariate models to explain which factors favour the healing of ulcers treated with PRP Full article
(This article belongs to the Special Issue Chronic Skin Wounds – New Insights in Underlying Pathophysiological Processes, Current Treatment Strategies and Advanced Clinical Approaches)
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9 pages, 2782 KiB  
Article
The Effects of Silver-Releasing Foam Dressings on Diabetic Foot Ulcer Healing
by Yu-Chi Wang, Hsiao-Chen Lee, Chien-Lin Chen, Ming-Chun Kuo, Savitha Ramachandran, Rong-Fu Chen and Yur-Ren Kuo
J. Clin. Med. 2021, 10(7), 1495; https://doi.org/10.3390/jcm10071495 - 3 Apr 2021
Cited by 19 | Viewed by 4503
Abstract
Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients and lead to high morbidity and mortality. Numerous dressings have been developed to facilitate wound healing of DFUs. This study investigated the wound healing efficacy of silver-releasing foam dressings versus silver-containing cream [...] Read more.
Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients and lead to high morbidity and mortality. Numerous dressings have been developed to facilitate wound healing of DFUs. This study investigated the wound healing efficacy of silver-releasing foam dressings versus silver-containing cream in managing outpatients with DFUs. Sixty patients with Wagner Grade 1 to 2 DFUs were recruited. The treatment group received silver-releasing foam dressing (Biatain® Ag Non-Adhesive Foam dressing; Coloplast, Humlebaek, Denmark). The control group received 1% silver sulfadiazine (SSD) cream. The ulcer area in the silver foam group was significantly reduced compared with that in the SSD group after four weeks of treatment (silver foam group: 76.43 ± 7.41%, SSD group: 27.00 ± 4.95%, p < 0.001). The weekly wound healing rate in the silver foam group was superior to the SSD group during the first three weeks of treatment (p < 0.05). The silver-releasing foam dressing is more effective than SSD in promoting wound healing of DFUs. The effect is more pronounced in the initial three weeks of the treatment. Thus, silver-releasing foam could be an effective wound dressing for DFUs, mainly in the early period of wound management. Full article
(This article belongs to the Special Issue Chronic Skin Wounds – New Insights in Underlying Pathophysiological Processes, Current Treatment Strategies and Advanced Clinical Approaches)
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11 pages, 1397 KiB  
Article
Inhibition of 11β-HSD1 Expression by Insulin in Skin: Impact for Diabetic Wound Healing
by Christina B. Brazel, Jan C. Simon, Jan P. Tuckermann and Anja Saalbach
J. Clin. Med. 2020, 9(12), 3878; https://doi.org/10.3390/jcm9123878 - 28 Nov 2020
Cited by 8 | Viewed by 2550
Abstract
Chronic, non-healing wounds impose a great burden on patients, professionals and health care systems worldwide. Diabetes mellitus (DM) and obesity are globally highly prevalent metabolic disorders and increase the risk for developing chronic wounds. Glucocorticoids (GCs) are endogenous stress hormones that exert profound [...] Read more.
Chronic, non-healing wounds impose a great burden on patients, professionals and health care systems worldwide. Diabetes mellitus (DM) and obesity are globally highly prevalent metabolic disorders and increase the risk for developing chronic wounds. Glucocorticoids (GCs) are endogenous stress hormones that exert profound effects on inflammation and repair systems. 11-beta-hydroxysteroid dehydrogenase 1 (11β-HSD1) is the key enzyme which controls local GC availability in target tissues such as skin. Since treatment with GCs has detrimental side effects on skin integrity, causing atrophy and delayed wound healing, we asked whether the dysregulated expression of 11β-HSD1 and consequently local GC levels in skin contribute to delayed wound healing in obese, diabetic db/db mice. We found increased expression of 11β-HSD1 during disturbed wound healing and in the healthy skin of obese, diabetic db/db mice. Cell analysis revealed increased expression of 11β-HSD1 in fibroblasts, myeloid cells and dermal white adipose tissue from db/db mice, while expression in keratinocytes was unaffected. Among diabetes- and obesity-related factors, insulin and insulin-like growth factor 1 down-regulated 11β-HSD1 expression in fibroblasts and myeloid cells, while glucose, fatty acids, TNF-α and IL-1β did not affect it. Insulin exerted its inhibitory effect on 11β-HSD1 expression by activating PI3-kinase/Akt-signalling. Consequently, the inhibitory effect of insulin is attenuated in fibroblasts from insulin-resistant db/db mice. We conclude that insulin resistance in obesity and diabetes prevents the down-regulation of 11β-HSD1, leading to elevated endogenous GC levels in diabetic skin, which could contribute to impaired wound healing in patients with DM. Full article
(This article belongs to the Special Issue Chronic Skin Wounds – New Insights in Underlying Pathophysiological Processes, Current Treatment Strategies and Advanced Clinical Approaches)
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Review

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14 pages, 536 KiB  
Review
The Role of Extracellular Matrix in Skin Wound Healing
by Nikolai N. Potekaev, Olga B. Borzykh, German V. Medvedev, Denis V. Pushkin, Marina M. Petrova, Artem V. Petrov, Diana V. Dmitrenko, Elena I. Karpova, Olga M. Demina and Natalia A. Shnayder
J. Clin. Med. 2021, 10(24), 5947; https://doi.org/10.3390/jcm10245947 - 18 Dec 2021
Cited by 60 | Viewed by 5740
Abstract
Impaired wound healing is one of the unsolved problems of modern medicine, affecting patients’ quality of life and causing serious economic losses. Impaired wound healing can manifest itself in the form of chronic skin wounds or hypertrophic scars. Research on the biology and [...] Read more.
Impaired wound healing is one of the unsolved problems of modern medicine, affecting patients’ quality of life and causing serious economic losses. Impaired wound healing can manifest itself in the form of chronic skin wounds or hypertrophic scars. Research on the biology and physiology of skin wound healing disorders is actively continuing, but, unfortunately, a single understanding has not been developed. The attention of clinicians to the biological and physiological aspects of wound healing in the skin is necessary for the search for new and effective methods of prevention and treatment of its consequences. In addition, it is important to update knowledge about genetic and non-genetic factors predisposing to impaired wound healing in order to identify risk levels and develop personalized strategies for managing such patients. Wound healing is a very complex process involving several overlapping stages and involving many factors. This thematic review focuses on the extracellular matrix of the skin, in particular its role in wound healing. The authors analyzed the results of fundamental research in recent years, finding promising potential for their transition into real clinical practice. Full article
(This article belongs to the Special Issue Chronic Skin Wounds – New Insights in Underlying Pathophysiological Processes, Current Treatment Strategies and Advanced Clinical Approaches)
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