Abstract
Chronic leg ulcers (CLUs) are full thickness wounds that usually occur between the ankle and knee, fail to heal after 3 months of standard treatment, or are not entirely healed at 12 months. CLUs present a considerable burden on patients, subjecting them to severe pain and distress, while healthcare systems suffer immense costs and loss of resources. The poor healing outcome of the standard treatment of CLUs generates an urgent clinical need to find effective solutions for these wounds. Tissue Engineering and Biomaterials Science offer exciting prospects for the treatment of CLUs, using a broad range of skin substitutes or scaffolds, and dressings. In this review, we summarize and discuss the various types of scaffolds used clinically in the treatment of CLUs. Their structure and therapeutic effects are described, and for each scaffold type representative examples are discussed, supported by clinical trials. Silver dressings are also reviewed due to their reported benefits in the healing of leg ulcers, as well as recent studies on new dermal scaffolds, reporting on clinical results where available. We conclude by arguing there is a further need for tissue-engineered products specifically designed and bioengineered to treat these wounds and we propose a series of properties that a biomaterial for CLUs should possess, with the intention of focusing efforts on finding an effective treatment.
Highlights
Cutaneous wound healing is a complex biological process, reliant on a series of highly regulated and overlapping physiological events including hemostasis, inflammation, proliferation, and tissue remodeling [1]
They found that ulcers treated with Apligraf displayed three distinct transcriptomic patterns, suggesting that Apligraf induced a shift from a non-healing to a healing tissue response involving modulation of inflammatory and growth factor signaling, keratinocyte activation, and attenuation of Wnt/β-catenin signaling
The human amniotic membrane (HAM) plus standard of care (SOC) group had a mean size reduction of 48.1% compared with 19.0% in the SOC alone group
Summary
Cutaneous wound healing is a complex biological process, reliant on a series of highly regulated and overlapping physiological events including hemostasis, inflammation, proliferation, and tissue remodeling [1]. They consist of a group of biomaterials that provide wound cover for tissue repair and regeneration after an injury that extends deeper than the epidermis of the skin [17] These scaffolds or substitutes vary in their material composition (biological origin, natural or synthetic polymers, ceramics), permanence (temporary or permanent), intended layer of replacement (epidermis, dermis, or both), and the presence or lack of cells [17]. We discuss the various types of scaffolds used clinically in the treatment of CLUs, such as VLUs, arterial leg ulcers (ALUs) and DFUs (Table 1). Their structure and their therapeutic effects will be described. -Silver is a wide-ranging antibiotic with antiseptic, anti-inflammatory, and healing properties
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