Abstract
Over time, we have come to recognize a very complex network of physiological changes enabling wound healing. An immunological process enables the body to distinguish damaged cells and begin a cleaning mechanism by separating damaged proteins and cells with matrix metalloproteinases, a complement reaction, and free radicals. A wide variety of cell functions help to rebuild new tissue, dependent on energy provision and oxygen supply. Like in an optimized “bio-reactor,” disturbance can lead to prolonged healing. One of the earliest investigated local factors is the pH of wounds, studied in close relation to the local perfusion, oxygen tension, and lactate concentration. Granulation tissue with the wrong pH can hinder fibroblast and keratinocyte division and proliferation, as well as skin graft takes. Methods for influencing the pH have been tested, such as occlusion and acidification by the topical application of acidic media. In most trials, this has not changed the wound’s pH to an acidic one, but it has reduced the strong alkalinity of deeper or chronic wounds. Energy provision is essential for all repair processes. New insights into the metabolism of cells have changed the definition of lactate from a waste product to an indispensable energy provider in normoxic and hypoxic conditions. Neovascularization depends on oxygen provision and lactate, signaling hypoxic conditions even under normoxic conditions. An appropriate pH is necessary for successful skin grafting; hypoxia can change the pH of wounds. This review describes the close interconnections between the local lactate levels, metabolism, healing mechanisms, and pH. Furthermore, it analyzes and evaluates the different possible ways to support metabolism, such as lactate enhancement and pH adjustment. The aim of wound treatment must be the optimization of all these components. Therefore, the role of lactate and its influence on wound healing in acute and chronic wounds will be assessed.
Highlights
The prolonged healing of wounds remains an unresolved challenge in modern medicine
The implantation of polyglactin resulted in a statistically significant increase in vascular endothelial growth factor (VEGF) and a doubling of TGF-β levels; IL-1β was significantly elevated on Day 7, but on the other days, it showed no significant difference from controls
The context of lactate-dependent angiogenesis exhibited a direct relationship between VEGF and lactate in a non-toxic range, and oxamate could antagonize lactate’s effect
Summary
The prolonged healing of wounds remains an unresolved challenge in modern medicine. Wounds exhibiting prolonged healing are primarily minor, they have a substantial social impact and influence the patient’s social status, daily living, and professional outcomes. The reasons given are the growing prevalence of chronic and surgical wounds as well as burn wounds. Costdriving components include the increasing use of advanced wound care products, often as first-line therapies, where the advantages of these products over conventional treatment are the driving forces in the market [2]. Frailty, or vascular or immunological diseases even may affect burn wounds [3]. Chronicity in burn wounds is a neglected topic, but Saaiq reported the incidence of Majolins ulcers as between 0.77 and 2%, primarily deriving from the healing per second intention [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
