David Rovee, PhD Editor, WOUNDS

Dear Readers:

I welcome the addition of our new department editor, Dr. Sarah Cockbill, who heads the department on veterinary wounds. Many of us who have worked with wound healing in experimental animals always sought the similarities between the animal and the human. Dr. Cockbill points out that perhaps too many assumptions have been made about these similarities and that there are important ongoing investigations into the mechanisms of healing in both large and small animals. An example of some of this work appears in the paper by Cochrane, et al., In-vitro wound contraction in the horse: Differences between body and limb wounds. The authors studied equine fibroblast contraction in vitro from several sites on the body as well as from the lower limb and granulation tissue of lower-limb wounds. While wounds on the general body skin heal uneventfully, wounds on the lower limb of the horse often are complicated by exuberant granulation tissue (termed proud flesh), either failure to heal or slow healing, and little contraction. These clinical observations are different from the in-vitro findings that revealed fibroblasts from granulating tissue of wounds demonstrated a greater rate of contraction compared to fibroblasts taken from other sites. The authors speculate that various local environmental factors play a role in determining the contractile activity of the fibroblast in vivo and that additional research is needed to determine those factors that would allow the fibroblasts to contract to their full potential seen in vitro.

Huang, et al., (Apoptosis in skin wound healing) review the significance of apoptosis in the wound healing process. Apoptosis, a term introduced in 1972, refers to the physiological cell death process that removes unwanted cells. It is a process that receives considerable attention as being important in maintaining homeostasis and growth in tissues. The authors discuss its basis and relevance to normal and abnormal wound healing.

Demling and DeSanti (Topical doxepin significantly decreases itching and erythema in the chronically pruritic burn scar) report on the safety and efficacy of topical doxepin cream in controlling itch and erythema in the chronic pruritic burn wound. Pruritus, which had been present for months prior to patients’ enrollment in the study, resolved within three months of treatment. Furthermore, the itching following cessation of topical treatments was decreased in contrast to experience with the use of oral antihistamines.

Abai, et al., (Two cases of traumatic wounds in patients with Ehlers-Danlos Syndrome successfully treated with a bioengineered skin equivalent) review the types of the rare disorder, Ehlers-Danlos syndrome (EDS). EDS was first described in 1891, and patients with the disorder often show skin and connective tissue fragility, poor wound healing, easy bruising, and hypermobility of joints. In two anecdotal cases, the authors present their positive experience in treating wounds on EDS patients. While pointing out the need for a larger controlled trial to understand and corroborate their findings, they recognize the difficulty of such a study due to the low incidence of EDS.

Another rare disorder leading to ischemic ulcers of the leg is reviewed by Davison, et al., (Martorell’s ulcer revisited). These ulcers result as a complication of hypertension. They are refractory to good local wound care or more aggressive therapy. The authors report a case study of Martorell’s ulcer and discuss the importance of clinical suspicion in recalcitrant, painful, anterolateral leg wounds when atherosclerotic or venous stasis disease is absent.

In this month’s Evidence Corner, Dr. Laura Bolton discusses the importance and challenges of consistent offloading in studying and treating neuropathic diabetic foot ulcers (DFU). She reviews two recent publications of topical treatments for DFUs. The first paper reports on the use of a collagen/oxidized regenerated cellulose dressing (C/ORC) versus standard moistened gauze. While there were no significant differences in safety or healing in the two treatment groups, the patients and physicians preferred the C/ORC dressing. The second paper reviewed is a compilation of the few published randomized controlled studies on the effectiveness of debridement modalities for improving healing of DFUs. It was concluded that there is evidence that autolytic debridement by hydrogel dressings increases the healing rate of DFUs. It is hoped that “…this summary will stimulate research into the relative benefits of those debriding modalities that, as yet, lack proof of healing efficacy for diabetic foot ulcers.”

David T. Rovee, PhD
Editor, WOUNDS