March 2004

Dear Readers,

The second contribution to the Veterinary Wounds Department appears in this issue. Department Editor Dr. Sarah Cockbill’s commentary discusses the relevance and importance of research into animal wound healing to emerging treatments for human acute or chronic wounds. Cupp, et al., (Use of a recombinant vasoactive protein [rSVEP] to enhance healing of surgically created wounds) report their studies on the recombinant form of a salivary protein isolated from the black fly. Local application of the protein in dog skin was found to enhance blood flow to the site and also to enhance healing of experimental incisional and excisional wounds. Whether these findings hold promise for treatment of chronic wounds will require further study.

Pianigiani, et al., (Dermal allograft plus autologous epidermal graft: Evaluation of two different techniques in chronic, nonhealing leg ulcers) studied two different grafting options to treat chronic leg ulcers in a large cohort of patients (n=315). The wounds were first treated with a de-epidermized dermal allograft (DED). Five to seven days later, either mesh autograft (n=150) or cultured epithelial grafts (n=165) were applied. At one month post graft, the cell cultured graft showed somewhat better healing (45 versus 26 healed); results at six months and one year follow up were comparable for each method. Of all patients treated, 75 percent achieved complete healing. Based upon the findings, the use of cultured epithelial autografts may offer the best approach in cases of extensive ulcers when donor areas are lacking or when a patient refuses mesh autografting.

Hjerppe, et al., (Treatment of chronic leg ulcers with a human fibroblast-derived dermal substitute: A case series of 114 patients) studied the effects of a human fibroblast derived dermal substitute (HDS) on healing of ulcers of the lower limb that had resisted conventional therapy. Following treatment with HDS, 31 to 93 percent of the wounds, depending upon the ulcer type, achieved complete healing.

In a similar case series, Delfanian, et al., (Application of living skin equivalent for the treatment of chronic lower-extremity ulcers recalcitrant to conventional therapeutic methods) present a case series of 22 patients with chronic wounds of various etiologies. The duration of the wounds prior to study was quite long (mean of 15 months), and all had failed to respond to conventional treatment. Following treatment with a living skin equivalent (LSE), 14 (64%) of the ulcers healed completely. The authors discuss the limitations of this retrospective, uncontrolled study while recognizing that LSE treatment may be a useful adjunctive treatment for nonresponding ulcers of the lower limb.

Active treatments, such as the LSE, the HDS, and platelet-derived growth factor, have received Food and Drug Administration approval for specific indications. As these available products are used in areas outside the label, there have been many reports suggesting efficacy in a broader category of difficult-to-heal lesions. In the preceding two papers, the authors point to the desirability of randomized, prospective, clinical trials of these treatments to document efficacy, improvement in quality of life, and cost effectiveness for additional indications. This is a position with which I am in complete agreement. However, because of the difficulty and expense of such studies, the carefully conducted case series may be the more likely and reasonable route leading us to a better understanding of the applicability and benefits of these relatively new treatment modalities.

Finally, I call your attention to Dr. David Voigt’s letter to the editor regarding a case review on chronic ulceration in a radiotherapy site [Hall, et al., WOUNDS 2003;15(10):346–50]. The authors provide an update on this case in Diagnostic Dilemmas.

David T. Rovee, PhD
Editor, WOUNDS