September, 2004

Dear Readers:

       I have had the pleasure to work on Wounds over the last decade with our Executive Editor, Elizabeth Klumpp. She has managed the difficult areas of producing each issue of the journal, thereby making my job quite easy. Therefore, it is with personal sadness to report that Elizabeth has decided to change directions in her career. She has resigned from HMP in order to spend more time with her three young children. Our Editorial Advisory Board members, her colleagues at HMP, and I will certainly miss Elizabeth. She plans to work in her home office as an independent contractor on selected projects for clients, including HMP. We wish her well in her new endeavors.

       In the article by Weed, et al., (Autologous platelet lysate product versus placebo in patients with chronic leg ulcerations: A pilot study using a randomized, double-blind, placebo-controlled trial) the authors present a well designed study to assess the efficacy of platelet lysate (PL) for improving wound healing of chronic wounds. Twenty-six patients were treated with either PL (n=15) or placebo (n=11). Following a 12-week treatment period and a two-week hiatus in treatment, those patients who remained unhealed were crossed over to the other treatment for an additional 12 weeks. The primary end point was complete wound healing; the secondary end point was rate of healing. The data collected indicated that PL treatment of the wounds did not result in a greater incidence of healing nor was an increased rate of healing detected. The literature contains papers showing efficacy as well as others showing lack of efficacy. The authors have conducted a carefully controlled study, reported their findings, and presented a balanced discussion of the weaknesses in the study. They address possible factors as to why they did not see positive effects of the treatment.

       The use of in-vitro culture systems is important for understanding cell behavior seen in wound healing. Falanga, et al., (Viability and apoptosis of wound fibroblasts after cryopreservation) employed flow cytometry to investigate how the optimal percent of fetal bovine serum (FBS) used in cryopreservation may differ between dermal fibroblasts from acute wounds and chronic wounds in the same patients. After thawing the cryopreserved cells from either source and allowing them to attach to tissue culture plastic, no differences in viability or apoptosis were noted at the various concentrations of FBS. In studies of unattached cells following thawing, differences between acute and chronic wound fibroblasts were seen at varying FBS concentrations. In acute wound fibroblasts, high FBS concentrations up to 80 percent improved cell viability and reduced apoptosis. In fibroblasts from chronic wounds, FBS concentrations up to 20 percent increased viability and reduced apoptosis, but higher concentrations decreased viability. The authors suggest that “…the appropriate FBS concentrations for certain fibroblast types may need to be determined depending on the disease state and the cell strain involved.”

       Etöz, et al., (Isolated palatal ulcer induced by methotrexate: A case report) report the occurrence of an oral ulcer in a patient treated with high-dose methotrexate for seronegative arthritis. It has been reported previously that methotrexate in combination with anti-inflammatory drugs may cause oral ulcerations; however, this patient had been treated with methotrexate alone. The authors consider that both drug interactions and individual properties of patients play a role in methotrexate toxicity.

       In Diagnostic Dilemmas, Dasgeb and Phillips discuss a patient who was referred with a necrotic ulcer over her left chest. Two years earlier after the treatment for breast cancer she had developed an ulcer at the radiation therapy site. A computed tomography scan revealed chronic inflammation and fibrosis, with the fibrotic process extending from the chest wall to the upper lobe of the left lung. The diagnosis was osteoradionecrosis, which can be defined as the replacement of the normal structure of bone by fibrosis after irradiation. The authors discuss acute radiation dermatitis, chronic radiation dermatitis, and radiation necrosis. They list therapeutic approaches that have been shown beneficial in managing radiation-induced wounds and the basis for selecting the treatment of this patient.