August, 2006

Dear Readers,

Zhang et al report findings from an experimental study on the effects of decorin on keloid fibroblasts (Recombinant human decorin inhibits cell proliferation and downregulates TGF-b1 production in keloid fibroblasts). The authors point out that the pathophysiology leading to overproduction of type I collagen might be related to the biological activities of TGF-β1, some of which decorin is known to inactivate. The authors analyzed keloid fibroblasts in vitro for cell proliferation, TGF-β1 production, and pro-collagen production. They found that decorin significantly reduced proliferation. It was also seen to significantly reduce the levels of TGF-β1 and type I pro-collagen production. Future investigations will be required to determine the role of decorin in vivo to prevent keloid formation.

Soldevilla et al (Epidemiology of chronic wounds in Spain: results of the first national studies on pressure and leg ulcer prevalence) conducted a nationwide survey to determine the prevalence of pressure and leg ulcers in Spain. They report the data broken down by home care, hospitals, and socio-health centers. It can be seen from the results that both pressure and leg ulcers constitute a major health problem in the country. The data reveal “…that prevention [of pressure ulcers] is not yet considered to be a priority…” and “…that there is little use of effective compression therapy systems [for venous ulcers].” The authors conclude that “…a global approach to the pressure and leg ulcer problem in Spain is needed.”

Mosti and Mattaliano (The debridement of chronic leg ulcers by means of a new, fluidjet-based device) report their experiences in the debridement of leg ulcers using a hydrosurgery device based on fluidjet technology. Of 469 patients with ulcers, 142 were treated with the hydrosurgery device, while 327 served as controls treated with moist wound dressings. They found that 108 cases were adequately debrided by a single operative procedure, 27 patients required 2 procedures, and 7 required 3. Use of the device promoted quicker ulcer debridement and a shortened time to healing compared to the controls.

Weiland (The effects of L-arginine on symptomatic patients with nonreconstructable vascular disease) presents his findings on the treatment of patients with vascular disease that cannot be reconstructed by angioplasty, stenting, or bypass. In a 6-patient case series, L-arginine was administered in an effort to increase blood supply to the wound site. L-arginine acts as a precursor to nitric oxide, a potent vasodilator. In all 6 cases, pain was reduced, and the ulcers healed completely in 4 patients and improved in the remaining 2. Recognizing the limitations of the case series, the author encourages “…the trial use of L-arginine in this select group of patients.”