Advanced Therapies In Wound Management
The term ‘advanced wound therapy’ is sometimes used to describe topical wound products and devices that actively promote wound healing. These wound products and devices typically cost more than other, conventional modalities.1 Examples of advanced therapies include living skin equivalents and topical growth factors, as well as devices that directly change the local wound environment, temperature therapy, and synthetic skin dressings.1–3 Because of the greater costs associated with using advanced therapies, these products tend to be reserved for wounds identified as potentially difficult to heal. Two areas of advanced wound care currently seeing the most exciting innovations are growth-factor products and biological skin substitutes.
Growth Factors
Growth factors are central to the regulation of cell proliferation, differentiation, and organ growth,1 and therefore have been studied for some years for their potential in wound healing. Over the past 10 years, a number of growth factors, including recombinant human platelet-derived growth factor (rh-PDGF), epidermal growth factor (EGF), and basic fibroblast growth factor (bFGF) have been developed and are becoming available for use. Currently, only rh-PDGF is approved by the FDA for use in wound therapy.
Biological Skin Substitutes
The need for alternatives to skin grafts that can promote healing, minimize contracture and scarring, and offer immunology compatibility has resulted in the development of tissue engineered skin equivalents and skin substitutes. Amongst the synthetic skin substitutes available in the market are Biobrane®, Dermagraft®, Integra®, Apligraft®, Matriderm®, Orcel®, Hyalomatrix® and Renoskin®,2 although there is also a substantial number of synthetic substitutes undergoing in vitro or animal testing. These bioengineered skin substitutes provide temporary or permanent wound coverage and offer the advantages of availability in large quantities and negligible risk of infection or immunologic issues. The principal factor limiting the use of these products at the moment is their relative expense. 3
Despite recent advances in skin technologies, there is currently no ideal substitute available that offers fully effective and scar-free wound healing. Further research is required not only to compare different skin substitutes but also to evaluate new biological and synthetic materials that can be utilized in wound healing.
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References
- Sussman C and Bates-Jensen B. Wound Care: A Collaborative Practice Manual for Health Professionals. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.
- Halim AS, Khoo TL, and Yussof SJM. Biologic and synthetic skin substitutes: An overview Indian J Plast Surg. 2010; 43(Suppl): S23–S28.
- Murphy PS, Evans GRD. Advances in wound healing: a review of current wound healing products. Plast Surg Int 2012; article 190436.