• Main
  • Useful links
  • Information for Contributors
  • About
  • Editorial board

    •
    Bulletin of problems biology and medicine / Issue 2 (156), 2020 / MODERN ATTITUDES FOR CHRONIC WOUND TREATMENT

    Kasrashvili G. G., Ksonz I. V., Gulmamedov P. F., Andreev P. O., Kolesnik H. I.

    MODERN ATTITUDES FOR CHRONIC WOUND TREATMENT

    About the author:

    Kasrashvili G. G., Ksonz I. V., Gulmamedov P. F., Andreev P. O., Kolesnik H. I.

    Heading:

    LITERATURE REVIEWS

    Type of article:

    Scentific article

    Annotation:

    Treatment for chronic wounds is a significant problem in the daily practice of any surgeon. Despite long-term experience the treatment for such wounds is time consuming and expensive. Almost every case requires a multidisciplinary approach to obtain positive results. The term “chronic wound” was first used in the literature in the 1950s to refer to the wounds that were difficult to treat or they did not follow normal healing process. However, the term was criticized for its uncertainty as to the duration of the chronic process. Such alternative definitions were proposed as bad healing wounds, trophic ulcers, complex wounds. Even today the opinions of the authors differ. Some believe that “chronic wound” is any wound that has no signs of reducing its size by 20-40% after 2-4 weeks of optimal treatment or when there is no complete healing after 6 weeks. According to other authors’ opinion a “chronic” one can be called any wound that has not undergone a regulated and timely repair to develop anatomical and functional integration within 3 months. The goal of the research is to study and analyze current methods of treatment for chronic wounds based on the literature sources. The object and research methods. The methods of systematic and comparative analysis and bibliosemantic method of studying the modern view of treatment for chronic wounds were applied to search for the information. The following scientific sources were analyzed from the following databases: Web of Science, Scopus, PubMed, Google Scholar, eLIBRARY.ru from 2015 to 2020. There were used such key words as “chronic wounds”, “cleaning of a wound bed”, “modern dressing materials”, “collagen”, “growth factors”, “stromal vascular fraction”, “PRP therapy”, “vacuum technologies”. The search results are 250 sources, of which met the terms of the request. The results of the study and their discussion. There are a lot of factors that affect the process of wound healing. Appropriate systems are formed to help the surgeon to analyze the causes of failure in their healing. One of these systems was named TIME-H. An important and one of the first steps in the healing process is wound bed preparation – debridement. It is performed in five ways: surgical, mechanical, autolytic, enzymatic and/or biological. Another important element in wound bed preparation for healing is local bandage care. The most commonly used modern dressing materials in clinical practice are hydrogels, hydrocolloids, alginates, foam dressings, film dressings. The last type of modern wound dressings is bioactive dressings; at the same time the most up-to-date and promising dressing materials are “Smart” dressings that also deserve interest. The surgeons use the following modern methods of wound treatment such as human skin equivalents that are bioengineered structures (skin substitutes) consisting of a cellular component (cultured human skin cells) and a substrate (matrix). They are used to treat both acute and chronic wounds. There is one more thing that is collagen. Numerous studies have proven that collagen preparations are bioactivators and they promote their own tissue regeneration integrating into the surrounding natural tissues. Growth factors also play an important role in wound healing. Recently, stromal vascular fraction (SVF) that is derived from adult fat has opened new directions in wound healing. Platelet-rich plasma (PRP therapy) is also widely used. At the present stage vacuum therapy is an innovative method of wound treatment of different etiology which accelerates the course of the wound process. We can identify the use of hyperbaric oxygen therapy, extracorporeal shock-wave electrostimulation, laser and magnetic therapy from treatment options of chronic wounds. An important role is played by immobilizing-unloading systems and proper nutrition. We can distinguish free skin plastic surgery with a split auto graft, the use of full-layer skin grafts between modern surgical methods of treatment for chronic wounds. To replace the defects of soft tissues with exposing deep anatomical structures the transplantation of tissue complexes with axial type of circulation is considered as a method of choice; there may be used perforated flaps, propeller flap. One of the techniques for reconstructive surgery may be keystone island flap technique. Free transplantation of tissue complexes using a microvascular suture may also be used. Conclusions. The treatment for chronic wounds remains an urgent problem to date requiring the surgeon to seek an individual approach to each patient and each wound. Thus, there is a wealth of data on various methods and method of treatment for chronic wounds based on the literature we have learned. Despite such diversity and positive results most of them require further investigation of the mechanisms that influence wound healing processes.

    Tags:

    chronic wounds, vacuum technology, collagen, growth factors, stromal vascular fraction, PRP therapy.

    Bibliography:

    1. Cwaliński J, Paszkowski J, Banasiewicz T. New perspectives in the treatment of hard-to-heal wound. Negative Pressure Wound Therapy Journal. 2018;5(4):10-2.
    2. Johani K, Malone M, Jensen SO, Dickson HG, Gosbell IB, Hu H. Evaluation of short exposure times of antimicrobial wound solutions against microbial biofilms: from in vitro to in vivo. Journal of Antimicrobial Chemotherapy. 2018 Feb;73(2):494-502.
    3. Kyaw BM, Järbrink K, Martinengo L, Car J, Harding K, Schmidtchen A. Need for Improved Definition of “Chronic Wounds” in Clinical Studies. Acta Derm Venereol. 2018 Jan 12;98(1):157-8. DOI: 10.2340/00015555-2786
    4. Obolenskij VN. Sovremennye metody lecheniya hronicheskih ran. Medicinskij sovet. 2016;10:148-54. [in Russian].
    5. Dubhashi SP, Sindwani RD. A Comparative Study of Honey and Phenytoin Dressings for Chronic Wounds. The Indian Journal of Surgery. 2015 Mar 8;77(3):1209-13. DOI: 10.1007/s12262-015-1251-6
    6. Hall KD, Patterson JS. Three Cases Describing Outcomes of Negative-Pressure Wound Therapy With Instillation for Complex Wound Healing. J Wound Ostomy Continence Nurs. 2019 May/Jun;46(3):251-5. DOI: 10.1097/WON.0000000000000516
    7. Pleshkov VG, Privol’nev VV, Golub AV. Lechenie hronicheskih ran. Vestnik Smolenkskoj gosudarstvennoj medicinskoj akademii. 2015;14(2):58-65. [in Russian].
    8. Derakhshandeh H, Kashaf SS, Aghabaglou F, Ghanavati IO, Tamayol A. Smart Bandages: The Future of Wound Care. Trends Biotechnol. 2018 Dec;36(12):1259-74. DOI: 10.1016/j.tibtech.2018.07.007
    9. WoundSource Practice Accelerator. The Goals of Wound Debridement [Internet]. WoundSource: Kestrel Health Information, Inc; 2019 April 30th [cited 2020 April 29]. Available from: https://www.woundsource.com/blog/goals-wound-debridement
    10. Gain YuM, Gerasimenko MA, Shahraj SV, Hryshchanovich VYa, Gain MYu, Bordakov PV. Innovacionnye principy kompleksnogo lecheniya hronicheskih ran. Innovacionnye tekhnologii v medicine. 2017;5(4):223-42. [in Russian].
    11. Slavnikov IA, Dundarov ZA, Yarec YuI. Ocenka effektivnosti sposobov podgotovki k plasticheskomu zakrytiyu hronicheskih ran u pacientov s saharnym dіabetom. Zhurnal Grodnenskogo gosudarstvennogo medicinskogo universiteta. 2018;6:735-9. DOI: 10.25298/2221-8785- 2018-16-6-735-739 [in Russian].
    12. Uccioli L, Izzo V, Meloni M, Vainieri E, Ruotolo V, Giurato L. Non-healing foot ulcers in diabetic patients: general and local interfering conditions and management options with advanced wound dressings. J Wound Care. 2015;24(4b):35-42. DOI: 10.12968/jowc.2015.24. Sup4b.35
    13. Lim K, Free B, Sinha S. Modified TIME-H: a simplified scoring system for chronic wound management. J Wound Care. 2015 Sep;24(9):415- 9. DOI: 10.12968/jowc.2015.24.9.415
    14. El-Sabbagh AH. Negative pressure wound therapy: An update. Chin J Traumatol. 2017 Apr;20(2):103-7. DOI: 10.1016/j.cjtee.2016.09.004
    15. Manna B, Morrison CA. Wound Debridement. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan [Updated 2020 Feb 14; citation 2020 April 29]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507882/
    16. Frykberg RG, Jaminelli B. Challenges in the Treatment of Chronic Wounds. Advances in Wound Care. 2015 Sept;4(9):560-82.
    17. Colenci R, Abbade LPF. Fundamental aspects of the local approach to cutaneous ulcers. An Bras Dermatol. 2018 Nov/Dec;93(6):859-70. DOI: 10.1590/abd1806-4841.20187812
    18. Laurel Mt. Methods of Wound Debridement: Best Practice for Clinicians [Internet]. NJ: Wound, Ostomy and Continence Nurses Society™; 2015 [cited 2020 April 29]. Available from: https://cdn.ymaws.com/www.wocn.org/resource/resmgr/Publications/Methods_of_Wound_ Debridement.pdf?hhSearchTerms=»
    19. Bekara F, Vitse J, Fluieraru S, Masson R, Runz A, Georgescu V, et al. New techniques for wound management: A systematic review of their role in the management of chronic wounds. Arch Plast Surg. 2018 Mar;45(2):102-10. DOI: 10.5999/aps.2016.02019
    20. Ivanusa SYa, Zubarev PN, Risman BV, Litvinov OA. Sovremennye principy lecheniya gnojnyh ran: uchebnoe posobie dlya slushatelej fakul’teta podgotovki vrachej i ordinatorov po special’nosti «Hirurgiya». SPb: Onli-Press; 2017. 36 s. [in Russian].
    21. Ilenghoven D. A Review of Wound Dressing Practices. Clinical Dermatology Open Access Journal. 2017;2(6):1-12.
    22. Weller CD, Team V, Sussman G. First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence. Front Pharmacol. 2020 Feb 28;11:155. DOI: 10.3389/fphar.2020.00155
    23. Lei J, Sun L, Li P, Zhu C, Lin Z, Mackey V, et al. The Wound Dressings and Their Applications in Wound Healing and Management. Health Sci J. 2019;13(4):662. DOI: 10.36648/1791-809X.1000662
    24. Shi C, Wang C, Liu H, Li Q, Li R, Zhang Y, et al. Selection of Appropriate Wound Dressing for Various Wounds. Front BioengBiotechnol. 2020 Mar 19;8:182. DOI: 10.3389/fbioe.2020.00182
    25. Velding K, Klis SA, Abass KM, van der Werf TS, Stienstra Y. The Application of Modern Dressings to Buruli Ulcers: Results from a Pilot Implementation Project in Ghana. Am J Trop Med Hyg. 2016 Jul 6;95(1):60-2. DOI: 10.4269/ajtmh.15-0378
    26. Andriotis EG, Eleftheriadis GK, Karavasili C, Fatouros DG. Development of Bio-Active Patches Based on Pectin for the Treatment of Ulcers and Wounds Using 3D-Bioprinting Technology. Pharmaceutics. 2020 Jan 9;12(1):56. DOI: 10.3390/pharmaceutics12010056
    27. Dhivya S, Padma VV, Santhini E. Wound dressings – a review. Biomedicine (Taipei). 2015 Dec;5(4):22. DOI: 10.7603/s40681-015-0022-9
    28. Pang Q, Lou D, Li S, Wang G, Qiao B, Dong S, et al. Smart Flexible Electronics-Integrated Wound Dressing for Real-Time Monitoring and On-Demand Treatment of Infected Wounds. Adv Sci (Weinh). 2020 Jan 10;7(6):1902673. DOI: 10.1002/advs.201902673
    29. Derakhshandeh H, Aghabaglou F, McCarthy A, Mostafavi A, Wiseman C, Bonick Z, et al. A Wirelessly Controlled Smart Bandage with 3DPrinted Miniaturized Needle Arrays. Adv. Funct. Mater. 2020 March 24;30(13):1-11. DOI: https:// doi.org/10.1002/adfm.201905544
    30. Su L, Zheng J, Wang Y, Zhang W, Hu D. Emerging progress on the mechanism and technology in wound repair. Biomed Pharmacother. 2019 Sep;117:109191. DOI: 10.1016/j.biopha.2019.109191
    31. Meleshina AV, Bystrova AS, Rogovaya OS, Vorotelyak EA, Vasil’ev AV, Zagajnova EV. Tkaneinzhenernye konstrukty kozhi i ispol’zovanie stvolovyh kletok dlya sozdaniya kozhnyh ekvivalentov (obzor). Sovremennye tekhnologii v medicine. 2017;9(1):198-220. [in Russian].
    32. Savoji H, Godau B, Hassani MS, Akbari M. Skin Tissue Substitutes and Biomaterial Risk Assessment and Testing. Front Bioeng Biotechnol. 2018 Jul 26;6:86. DOI: 10.
    33. 89/fbioe.2018.00086 33.Silina EV, Stupin VA, Gabitov RB. Rol’ kollagena v mekhanizmah zazhivleniya hronicheskih ran pri sindrome diabeticheskoj stopy. Klinicheskaya medicina. 2018;96(2):106-15. [in Russian].
    34. Yamakawa S, Hayashida K. Advances in surgical applications of growth factors for wound healing. Burns Trauma. 2019 Apr 5;7:10-23. DOI: 10.1186/s41038-019-0148-173
    35. Park JW, Hwang SR, Yoon IS. Advanced Growth Factor Delivery Systems in Wound Management and Skin Regeneration. Molecules. 2017 Jul 27;22(8):1259. DOI: 10.3390/molecules22081259
    36. Bi H, Li H, Zhang C, Mao Y, Nie F, Xing Y, et al. Stromal vascular fraction promotes migration of fibroblasts and angiogenesis through regulation of extracellular matrix in the skin wound healing process. Stem Cell Res Ther. 2019 Oct 17;10(1):302-22. DOI: 10.1186/s13287- 019-1415-6
    37. Deng C, Wang L, Feng J, Lu F. Treatment of human chronic wounds with autologous extracellular matrix/stromal vascular fraction gel: A STROBE-compliant study. Medicine (Baltimore). 2018 Aug;97(32):11667. DOI: 10.1097/MD.0000000000011667
    38. Hesseler MJ, Shyam N. Platelet-rich plasma and its utility in medical dermatology: a systematic review. J Am Acad Dermatol. 2019 Sep;81(3):834-46. DOI: 10.1016/j.jaad.2019.04.037
    39. Pinto NR, Ubilla M, Zamora Y, Del Rio V, Dohan Ehrenfest DM, Quirynen M. Leucocyte- and platelet-rich fibrin (L-PRF) as a regenerative medicine strategy for the treatment of refractory leg ulcers: a prospective cohort study. Platelets. 2018 Jul;29(5):468-75. DOI: 10.1080/09537104.2017.1327654
    40. Terskov DV, Cherdancev DV, Dyatlov VYu, Kovalenko AA. Evolyuciya primeneniya otricatel’nogo davleniya dlya lecheniya ran. Sovremennye problemy nauki i obrazovaniya [Internet]. 2016 [citirovano 2020 apr. 6];(3). Dostupno: https://www.science-education.ru/ru/ article/view?id=24723 [in Russian].
    41. Hurd T, Rossington A, Trueman P, Smith J. A Retrospective Comparison of the Performance of Two Negative Pressure Wound Therapy Systems in the Management of Wounds of Mixed Etiology. Adv Wound Care. 2017 Jan 1;6(1):33-7. DOI: 10.1089/wound.2015.0679
    42. Orlov AG, Lipin AN, Kozlov KL. Lechenie hronicheskih ran – vzglyad cherez veka. Kubanskij nauchnyj medicinskij vestnik. 2016;5:147-53. [in Russian].
    43. Chasnojt’ ACh, Zhilinskij EV, Serebryakov AE, Leshchenko VT. Mekhanizmy dejstviya vakuumnoj terapii ran. Medicinskie novosti. 2015;7:12-6. [in Russian].
    44. Cozza V, Pepe G, Cintoni M, De Maio F, Tropeano G, Magalini S, et al. Vacuum-assisted closure (VAC®) systems and microbiological isolation of infected wounds. World Journal of Emergency Surgery. [Internet]. 2018 [cited Apr 8];13:53. Available from: https://doi.org/10.1186/ s13017-018-0216-z
    45. Kirsner R, Dove C, Reyzelman A, Vayser D, Jaimes H. A prospective, randomized, controlled clinical trial on the efficacy of a single-use negative pressure woundtherapy system, compared to traditional negative pressure wound therapy in thetreatment of chronic ulcers of the lower extremities. Wound Repair Regen. 2019 Sept;27(5):519-29. DOI: 10.1111/wrr.12727
    46. Petrenko OM. Vakuum-terapiia u kompleksnomu likuvanni khronichnykh ran nyzhnikh kintsivok. Kharkivska khirurhichna shkola. 2015;6:149-54. [in Ukrainian].
    47. Kyzymenko OO, Liakhovskyi VI, Horodova-Andrieieva TV. Vplyv terapii vidiemnym tyskom na mikrobne zabrudnennia hniinonekrotychnykh uskladnen syndromu diabetychnoi stopy. Khirurhiia Ukrainy. 2018;4:44-7. DOI: http://doi.org/10.3978/SU2018-4-44 [in Ukrainian].
    48. Müller CS, Burgard B, Zimmerman M, Vogt T, Pföhler C. On the significance of negative-pressure wound therapy with instillation in dermatology. J Dtsch Dermatol Ges. 2016 Aug;14(8):786-95. DOI: 10.1111/ddg.13038
    49. Meloni M, Izzo V, Vainieri E, Giurato L, Ruotolo V, Uccioli L. Management of negative pressure wound therapy in the treatment of diabetic foot ulcers. World J Orthop. 2015 May 18;6(4):387-93. DOI: 10.5312/wjo.v6.i4.387
    50. Gain YuM, Bordakov PV, Bordakov VN, Shahraj SV, Gain MYu, Elin IA. Vakuum-terapiya ran pri hirurgicheskoj infekcii myagkih tkanej. Voennaya medicina. 2016;4:64-72. [in Russian].
    51. Han G, Ceilley R. Chronic Wound Healing: A Review of Current Management and Treatments. Adv Ther. 2017 Mar;34(3):599-610. DOI: 10.1007/s12325-017-0478-y
    52. Carmignano SM. Extracorporeal Shock Wave Therapyin Chronic Wound Care [Internet]. IntechOpen; 2019 [cited 2020 April 29]. Available from: https://www.researchgate.net/publication/338006027_Extracorporeal_Shock_Wave_Therapy_in_Chronic_Wound_Care
    53. Zhang L, Weng C, Zhao Z, Fu X. Extracorporeal shock wave therapy for chronic wounds: A systematic review and meta-analysis of randomized controlled trials.Wound Repair Regen. 2017 Aug;25(4):697-706. DOI: 10.1111/wrr.12566
    54. Houghton PE. Electrical stimulation therapy to promote healing of chronic wounds: a review of reviews. Chronic Wound Care Management and Research. 2017;4:25-44. DOI: 10.2147/CWCMR.S101323
    55. Rashidi S, Yadollahpour A, Jalilifar M, Naraqi AM, Rezaee Z. Laser Therapy for Wound Healing: A Review of Current Techniques and Mechanisms of Action. Biosciences Biotechnology Research Asia. 2015;12:217-23.
    56. Zahedi M, Yadollahpour A. Therapeutic Effects Of Static Magnetic Fieldsfor Diabetic Wound Healing: A Review Of The Current Evidence. Biosci Biotech Res Asia. 2016;13(1):353-60. DOI: http://dx.doi.org/10.13005/bbra/2040
    57. Gorohov SV, Udovichenko OV, Ul’yanova IN, Berseneva EA, Galstyan GR. Pedograficheskaya i klinicheskaya ocenka effektivnosti immobiliziruyushchih razgruzochnyh povyazok pri sindrome diabeticheskoj stopy. Saharnyj diabet. 2012;3:50-8. [in Russian].
    58. Barchitta M, Maugeri A, Favara G, Magnano San Lio R, Evola G, Agodi A, et al. Nutrition and Wound Healing: An Overview Focusing on the Beneficial Effects of Curcumin. Int J Mol Sci. 2019 Mar 5;20(5):1119. DOI: 10.3390/ijms20051119
    59. Kim P. Time is tissue: Tips to manage and prevent chronic wounds and ulcers [Internet]. Dallas: UTSouthwestern Medical Center; 2020 February 6 [cited 2020 April 29]. Available from: https://utswmed.org/medblog/time-tissue-tips-manage-and-prevent-chronic-wounds-andulcers/
    60. Bojko SA, Boldizhar AA, Boldizhar PA, Gorlenko FV, Gubergric NB, Dronov AI, i dr. Hirurgiya: uchebnik. V 2 tomah. T 2. 3-e izd. Kondratenko PG, Rusin VI, redaktory. Kiev: izdatel’ Zaslavskij AYu; 2017. 676 s. [in Russian].
    61. Badyul PA, Slesarenko SV. Rekonstrukciya rubcovyh kontraktur shei perforantnymi loskutami. Khirurhiia Ukrainy. 2016;1:74-80. [in Russian].
    62. Badyul PA, Slesarenko SV, Ivchenko DV, Antonova TS, Slesarenko KS. Ispol’zovanie perforantnyh ostrovkovyh loskutov keystone dlya zakrytiya obshirnyh ranevyh defektov konechnostej. Problemy travmatolohii ta osteosyntezu. 2015;1(1):37-41. [in Russian].
    63. Slesarenko SV, Badyul PA, Oksimec VM, Kovbasa EA, Slesarenko DS. Sluchaj uspeshnoj rekonstrukcii kriticheski povrezhdennoj nizhnej konechnosti. Travma. 2017;18(5):77-82. [in Russian].

    Publication of the article:

    «Bulletin of problems biology and medicine» Issue 2 (156), 2020 year, 36-42 pages, index UDK 616-001.4-036.12-039.22-002.2-089.844

    DOI:

    10.29254/2077-4214-2020-2-156-36-42