ABSTRACT
A chronic refractory wound is caused by continuous skin damage. At the same time， it may be formed due to repeated infection， vascular insufficiency， diabetes， tumors， chronic osteomyelitis， and other reasons， resulting in wound repair interruption and recovery delay. Chronic refractory wound seriously affects the quality of life of patients and consumes a lot of medical resources. Polysaccharides in traditional Chinese medicine （TCM） are the effective components of most TCM. Modern pharmacological studies have found that polysaccharides contained in TCM have anti-inflammatory， antioxidant， anti-radiation， hypoglycemic， antiviral， anti-tumor， hypolipidemic， and immunomodulatory effects. Through the summary and analysis of the literature， it was found that the mechanism of polysaccharides in TCM to promote chonic refractory wound repair was mainly realized from the following aspects： firstly， regulating inflammatory cytokines like interleukin-4 （IL-4）， interleukin-10 （IL-10）， interleukin-8 （IL-8）， and tumor necrosis factor-α （TNF-α） or regulating macrophage-related inflammatory proteins and chemotactic proteins like MIP-2， MCP-1， to shorten the inflammatory period. Secondly， activating growth factors like platelet-derived growth fator （PDGF）， basic fibroblast growth factor （bFGF）， TGF-α， and vascular endothelial growth factor （VEGF） to recruit endothelial cells and fibroblasts into tissue proliferation. Thirdly， activationg VEGF and its downstream receptor vascular endothelial growth factor receptor-1 （VEGFR-1） and vascular endothelial growth factor receptor-2 （VEGFR-2）-mediatated protein kinase C/extracellular regulated kinases （PKC/ERK） signaling pathway or promoting angiogenesie and improving wound blood flow through angiotensin （ANG）. Fourthly， promoting the ablility of collagen synthesis by enhancing the secretion of hydroxyproline and hyaluronic acid （HA） from fibroblasts （FB） and regulating relevant matrix metalloenzymes and their enzyme inhibitor to regulate the extracellular matrix. Fifthly， eliminating free radiccals to reduce the damage caused by oxidative stress to tissue. Sixthly， enhancing the phagocytic ability of macrophages， the activity of natural killer cells， and the proliferation of T cells to improve the defense ability of tissue. Polysaccharides in TCM can repair wounds in many ways at the same time. Its advantage lies in the multiple targets and multiple pathways. It is expected that the research will pay more attention to the mechanism of wound repair by polysaccharide components in TCM when improving the treatment of chronic refractory wounds.
ABSTRACT
ObjectiveTo compare the effect of different solvent extracts of spore powder and fruiting body of Lasiosphaera Calvatia on fibroblasts and wound healing of full-thickness skin defect， in order to screen the optimal medication part of Lasiosphaera Calvatia. MethodThe effect of water extract and alcohol extract of spore powder and fruiting body on cell proliferation and cell migration of mouse skin fibroblasts （MSF） were examined in vitro. Cell proliferation and activity test （CCK-8） method was used for cell proliferation， scratch assay was used for cell migration， flow cytometry was conducted to explore cell cycle， enzyme-linked immunosorbent assay （ELISA） was used to determine the production of collagen Ⅰ and Ⅲ. At the same time， a full-thickness skin defect wound model was established to investigate the therapeutic effect of different solvent extracts of spore powder. Ultraviolet-visible spectrophotometry was used to measure the contents of index components in different solvent extracts. ResultThe water extract of spore powder and fruiting body had certain cytotoxicity， while the alcohol extract could promote proliferation， migration and production of collagen Ⅰ and Ⅲ of MSF， and the effect of spore powder was significantly higher than that of fruiting body. When the concentration was 10 mg·L-1， the cell proliferation rate of alcohol extract of spore powder was as high as （159.22±15.95）%， and could promote MSF from the G0/G1 phase to S phase and G2/M phase with an increased proliferation index. The alcohol extract also promoted the migration of fibroblasts， secreted collagen Ⅰ and Ⅲ. On in vivo model， the alcohol extract of spore powder significantly accelerated wound healing on mice， effectively promoted the complete epithelialization of wound tissue， and generated new collagen fiber. The results of determination showed that the contents of polyphenols and flavonoids in the alcohol extract were higher than the alcohol extract of fruiting body. ConclusionThe alcohol extract of spore powder in Lasiosphaera Calvatia has active components in the treatment of wounds with good development prospect， and the medicinal components may be polyphenols and flavonoids.
ABSTRACT
BACKGROUND: Platelet-rich plasma and negative pressure drainage therapy have been widely used and achieved good clinical outcomes in the treatment of various chronic wounds. However, there is no randomized controlled trial regarding their combined effect on chronic refractory wounds. OBJECTIVE: To systematically evaluate the efficacy of platelet-rich plasma with negative pressure therapy on chronic refractory wounds. METHODS: Databases of CNKI, VIP, WanFang, SinoMed, Web of Science, PubMed, and EMbase were searched for the randomized controlled trials regarding the efficacy of platelet-rich plasma combined with negative pressure therapy on chronic refractory wounds. Included studies were evaluated using the Cochrane system evaluation method. Meta-analysis was performed using RevMan 5.3 software. The primary outcomes included wound healing rate, time for wound healing, length of hospital stay, pain score and positive rate of bacteria. RESULTS AND CONCLUSION: A total of 11 randomized controlled trials were included, including 743 patients with chronic wounds. The observation group was treated with platelet-rich plasma combined with negative pressure drainage. The control group was treated with conventional dressing or simple negative pressure drainage. The Meta-analysis results showed that compared with the control group, there was significantly increased wound healing rate [relative risk (RR)=2.19, 95% confidence interval (CI) (1.82, 2.62), P < 0.000 01], significantly shortened time for wound healing [mean standard difference=-0.81, 95%CI (-1.00,-0.62), P < 0.000 01], significantly shortened length of hospital stay [mean difference=-7.11, 95%CI (-8.12,-6.11), P < 0.000 01], and significantly lowered positive rate of bacteria [RR=0.35, 95%CI (0.22, 0.54), P < 0.000 01] in the observation group. There was no significant difference between the two groups in the pain score [SMD=-5.97, 95%CI (-14.33, 2.40), P=0.16]. To conclude, platelet-rich plasma combined with negative pressure drainage can promote the healing of chronic refractory wounds and reduce the incidence of infection.
ABSTRACT
One patient with chronic refractory wound in right lower leg was admitted to our department in June 2017, which experienced repeated ulceration for 4 years. On 4 days post admission, two bamboo sticks were taken out from the deep muscle of the right lower leg. The wound was repaired by perforator flap of posterior tibial artery in the right lower leg. The donor site was covered with split-thickness skin in the upper leg of the same side. On 7 days post operation, the flap and skin graft survived. During follow-up of 12 months, the flap had good appearance. This case suggests that the first thing for the treatment of chronic refractory wound is to find out the cause of wound.
ABSTRACT
There are many pathogenic correlation factors of chronic refractory wound. Due to the complexity and particularity of the causes of wounds and lack of a standard diagnosis guide, it is hard to treat this kind of wound. Based on our recent scientific research data and the relative research at home and abroad in the present, we systematically analyze and summarize the causes and non-surgical treatment of chronic refractory wound in this article.