DigitalUM :: Browsing by Subject "Wound healing"

Browsing by Subject "Wound healing"

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Open Access
Abordaje de las heridas crónicas y complejas tratadas con injertos cutáneos autólogos : una revisión exhaustiva (Scoping Review)
(Universidad de Murcia, 2025-12-18) Sánchez González, Montserrat; Soria Aledo, Victoriano; Verdú Soriano, José; Sin departamento asociado; Escuela Internacional de Doctorado
OBJETIVOS Objetivo General Analizar, de manera exploratoria, la evidencia científica en relación con las heridas crónicas y complejas y el tratamiento con injertos cutáneos autólogos. Objetivos específicos • Examinar el alcance, la variedad y la naturaleza del abordaje de las heridas crónicas y complejas tratadas con injertos cutáneos • Identificar mejores evidencias en el abordaje de las heridas crónicas y complejas tratadas con injertos cutáneos autólogos. • Sintetizar el conocimiento existente relacionado con el abordaje de las heridas crónicas y complejas tratadas con injertos cutáneos. • Identificar posibles elementos de mejora en el cuidado de los pacientes con heridas crónicas y complejas tratadas con injertos cutáneos autólogos. • Analizar la eficacia y efectividad de los injertos cutáneos autólogos, en comparación con otras terapias en el tratamiento de las heridas crónicas y complejas. METODOLOGÍA Este estudio se desarrolló como una revisión exploratoria (scoping review) para analizar la evidencia sobre el empleo de injertos cutáneos autólogos en el tratamiento de heridas crónicas y complejas, siguiendo las guías del Instituto Joanna Briggs y PRISMA-ScR (2020). El marco PCC (Población, Concepto, Contexto) consideró a pacientes con heridas crónicas o complejas, los injertos autólogos como técnica principal y la práctica clínica en diversos entornos asistenciales. El protocolo se registró en Open Science Framework (OSF) y se aprobó como proyecto doctoral. La búsqueda se realizó entre diciembre de 2021 y abril de 2022 en ocho bases de datos internacionales (PubMed, Scopus, Web of Science, Cochrane, Cinahl, Embase, Scielo y Lilacs) y literatura gris. Se incluyeron estudios publicados entre 2001 y 2021 en inglés, español o portugués, centrados en heridas crónicas tratadas con injertos autólogos. Se excluyeron investigaciones en animales, protocolos, consensos, guías y publicaciones sin datos clínicos. La selección se llevó a cabo en tres fases: cribado inicial, lectura completa y evaluación metodológica mediante herramientas de la red EQUATOR (CONSORT, PRISMA, STROBE, TREND, CARE). Los ítems se transformaron a una escala de 0–100 para homogenizar la valoración de la calidad. RESULTADOS De los 29.227 registros identificados, se seleccionaron 36 estudios: 12 ensayos clínicos aleatorizados, 7 series de casos, 6 cohortes, 6 revisiones sistemáticas o metaanálisis y 5 cuasiexperimentales. Los principales motivos de exclusión fueron el uso de injertos no autólogos (828), estudios sobre heridas agudas (24) y trabajos sin datos clínicos (68). La calidad metodológica fue en general buena: 19 estudios alcanzaron nivel muy bueno (76–100%) y 17 bueno (51–75%). Los mayores puntajes correspondieron a revisiones sistemáticas (82,3% con PRISMA) y cuasiexperimentales (86,4% con TREND), mientras que los observacionales obtuvieron resultados más bajos (61,5% con STROBE). La evolución temporal mostró un aumento sostenido de publicaciones desde 2015, con un máximo en 2020. En cuanto a la distribución geográfica, España lideró con cinco artículos, seguida de Italia y China con cuatro cada una, además de estudios en Japón, Francia, Países Bajos, Estados Unidos, Brasil, Suecia, Sudán y Nueva Zelanda. El injerto de espesor parcial (STSG) fue la técnica más aplicada, especialmente en úlceras vasculares crónicas. Sus beneficios principales fueron aceleración de la cicatrización, disminución del dolor, mejoría funcional e impacto positivo en la calidad de vida. También se reportaron innovaciones como injertos en sacabocados con apósitos bioactivos, técnicas mixtas, uso de plasma rico en plaquetas (PRP) y combinación con terapia de presión negativa, con resultados alentadores en prendimiento y complicaciones. CONCLUSIONES En conclusión, los injertos cutáneos autólogos representan una alternativa eficaz y segura en heridas crónicas y complejas. No obstante, persisten limitaciones como la falta de estandarización, escasa inclusión de indicadores centrados en el paciente y ausencia de estudios multicéntricos de gran escala. Se requieren investigaciones más sólidas para consolidar recomendaciones aplicables en diferentes contextos clínicos.
Open Access
Comparison of clinical outcomes of immediate versus delayed placement of dental implants: A systematic review and meta- analysis
(Wiley, 2021) Dopico, Jose; Kalemaj, Zamira; Buti, Jacopo; Ruben Garcia-Sanchez; Mardas, Nikos; Pardo Zamora, Guillermo; Dermatología, Estomatología, Radiología y Medicina Física; Facultades de la UMU
Objective: Two focused questions were addressed: Focused question (Q1) 1) Are there any differences between immediate and delayed placement in terms of (i) sur- vival rate, (ii) success rate, (iii) radiographic marginal bone levels, (iv) height/(v)thick- ness of buccal wall, (vi) peri-implant mucosal margin position, (vii) aesthetics outcomes and (viii) patient reported outcomes? Focused question 2 (Q2) What is the estimated effect size of immediate implant placement for all parameters included in Q1? Materials and methods: An electronic search (MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials and OpenGray) and hand search were conducted up to November 2019. Randomised controlled trials (RCT) with delayed implant place- ment as controls were eligible in the analysis for Q1. Immediate dental implant arms RCTs, controlled clinical trials (CCTs) and prospective case series of immediate implant placement were eligible in the analysis for Q2. Results: Six papers (RCTs) were included in the analysis for Q1 and 53 papers (22 RCTs, 11 CCTs and 20 case series) for Q2. Q1: Meta-analyses did not show any signifi- cant difference in implant survival, but it did for bone levels and PES scores at 1 year post-loading, favouring the immediate group. Q2: Meta-analyses showed that imme- diate implants had a high survival rate (97%) and presented high PES scores (range 10.36 to 11.25). Information regarding marginal bone loss and gingival/papillary re- cession varied among all included studies. Conclusion: Similar survival rate was found between immediate and delayed implants. Immediate implants presented threefold early complications and twofold delayed complications. Success criteria should be reported more consistently, and the inci- dence/type of complications associated with immediate implants should be further explored.
Open Access
Editorial: skin lesion vitality assessment for forensic science: Current research and new perspectives
(Frontiers Media, 2022-08-15) Fineschi, Vittorio; Madea, Burkhard; Bacci, Stefano; Legaz Pérez, Isabel; Ciencias Sociosanitarias
Open Access
Effects of four polyphenols on mouse wound healing and the gene expression profile of resveratrol action
(Universidad de Murcia, Departamento de Biologia Celular e Histiologia, 2024) Hu, Xiao; Zhang, Hanbin; Chen, Zhenguo
Studies have demonstrated the potent effects of polyphenols on cutaneous wound healing. However, the molecular mechanisms underlying polyphenol activity are incompletely understood. Herein, mice were experimentally wounded, intragastrically treated with four polyphenols, resveratrol, tea polyphenols, genistein, and quercetin; and monitored for 14 days. Resveratrol was the most effective compound, promoting wound healing starting at day 7 after wounding, by enhancing cell proliferation and reducing apoptosis and subsequently promoting epidermal and dermal repair, collagen synthesis and scar maturation. RNA sequencing was performed in control and resveratrol-treated tissues on day 7 after wounding. Resveratrol treatment upregulated 362 genes and downregulated 334 genes. Gene Ontology enrichment analysis showed that differentially expressed genes (DEGs) were associated with different biological processes (keratinization, immunity, and inflammation), molecular functions (cytokine and chemokine activities), and cellular components (extracellular region and matrix). Kyoto Encyclopedia of Genes and Genomes pathway analysis indicated that DEGs were predominantly enriched in inflammatory and immunological pathways, including cytokine-cytokine receptor interaction, chemokine signaling, and tumor necrosis factor (TNF) signaling. These results show that resveratrol accelerates wound healing by promoting keratinization and dermal repair and attenuating immune and inflammatory responses.
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Effects of topical applications of porcine acellular urinary bladder matrix and Centella asiatica extract on oral wound healing in a rat model
(Springer, 2019) Camacho Alonso, Fabio; Torralba Ruiz, M. R.; García Carrillo, N.; Lacal Luján, J.; Martínez Díaz, F.; Sánchez Siles, M.; Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica
Objectives To evaluate the effects of topical applications of porcine acellular urinary bladder matrix (AUBM) and Centella asiatica extract (CAE) on the healing of tongue wounds in a rat model. Materials and methods Wounds were made in the tongue using a punch tool in 64 male Sprague-Dawley rats, randomized into four groups (n = 16 per group): group 1 (control), group 2 (CAE), group 3 (AUBM mixed with orabase), and group 4 (orabase). No product was applied in group 1 and groups 2–4 received three daily topical applications. The animals were weighed on day 0 and at the time of euthanasia. Four rats in each group were euthanized at days 2, 7, 14, and 21 and the tongues were processed for: macroscopic morphometric analysis, myeloperoxidase (MPO) and malondialdehyde (MDA) levels, histological wound repair (degree of reepithelialization and inflammation), and CD31 positivity. Results The animals’ weight gain, histological wound repair, and CD31 positivity from greatest to least were: AUBM > CAE > orabase > control. Percentage of tongue occupied by wound, MPO, and MPA levels from least to greatest were: AUBM < CAE < orabase < control, whereby the AUBM group showed significant differences (p ≤ 0.05) in comparison with the other groups on days 2, 7, 14, and 21 for percentage of tongue occupied by wound and MDA and on days 7, 14, and 21 for MPO. Conclusions CAE is effective for oral tissue regeneration, while AUBM is an even more potent means of oral mucosa regeneration. Clinical relevance AUBM may be beneficial to patients with oral wounds; this finding requires further clinical and laboratory investigation.
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Effects of topical applications of porcine acellular urinary bladder matrix and Centella asiatica extract on oral wound healing in a rat model
(Springer Heidelberg, 2018-09-24) Camacho Alonso, Fabio; Torralba Ruiz, M.R.; García Carrillo, N.; Lacal Luján, J.; Martínez Díaz, F.; Sánchez Siles, M.; Dermatología, Estomatología, Radiología y Medicina Física
Objectives To evaluate the effects of topical applications of porcine acellular urinary bladder matrix (AUBM) and Centella asiatica extract (CAE) on the healing of tongue wounds in a rat model. Materials and methods Wounds were made in the tongue using a punch tool in 64 male Sprague-Dawley rats, randomized into four groups (n = 16 per group): group 1 (control), group 2 (CAE), group 3 (AUBM mixed with orabase), and group 4 (orabase). No product was applied in group 1 and groups 2–4 received three daily topical applications. The animals were weighed on day 0 and at the time of euthanasia. Four rats in each group were euthanized at days 2, 7, 14, and 21 and the tongues were processed for: macroscopic morphometric analysis, myeloperoxidase (MPO) and malondialdehyde (MDA) levels, histological wound repair (degree of reepithelialization and inflammation), and CD31 positivity. Results The animals’ weight gain, histological wound repair, and CD31 positivity from greatest to least were: AUBM > CAE > orabase > control. Percentage of tongue occupied by wound, MPO, and MPA levels from least to greatest were: AUBM < CAE < orabase < control, whereby the AUBM group showed significant differences (p ≤ 0.05) in comparison with the other groups on days 2, 7, 14, and 21 for percentage of tongue occupied by wound and MDA and on days 7, 14, and 21 for MPO. Conclusions CAE is effective for oral tissue regeneration, while AUBM is an even more potent means of oral mucosa regeneration. Clinical relevance AUBM may be beneficial to patients with oral wounds; this finding requires further clinical and laboratory investigation.
Open Access
Evaluation of the Wachtel healing Index and its correlation with early implantation success or failured at two months
(MDPI, 2024-11-22) Moya Villaescusa, María José; Sánchez Pérez, Arturo; Lara Hernández, Nerea; Jornet García, Alfonso; Montoya Carralero, José María; Dermatología, Estomatología, Radiología y Medicina Física
Implants are increasingly used in dentistry. Nevertheless, several factors can cause treatment failure. To assess initial wound healing, various indices have been developed. The purpose of this study was to assess the relationship between early wound healing and implant success. Fifty single implants (25 in women and 25 in men) were placed in patients meeting the inclusion criteria. The implants (Ticare®) were placed via the two-stage technique. Patients were assessed at 24 h, one week, one month, and two months post-implantation. At the final evaluation, implantation failure or success was recorded. Postoperative pain in these patients at one week after placement was assessed with a visual analogue scale (VAS), and the Wachtel soft tissue early healing index was used to measure healing. Two months after implant placement, the success rate was 92%. No statistically significant relationship was found between the Wachtel index and short-term implant success or failure. Additionally, there was no relationship between implant success or failure and variables such as smoking, diabetes status, age, sex, or guided bone regeneration (GBR). Neither the Wachtel index nor any of the other variables studied is a predictor of early implantation success.
Open Access
Human skin model for mimic dermal studies in pathology with a clinical implication in pressure ulcers
(Universidad de Murcia. Departamento de Biología Celular e Histología, 2018) Cristóbal, Lara; Ortega, Miguel A.; Asúnsolo, Ángel; Romero, Beatriz; Álvarez Mon, Melchor; Buján, Julia; Maldonado, Andrés A.; García Honduvilla, Natalio
Despite advances in regenerative medicine and tissue engineering, human skin substitutes remain a clear goal to achieve. Autografts remain the principal clinical option. The long-term changes in dermis, as well as its response after injuries, are not well known. Research in this field has been hindered by a lack of experimental animal models. This study analyzes the architectural dermal scaffold (collagen and elastin fibers plus fibrillin-microfibrils) changes in a model of human skin pressure ulcers in mice. Immunosuppressed NOD/Scid mice (n=10) were engrafted with human skin of dimensions 4x3 cm. After 60 days as a permanent graft, a pressure ulcer (PU) was created in the human skin using a compression device. Three study groups were established: full-thickness skin graft before (hFTSG) and after applying mechanical pressure (hFTSG-PU). Native human skin was used as control group. Evaluations were conducted with visual and histological assessment. Scaffold components from each group were compared by immunohistochemical staining (tropoelastin, collagen I and III, metalloproteins (MMP), fibulins, and lysil oxidases (LOX) among others). The long-term engrafted skin showed a certain degradative state of dermis scaffold, as noticed by the active expression of MMPs and tropoelastin compared to native skin. However, a great reparative response after pressure ulcer onto the engrafted skin was observed. A significant increase of fibrillin microfibrils components (TGF-β, MAGP-1 and fibrillin-1), and matrix suprastructures of collagen I, III and LOX lead to an active restructuration of dermal tissue. Our human skin model in mice revealed the important role of the dermal scaffold component to reach skin stability and its capability to react to mechanical pressure injuries. These results showed the important role of dermal scaffold to support the histoarchitecture and mechanosensation of the human skin.
Open Access
Immunohistochemical and radiological characterization of wound healing in porcine liver after radiofrequency ablation
(Universidad de Murcia. Departamento de Biología Celular e Histología, 2016) Stadlbauer, Vanessa; Lang-Olip, Ingrid; Leber, Bettina; Mayrhauser, Ursula; Koestenbauer, Sonja; Tawdrous, Monika; Moche, Michael; Sereinigg, Michael; Seider, Daniel; Iberer, Florian; Wiederstein-Grasser, Iris; Horst Portugaller, Rupert; Stiegler, Philipp
Background: Radiofrequency ablation (RFA) is a minimal invasive therapeutic option for patients with hepatocellular carcinoma or liver metastases. We investigated RFA-induced cellular changes in the liver of pigs. Material and Methods: Healthy pigs (n=18) were sacrificed between day 0 and 3 months after RFA. The wound healing process was evaluated by computed tomography (CT), chromotrope anilinblue (CAB) staining of large-scale and standard tissue sections. Immunohistochemistry (IHC) for heat shock protein 70, Caspase-3, Ki67, Reelin, Vinculin, Vimentin and αSMA was perfomed. Results: One day after RFA, CAB staining showed cell damage and massive hyperaemia. All IHC markers were predominantly expressed at the outer borders of the lesion, except Reelin, which was mainly detected in untreated liver regions. By staining for Hsp70, the heat stress during RFA was monitored, which was most distinct 1-2 days after RFA. CT revealed decreased lesion size after one week. Development of a Vimentin and α-SMA positive fibrotic capsule was observed. Conclusion: In the early phase signs of cell damage, apoptosis and proliferation are dominant. Reduced expression of Reelin suggests a minor role of hepatic stellate cells in the RFA zone. After one week myofibroblasts become prominent and contribute to the development of the fibrotic capsule. This elucidates the pathophysiology of RFA and could contribute to the future optimization of RFA procedures.
Open Access
In vitro and in vivo efficacy evaluation of new self-assembling curcumin loaded nanohyaluronan-glycerosomes on wound restoring in health and diabetic rats
(Elsevier, ) Gómez García, Francisco José; Ramírez Andreo, Antonio; Manconi, María; Manca, María Letizia; Matricardi, Pietro; Di Meo, Chiara; Fernàndez-Busquets, Xavier; Martínez Díaz, Francisco; Salmerón Martínez, Diego; López Jornet, Pía; Ciencias Sociosanitarias
In this study the wound healing efficacy of new self-assembling curcumin loaded nanohyaluronan-glycerosomes has been tested in healthy and diabetic rats. Curcumin was loaded in nanohyaluronan-liposomes and -glycerosomes, special vesicles obtained mixing curcumin, hyaluronan nanohydrogel and soy lecithin. Curcumin loaded liposomes and glycerosomes were also prepared, characterized and tested as references. The physico-chemical (size and size distribution, surface charge and morphology), and technological (entrapment efficiency, stability over time and skin delivery) characteristics and biological performances (safety, ability to protect in vitro cells from oxidative damage) of prepared formulations were measured. Finally, they were daily applied to skin wounds of healthy or diabetic rats. The animal skin was excided and analysed at days 3, 7 and 14. The macroscopic observation underlined the higher ability of curcumin loaded nanohyaluronan-glycerosomes to improve wound healing in diabetic rats, already on day 3 up to day 14 (p < 0.05). Histopathological analysis confirmed an accelerated re-epithelization in healthy rats, while increased angiogenesis in diabetic ones. The superior therapeutic efficacy of curcumin loaded nanohyaluronan-glycerosomes compared to other formulations can be related to their enhanced ability to deliver higher curcumin concentrations at the wound site due to a synergistic effect of glycerol, hyaluronan nanohydrogel and lecithin.
Open Access
Localization of thrombospondin-l and its cysteine-serine-valine-threonine-cysteine-glycine receptor in colonic anastomotic healing tissue
(Murcia : F. Hernández, 1998) Roth, J.J.; Buckmire, M.A.; Rolandelli, R.H.; Granick, M.S.; Tuszynski, G.P.
Thrombospondin-l (TSP-1) is a matrix protein implicated in mechanisms of wound healing. TSP-1 contains the sequence cysteine-serine-valinethreonine- cysteine-glycine (CSVTCG) that has been shown to function primarily as a cell adhesion domain. Our laboratory has isolated a novel receptor specific for the CSVTCG adhesive domain of TSP-1. Immunohistochemical staining techniques and computerized image analysis were used to identify and quantitate TSP-1 and its CSVTCG receptor in surgically created colon anastomotic wounds. Histopathologic and quantitative examination demonstrated increased expression of TSP- 1 and its CSVTCG receptor in areas of wound healing. These findings suggest a role for TSP-1 and its CSVTCG receptor in wound healing. The control of expression and activity of these molecules may eventually be the basis for the development of wound healing agents that could significantly reduce the morbidity from surgical intervention.
Open Access
Mast cells and wound healing: Still an open question
(Universidad de Murcia, Departamento de Biologia Celular e Histiologia, 2025) Fernández Guarino, Montserrat; Bacci, Stefano
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Measurement of ridge alterations following tooth removal: a radiographic study in humans
(Wiley, 2010-01-11) Moya Villaescusa, María José; Sánchez Pérez, A.; Dermatología, Estomatología, Radiología y Medicina Física
Objective: The aim of this study was a radiographic mesiodistal analysis of the shape of the bone crest 3 months after tooth removal. Material and methods: One hundred single tooth extractions were performed on 100 patients because of orthodontic or prosthetic causes. Bite blocks were used for two radiographs: one on the day of extraction and the other after healing of the socket, 3 months later. These X-rays were used to determine: (1) the most apical distance of alveolar ridge resorption, with baseline as the line between bone-to-teeth contact (the greatest distance in bone resorption height) and (2) the mesiodistal distance (MDD) and mesial and distal angles arising after bone tissue modeling. Results: Significant differences (P<0.05) emerged between the MDDs of multiple- [8 mm, 95% confidence interval (CI): 6.09, 9.90] and single-root teeth (5.60 mm, 95% CI: 4.80, 6.50). However, mesial or distal angles or the most apical distance of alveolar ridge resorption did not differ (mean distance in height=4.32 mm, 95% CI: 3.85, 4.78; mean angle=24°). Conclusions: In this study, the post-extraction mesiodistal bone distance between teeth adjacent to the edentulous ridge depends on the size of the edentulous space. Nevertheless, the distance does not affect the distance in bone loss height. The distance of bone resorption height reaches a balance at the midpoint, which we consider indicative of stable healing. This resorption process must be considered when placing dental implants in fresh extraction sockets, especially in aesthetic sites, because the implant surfaces could be exposed after 3 months.
Open Access
Molecular insights into the interaction of cathepsin D and iron in chronic wound healing: exploring therapeutic potential and mechanisms
(MDPI, 2025-02-21) Rodríguez-Moreno, María; Legaz Pérez, Isabel; Ciencias Sociosanitarias; Facultad de Química
Background: Chronic wounds, such as diabetic ulcers, often fail to progress through healing due to persistent inflammation, infections, and extracellular matrix (ECM) imbalances. Cathepsin D, an aspartate protease active in acidic environments, plays a pivotal role in wound healing by mediating inflammatory responses, ECM remodeling, and macrophage phenotype transitions. Its dysregulation, however, can impair healing, highlighting the need for targeted modulation of its activity. The aim of this study was to investigate the molecular interaction between Fe2+ and cathepsin D’s catalytic core and ionic zipper under physiological and acidic conditions to identify strategies to enhance tissue repair and accelerate the healing of chronic wounds. Methods: The molecular structure of active cathepsin D was obtained from the Protein Data Bank (PDB) and analyzed using UCSF Chimera. Molecular interactions between cathepsin D and ferrous ions (Fe2+) were studied, focusing on key residues (D33 and D231) and ionic zipper residues (E5, E180, and D187). Results: Our results showed that the active form of cathepsin D, a 96 kDa dimer, consisted of heterodimers with distinct amino acid chains, where residues D33 and D231 formed the active site, and E5, E180, and D187 constituted the ionic zipper. A functional pocket containing the conserved residues D33 and D231, essential for proteolytic activity, was identified. At physiological pH (~7.5), D33 exhibited the most potent interactions with Fe2+, with interaction energies of −7 × 1017 J at oxygen atoms of the carboxylate group (OD1) and α-carbon (CA) atoms, whereas D231 showed slightly lower energies of −6 × 1017 J at γ-carbon atom (CG) and CA atoms. At acidic pH (~4), E5 was the primary interacting residue, with the shortest distance to Fe2+ (2.69 Å), and showed stable interactions across several atoms, emphasizing its role in metal binding. Conclusions: pH conditions strongly influence the interaction of cathepsin D with Fe2. At physiological pH, residues D33 and D231 demonstrate robust and energetically efficient binding with Fe2+. At the same time, under acidic conditions, E5 emerges as the primary residue involved, potentially affecting the ionic zipper of cathepsin D. These insights provide a molecular foundation for targeting specific residues to modulate cathepsin D activity, presenting promising opportunities for therapeutic strategies aimed at improving chronic wound healing.
Open Access
Phenotypic changes and possible angiogenic roles of pericytes during wound healing in the mouse skin
(Editores F. Hernan dez y Juan F. Madrid. Murcia, Universidad de Murcia, Departamento de Biologia Celular e Histologia, 2011) Morikawa, Shunichi; Ezaki, Taichi
Pericytes (PCs) are attracting increasing attention as a crucial target for anti-angiogenic therapy. In this study, we sought to determine the functional significance of PCs during angiogenesis by using a skin wound healing model in which different angiogenic stages are identifiable. Angiogenesis was first observed on Day 3 after wounding and increased greatly on Day 5. On Day 5, the leading edge of the regenerating vessels (vascular advancing front; VAF) appeared to be composed of immature vessels, and was further divided into “tip” and “following” regions according to maturational differences. PCs distributed in regenerating vessels showed phenotypic differences according to different regions. PCs that expressed PDGFR-ß alone and lacked vascular basement membrane (BM) were predominant in the tip region of the VAF, while PCs that expressed both PDGFR-ß and NG2 with their BM coating were numerous in the following regions toward the rear of the VAF. Moreover, PCs in the VAF expressed VEGF-A and associated with most proliferating endothelial cells (ECs). VEGF-A expression of PCs and the proliferating ECs totally disappeared in the region toward the rear of the VAF. We conclude that PCs can differ in their phenotype according to the stage of angiogenesis during wound healing. They may promote angiogenesis at the initial stage but might in turn stabilize the newly formed vessels at the later stage.
Open Access
Plasma rico en plaquetas en el tratamiento de las heridas crónicas
(Universidad de Murcia. Facultad de Ciencias Socio-Sanitarias de Lorca., ) Dato Vidal, Mercedes; Romera Guirado, Francisco José; Ciencias Sociosanitarias (Lorca)
Las heridas crónicas continúan siendo un importante problema de salud pública, tanto en España como en otros países de nuestro entorno afectando a pacientes de todos los niveles asistenciales. Ello plantea a los profesionales de la salud un desafío en la curación de las mismas. Se ha experimentado un notable avance en la aplicación el plasma rico en plaquetas y sus derivados, aunque existen ciertas controversias en cuanto a la mejora de la cicatrización de estas heridas. Objetivo: analizar la efectividad del uso de plasma rico en plaquetas en pacientes adultos para promover la cicatrización de las heridas crónicas. Metodología: se realiza una revisión bibliográfica de la literatura científica mediante búsqueda en diferentes bases de datos y limitándose esta búsqueda a artículos publicados en los últimos 10 años, en idiomas en inglés y español. Resultados: se incluyeron 8 estudios que proporcionan información científica sobre la eficacia del uso de plasma rico en plaquetas en la mejora de la cicatrización de las heridas crónicas. En total se seleccionaros 2 revisiones sistemáticas, una de ellas con meta-análisis y 3 ensayos clínicos aleatorizados, así como 3 Guías de Práctica Clínica. Conclusiones: el plasma rico en plaquetas puede mejorar la cicatrización de las heridas crónicas, disminuyendo el área, el tiempo de curación y la mínima aparición de efectos adversos. Es necesario protocolizar la producción del PRP, su cantidad y composición y la frecuencia de aplicación, a la vez que se recomienda la elaboración de trabajos con alta evidencia científica para poder discernir más fehacientemente la efectividad de dicho tratamiento. Palabras clave: Heridas crónicas, Úlceras, Plasma rico en plaquetas y Cicatrización de heridas.Chronic wounds continue to be an important public health problem, both in Spain and in other countries of our environment affecting patients of all levels of care. This is a challenge for health professionals in order to cure them. Significant progress has been made in the application of platelet-rich plasma and its derivatives, although there are some controversies regarding the improvement of the healing of these wounds. Objective: to analyze the effectiveness of the use of platelet-rich plasma in adult patients to promote the healing of chronic wounds. Methodology: a bibliographical review of the scientific literature has been carried out through a search in different databases and this search has been limited to articles published in the last 10 years, in English or Spanish languages. Results: eight studies providing scientific information on the efficacy of the use of platelet-rich plasma in improving healing of chronic wounds were included. In total, 2 systematic reviews were selected, one with meta-analysis and 3 randomized clinical trials, as well as 3 clinical practice guidelines. Conclusions: platelet-rich plasma can improve the healing of chronic wounds, decreasing the area, healing time and minimal occurrence of adverse effects. It is necessary to record platelet-rich plasma production, its quantity and composition and frequency of application. It is also recommended the elaboration of works with high scientific evidence to be able to discern more reliably the effectiveness of this treatment. Key words: Chronic wounds, Ulcer, Platelet-rich plasma and Wound healing.
Open Access
Terapia tópica en el tratamiento de las heridas crónicas
(2014) Da Silva, Priscilla Nicácio; de Almeida, Onislene Alves Evangelista; Rocha, Izabella Chrystina
El cuidado de la heridas retorna a la Antigüedad, cuando el hombre buscando mejores resultados en la cicatrización en menores intervalos de tiempo, hacía uso de diversos métodos y sustancias en el tratamiento de lesiones1,2. Actualmente, la terapéutica empleada en las heridas aún da lugar a discusiones, ya que debe atender a la herida y a su portador, con el fin de incluir la planificación y la realización de su cuidado. Se trata de un estudio descriptivo, exploratorio, con abordaje cuantitativo no probabilístico, cuyo objetivo central fue conocer la terapia tópica empleada para el tratamiento de heridas abiertas y crónicas por los usuarios de Unidades Básicas de Salud de la Familia (UBSFs) en el estado de Goiás, Brasil. Participaron en esta encuesta 19 personas de ambos sexos, con una edad media de 56,5 años, con heridas abiertas más de 3 meses. Para la recolección de datos se realizó la observación directa de la lesión con un instrumento dirigido semiestructurado, con preguntas sobre datos socioeconómicos del portador y relativos a la terapéutica de la herida. Los resultados mostraron que los productos tópicos más utilizados fueron antibióticos, antisépticos, siendo el principal la polivinilpirrolidona yodo (PVPI) y antifúngicos. También se verificó el empleo de sustancias impropias para la curación, como el producto creolina. Hubo desacuerdo entre los datos encontrados en la encuesta y lo sugerido por la literatura, ya que la mayoría de los productos tópicos utilizados en el tratamiento de heridas está en disonancia con lo indicado por la literatura investigada.
Open Access
The angiogenesis promoter, proadrenomedullin Nterminal 20 peptide (PAMP), improves healing in both normoxic and ischemic wounds either alone or in combination with autologous stem/progenitor cells
(F. Hernández y Juan F. Madrid. Universidad de Murcia. Departamento de Biología Celular e Histología, 2013) García-Honduvilla, Natalio; Cifuentes, Alberto; Bellón, Juan Manuel; Buján, Julia; Martínez, Alfredo
A combination of vascular pathologies and other complicating factors results in chronic wounds which constitute a serious burden for both patients and national health systems, due to prolonged hospital stays, high costs, and prolonged nursing staff dedication. Here we investigate whether proadrenomedullin N-terminal 20 peptide (PAMP), a naturally occurring peptide of the skin with antimicrobial and proangiogenic properties, either alone or in combination with autologous skeletal muscle stem/progenitor cells, acts as a wound healing factor. The rabbit ear was chosen as a test system, since it offers a reliable model for normoxic and ischemic wounds. Topical treatments with PAMP, stem/progenitor cells, or a combination of both, resulted in significant improvements of healing, when compared to untreated wounds. PAMP was very effective in promoting reepithelialization and angiogenesis, whereas treatment with stem/progenitor cells alone resulted in less wound contraction. Interestingly, the combination of PAMP and stem/progenitor cells, while maintaining angiogenic potency, reverted to the contraction levels observed in the untreated controls. Under ischemic conditions, generalized necrosis of the dermis and the underlying cartilage was observed in untreated wounds. Treatments of these wounds with PAMP or stem/progenitor cells allowed a timely recovery. In conclusion, PAMP either alone or in combination with autologous stem/progenitor cells may provide a useful tool for improving wound healing both in normoxic and ischemic conditions.
Open Access
Therapeutic effects of platelet derived growth factor overexpressed-mesenchymal stromal cells and sheets in canine skin wound healing model
(Universidad de Murcia, Departamento de Biologia Celular e Histiologia, 2020) Kim, Namyul; Choi, Kyeong Uk; Lee, Eunbee; Lee, Seoyun; Oh, Jiwon; Kim, Woo keyoung; Woo, Sang-Ho; Kim, Dae-Yong; Kim, Wan-Hee; Kweon, Oh-kyeong
Adipose-derived mesenchymal stromal cells (Ad-MSCs) have excellent potential for skin wound repair. Moreover, platelet-derived growth factor (PDGF) has strong wound healing properties. The purpose of the present study was to compare the healing effects of PDGF-overexpressing canine allogeneic Ad-MSCs (PDGF-MSCs) and their cell sheets (PDGF-CSs) as compared to unexpressed Ad-MSCs (U-MSCs) and their cell sheets (UCSs) in a cutaneous wound healing model induced upon dogs. In in vitro study, the expression of immunomodulatory and growth factors was assessed by qRT-PCR. In in vivo study, cells and sheets were transplanted into a square-shaped full-thickness (1.5×1.5 cm) skin defect model created in 12 dogs. After 5 and 10 days, wounds were harvested and evaluated macroscopically and histopathologically. The qRT-PCR results showed that the PDGF-B gene was significantly upregulated (p<0.05) in PDGF-CS and PDGF-MSCs groups. Upon gross analysis of the wound, all stromal cells and their sheet groups showed accelerated (p<0.05) cutaneous wound healing compared to the negative control groups. As compared to U-MSCs and UCSs, the PDGF-MSCs showed significant epithelization on days 5 and 10 of healing, whereas PDGF-CSs showed improved epithelization only on day 10. In the granulation tissue analysis, PDGF-CSs and UCSs promoted more formation (p<0.05) of upper granulation tissue, collagen, and activated fibroblasts than PDGF- MSCs, and U-MSCs. Especially, the PDGF-CSs presented the highest formation and maturation of granulation tissue among all groups. All considered, PDGF overexpressed stromal cells or cells sheets can improve cutaneous wound healing in a canine model.
Open Access
Tiempo de cicatrización de las heridas crónicas, a propósito de un estudio de prevalencia e incidencia
(Universidad de Murcia, 2017) Lanau Roig, Anna; Fabrellas, Nuria; Sáez Rubio, Gema; Wilson, Kate
Objetivo: Determinar el tiempo medio de cicatrización de las heridas crónicas, así como su prevalencia e incidencia. Método: Estudio retrospectivo transversal en el ámbito de atención primaria de Barcelona ciudad, con una población de 15.589 habitantes mayores de 15 años. El periodo de estudio fue de 1 de enero a 31 de diciembre de 2013. Se recogió información sobre la etiología de las heridas crónicas y el tiempo necesario para su cicatrización. Resultados: Fueron localizados 416 registros de lesiones de los cuales el 10,33% pertenecían a heridas crónicas. La mediana de duración fue de 152 días y la media de 311 días, siendo las úlceras por presión las de mayor duración. Se observó una diferencia estadísticamente significativa (p<0,05) entre la media de duración de las heridas atendidas en el centro de salud y las atendidas a domicilio. La prevalencia fue del 0,28% y la incidencia del 0,24%, las lesiones con mayor prevalencia e incidencia fueron las úlceras venosas. Conclusiones: El tiempo de curación depende del tipo de herida y del lugar de atención. La mayor prevalencia e incidencia se da en úlceras de extremidad inferior.