Comment on “Topically Applied Connective Tissue Growth Factor/CCN2 Improves Diabetic Preclinical Cutaneous Wound Healing: Potential Role for CTGF in Human Diabetic Foot Ulcer Healing”

Abstract

A recent paper in this journal, presented a novel method by topical application of growth factors in stimulating diabetic cutaneous wound healing that caught our attention. We believe that the experimental method in the article is efficient and creative, but it also has some controversies and shortcomings to be discussed. We noted that the authors used “Tegaderm” as a semiocclusive dressing film and stated that it exerted a “splinting effect” on the wound margins and controlled contraction. Indeed, the “Tegaderm” itself can serve as a dressing film to isolate the wound bed with outside environments while the “splinting effect” is mainly achieved by adding silicone splints around the wound. Considering the unique properties of silicone splints and “Tegaderm,” our experimental group propose an alternative method named “combined-suturing” technique that is not only suturing the silicone splints but also securing the “Tegaderm” around the wound. The specific reasons and operative procedures are explained in detail in this letter.

The dual delivery of KGF and bFGF by collagen membrane to promote skin wound healing

“…In our study, the applicability of a splinted wound model (H. Li et al, ) for ascertaining the ability of a collagen membrane with KGF and bFGF to facilitate wound closure was evaluated. Aside from the enhanced cell migration caused by both growth factors, one of the major reasons for the predominant effect on wound closure could have been the mitogenic effect of KGF and bFGF, judging from the Ki67 immunostaining results.…”

“…Initially, 15 rats were included in each group. Surgery was performed on the animals using a previously described procedure reported by our group (H. Li et al, ). After anaesthesia, shaving preparation, and sterilization, we created four full‐thickness round wounds (Φ = 8 mm) bilaterally on each rat dorsum.…”

“…The widely utilized murine excisional wound model still has some disadvantages because it does not completely model human wound healing due to its inability to prevent skin contracture in rodents (Ud‐Din & Bayat, ). Therefore, we added a silicone splint to prevent unpredicted contracture and covered the wound with Tegaderm (H. Li, Cao, Huang, & Man, ) to maintain proper hydrophilicity (Persin et al, ). Apparently, many factors have influenced the results obtained using animals; thus, the underlying mechanism has been difficult to identify.…”

<p>CTGF Loaded Electrospun Dual Porous Core-Shell Membrane For Diabetic Wound Healing</p>

“…Overall, the obtained results demonstrate that the CTGF loaded core-shell fibers can have a significant positive impact on the viability and migration of multiple cells that are relevant in diabetic wound healing and facilitate subsequent wound contraction. Since the effective dose and duration of growth factor gradients are important factors that facilitate angiogenesis and wound healing, a slow release of CTGF might have significantly contributed to the overall performance of the developed membranes 7. Future studies should focus on the effect of PLA-PVA-CTGF on cell proliferation, angiogenesis, and wound closure rate in vivo using small animal models.…”

“…During the past few decades, various biomolecules such as vascular endothelial growth factor (VEGF),4 epidermal growth factor (EGF),5 platelet derived growth factor (PDGF)6 and connective tissue growth factor (CTGF)7 have been tried as suitable treatment regimens for managing diabetic wounds 8. For instance, CTGF can play an important role in promoting cell proliferation, cell migration and angiogenesis which will improve diabetic wound healing 9–11.…”