The Use of Biologic Scaffolds in the Treatment of Chronic Nonhealing Wounds

Abstract

Injuries to the skin as a result of illness or injury, particularly chronic nonhealing wounds, present a major healthcare problem. Traditional wound care approaches attempt to control the underlying causes, such as infection and ischemia, while the application of wound dressings aims to modify a poorly healing wound environment into a microenvironment more closely resembling an acute wound allowing the body to heal the wound naturally. Regenerative medicine approaches, such as the use of biologic scaffold materials comprising an intact extracellular matrix (ECM) or individual components of the ECM, are providing new therapeutic options that focus upon the provision of biochemical cues that alter the wound microenvironment to facilitate rapid restoration of normal skin architecture. The incidence of chronic nonhealing wounds continues to increase. For example, between 15% and 20% of diabetics are likely to develop chronic, nonhealing foot wounds creating an increasing burden on healthcare systems worldwide. Developing a thorough understanding of wound microenvironment and the mechanisms by which biologic scaffolds work has the potential to markedly improve outcomes in the clinical translation for the treatment of chronic wounds.

Optimization and integration of nanosilver on polycaprolactone nanofibrous mesh for bacterial inhibition and wound healing in vitro and in vivo

“…1,59,60 Wound dressings impregnated with antimicrobials can prevent local bacterial infection and maintain the natural microenvironment for cell proliferation and tissue regeneration to promote wound healing. 3,61 As described earlier, compared with the control, PCL and PCL/DA groups, the biocompatible PCL/NS1.0 was efficient to protect the wounds from bacterial infection ( Figure 9) and maintain a natural and aseptic wound microenvironment without severe inflammation response to promote keratinocyte proliferation (Figures 11 and 12). Thus, the reepithelialization process was much faster in the PCL/NS1.0 group than that in the control, PCL and PCL/DA groups ( Figure 10).…”

“…[1][2][3] Antibiotics are generally used to provide the antibacterial activity in the clinical setting, but their overuse has caused antibiotic resistance to bacterial pathogens, which further led to the emergence of multidrug-resistant (MDR) bacteria. 4,5 Thus, an alternative solution is urgently needed.…”

Controlling stem cell behavior with decellularized extracellular matrix scaffolds

“…To date, clinical application with decellularized ECM has included acellular administration, mainly in the form of ECM sheets as surgical patches [90, 91], and recently the initiation of a clinical trial with an injectable cardiac ECM derived hydrogel (clinicaltrials.gov identifier NCT02305602). The acellular route is undoubtedly easier in terms of translation and has the potential to modulate the fate of endogenous progenitor cells.…”

The Use of Urinary Bladder Matrix in the Treatment of Trauma and Combat Casualty Wound Care

“…ECM scaffold materials are derived from the decellularization of many tissue sources (e.g., urinary bladder [UBM], small intestinal submucosa [SIS], dermis [D-ECM]) that arise from a number of different species (e.g., human, porcine, bovine, ovine, shark) [13][14][15][16][17][18][19][20]. ECM scaffolds consist of a tissue source specific three-dimensional arrangement of structural and functional molecules such as collagen, laminin, fibronectin, glycosaminoglycans and growth factors.…”

“…The exact mechanisms of ECM scaffold mediated constructive remodeling require further elucidation. However, it is currently known that within hours of being surgically placed at a site of tissue injury, ECM scaffolds are infiltrated by host derived mononuclear cells, which facilitate proteolytic degradation of the scaffold thereby generating a variety of bioactive molecules including matricryptic peptides [19,20]. These events are important in orchestrating the complex host response that ensues -antibacterial and angiogenic activity, the migration, proliferation, and/or differentiation of endogenous multipotent progenitor cells, and modulation The use of urinary bladder matrix in the treatment of trauma & combat casualty wound care Special Report of the local immune response toward potentially anti-inflammatory macrophage phenotype [13,[21][22][23][24][25].…”