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The use of antioxidants in healing
Martin A
Warner-Lambert Company, Morris Plains, New Jersey 07950,
USA.
Dermatologic Surgery (USA), 1996, 22/2 (156-160)
BACKGROUND. Antioxidants enhance the healing of infected
and noninfected wounds by reducing the damage caused by oxygen
radicals.
OBJECTIVE. Studies were conducted to determine if the CRT
components (vitamin E, sodium pyruvate, and specific fatty
acids) could synergistically enhance healing.
METHODS. In vitro and in vivo studies were used to assess
the effect of various combination of CRT components.
RESULTS. CRT reduced oxidative damage to keratinocytes and
monocytes exposed to ultraviolet light and toxic chemicals and
provided protection to human subjects exposed to ultraviolet
irradiation. CRT dramatically facilitated healing of infected
and noninfected wounds. In herpes-infected guinea pigs, CRT
reduced vaginal viral lesion development, severity, and
duration, thus facilitated healing of the lesions. CRT also
reversed doxorubicin cytotoxicity in monocytes and reversed
doxorubicin-impaired wound healing in rats.
CONCLUSION: The CRT colly to enhancing healing of
injuries.
regulation of macrophage arginine metabolism: a
proposed role in wound healing.
Shearer JD; Richards JR; Mills CD; Caldwell MD
Department of Surgery, University of Minnesota, Minneapolis
55455, USA.
Am J Physiol (United States) Feb 1997, 272 (2 Pt 1)
pE181-90
Nitric oxide (NO) and ornithine, products of NO synthase or
arginase, respectively, have opposing biological activities.
The effect of mediators of leukocyte activation and inhibition
on arginine metabolism of resident mouse peritoneal exudate
cells (MPEC) was determined. Factors that increased basal NO
synthase activity, interferon (IFN)-gamma and
lipopolysaccharide (LPS), decreased arginase activity in
intact cells. Transforming growth factor (TGF)-beta1 decreased
IFN-gamma-stimulated NO synthase activity and produced a
reciprocal increase in urea and ornithine release. TGF-beta1
had no effect on the activity of these enzymes in
LPS-stimulated MPEC. Corticosterone (Cort, 100 ng/ml)
decreased the basal activity of both enzymes.However, Cort
inhibited NO synthase activity and increased ornithine release
in MPEC exposed to IFN-gamma or LPS. The difference between
arginase activity in intact cells vs. that of cell lysates
suggested intracellular inhibition of arginase activity.
Products of NO synthase, NO and citrulline, were shown to
inhibit MPEC arginase activity under maximal assay conditions.
Intracellular pH was not altered by exposure of MPEC to LPS,
IFN-gamma, TGF-beta, and Cort. This reciprocal change in
arginine metabolism is proposed to be an important component
of wound healing. Expression of NO synthase creates a
cytotoxic environment that may be important to the early phase
of wound healing. As wound healing progresses, increased
arginase activity produces an environment favorable for
fibroblast replication and collagen production.
The utilization of nutrient substances during wound
healing
Mayer NA; Muller MJ; Herndon DN
Anesteziol Reanimatol (Russia) Sep-Oct 1996, (5)
p29-39
The process of wound healing represents a series of complex
physicochemical reactions requiring different nutritional
microcomponents at each stage. In patients with extremely
grave diseases and injuries the course of wound healing is
impaired because of a hypermetabolic reaction to stress,
leading to protein catabolism. The hypothalamus responds to
cytokine stimulation by changes of thermoregulation (increase
of heat production) and increased production of stress
hormones (catecholamines, hydrocortisone, and glucagon). In
turn, stress hormones trigsis and proteolysis processes.
Hyperproduction of glucose at the expense of skeletal muscle
tissue degradation leads to the formation of amino acid
substrate for liver glyconeogenesis. Additional nutrients are
obligatory for wound healing in such patients. Protein
catabolism cannot be arrested by amino acids alone partly
because amino acid transport is impaired; it can be normalized
by anabolics, such as growth hormone and insulin-like growth
factor 1. Treatment with growth hormone yields a dramatic
positive effect in severely burned children. Proteins and
vitamins, specifically arginine and vitamins A, B, and C
provide the optimal nutritive support during wound
treatment.
A multicenter clinical trial. Zinc acexamate versus
famotidine in the treatment of acute duodenal ulcer. Study
Group of Zinc acexamate (new UP doses)
Garcia-Plaza A; Arenas JI; Belda O; Diago A; Dominguez A;
Fernandez C; Martin L; Pallares A; Rodrigo L; de la Santa
Jw
Rev Esp Enferm Dig (Spain) Nov 1996, 88 (11)
p757-62
A multicentric double-blind trial comparing 600 mg/d of
Zinc Acexamate (ACZ) and 40 mg/d of Famotidine (FMT) in the
short term treatment of acute duodenal ulcer included 199
patients, diagnosed by endoscopy. One-hundred and five
patients received ACZ and 94 FMT, during four weeks. A
clinical control took place at two weeks and a second clinical
and endoscopic control at the end of the treatment (4 weeks).
Complete cicatrization of the ulcer was observed in 56.5% of
patients on ACZ and in 69.5% of patients of FMT (N.S.). A
reduction of more than 50% of the ulcer diameter was recorded
in 78.8% of the ACZ group and in 79.9% of the FMT group.
Alcohol and smoking did not influence the results. Both
treatments were equally effective in the disappearance of
symptoms. The incidence of adverse reactions was very low in
both groups (< 5%) and no patient dropped from the trial
for this reason. In conclusion, a dosage of 600 mg/d of ACZ
has ptors:
Endogenous zinc concentrations in
cysteamine-induced duodenal ulcers in the rat.
Troskot B; Simicevic VN; Dodig M; Rotkvic I; Ivankovic D;
Duvnjak M
Department of Gastroenterology, University Hospital Sestre
Milosrdnice, Medical School, University of Zagreb,
Croatia.
Biometals (England) Oct 1996, 9 (4) p371-5
Exogenously administered zinc compounds have been shown to
possess anti-ulcer activity against a wide variety of
ulcerogenic agents, both in laboratory animal models and in
human peptic ulcer disease. However, a strong possibility
exists that endogenous zinc may also play an important role
during noxious events by various mechanisms. Therefore, the
aim of this study was to focus on the changes of endogenous
zinc serum and tissue concentrations in cysteamine-induced
duodenal lesions. We used atomic absorption spectrophotometry
to determine the tissue and serum concentrations of zinc in
normal (control) rats and those with cysteamine-induced
duodenal ulcers. The results obtained in this study indicated
that the onset, development and spontaneous healing of ulcer
lesions were associated with certain shifts in zinc serum and
tissue concentrations. Prior to ulcer formation, a significant
increase was noted in serum zinc values. With the onset of
duodenal lesions, zinc serum concentrations significantly
decreased, while there was a significant increase in duodenal
tissue concentrations when compared to healthy control
animals. Zinc tissue concentrations decreased and returned to
starting values by the end of the first week of spontaneous
healing. This decrease in zinc tissue concentration
corresponded to the healing rate of the duodenal ulcers. Serum
zinc concentrations also returned to starting values within
the first week period. These observations indicate and confirm
that zinc could play an important role in duodenal ulcer
disease and represent a natural defense system in the
body.
Vitamin supplementation? Experimental study on
humans.
Vaxman F; Olender S; Lambert A; Nisand G; Grenier JF
INSERM U61 et Laboratoire Pautrier, Chirurgie B, Hopitaux
Universitaires de Strasbourg, France.
Eur Surg Res (Switzerland) Jul-Aug 1996, 28 (4)
p306-14
The improvement of the wound healing process in humans by
vitamin supplements is still controversial because of the lack
of a clearly demonstrated correlation with the mechanical
properties of scars.
OBJECTIVE: The aim of this work was to study the effects of
high doses of ascorbic acid (AA) and pantothenic acid (PA) on
the wound healing process of human skin.
METHOD: Two groups of patients undergoing surgery for
tattoo removal by the successive resection procedure received
AA (1 or 3 g/day) and PA (0.2 or 0.9 g/day). More than 80
mechanical, biological and histological parameters were
investigated in both preoperated skin and the scars.
RESULTS: The breaking energy of scars was higher in group
2, and energy and treatment were directly correlated (p =
0.006). Mg and Mn significantly rose in group 2 whereas Fe
decreased in a dose-dependent manner. Intragroup comparison
showed patient and treatment effects for Mg, a time.treatment
effect for Cu and a treatment effect for Fe.
CONCLUSION: The degree and rapidity of variations rather
than the variations of the absolute values themselves of
fibroblasts, hydroxyproline, Fe, Cu and Mg are significantly
related to the enhancement of the mechanical properties of
scars. From this study, it may be assumed that in order to
obtain 'better', more solid and resistant scars, the decrease
of Fe must be quick and acute in order to avoid the harmful
effects of toxic radicals; the increase of Cu, Mg and Mn must
be early and high in order to have more stable and solid
collagen.
Human dermal fibroblasts produce nitric oxide and
express both constitutive and inducible nitric oxide synthase
isoforms.
Wang R; Ghahary A; Shen YJ; Scott PG; Tredget EE
Department of Surgery, University of Alberta, Edmonton,
Canada.
J Invest Dermatol (United States) Mar 1996, 106 (3)
p419-27
Nitric oxide (NO) is produced by a variety of human and
animal cells and is involved in a broad rray of physiological
and pathophysiological processes. It can cause vasodilation,
serve as a neurotransmitter, and have anti-neoplastic,
anti-microbial, and anti-proliferative effects. In this study,
we have demonstrated that fibroblasts derived from human skin
spontaneously produce NO and that this production can be
enhanced by stimulating the cells with interferon-gamma and
lipopolysaccharide. The production of NO by human dermal
fibroblasts can be blocked by NG-monomethyl-L-arginine
(L-NMMA). The inhibitory effect of L-NMMA on NO production was
restored by addition of L-arginine but not D-arginine. By
measuring the rate of conversion of [14C]L-arginine to
[14C]L-citrulline, we show that unstimulated cells expressed
only Ca2+-dependent NO synthase (NOS) activity (1.36 +/- 0.57
pmol/mg/min; n = 4) whereas stimulated cells expressed both
Ca2+-dependent (2.60 +/- 0.54 pmol/mg/min; n = 4) and
-independent (1.59 +/- 0.14 pmol/mg/min; n = 4) NOS
activities. With reverse transcription polymerase chain
reaction (RT-PCR), the 422-bp RT-PCR product for human
endothelial constitutive NOS and the 462-bp RT-PCR product for
human hepatocyte inducible NOS were detected in proportion to
the amount of mRNA-related RT-cDNA added to the reaction
mixture. Further evidence by immunocytochemistry demonstrated
that human dermal fibroblasts express both constitutive and
inducible NOS proteins. These data collectively suggest that
in addition to macrophages and other inflammatory cells,
nitric oxide production by dermal fibroblasts could be
important during the inflammatory stages of wound healing and
possibly also in the later stages of proliferation and tissue
remodeling after skin injury in humans.
Nutritional factors affecting wound healing
Thomas DR
Ostomy Wound Manage (United States) Jun 1996, 42 (5) p40-2,
44-6, 48-9
The consistent relationship between poor nutritional status
and risk of complications forms the cornerstone of nutritional
support. Yet there is controversy about the ability of
nutritional support to reduce complications or improve wound
healing. This controversy stems from a number of issues.
Diagnosing poor nutrition is not always easy and straight
forward. There is sometimes a question whether a patient is
malnourished or simply in overall poor health. Studies
examining the relationship between nutrition and patient
outcome are typically based on animal rather than human
models. Even in clinical settings, aspects of care such as
enteral or parenteral nutrient delivery may decrease the
benefit of nutritional support, making outcomes even harder to
measure. The effect of specific nutrients have been examined,
such as protein, amino acids, vitamins C and A, and zinc.
However, there are still questions regarding how much
individual supplementation of a nutrient will positively
affect overall outcomes. Although the relationship between
specific nutrients and wound healing is not clearly defined by
current studies, each patient should be provided with a
complete, balanced therapeutic diet. There is at least
suggestive evidence that improvement in nutritional status can
improve outcomes of wound healing.
Role of lactose, arginine and lysine combination in
fracture healing (an experimental study)
Fini M; Giardino R; Nicoli Aldini N; Martini L; Rocca M;
Bertoni F; Capelli S; Cantelli Forti G; Sapone A; Rossetti A;
Morrone G; Giavaresi G
Cattedra di Fisiopatologia Chirurgica, Universita di
Bologna.
Ann Ital Chir (Italy) Jan-Feb 1996, 67 (1) p77-82; discussion
82-3
L-arginine and L-lysine are essential amino acids which
seem to possess some properties able to influence bone
fractures healing. In fact, the increase of intestinal calcium
adsorption but also in collagen synthesis, in insulin and
growth hormone secretion and in osteoblastic activation. So,
an experimental in vivo model was carried out by using 50
adult rabbits which, under general anaesthesia, were submitted
to an osteotomy of the left fibula. Animals were divided into
5 groups and were daily treated with a mixture of lactose,
L-arginine and L-lysine or with the only lactose (control
group) at the same dosage as recommended for humans. They were
sacrificed after 15, 30, 40, 50 and 60 days for radiological
and histological studies. The results of the study showed that
the pharmacological mixture containing L-arginine and L-lysine
accelerates and ameliorates the healing processes and this
positive effect was particularly evident from the 30th day
after the osteotomy. We think that these results are linked
not only to calcium metabolism but also to different
biological properties which positively contribute to good
healing of bone fractures.
Activation of a mouse macrophage cell line by
acemannan: The major carbohydrate fraction from Aloe vera
gel
Zhang L.; Tizard I.R.
Dept. of Veterinary Pathobiology, Texas A and M University,
College Station, TX 77843 USA
Immunopharmacology (Netherlands), 1996, 35/2
(119-128)
Acemannan is the name given to the major carbohydrate
fraction obtained from the gel of the Aloe vera leaf. It has
been claimed to have several important therapeutic properties
including acceleration of wound healing, immune stimulation,
anti-cancer and anti-viral effects. However, the biological
mechanisms of these activities are unclear. Because of this
wide diversity of effects, it is believed that they may be
exerted through pluripotent effector cells such as
macrophages. The effects of acemannan on the mouse macrophage
cell line, RAW 264.7 cells were therefore investigated. It was
found that acemannan could stimulate macrophage cytokine
production, nitric oxide release, surface molecule expression,
and cell morphologic changes. The production of the cytokines
IL-6 and TNF-alpha were dependent on the dose of acemannan
provided. Nitric oxide production, cell morphologic changes
and surface antigen expression were increased in response to
stimulation by a mixture of acemannan and IFN-gamma. These
results suggest that acemannan may function, at least in part,
through macrophage activation.
Wound healing effects of aloe gel and other topical
antibacterial agents on rat skin
Heggers J.P.; Kucukcelebi A.; Stabenau C.J.; Ko F.;
Broemeling L.D.; Robson M.C.
Dept Surg Plastic/Microbiol/Immunol., Univ. Texas Medical
Branch/Shriners, Burns Institute, Galveston, TX 77550
USA
Phytotherapy Research (United Kingdom), 1995, 9/6
(455-457YRE)
The effects of topical antibacterials were studied in an
acute wound healing model. Sprague- Dawley rats after
appropriate anaesthesia received four 1.5 cm2 dorsal defects
through the skin and panniculus carnosus. Skin defects were
treated for 14 days with 2% mupirocin ointment, 1% clindamycin
cream, 1% silver sulfadiazine cream+Aloe vera gel, and silver
sulfadiazine combined with Aloe gel. An untreated group served
as controls. Each group was comprised of 10 animals each to
achieve statistical significance. Wound closure rate was
assessed by serial planimetry. Following healing, the breaking
strength of each resultant scar was determined. Wound
half-lives and overall healing rates were calculated by
regressing the log of the areas of all wounds over time.
Overall healing rates of all the treated groups were
significantly different compared with control group
(p<0.05) The Aloe group had the shortest half-life and
healed faster than the control group. All the other treated
groups had no longer half-lives when compared with the control
group. While silver sulfadiazine+Aloe increased the breaking
strength of the healed wound, Aloe alone did not, but
demonstrated an increase over the control. Topical Aloe
significantly enhances the rate of wound healing and when
combined with silver sulfadiazine reverses the wound retardant
effect observed with silver sulfadiazine. Clindamycin and
mupirocin significantly delay wound closure. However mupirocin
enhanced the breaking strength of the wound.
Acemannan-containing wound dressing gel reduces
radiation-induced skin reactions in C3H mice
Roberts D.B.; Travis E.L.
Texas Univ. M. D. Anderson Can. Ctr., Box 66, 1515 Holcombe
Blvd., Houston, TX 77030-4095 USA
International Journal of Radiation Oncology Biology Physics
(USA), 1995, 32/4 (1047-1052)
Purpose: To determine (a) whether a wound dressing gel that
contains acemannan extracted from aloe leaves affects the
severity of radiation- induced acute skin reactions in C3H
mice; (b) if so, whether other commercially available gels
such as a personal lubricating jelly and a healing ointment
have similar effects; and (c) when the wound dressing gel
should be applied for maximum effect.
Methods and Materials: Male C3H mice received graded single
doses of gamma radiation ranging from 30 to 47.5 Gy to the
right leg. In most experiments, the gel was applied daily
beginning immediately after irradiation. To determine timing
of application for best effect, gel was applied beginning on
day -7, 0, or +7 relative to the day of irradiation (day 0)
and continuing for 1, 2, 3, 4, or 5 weeks. The right inner
thigh of each mouse was scored on a scale of 0 to 3.5 for
severity of radiation reaction from the seventh to the 35th
day after irradiation. Dose- response curves were obtained by
plotting the percentage of mice that reached or exceeded a
given peak skin reaction as a function of dose. Curves were
fitted by logit analysis and ED50 values, and 95% confidence
limits were obtained.
Results: The average peak skin reactions of the wound
dressing gel- treated mice were lower than those of the
untreated mice at all radiation doses tested. The ED50 values
for skin reactions of 2.0-2.75 were approximately 7 Gy higher
in the wound dressing gel-treated mice. The average peak skin
reactions and the ED50 values for mice treated with personal
lubricating jelly or healing ointment were similar to
irradiated control values. Reduction in the percentage of mice
with skin reactions of 2.5 or more was greatest in the groups
that received wound dressing gel for at least 2 weeks
beginning immediately after irradiation. There was no effect
if gel was applied only before irradiation or beginning 1 week
after irradiation.
Conclusion: Wound dressing gel, but not personal
lubricating jelly or healing ointment, reduces acute
radiation-induced skin reactions in C3H mice if applied daily
for at least 2 weeks beginning immediately after
irradiation.
Anti-inflammatory and wound healing properties of
Aloe vera
Udupa S.L.; Udupa A.L.; Kulkarni D.R.
Department of Biochemistry, Kasturba Medical College, 576119
Manipal, Karnataka India
Fitoterapia (Italy), 1994, 65/2 (141-145)
The fresh juice of the indigenous drug A. vera (0.2 ml/100
g, i.p.)was studied for its anti inflammatory and by observing
percent reduction in carrageenin-induced paw oedema at 3 h.
Wound healing effects were studied on incision (skin breaking
strength), excision (percent wound contraction and
epithelisation time) and dead space (granuloma breaking
strength and biochemical parameters) wound models. A. vera
showed significant anti-inflammatory activity in acute
inflammatory model without any significant effect on chronic
inflammation. Significant increase in breaking strength (skin
and granuloma tissue), enhanced wound contraction and
decreased epithelisation period were observed. An increase in
lysyl oxidase activity and mucopolysaccharide content were
also seen. This drug could therefore increase tensile strength
by increasing cross-linking in collagen and interactions with
the ground substance.
Beneficial effects of Aloe in wound healing
Heggers J.P.; Pelley R.P.; Robson M.C.
Department of Surgery, University of Texas Medical Branch,
Galveston, TX 77550 USA
Phytother. Res. (United Kingdom), 1993, 7/Spec. Iss.
(S48-S52)
The therapeutic effects of Aloe vera have been examined in
preventing progressive dermal ischaemia caused by burns,
frostbite, electrical injury,distal dying flap and
intra-arterial drug abuse. In vivo analysis of these injuries
showed that the mediator of progressive tissue damage was
thromboxane A2 (TxA2). Experimentally Aloe was compared to a
variety of antithromboxane agents to include U38450, a
lodoxamide, a lazaroid and Carrington wound gel. In the burn
injury Aloe when compared with the control and the Carrington
wound gel (p = 0.05). Tissue survival in the experimental
frostbite injury was 28.2% when compared with the control (p =
0.05). Similar results were obtained for the electrical
injury, and intra-arterial drug abuse. Clinically burn
patients treated with Aloe healed without tissue loss as did
those with frostbite (p = 0.001). In the intra-arterial drug
abuse patients Aloe reversed the tissue necrosis. This
therapeutic approach was used to prevent progressive tissue
loss in each injury by actively inhibiting the localized
production of TxA2. Aloe not only acts as a TxA2 inhibitor but
maintains a homeostasis within the vascular endothelium as
well as the surrounding tissue.
The stimulation of postdermabrasion wound healing
with stabilized aloe vera gel-polyethylene oxide
dressing
Fulton J.E. Jr.
The Acne Research Institute, 1587 Monrovia Street, Newport
Beach, CA 92663 USA
J. Dermatol. Surg. Oncol. (USA), 1990, 16/5
(460-467)
Full-face dermabrasion provided an ideal opportunity to
document the effects of dressings on wound healing management.
Following the procedure, the abraded face was divided in half.
One side was treated with the standard polyethylene oxide gel
wound dressings. The other side was treated with a
polyethylene oxide gel dressing saturated with stabilized aloe
vera. The polyethylene oxide dressing provided an excellent
matrix for the release of aloe vera gel during the initial 5
days of wound healing. By 24-48 hours there was dramatic
vasoconstriction and accompanying reduction in edema on the
aloe-treated side. By the third to fourth day there was less
exudate and crusting at the aloe site, and by the fifth to
sixth day the reepithelialization at the aloe site was
complete. Overall, wound healing was approximately 72 hours
faster at the aloe site. This acceleration in wound healing is
important to reduce bacterial contamination, subsequent keloid
formation, and/or pigmentary changes. The exact mechanism of
acceleration of wound healing by aloe vera is unknown.
Aloe vera gel hindered wound healing of
experimental second-degree burns: A quantitative controlled
study
Kaufman T.; Kalderon N.; Ullmann Y.; Berger J.
Department of Plastic Surgery, Bruce G. MacMillan Burn Wound
Healing Research Unit, Haifa Israel
J. Burn Care Rehabil. (USA), 1988, 9/2 (156-159)
In the present study, Aloe vera gel (AVG) was applied to
experimental second-degree burns in guinea pigs, and its
effects on epithelialization, wound contraction, newly formed
granulation tissue, and regeneration of hair follicles was
compared with that effected by 1% silver sulfadiazine cream
(AgSD). Epithelialization (% mean plus or minus SEM) on
postburn day 8, 16, and 24 of the AVG-treated wounds was
38.72% plus or minus 2.71%, 60.34% plus or minus 3.28%, and
92.46% plus or minus 2.26%, respectively, while that of
AgSD-treated burns was 53.35% plus or minus 2.65%, 94.84% plus
or minus2.65%wounds was significantly higher than that of the
AgSD-tr eated burns during 24 days of the study (P < .001).
The thickness of the newly formed granulation tissue was
higher in the AVG-treated wounds (P < .001), while the hair
follicles count was significantly lower (P < .001) compared
with the AgSD-treated burns. It is concluded that this
preparation of Aloe vera gel hindered the healing process of
the present burn wound model when compared with 1% silver
sulfadiazine cream.
Biological activity of Aloe vera
Davis R.H.; Leitner M.G.; Russo J.M.; Maro N.P.
Pennsylvania College of Podiatric Medicine, Department of
Physiological Sciences, Philadelphia, PA 19107 USA
Med. Sci. Res. (UK), 1987, 15/5 (235)
In this study, the authors attempted to show the
comparative biological activity of Aloe vera as measured by
standard anti-inflammatory tests. Wound healing was improved
24% in mice by a 100 mg/kg Aloe vera dose whereas 10 mg/kg
improved healing 31% in rats. A slightly greater response of
44% was obtained on inhibiting mustard induced edema by 10
mg/kg Aloe vera. A marked inhibition of 58% PMN infiltration
into an inflamed area by 2 mg/kg aloe was noted. No reduction
of granuloma tissue formation around a cotton pellet under the
skin was shown at doses up to 400 mg/kg. These data suggest
that Aloe vera inhibits inflammation and improves wound
healing. Aloe vera probably does not act like a steroid since
it was most effective on acute inflammation and had no effect
on granuloma tissue formation.
Cutaneous tissue repair: Practical implications of
current knowledge. II
Reed B.R.; Clark R.A.F.
Department of Dermatology, University of Colorado Health
Sciences Center, Denver, CO 80262 USA
J. Am. Acad. Dermatol. (USA), 1985, 13/6
(919-941)
This article reviews the scientific basis for the certain
factors that delay wound repair in the clinical setting. A
brief history of wound healing is given, followed by a
discussion of endogenous local factors (bacterial infection,
hypoxia, foreign body, and desiccation) and endogenous
systemic factors (nutritional deficiencies, aging, coagulation
disorders, and the Ehlers-Danlos syndromes) associated with
poor wound repair. Also reviewed are the mechanisms by which
exogenously administered agents (glucocorticoids,
antineoplastic agents, and anticoagulants) may delay healing.
Commonly used topical antimicrobials, their spectrum of
activity, and evidence of effects on wound healing are
examined. Finally, properties of commercially available wound
coverings and wound care in the future are discussed.
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