Delayed wound healing can cause significant issues for immobile and ageing individuals as well as those living with co-morbid conditions such as diabetes, cardiovascular disease, and cancer. These delays increase a patient’s risk for infection and, in severe cases, can result in the formation of chronic, non-healing ulcers (e.g., diabetic foot ulcers, surgical site infections, pressure ulcers and venous leg ulcers). Chronic wounds are very difficult and expensive to treat and there is an urgent need to develop more effective therapeutics that restore healing processes. Sustained innate immune activation and inflammation are common features observed across most chronic wound types. However, the factors driving this activation remain incompletely understood. Emerging evidence suggests that the composition and structure of the wound microbiome may play a central role in driving this dysregulated activation but the cellular and molecular mechanisms underlying these processes require further investigation. In this review, we will discuss the current literature on: 1) how bacterial populations and biofilms contribute to chronic wound formation … read more
Tag: inflammation
How Activity Benefits the Healing Patient
Maintaining an active lifestyle is critical to good health; this is especially true for patients recovering from wounds or extended hospital stays. Robust activity can improve mental health, reduce the risk of infection, and accelerate wound healing.1 Staying active can be challenging for patients with wounds, however, and it is critical that health care professionals take steps to enable their patients to stay as active as possible.
The Healing Benefits of Activity
Aside from the long-term benefits to heart health, mental health, and longevity, exercise provides many direct and indirect benefits to patients healing from wounds. Physical activity can promote rapid wound healing, reduce oxidative damage, and promote a healthy lifestyle. This can improve patient outcomes and reduce the costs of treatment.
Exercise Benefits Mental Health – There is ample evidence that exercise promotes good mental health, reduces the effects of depression, and causes people to report a greater level of happiness. These effects are especially important for those who have had an extended stay in a hospital or who are in a long-term care facility because these populations may be at greater risk of developing mental health problems.
Exercise Reduces Inflammation – Inflammation is one of the major causes of delayed healing. Research shows that wounds with low levels of inflammation heal much more quickly and completely. Exercise and other physical activity have been shown to reduce the level of inflammatory markers in the blood, thus helping to reduce the level of inflammation and promote rapid healing. Reduced inflammation may also provide palliative benefits by decreasing pain and discomfort in wounds … read more
Managing inflammation by means of polymeric membrane dressings …
… in pressure ulcer prevention
Inflammation is the immediate normal response of the immune system to localised microscopic cell damage that precedes macroscopic tissue damage. Inflammation is triggered by secretion of chemokines that attract immune system cells to the sites of cell damage and facilitate their extravasation through increase in capillary permeability. The increased permeability of capillary walls in the inflammatory state consequently causes fluid leakage from the vasculature and, hence, oedema and associated pain. Polymeric membrane dressings (PolyMem®, Ferris Mfg. Corp.) are multifunctional dressings that focus and control the inflammation and oedema, and reduce pain. The literature reviewed in this article suggests that by having these effects on the inflammatory response, especially in fragile patients, the PolyMem dressing technology may facilitate repair of micro-damage in cell groups, which counteracts the evolution of damage to a macroscopic (tissue) level. Reducing the spread of inflammation and oedema in tissues appears to be a unique feature of PolyMem dressings, which supports repair of cell-scale damage under intact skin and tilts the delicate balance between the counteracting damage build-up and tissue repair mechanisms, thus promoting reversibility and self-healing … read more
Altered macrophage phenotypes impair wound healing
One of the defining features of chronic wounds is their high levels of inflammation. Patients present with high levels of inflammation, around 80%, of cells at the wound margin being macrophages and with wound fluid laden with proinflammatory cytokines. The latter is in part responsible for preventing wound closure, along with the low levels of growth factors. In healthy acute wounds, two types of macrophages can be found: pro-inflammatory M1 macrophages and antiinflammatory M2 macrophages, with more M1 cells present early post-injury and M2 appearing later to regulate repair and wound closure. This pro-repair M2 phenotype, that secrete a range of mediators including growth factors that regulate re-vascularisation and closure of a wound, is lacking in chronic wounds, leading to excessive inflammation, enhanced degradation within the wound, reduced matrix deposition and lack of closure … read more
Inflammation in Chronic Wounds
Non-healing chronic wounds present a major biological, psychological, social, and financial burden on both individual patients and the broader health system. Pathologically extensive inflammation plays a major role in the disruption of the normal healing cascade. The causes of chronic wounds (venous, arterial, pressure, and diabetic ulcers) can be examined through a juxtaposition of normal healing and the rogue inflammatory response created by the common components within chronic wounds (ageing, hypoxia, ischaemia-reperfusion injury, and bacterial colonisation). Wound bed care through debridement, dressings, and antibiotics currently form the basic mode of treatment. Despite recent setbacks, pharmaceutical adjuncts form an interesting area of research.
The skin forms an important and effective barrier against the environment. It plays a vital role in protection against insults such as bacteria, xenobiotics and dehydration. When a cutaneous injury occurs, the body initiates a series of complex events to re-establish this protection. Wound healing can be roughly divided into four continuous and overlapping phases: (1) haemostasis; (2) an immediate inflammatory response defined by an infiltration of cytokine-releasing leukocytes with antimicrobial functions; (3) these cytokines kick off a proliferative phase where new epithelium, blood vessels, and extracellular matrix (ECM) are laid down; (4) over a period of weeks to months, the wound contracts as the ECM is remodelled [1]. These highly regulated cellular, humoral and molecular processes have been described as an orchestral performance—a potential flawless interplay can lead to perfect regeneration; however, human adult wounds undergo a repair process that leads to scarring, and, in some cases, non-healing chronic wounds …. read more