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Potential therapeutic approaches to

treatment of intrinsic defects in chronic wounds

Conventional wound therapies tend to focus on dealing with extrinsic factors that have a negative impact on healing. Glycaemic control and offloading the affected foot with diabetic foot ulcers, compression therapy to treat vascular disease in venous leg ulcers and pressure relief for decubitus ulcers. Whilst these measures will induce healing of many chronic wounds a significant proportion will fail to heal or only heal slowly (Franks, 1995).

The growing body of knowledge of chronic wound biology allows for a rational approach to develop new treatments. Initiation of healing a chronic wound intuitively requires conversion of the chronic healing status to that of a healing acute wound. This is concept is supported by evidence at the molecular level from those wounds that respond to conventional therapies. For example, the cytokine profiles of wound fluid taken from leg ulcers responding to compression therapy change from angiostatic to angiogenic cytokines whilst those representing the inflammatory state indicate a change from a chronic to resolving inflammation as might be seen in an acute wound (Fivenson, 1997). Studies of this type characterising the cell and molecular biology of the chronic wound state have identified a number of intrinsic factors as potential targets for therapy.

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