Skin wound healing is a complex and sometimes intricate process, dependent on a number of regulated factors that act in concert to repair skin damage and restore barrier function. Impaired wound healing can lead to the formation of chronic, non-healing wounds. Chronic wounds that do not heal within the expected period of 3 months not only result in pain and disfigurement, but also impose a significant burden on patients. Chronic wounds are a consequence of local tissue hypoxia, bacterial colonization, and repetitive ischemia-reperfusion injury. Long-healing wounds can occur for a variety of reasons, including arterial disease, diabetes, vasculitis, venous valve insufficiency, previous radiation and skin malignancies, and immunological problems.
Addressing factors that cause delayed wound healing involves assessing the underlying pathology and considering the use of advanced therapeutic agents. Although a variety of wound treatment options are available, few have demonstrated effectiveness in healing chronic wounds and restoring tissue to its pre-injury state. In contrast to normally healing wounds, chronic wounds exhibit increased levels of proinflammatory cytokines, reactive oxygen species (ROS), proteases, and senescent cells.
Traditional chronic wound care protocols rely on surgical debridement of necrotic or infected tissue, followed by the use of dressings and topical agents that protect the wound from infection and promote healing. For some chronic wounds, such as diabetic foot ulcers, offloading via external compression is critical to minimize pressure on the wound. Additionally, diabetic foot ulcers, venous leg ulcers, and open amputation wounds can be treated with negative pressure wound therapy to promote granulation tissue formation, wound area reduction, primary healing, and improved skin graft retention when applied to the wound bed.
Although these therapeutic options While varied and can be tailored to each patient, these methods have limited success and do not always achieve complete wound closure.
Consequently, bioactive cell component therapy has become an interesting area due to its potential in the treatment of non-healing wounds. The grown cells have the unique ability to self-renew and differentiate into different cell types. Moreover, dormice can enhance the secretion of cytokines and growth factors necessary for immunomodulation and regeneration, which are two critical functions that are not sufficiently addressed in the pathogenesis of chronic wound healing. This is a very promising treatment for improving the healing of chronic wounds without the associated risks of major surgical procedures and additional donor site complications. Cells grown in vitro deliver cytokines, chemokines and growth factors, induce angiogenesis and innervation, and also alter the inflammatory process of the wound. We most often use mesenchymal cells, which constitute a pluripotent heterogeneous population of cells in human adipose tissue.
Biocomponents have demonstrated clinical effectiveness in the treatment of chronic wounds secondary to severe radiation injuries, chronic fistulas and ulcerations, including venous leg ulcers. Mechanistically, this population of cells promotes angiogenesis, increases the secretion of growth factors and cytokines, and mediates the proliferation of human dermal fibroblasts through direct cell contact and paracrine activation during the reepithelialization phase of wound healing.
This is the most studied type of therapy using a combination of bio-cell cultures in the clinical treatment of chronic wounds. They demonstrated results of improved wound healing and closure, tissue ultrastructure and hydration, new vessel formation, and pain symptoms. In the treatment of chronic ulcers secondary to peripheral arterial disease, Marino et al.] observed a decrease in ulcer size, depth, pain, and improvement in percutaneous saturation in all patients during the course of treatment. The versatility of this method is also emphasized in the treatment of chronic Crohn’s fistulas; Patients treated experienced improved wound healing over 8 weeks without any side effects or other medications. They also found improved re-epithelialization and ulcer healing with wound matrix combined with compression therapy.
The bulk of the grown cultuts are of epidermal origin and belong to the population of mesenchymal cells present in the epidermis and responsible for the homeostasis of the superficial layers of the skin. This population includes cells from the interfollicular region, sebaceous glands, and bulge region.
Clinically, this therapy is used to treat chronic ulcers, burns, and non-healing wounds secondary to epidermolysis bullosa nodosa. The method promotes both reepithelialization during wound healing and regeneration of the functional epidermal layer of the skin. This therapy focuses on the use of the secretome, targeting the physiology of damaged tissue, which releases various growth factors and cytokines derived from biosecretion. This therapeutic principle is widely used in the field of regenerative medicine, especially in the treatment of chronic wounds.
This therapy has the potential to increase the rate of wound healing by accelerating wound closure time by interacting with various cells: immune cells, fibroblasts, endothelial cells and other cells to modulate wound healing.
After the first week of treatment, in all our cases, we saw that the color of the wound bed changed to pink, which proves the effectiveness of the treatment. The first effect of this treatment is to enhance angiogenesis, allowing nutrition to be provided again and facilitating the diapedesis of inflammatory cells, macrophages and neutrophils that remained obstructed in the area surrounding the wound. Macrophages and neutrophils begin to fulfill their role as cells that kill bacteria and disinfect the site of damage. Macrophages play a vital role as phagocytic cells in wound healing. Enzymes such as cytokines, necrosis factor, interleukins and collagenase produced during phagocytosis play a role in removing foreign material and promoting fibroblasts and angiogenesis.
Vascular endothelial growth factor and platelet growth factor secreted by macrophages transfer granulation tissue from the proliferation phase to the tissue regeneration phase. The bio preparation contains many neurotrophic factors, which have various beneficial factors in modulating and inducing vascularization and regeneration in the wound area, nerve repair, muscle, nerve and skin regeneration by accelerating the increase in cell number, reducing the incidence of post-inflammatory complications. fibrosis and increased fiber organization. The amount of pus in the wounds decreased significantly after the second week of treatment, which may indicate the activity of neutrophil factors in this study.