Inflammation the Forgotten Evil in Non-healing Wounds

It is well documented that non-healing wounds are trapped in the inflammatory phase of healing, and fail to progress to closure because of the persistence of a hostile wound environment. Patients with non-healing wounds are typically elderly, and have co-morbidities such as diabetes, circulatory problems and auto-immune conditions such as rheumatoid arthritis. Their underlying disease state means that these patients are predisposed to producing an inappropriate inflammatory response. When they have a wound, it gets ‘stuck’ in inflammation releasing excessive pro-inflammatory cytokines, free radicals and inflammatory proteases, which cause unnecessary tissue destruction. Bacteria can augment this pro-inflammatory response however they are not the fundamental reason why such wounds do not heal.

If we are to help these wounds progress to healing we need to break this chronic inflammatory cycle, ensure bacterial bioburden is controlled while dealing with the visual symptoms of the wound.

In this study we collected wound fluid from diabetic and non-diabetic patients and found that there are fundamental differences in the underlying wound biochemistry. Diabetic patients with venous leg ulcers were found to have a more aggressive wound environment, exemplified by substantially higher levels of the inflammatory protease elastase, and pro-inflammatory cytokines such as IL-1 beta and TNF-alpha. When these patients were treated for 4 weeks with Collagen/ORC products their wounds progressed towards healing which corresponded with reduced levels of both inflammatory cytokines and inflammatory proteases. This suggests that if we deal with the underlying problem of inflammation we have a better chance of getting these wounds to heal.