Vasculogenic ulcers (venous, arterial, and/or both) are the most common type of ulcers in the legs. They are chronic and may last from weeks to years and show high recurrence rates. A venous leg ulcer (VLU) results from damage to superficial and/or deep vein valves, impairing venous return, causing increased venous pressure, and compromising the supply of oxygen and tissue growth factors. Arterial leg ulcers are associated with the interruption or decrease of blood flow, resulting in tissue ischemia and cell death due to nutrient and oxygen deficits. Mixed leg ulcers are a combination of the chronic venous insufficiency and peripheral arterial occlusive disease.
Venous leg ulcers negatively affect the patient’s quality of life, causing exudate, bad smell, pain, depression, social isolation, personal hygiene difficulties, and limitations in physical mobility, and, in severe cases, amputation. Arterial and mixed leg ulcer treatment includes revascularization, debridement, systemic therapies (antibiotics, analgesia, pharmacotherapies), patient education and nutrition.
Advanced dressings and topical agents (e.g., hydrocolloids, alginates, hydrogels, foams, antimicrobials) are applied to protect the ulcer surface, absorb the exudate, and provide comfort and a humid environment ideal for healing.
Extracellular matrix technologies that can be derived from human sources (allografts) (e.g., donated human skin) or animal sources (xenografts) (e.g., porcine, equine, bovine) are part of the tissue engineering, with several products available in the market.
The matrix can provide a tissue scaffold for the patient’s own cells, allowing cellular interaction for migration, proliferation and differentiation, thus promoting re-epithelialization, revascularization and closure.
De Angelis and coll conducted this study in which from January 2015 to September 2018, 35 patients affected by vasculogenic chronic ulcers localized on the inferior limbs (17 patients affected by venous ulcers, 11 patients with arterial ulcers and seven patients withmixed arterial/venous ulcers)were treated with the application of collagen dermal substitute template, followed by the autologous dermal-epidermal graft (DEG). It is Bi-Layer Matrix, consists of a porous resorbable matrix of about 2 mm thickness made of stabilized native collagen type I and a silicone sheet of about 2 mm in thickness mechanically reinforced with a polyester (200 _m) fabric.
The first surgical step consisted in a careful debridement of the injured tissue and the implant of dermal substitute. After 28 days the silicon sheet was removed and the autologous skin graft was implanted.
Dermal skin substitutes (DS) represent a main group of extracellular matrix products providing ECM replacement in the form of porous three-dimensional dermal templates to stimulate wound healing. They represent a relatively new therapeutic option in chronic wound management. More than 90% of patients healed after four weeks from the implant. This treatment consists in cost reduction and hospitalization, improving the patient’s quality of life.
Authors: Barbara De Angelis and coll
Newspaper J Clin Med. 2019 Apr 17;8(4):525.