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17.5 Improved healing and down-regulation of gelatinase in neuropathic foot ulcers treated with a primary wound dressing containing Ca, K, Rb, Zn and total contact cast
Oscar M. Alvarez, PhD; Linda Waltrous, RN, BSN; Martin Wendelken, DPM, RN; Lee Markowitz, DPM; Emannuel Pappous, MD; Center for Curative and Palliative Wound Care Background: One element contributing to wound chronicity is the imbalance of matrix metallo-proteases (MMPs) and their specific inhibitors (TIMP) in the wound bed, resulting in the premature degradation of the provisional matrix. Both, in vitro and in vivo studies have shown that a formulation of polyhydrated ionogens (PHI) may down-regulate the over expression of gelatinases A & B (MMP-2 and MMP-9) in chronic wounds.
Design: A parallel, uncontrolled evaluation (feasibility study) comparing the rate of wound healing and gelatinase content in neuropathic foot ulcers treated with a new PHI-impregnated primary wound dressing (PHI-WD*). PHI-WD is a primary wound dressing containing the trace elements Ca, K, Rb, and Zn, formulated with petrolatum and citric acid and impregnated onto an ethylene vinyl acetate mesh screen.
Methods: Nine subjects with neuropathic plantar foot ulcers were treated once weekly with PHI-WD and total contact cast (TCC). Wound tissue for MMP-2, MMP-9 and TIMP-2 analysis were obtained at baseline (prior to initial treatment), at week-3 and at week-6 (post-treatment). The concentrations of MMP-2, MMP-9 and TIMP-2 were measured in extracts of ulcer tissue homogenates using ELISA and gelatin-zymography. Wound assessments were performed once weekly and the rate of healing was calculated by digital photo planimetry. Results: Treatment with PHI-WD for 6 weeks resulted in 4-fold decrease of MMP-2, a 6-fold decrease of MMP-9 (P < 0.05) and a 45% increase in TIMP-2. The rate of wound healing was 20% greater when compared to historical controls treated with nonadherent dressing and TCC. |