Growth factors in wound healing: the next great innovation?

Wound healing is a complex process that, in the vast majority of cases, normally leads to complete healing. It can be likened to the construction of a building, having many of the same requirements. As long as these requirements are satisfied, the healing of the acute wound proceeds uneventfully. Unfortunately, significant impediments to healing occasionally exist and the acute wound stops healing, becoming chronic. If these impediments can be controlled, most of these chronic wounds will eventually heal, albeit slowly. For example, the venous leg ulcer will heal once one applies proper compression therapy that provides the necessary support counteracting the underlying venous hypertension and provides appropriate wound care. Similarly, diabetic neuropathic foot ulcers will not heal until the disordered glucose metabolism is controlled and causative pressure on the foot is offloaded. Thus, successful healing of chronic wounds involves the treatment of underlying causes. Sometimes, however, proper management of these underlying diseases does not result in healing. Conventional therapy, unfortunately, does not have an answer for this dilemma. Growth factors provide a means by which cells are able to communicate with each other. They have profound effects on cell proliferation, migration, and extracellular matrix synthesis and release. Considering applying topically active growth factors directly to the wound surface in order to stimulate some aspect of the healing process has always been attractive. To date, Platelet-Derived Growth Factor (PDGF) has been the most researched of all the growth factors. Originally studied in the management of pressure ulcers, PDGF was eventually approved in North America for the treatment of diabetic lower extremity ulcers. The clinical data surrounding these indications will be reviewed. The future in growth factor research may require a greater understanding of how these substances interact with each other. Wound dressings of the future may include several growth factors, each with a specific function. In this way, the application of topically active growth factors to chronic ulcers just might be the next great innovation in wound healing.