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Wound Bed Preparation and the Role of Enzymes: A case for Multiple Actions of Therapeutic Agents

Falanga V (2002) Wound Bed Preparation and the Role of Enzymes: A case for Multiple Actions of Therapeutic Agents, Wounds; 14 (2): 47 - 57

 

Abstract

Wound bed preparation as a concept is revolutionising the way we approach chronic wounds. We define it as the global management of wounds to accelerate endogenous healing or to facilitate the effectiveness of therapeutic products. As a result of this more encompassing way of approaching wounds, a number of new concepts are emerging. We now talk about the possibility that a cellular burden, compromising phenotypically abnormal cells, exists in chronic wounds and needs to be removed or corrected. We have come to recognise the deleterious effects of excessive exudates, which breaks down extracellular matrix material and blocks the effectiveness of new forms of therapy, including growth factors and bioengineered skin. We are becoming more cognisant of the pathophysiologic abnormalities of chronic wounds and of ways to correct them. We have also come to recognise that chronic wounds may be in need of constant or more steady state debridement. Hence, the concept of maintenance debridement may need to be tested. In this review of wound bed preparation, we now propose that this more comprehensive approach to wounds will allow us to explore new therapeutic benefits of existing treatment modalities. As a proof of principle, we have examined the potential role of enzymatic debridement in other aspects of wound bed preparation. The hope is that in the context of wound bed preparation we will begin to re-evaluate commonly used treatments for opportunities to explore their other properties and therapeutic benefits.