Clinical And Basic Research On Chronic Refractory Wounds

Background: Chronic refractory wounds are a large group of tissue injuries that exist on the body surface and may arise when the wound healing process fails to achieve anatomic and functional integrity in a timely and orderly manner.The cascade of events involved in wound healing can be halted by a myriad of factors,including skin infections,diabetes,pressure ulcers and vascular diseases of the lower extremities,malignant trauma,and so forth,resulting in non‐healing wounds that bring incredible discomfort to patients being laden with anxiety both physically and mentally while draining the medical health service system with a colossal waste of resources.The factors affecting the healing of wounds include local microenvironment such as inflammation,immunity,infection and hypoxia,and systemic environmental factors such as diabetes,vascular sclerosis and malnutrition,which can be superimposed on each other,making the treatment of wounds much more difficult and eventually leading to delayed healing.Bacterial infection has been considered as one of the major obstacles to wound healing,and the detection rate of MDROS has been increasing year by year.The aim of this study is to summarize the methods of surgical and non-surgical adjuvant treatment for accelerating the healing of chronic refractory wounds,and to find potential alternatives or downgrades for antibiotic replacement therapy.Methods: This study contains two major parts.The first part first investigated whether there were statistical differences in wound healing time,gross and microscopic manifestations of wounds treated with artificial dermis combined with PRP and with artificial dermis alone using animal experiments.Then we collected clinical cases of chronic refractory wounds to investigate whether there were statistical differences between the artificial dermis combined with PRP and artificial dermis treatment groups in terms of wound healing time,resistance to infection,artificial dermis vascularization and healing outcome.In the second part,Three common drug-resistant bacteria Methicillin‐resistant Staphylococcus aureus（MRSA）,Extended‐spectrum β‐lactamases ‐producing Escherichia coli（ESBLs‐Eco）,and the MDR Pseudomonas aeruginosa（MDR‐Pae）were employed to evaluate the antibacterial effects of the Blue LED light in vitro.Effects of RBLL on in vivo wound healing were evaluated by analyzing time to closure,wound score,semi-quantitative test for bacterial culture,histopathological examination and Masson staining of skin tissue,immunohistochemical（IHC）staining,and western blot analysis（WB）of wound tissue.Results: The results of animal experiments and clinical studies showed that there was a statistical difference in wound healing time between the artificial dermis combined with PRP group and the artificial dermis alone group.The Masson staining showed that the collagen arrangement on the combined PRP side was more regular and orderly.The results of the clinical study showed that the artificial dermis combined with PRP group took less time to control the wound infection,and the vascularization time of the artificial dermis was also significantly reduced in the combined treatment group.Blood supply to the surface and inhibited excessive inflammatory response.In the second part,Blue LED light inhibited MRSA,ESBLs‐Eco,and MDR‐Pae in vitro study.In vivo,Red ＆ Blue LED light accelerated wound healing,reduced levels of pathogenic bacteria on the wound surface while increasing the blood supply to the wound surface and inhibiting the excessive inflammatory response.Conclusions: Artificial dermis combined with PRP can accelerate artificial dermis vascularization and shorten the healing time of chronic wounds.Red ＆ Blue LED light shows great potential benefit for the treatment of multi-drug resistant bacterial infections wounds,indicating that Red ＆ Blue LED light is an effective,convenient,painless and safe non-surgical adjunctive treatment modality for refractory multi-drug resistant infections wounds.