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    New integrated therapies for wound healing on the horizon


    Dr. Brem
    Mineola, N.Y. — An integrated, simultaneous therapy using new treatment options and comprehensive care of the patient's underlying medical issues are leading to great advances in wound healing, according to Harold Brem, M.D., F.A.C.S., chief of the division of wound healing and regenerative medicine, Winthrop University Hospital, Mineola, N.Y.

    "The elderly, disabled and those with diabetes will nearly all heal if you provide simultaneous and not sequential treatment," he says. "In a patient with a chronic wound, clinicians have to take into account that the underlying, sometimes systemic, problems — such as arthesclerotic heart disease — also must be treated."

    Dermatologists often see wound-healing cases first. Early detection and treatment can save a limb or sometimes a life in patients who are at risk due to their age, impaired ability to fight infection or underlying conditions such as diabetes or atherosclerotic disease, i.e., ischemia, Dr. Brem says.


    "Today, innovative treatments are being used in chronic woundcare, including cellular therapy, stems cells, growth factors and other regenerative medicine, such as hyperbaric oxygen, collagen-based therapies and negative-pressure therapy," Dr. Brem says. "These therapies are the standard of care for wound healing at our center. This is a major change in 2011, and all six types of therapies were not commonly used together, even one year ago. Although some of these therapies have been available since 1998, all of these treatments have only recently become part of a standard of care for wound and regenerative medicine patients."

    A patient with a wound before (left) and after treatment with combination therapy. (Photos: Scott Gorenstein, M.D., Winthrop University Hospital)
    Cellular therapy (Apligraf, Organogenesis) was initially shown to work in diabetic foot ulcers and in venous ulcers by Vincent Falanga, M.D., Robert Kirsner, M.D., and others.1, 2 "It is the only drug that is indicated for multiple types of chronic wounds. We have also shown that it also works on pressure ulcers," Dr. Brem says.

    Recently, a study revealed that this treatment has endogenous epidermal stem cells in it.3 "This finding explained the mechanism of why the cellular therapy was working in most types of chronic wounds," he says. "It became standard of care once we realized the stem cells resulted in closure, not only for diabetic and venous ulcers, but also pressure, sickle cell and multiple other types of chronic wounds by stimulating endogenous tissue to heal."


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