Tehran University Medical Journal

Wound healing and reduction of its recovery time is one of the most important issues in medicine. Wound is defined as disruption of anatomy and function of normal skin. This injury could be the result of physical elements such as  surgical incision, hit or pressure cut of the skin and gunshot wound. Chemical or caustic burn is another category of wound causes that can be induced by acid or base contact irritation. Healing is a process of cellular and extracellular matrix interactions that occur in the damaged tissue. Wound healing consists of several stages including hemostasis, inflammatory phase, proliferative phase and new tissue formation which reconstructs by new collagen formation. Wounds are divided into acute and chronic types based on their healing time. Acute wounds have sudden onset and in normal individuals usually have healing process of less than 4 weeks without any residual side effects. In contrast, chronic wounds have gradual onset. Their inflammatory phase is prolonged and the healing process is stopped due to some background factors like diabetes, ischemia or local pressure. If the healing process lasts more than 4 weeks it will be classified as chronic wound. Despite major advances in the treatment of wounds, still finding effective modalities for healing wounds in the shortest possible time with the fewest side effects is a current challenge. In this review different phases of wound healing and clinical types of wound such as venous leg ulcer, diabetic foot ulcer and pressure ulcer are discussed. Also acute wound models (i.e burn wounds or incisional wound) and chronic wound models (such as venous leg ulcers, diabetic foot ulcer, pressure ulcers or bedsore) in laboratory animals are presented. This summary can be considered as a preliminary step to facilitate designing of more targeted and applied research in this area.

Background: Burns is a major health problem due to severe side effects and limited financial resources. Some herbs are cheap and available, such as Arnebia euchroma can be effective treatment of burn wounds and reduce recovery time. The aim of this study was to evaluate the effect of Arnebia euchroma ointment on healing of deep second-degree burn wound in rats.
Methods: This experimental study was conducted in animal laboratory of Hazrat Fatemeh Hospital in 2015, Tehran. In this study 24 male Sprague-Dawley rats weighing approximately 300 to 350 g were selected. After general anesthesia, back of each rat was shaved with clipping device. Then second-degree burn with the area of 2×4 cm was induced on them. Rats were randomly divided into 2 groups, 12 in each. The surface of the wound in the first group was covered with Arnebia euchroma ointment and in the second group with Vaseline. Dressing was done daily until complete recovery and the wound healing process was monitored by photographing every five days. On day 20, the samples were sent for pathological evaluation of the amount of collagen and inflammatory cells.
Results: Results showed that, during days from 5 to 15 the extent of the wounds reduced in both groups (P= 0.000). The reduction of wound size was significantly higher in Vaseline group compared to Arnebia euchroma ointment group (P= 0.040). The results of the pathological examination showed no significant difference in the amount of collagen and inflammatory cells in the two groups.
Conclusion: It seems Arnebia euchroma ointment to some extent reduced the extent of the wound especially in superficial burns compared to other dressings. However, it is better to conduct more similar studies with a larger sample size and different method and change in timing of dressing.

Background: Diabetes Mellitus is a prevalent disease worldwide and foot ulcer is one of the serious complications of chronic uncontrolled diabetes which could lead to various complications such as amputation of the extremity if left untreated. Total contact casting (TCC) is the gold standard in treatment of neuropathic and neuro ischemic diabetic foot ulcers (DFU) on which less emphasize is seen on routine medical practice. The aim of this study was to emphasize on healing effect of this off-loading method and to study the possible influence of variants on the healing rate of this technique.
Methods: In this cohort study, 92 diabetic patients with complaint of plantar foot ulcer grade 0, 1 and 2 according to Wagner classification had participated in Shahid Beheshti Hospital, Babol City, Iran, from March 2014 to February 2016. The demographic and biochemical information along with dimensions of foot ulcers were carefully recorded. After the primary cleansing, surgical debridement and dressing, TCC was applied on foot by the specialist and they were requested to return weekly for changing the TCC and re-evaluation of ulcers. The healing rate was calculated as decline in ulcer surface area per week.
Results: 92 patients of study sample with mean age of 63.9±10.56 year consisted of 76 patients with DM type 2 with BMI of 31.16±3.8 kg/m² and 58 male patients. The average healing rate of ulcers treated with TCC was 0.406 ±0.168 cm²/week. The duration of diabetes on average was 17.23±6.93 years. Most of the patients (n=45) had an ulcer on the forefoot and the healing rate of midfoot ulcers was slower. The average amount of baseline HbA1c was 8.2±0.19%. There was no relation between smoking history (P=0.94) and anti-diabetic regimen used by patients (P=0.754) with the healing rate.
Conclusion: The healing rate is slower in elderly patients and those with longer duration of diabetes. So in these two groups, TCC is to be applied for a longer duration in order to achieve complete healing.

Background: Aphanizomenon flos-aquae (AFA) is a type of blue-green algae and contains a source of biological compounds. These microalgae have many beneficial health effects. Recently, fucoidan, known sulfated polysaccharide component of AFA algae, has been claimed to stimulate stem-cell mobilization in animal models. Stem cells play an essential role in tissue repair process. In this study, we use excisional full thickness wound model to investigate the effectiveness of trademark AFA extract on skin wound repair process.
Methods: In this experimental study, 21 adult male Wistar rats (weighing 200-250 g) were used and under general anesthesia (intraperitoneally with a ketamine/xylazine solution), two round excisional wounds were created under sterile conditions by a 6 mm punch on the dorsum (paravertebral area) of all rats. Animals were randomly assigned into 3 groups. In groups 1 and 2 (SE-200, SE-400), StemEnhance© (StemTech Health Sciences Inc. British Columbia, Canada) were given respectively 200 or 400 mg/kg by oral gavage once daily and in group 3 (Sham), distilled water (DW) was given to all subjects. Post-wounding gavage of StemEnhance or DW started from 1st day and continued to 7th day. The wound surface area was monitored daily by digital camera and assessed by Image Tool™ software, version 3.5 (UTHSCSA, San Antonio, TX, USA). At 9th day post-wounding animals were sacrificed and repaired tissues were harvested by and assessed by a 8 mm punch. Repaired skin areas were processed for hematoxylin and eosin (H&E). Histopathological parameters of healing including inflammatory cell infiltration, angiogenesis, and fibroblast count were assessed by pathologist. Our study was conducted in the Physiology Department of Medical School, Bushehr University of Medical Sciences, Iran, from October 2016 to March 2016.
Results: Macroscopic imaging of wound area revealed that there was statistically significant difference in wound area reduction between SE-200 group and sham group on day 6 post wounding (P=0.032). Moreover, histological findings showed that the number of neutrophils, macrophages, fibroblasts, and microvessel density decreased in both StemEnhace-treated groups. There were no significant differences between two treatment groups.
Conclusion: According to the obtained results it seems that the extract of Aphanizomenon flos-aquae algae positively affects wound healing process by ameliorating inflammatory response in early healing phases.