Journal Scan / Research · December 19, 2021 Growth Factors for Treating Chronic Venous Leg Ulcers Wound Repair and Regeneration

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• In this systematic review of 13 trials involving 991 patients, the authors evaluated the use of growth factors for the treatment of venous leg ulcers. The use of any growth factor was associated with a significant increase in complete wound healing and a reduction in wound size. However, most studies had a low or very low quality of evidence due to the risk of bias, imprecision, or recall bias.

• Growth factors may be beneficial in the treatment of chronic venous leg ulcers, but further high-quality studies are needed.

–  Kelly B. Scarberry, MD

Written by

 

 

Richard Simman MD, FACS, FACCWS

I would like to congratulate the authors on this nice review and meta-analysis . Chronic venous leg ulcers (VLU) continue to challenge the wound care community, including dermatologists. Arterial studies are important to obtain early on to assure the safety of compression therapy and to rule out any arterial component of the ulcer. Careful venous studies to rule out reflux disease and venous hypertension are also important to determine if vein ablation is indicated. This may improve the healing rate and reduce the recurrence rate. Venous ultrasound will also show dilated perforators that may be ligated at the same time. Of course, deep venous system patency must be confirmed at the same time and prior to any intervention.

The chronicity and size of ulcers determine the projected healing rate.1-4 The provider should be aware of the availability of advanced cell and tissue products (CTPs). Many studies with high level of evidence have demonstrated their positive effect on the healing rate of these hard-to-heal ulcers. In parallel, the standard of care, including debridement, absorptive dressings, and compression therapy, should be an integral part of their treatment.

The article demonstrates that growth factors have a beneficial effect in complete wound healing of VLU. They may also increase the percent reduction in wound surface area. Based on the low quality of evidence, the authors also suggest that the benefit for growth factors identified in this review is not strong.

References

1. Cardinal M, Eisenbud DE, Phillips T, Harding K. Early healing rates and wound area measurements are reliable predictors of later complete wound closure. Wound Repair Regen. 2008;16(1):19-22. https://onlinelibrary.wiley.com/doi/10.1111/j.1524-475X.2007.00328.x
2. Moore K, Huddleston E, Stacey MC, Harding KG. Venous leg ulcers - the search for a prognostic indicator. Int Wound J. 2007;4(2):163-172. https://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X.2007.00335.x
3. Phillips TJ, Machado F, Trout R, et al. Prognostic indicators in venous ulcers. J Am Acad Dermatol. 2000;43(4):627-630. https://www.jaad.org/article/S0190-9622(00)86781-X/fulltext
4. Kantor J, Margolis DJ. A multicentre study of percentage change in venous leg ulcer area as a prognostic index of healing at 24 weeks. Br J Dermatol. 2000;142(5):960-964. https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2133.2000.03478.x
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Abstract

Chronic venous leg ulcers (VLU) are wounds that commonly occur due to venous insufficiency. Many growth factors have been introduced over the past two decades to treat VLU. This systematic review and meta-analysis evaluates the impact of growth factor treatments of VLU in comparison to control for complete wound healing, percent reduction in wound area, time to wound healing, and adverse events. A systematic review and meta-analysis of randomised trials was conducted. MEDLINE and EMBASE were searched up to December 2020. Studies were included if they compared a growth factor versus placebo or standard care in patients with VLU. From 1645 articles, 13 trials were included (n = 991). There was a significant difference between any growth factor and placebo in complete wound healing (P = 0.04). Any growth factor compared to placebo significantly increased the likelihood of percent wound reduction by 48.80% (P = <0.00001). There was no difference in overall adverse event rate. Most comparisons have low certainty of evidence according to Grading of Recommendations, Assessment, Development, and Evaluation. This meta-analysis suggests that growth factors have a beneficial effect in complete wound healing of VLU. Growth factors may also increase percent reduction in wound area. The suggestion of benefit for growth factors identified in this review is not a strong one based on the low quality of evidence.

Additional Info

• Article Citation

Wound Repair and Regeneration

Growth factors for treating chronic venous leg ulcers: A systematic review and meta-analysis

Wound Repair Regen 2021 Nov 16;[EPub Ahead of Print], Y Lee, MH Lee, SA Phillips, MC Stacey 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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