Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel.
Med Eng Phys. 2019 Oct;72:13-18. doi: 10.1016/j.medengphy.2019.08.010.
Chronic wounds which fail to progress to healing are currently considered among the most important, unsolved and expensive medical burdens, on the same scale of healthcare costs as all obesity-related problems taken together. Pressure ulcers (PUs) and diabetic foot ulcers (DFUs) make the most significant portion of these hard-to-heal wounds. Our research in the last twenty years has explained why quantitative, absolute and generic injury thresholds to predict when PUs or DFUs may occur will forever remain intangible, despite the vast efforts and resources that have been invested in allegedly discovering such injury thresholds. This perspective article explains the specific reasons for this, yet, it also describes the routes for constructive future medical engineering work which will likely lead to better prevention and treatment of PUs and DFUs, even if currently there are no simple or straight-forward injury thresholds to predict when a person may suffer a chronic wound. The role of mechanobiology, as a relatively new medical engineering discipline, is being depicted, in the context of basic and applied chronic wound research. Physical and biochemical biomarkers for early detection and for targeting prevention are also discussed, given the availability of mechanobiological approaches and methodologies to discover or test feasibility of such biomarkers towards clinical use. Finally, some inherent complexities in the prevention and treatment of PUs and DFUs are elucidated, particularly that: (i) the susceptibility to chronic wounds depend on integrated body system functions which are extremely difficult to predict in individuals, especially in seriously ill patients, and (ii) a continuum exists between prevention and treatment of wounds, and hence, in many cases, clinicians are required to treat an existing wound and protect adjacent tissues from deteriorating at the same time. This paper is an overview of our contemporary research concepts and latest published aetiological discoveries related to chronic wounds. Interested readers are encouraged to further study our cited literature for comprehensive analyses of the multiple specific topics that are briefly described here.
慢性伤口无法愈合，目前被认为是最重要、最未解决且代价最高的医疗负担之一，其医疗成本与所有肥胖相关问题相当。压力性溃疡（PU）和糖尿病足溃疡（DFU）是这些难以愈合的伤口中最主要的部分。我们在过去二十年的研究解释了为什么定量、绝对和通用的损伤阈值来预测何时可能发生 PU 或 DFU 将永远难以捉摸，尽管已经投入了大量的努力和资源来寻找这种损伤阈值。本文从具体原因解释了这一点，但也描述了未来具有建设性的医学工程工作的途径，这些工作可能会导致更好地预防和治疗 PU 和 DFU，即使目前还没有简单或直接的损伤阈值来预测何时一个人可能会患上慢性伤口。本文在基础和应用慢性伤口研究的背景下，描述了作为一个相对较新的医学工程学科的机械生物学的作用。鉴于机械生物学方法和方法的可用性，用于发现或测试此类生物标志物用于临床应用的可行性，还讨论了用于早期检测和靶向预防的物理和生化生物标志物。最后，阐明了在预防和治疗 PU 和 DFU 方面的一些固有复杂性，特别是：（i）慢性伤口的易感性取决于综合的身体系统功能，这些功能在个体中极难预测，尤其是在重病患者中；（ii）预防和治疗伤口之间存在连续性，因此，在许多情况下，临床医生需要同时治疗现有的伤口并保护相邻组织免受恶化。本文概述了我们当前的研究概念和最新发表的与慢性伤口相关的病因发现。鼓励感兴趣的读者进一步研究我们引用的文献，以全面分析这里简要描述的多个特定主题。
