UKH Linz der AUVA, HLMedConsult, Zehetlandweg 7, 4060 Leonding, Austria.
Burn Center, Plastic Surgery of Trauma Hospital Berlin, Warener Strasse 7, 12683 Berlin, Germany.
Medicina (Kaunas). 2021 Nov 1;57(11):1190. doi: 10.3390/medicina57111190.
Over time, we have come to recognize a very complex network of physiological changes enabling wound healing. An immunological process enables the body to distinguish damaged cells and begin a cleaning mechanism by separating damaged proteins and cells with matrix metalloproteinases, a complement reaction, and free radicals. A wide variety of cell functions help to rebuild new tissue, dependent on energy provision and oxygen supply. Like in an optimized "bio-reactor," disturbance can lead to prolonged healing. One of the earliest investigated local factors is the pH of wounds, studied in close relation to the local perfusion, oxygen tension, and lactate concentration. Granulation tissue with the wrong pH can hinder fibroblast and keratinocyte division and proliferation, as well as skin graft takes. Methods for influencing the pH have been tested, such as occlusion and acidification by the topical application of acidic media. In most trials, this has not changed the wound's pH to an acidic one, but it has reduced the strong alkalinity of deeper or chronic wounds. Energy provision is essential for all repair processes. New insights into the metabolism of cells have changed the definition of lactate from a waste product to an indispensable energy provider in normoxic and hypoxic conditions. Neovascularization depends on oxygen provision and lactate, signaling hypoxic conditions even under normoxic conditions. An appropriate pH is necessary for successful skin grafting; hypoxia can change the pH of wounds. This review describes the close interconnections between the local lactate levels, metabolism, healing mechanisms, and pH. Furthermore, it analyzes and evaluates the different possible ways to support metabolism, such as lactate enhancement and pH adjustment. The aim of wound treatment must be the optimization of all these components. Therefore, the role of lactate and its influence on wound healing in acute and chronic wounds will be assessed.
随着时间的推移，我们逐渐认识到一个非常复杂的生理变化网络，这个网络能够促进伤口愈合。一个免疫学过程使身体能够区分受损细胞，并通过基质金属蛋白酶、补体反应和自由基分离受损蛋白质和细胞，开始清洁机制。各种细胞功能有助于重建新的组织，这取决于能量供应和氧气供应。就像在优化的“生物反应器”中一样，干扰会导致愈合过程延长。最早研究的局部因素之一是伤口的 pH 值，它与局部灌注、氧张力和乳酸浓度密切相关。pH 值不正确的肉芽组织会阻碍成纤维细胞和角质形成细胞的分裂和增殖，以及皮肤移植物的存活。已经测试了影响 pH 值的方法，例如通过局部应用酸性介质进行闭塞和酸化。在大多数试验中，这并没有将伤口的 pH 值变为酸性，而是降低了深层或慢性伤口的强碱性。能量供应对于所有修复过程都是必不可少的。细胞代谢的新见解改变了乳酸的定义，使其从废物变成了正常氧和缺氧条件下必不可少的能量提供者。新生血管化依赖于氧供应和乳酸，即使在正常氧条件下也会发出缺氧信号。适当的 pH 值是成功进行皮肤移植的必要条件；缺氧会改变伤口的 pH 值。这篇综述描述了局部乳酸水平、代谢、愈合机制和 pH 值之间的紧密相互关系。此外，它还分析和评估了支持代谢的不同可能方法，例如增强乳酸和调整 pH 值。伤口治疗的目的必须是优化所有这些成分。因此，将评估乳酸及其对急性和慢性伤口愈合的影响。
