From Healing By Secondary Intent To Accelerated Regenerative Healing.

Despite numerous advanced woundcare solutions, the reality for patients with chronic wounds is the challenge of protracted treatment, with management of underlying primary pathology, to achieve wound healing by secondary intent. Manufactured tissue-engineered artificial skin engraftment to reconstruct skin has been disappointing in practice particularly in chronic wounds.

A review of around 60 current artificial skin and advanced wound products has been performed, to classify the intended therapeutic modalities and mechanistic inter-relationships and offer insight for developing next-generation products. A caveat to this analysis is the paucity of health-economic efficacy evidence for many of these.

Biointelligent scaffolds represent a new integrative modality in this space. Within a bio-engineered territory they can provide cell adhesive signals, a reservoir of activators and or signals for, or modulators of, tissue reconstruction, a proteolytic environment, a source of cryptic or released regulators, or delivery system for complex biological therapies.

An exemplar synthetic bio-intelligent scaffold has been developed primarily as a pro-angiogenic synthetic dermal replacement because neovascularisation rate could limit both speed and outcome (from lack of integration, fluid accumulation, inflammation, infection). It is a porous cross-linked protein-alginate composite. In acute full thickness wounds it shows rapid neovascularisation and cellularisation through the depth of scaffold within 7 days, and with a split thickness overgraft results in single step reconstruction. In a delayed healing wound, application of tissue scaffolds, especially that described here, stimulates an accelerated healing response.

These pre-clinical results suggest that bio-intelligent scaffolds may achieve accelerated regenerative healing rather than protracted healing by secondary intent. This defines a clear patient-led clinical goal ultimately leading to improving patient wellbeing. Successful wound management innovation relies on researchers, clinicians and the healthcare industry collaborating. Understanding regenerative wound healing mechanisms and developing appropriate models of chronic wounds are critical scientific contributions.