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Page 6 of 8 García Botero et al. Plast Aesthet Res 2018;5:15 I http://dx.doi.org/10.20517/2347-9264.2018.09

cellular growth and release of important substances for wound healing, while the human skin equivalents
cover the wound and may also provide growth factors .
[17]

Hydrocolloid dressings formed part of the occlusive dressing types and are usually composed of a matrix of
[19]
sodium carboxymethyl cellulose with an adhesive elastomeric substance attached to a polymer base . The
hydrocolloid matrix absorbs exudates away from the wound surface ensuring a humid environment and
promoting wound healing .
[20]
In a systematic literature review of 20 randomized controlled trials evaluating whether complex wound
dressings enhanced healing of venous ulcers, the author’s reported that only 25% of the trials, and less than
10% of the overall studies, showed a significant proportion of healed ulcers by using these complex wound
dressings . Also, the use of hydrocolloid dressings did not enhance the proportion of ulcers healed in
[17]
comparison to that of other dressing types, including growth factors. Similarly, a meta-analysis study from
COCHRANE identified that hydrocolloid is the most evaluated dressing type, and an analysis of 27 (60%)
studies, indicated that there was no evidence that the use of hydrocolloid dressings for the treatment of
chronic venous ulcers was more effective than other dressing types, and concluded that ulcer healing rates
were not affected by the type of dressing used beneath compression . Even though there was not enough
[21]
data for most of dressing types to provide significant evidence of which type was more effective for healing
venous ulcers, hydrocolloid dressings were more effective than low adherence dressings . Nonetheless, none
[21]
of these studies included growth factors dressing types or products with fibrin matrices, platelet-enriched-
plasma or autologous growth factors in their analysis.

Regardless of the availability of new complex dressing types, the gauze is the dressing that is still most
frequently used worldwide. Gauze is economical, easily available, absorbent and well known by health
personal. Petrolatum or Vaseline impregnated gauzes commonly are used to provide a moist environment,
and avoid desiccation that is conducive to wound healing .
[22]

The advancement of new biotechnologies has focused on development of alternative therapies by growing
tissue in vitro, producing recombinant growth factors and tissue engineering. In vitro studies with animal
models have reported a beneficial effect of growth factors, specifically, PDGF, fibroblast growth factor and
granulocyte-macrophage colony-stimulating factor, on the proportion of healed ulcers [9,11] . The practice
of using growth factors for the treatment of chronic ulcers was the consequence of research results that
demonstrated a significant reduction of localized growth factors in chronic wounds, resulting in cell cycle
arrest and senescence of the wound bedding cells .
[10]
Fibrin matrix and autologous growth factors became a cost-effective option for the management of patients
with venous ulcers in the lower limbs. These biological products can be obtained from the same patient’s
blood, and provides scaffolding for tissue growth, migration and cell regeneration. The beneficial effects
of the fibrin matrix may be enhanced when it is used with growth factors that stimulate cell proliferation.
Currently, the challenge is producing an improved system for releasing high concentrations of growth factors
to the bedding wound and establishing a close relationship between the bedding wound and Diana cells.

In our literature search we found little evidence for the efficacy of treating chronic venous ulcers with
products containing fibrin matrix, platelet-enriched- plasma and autologous growth factors. In fact, we
found only one pilot study that included patients with venous ulcers, but it also included patients with
arterial ulcers and from other etiologies. The 12 patients with venous ulcers were treated with a product
containing fibrin matrix, platelet-enriched- plasma and autologous growth factors, of which 8 (66.7%; 64.7%
of the treated ulcers) showed completed ulcer healing within 7.1 weeks (median = 6 weeks) after a mean of