Reduced Migration Potential of Epithelial Cells from Explants of Chronic Decubitus Ulcers: The Cause of Impaired Wound Healing?

Abstract

Decubitus ulcers of older patients are representative of impaired wound healing: chronic ischemia, recurring infections, necrosis, fibrin persistence with reduced fibrinolytic activity, a tendency to heal poorly with inability to epithelialize. Lack of epithelialization is the visible characteristic of impaired wound healing. The causes of impaired wound healing of chronic ulcers are only partially known. A clear, overall picture of how all the known factors interact is still missing. Certain is that infections (Brook 1991; Seiler et al. 1979), insufficient microcirculation (Ardon et al. 1991; Ek et al. 1984; Parkhouse and LeQuesne 1988), chronic tissue hypoxia (Dowd et al. 1983; Hauser et al. 1984; Seiler et al. 1979; Xakellis et al. 1991) and reduced fibrinolytic potential in the ulcer tissue (Larsson and Risberg 1977; Ljungnér and Bjergqvist 1985; Seiler et al. 1980) are, among other factors, important contributors. Since the epithelial cell initiates epithelialization, and since absence of epithelialization is actually the result of all factors interfering with wound healing, the migration pattern and mitosis of epithelial cells are of particular interest. In the search for causes of the missing epithelialization, tissue cultures were examined for their migration potential and for the mitosis pattern of both epithelial cells and fibroblasts from expiants derived from the edges of chronic decubitus ulcers of geriatric patients. It was noted that the epithelial cells taken from the edges of decubitus ulcers showed a significantly reduced migration potential (Seiler et al. 1989).