A team of researchers at the University of Miami Miller School of Medicine has received a five-year, $2.7 million grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases to develop strategies for effective debridement of patients with non-healing venous leg ulcers (VLUs).
The researchers’ long-term goal is to test the effect of wound-edge debridement on positive healing outcome and develop a practical and affordable assessment method that can be used at any clinic.
“Debridement is one of the cornerstones of standardized care for patients with chronic, non-healing wounds,” said Marjana Tomic-Canic, Ph.D., professor and director of the Wound Healing and Regenerative Medicine Research Program in the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, who is one of the principal investigators in the research. “However, it is challenging and requires making the non-healing wound even larger. Clinicians must determine to what extent to debride the wound and often do not know if the non-healing tissue was successfully removed.
“This research will provide a paradigm shift in clinical protocols, as it will provide guiding tools to verify the extent and success of the debridement procedure, which in turn will improve clinical outcomes.”
The researchers have already shown that biopsies obtained from the non-healing edges of VLUs before and after debridement have distinct morphologies and distinguishable gene and protein expression patterns.
“Cells generated from pre-debridement edge biopsies exhibit a non-healing phenotype, as evidenced by loss of migration and loss of ability to respond to growth factors, suggesting a loss of healing potential,” Dr. Tomic-Canic said. “Cells generated from post-debridement biopsy are migratory and responsive to growth factors. We will conduct a randomized clinical trial with multiple goals: to test if gene expression patterns can be utilized as a guiding tool for the extent of debridement and identification of potential markers of debridement margin; to test the effect of wound edge debridement on healing progression; and to develop a simple method of tissue assessment that will be more practical for use in clinics.”
The researchers are finalizing clinical protocol approvals and expect to begin enrolling patients this month.
The other investigators from the Department of Dermatology and Cutaneous Surgery are Robert S. Kirsner M.D., Ph.D., professor, chair and holder of the Harvey Blank Chair, who is another principal investigator, Irena Pastar, Ph.D., research associate professor, Hadar Lev-Tov M.D., assistant professor, and Leigh Nattkemper, Ph.D., research assistant professor.