Use of growth factors in therapy of chronic wounds. Experimental, clinical and financial aspects

Clinical trials on exogenous application of polypeptide growth factors in chronic wounds have not fulfilled the high expectations derived from results of experimental studies. There is no convincing evidence that growth factors may substitute for good wound care and efficient surgical approaches to wound closure. The ultimate goal of treatment of chronic ulcerations remains reconstitution of a durable skin envelope without unstable scarring. Therefore, optimization of current methods of wound therapy, including reconstructive vascular and plastic surgery and adequate metabolic and wound control, should be employed before any adjuvant growth factor therapy is attempted. As long as efficient and inexpensive therapy of chronic wounds by growth factors has not been demonstrated, empincal growth factor treatment should be rejected on scientific and economic grounds. Current use appears to be reasonable only under a regime of controlled clinical studies comparing growth factor treatment with conventional wound therapy and operative measures according to the rules of "good clinical practice".