The Promise of Topical Growth Factors in Healing Pressure Ulcers

Pressure ulcers are serious complications of medical care, associated with increased mortality rates, higher comorbidity, and increased burden and cost of treatment (1). In 1997, among 265 acute care hospitals, the overall prevalence of pressure ulcers was 10.1% (range, 1.4% to 36.4%) (2). Up to 66% of orthopedic patients develop pressure ulcers of varying severity (3). Pressure ulcers are difficult to heal. Only 75% of stage 2 pressure ulcers and 17% of stage 3 or stage 4 pressure ulcers heal in 8 weeks (4). Up to 23% of stage 2 pressure ulcers and 48% of stage 4 pressure ulcers remain unhealed at 1 year (5).

Therapy for pressure ulcers is generally empirical, based on anecdotal experience, or borrowed from the treatment of patients with acute wounds. A 1993 guideline panel made approximately 85 specific recommendations on the basis of careful literature review, but only 4 were level A recommendations and only 10 were level B recommendations (6). The chronic nature of pressure ulcers, the many comorbid conditions of affected patients, and often the attending physician's relative unfamiliarity with treatment options make management problematic. Clearly, better clinical approaches to the treatment of pressure ulcers are needed.

Pressure ulcers are a specific type of chronic wound resulting in visible evidence of pathologic changes in blood supply to dermal and supporting tissues, usually due to compression of the tissue over a bony prominence (7). About 95% of pressure ulcers occur in the lower part of the body (8). The sacrum is the most frequent pressure ulcer site (36%), and the heel is the next most common site (30%). Other body areas each account for approximately 6% of pressure …