Clarification of mechanisms for delayed re-epithelialization of chronic wounds -to establish treatment based on wound healing theory-

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To clarify the mechanisms of delayed re-epithelialization in chronic wounds, we examined the changes in α5β1 expression in the migrating epidermis, fibronectin (FN) distribution under the migrating epidermis, laminin-1expression at the dermal-epidermal junction and histological fmdings for pressure ulcers compared with those for bums (acute wounds, control). Four μm of paraffin sections in a serial of 22 samples with 20 pressure ulcers and 24 samples with 24 burns were stained for α5β1, FN and laminin-1 by a peroxidase immunohistochemical method. The sections were also stained with hematoxylin and eosin (HE). In these immunostained and HE stained specimens, we measured the distance of positive expression of α5β1, increased distribution of FN, negative or decreased expression of laminin-1, histological epidermal elongation (portion showing parakeratosis) and epidermal thickening using IPLab. We then analyzed the correlation of those findings within each group of burns or pressure ulcers … More . Next we sorted the differences in the findings between the two groups. With burn specimens, there was a statistically significant correlation between positive α5β1 and increased fibronectin, positive α5β1 and negative laminin-1, and increased fibronectin and negative laminin-1. In addition, epidermal elongation significantly correlated with positive α5β1, increased fibronectin, and negative laminin-1. With pressure ulcer specimens, a significant correlation was shown between positive α5β1 and increased FN, positive α5β1 and negative laminin-1, increased FN and epidermal elongation, and epidermal elongation and epidermal thickening. The pressure ulcer group showed a significant decrease in the distance of positive α5β1, increased FN, negative laminin-1 compared with the burn group. Increase in epidermal thickening was also significant. These data demonstrated that α5β1 and FN were the significant contributing factors in epidermal migration, and the decrease in α5β1 expression in the migrating epidemis and FN distribution under the migrating epidermis were considered to be mechanisms of delayed re-epithelialization with pressure ulcers. Less