elastin and Leg-Ulcer

A major feature of chronic wounds is the loss of tissue, with the exposure of dermal components preventing primary closure and leading to bacterial colonization. Bacterial colonization has been proposed as one of the common underlying pathologies present in chronic wounds. The objective of this exploratory study was to identify bacteria cultured from chronic venous leg ulcers and test for proteolytic activity that degrades matrix substrates.. Bacteria were isolated, cultured, and identified from six subjects (average age = 62.8 years) over 2-10 months under an approved protocol using swabs and microbiological culture media. Proteolytic activity against (a) gelatin, (b) an elastin substrate, and (c) a serine/trypsin-sensitive substrate was determined using a colorimetric plate assay with an ELISA plate reader and zymography.. We identified 13 bacteria that expressed proteolytic activity against one or more of the tested substrates. Of these, six were Gram-positive (Staphylococcus aureus, Enterococcus faecalis, Staphylococcus epidermidis, Streptococcus agalactiae, Corynebacterium, and Streptococcus bovis) and seven were Gram-negative (Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Morganella morganii, Klebsiella pneumoniae, Bacteroides fragilis, and Serratia marcescens) organisms. Two of these, S. aureus and P. aeruginosa, are recognized wound pathogens.. Multiple bacteria species isolated from colonized venous leg ulcers have the capacity to secrete proteases capable of degrading components of the extracellular matrix important for wound healing. Matrix degradation by bacteria may contribute to delays in tissue deposition and repair, suggesting that treatment of chronic wounds should include appropriate management of colonizing bacteria.

Topics: Adult; Aged; Aged, 80 and over; Chronic Disease; Elastin; Extracellular Matrix; Gelatin; Gram-Negative Bacteria; Gram-Positive Bacteria; Granulation Tissue; Humans; Leg Ulcer; Male; Microbiological Techniques; Middle Aged; Proteolysis; Skin

As deep soft tissue defects with exposed bone, cartilage or tendons are not suitable for wound closure with skin mesh grafts, other techniques are needed. We report on six patients, one female and five males, aged between 32 and 89 years, and deep soft tissue defects with exposed tendons, cartilage or bone. The aetiology of these defects was vascular (n = 3), tumour surgery (2), and post-traumatic (1). Wounds were treated with a collagen-elastin matrix applied above the exposed structures. In five patients, the procedure was combined with mesh graft transplantation in the same setting. Follow-up varied between 12 and 40 weeks. Wound healing was uncomplicated in all transplanted patients until first dressing change after 7 days. All but one transplant showed a 100% take rate and the transplant was stable within 10-14 days. A complete wound closure was also achieved without transplantation, but this took 8 weeks. No adverse effects were noted. There was no skin contracture of the skin grafts. Collagen-elastin matrix with split-thickness skin grafts is a useful tool in deep soft tissue. The time to heal can be reduced.

Topics: Adult; Aged; Aged, 80 and over; Biocompatible Materials; Elastin; Extracellular Matrix; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Leg Ulcer; Male; Severity of Illness Index; Skin Neoplasms; Skin Transplantation; Skin, Artificial; Soft Tissue Injuries; Wound Healing

Prolidase deficiency occurred in two sisters suffering from recurrent leg ulcers that appeared in early childhood. The patients presented the typical clinical symptoms of the disease, including characteristic facies, dermatologic manifestations of the lower extremities, splenomegaly, and hematologic anomalies. Large amounts of iminodipeptides were excreted into the urine, and prolidase activity in their erythrocytes was virtually absent. Changes associated with a connective-tissue disorder were demonstrated by light and electron microscopic studies of the patients' apparently normal skin. Collagen fibers were smaller than in controls and were irregularly packed; the fibrils had normal aspect but were significantly smaller than in one age-matched control. Elastin fibers appeared altered both in size and structure.

Topics: Adult; Chronic Disease; Collagen; Dipeptidases; Elastin; Erythrocytes; Female; Humans; Hydroxyproline; Leg Ulcer; Skin

Topics: Adolescent; Adult; Age Factors; Aging; Child; Child, Preschool; Collagen; Elastin; Female; Humans; Infant; Infant, Newborn; Leg Ulcer; Male; Middle Aged; Netherlands; Occupations; Sex Factors; Varicose Veins