Growth factors in clinical practice.

Wound repair consists of a complex interaction of cellular and biochemical events. Several growth factors have been identified as regulatory polypeptides co-ordinating the healing process. Although it is not known precisely why chronic wounds do not follow the normal pattern of healing, diminished growth factor content and accelerated growth factor degradation may contribute to poor healing. Topical application of different factors exert stimulatory effects on wounds in animal models. Human data are limited but the most investigated compound is recombinant human platelet-derived growth factor-BB (rhPDGF-BB). PDGF-BB enhances granulation tissue formation and facilitates epithelialisation. Clinical trials in patients with 'hard to heal' diabetic foot ulcers demonstrated significant improvement in the 'healing rate' and the 'time to healing' compared with controls. Refinement of therapeutic strategies with growth factors will take place in the future.