Refined Spruce Resin to Treat Chronic Wounds: Rebirth of an Old Folkloristic Therapy.

Significance: The treatment of chronic wounds results in an enormous drain on healthcare resources in terms of workload, costs, frustration, and impaired quality of life, and it presents a clinical challenge for physicians worldwide. Effective local treatment of a chronic wound has an important role, particularly in patients who are-because of their poor general condition, diminished life expectancy, or unacceptable operative risk-outside of surgical treatment. Recent Advances: Since 2002, our multidisciplinary research group has investigated the properties of Norway spruce (Picea abies) resin in wound healing and its therapeutic applications in wound care. Resin is a complex mixture of resin acids (e.g., abietic, neoabietic, dehydroabietic, pimaric, isopimaric, levopimaric, sandrakopimaric, and palustric acids) and lignans (e.g., pino-, larici-, matairesinol, and p-hydroxycinnamic acid) having substantial antimicrobial, wound-healing, and skin regeneration enhancing properties. Critical Issues: The cornerstone in successful wound care is an efficient causal treatment of the underlying co-morbidities, for example, diabetes, malnutrition, vascular- or certain systemic diseases. However, definitive diagnosis and specific therapy of a chronic wound is often difficult, because the etiology is practically always multi-factorial, and in the chronic phase, confounding factors such as infections invariably impede wound healing. Future Directions: To study the exact molecular mechanism of actions by which resin promotes cellular regeneration and epithelialization during the wound-healing process. To investigate potential antimicrobial properties of resin against the most ominous multidrug-resistant beta-lactamase (including carbapenemases and metallo-β-lactamases) producing bacteria, and to individualize those pharmacologically active compounds which are responsible for the antimicrobial activity of resin.