Chronic skin wounds, like the one that contributed to the death of actor Christopher Reeve, are a far-too-common problem in people with diabetes, circulatory problems or, in Reeve’s case, paralysis due to injuries or disease.

While new technologies ?including grafts of bioengineered skin ?exist to help promote the healing of chronic wounds, doctors have had no way to determine early on which wounds might require these advanced and expensive procedures. Furthermore, development of more effective and perhaps less expensive treatments have been hampered by the length and expense of clinical trials required to study them. New research supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases addresses both of these issues.

Focusing on prognostic models for leg ulcers caused by insufficient blood flow, David Margolis, M.D., at the University of Pennsylvania and his colleagues studied data on more than 20,000 people with the ulcers to try to determine which, if any, factors predicted complete healing of the wound by the 24th week. Among their findings: Wounds smaller than 10 square centimeters and less than a year old had about 70 percent chance of healing by the 24th week, while a wound older and larger than that had about an 80 percent chance of staying open after 24 weeks. Using information such as this concerning which wounds are unlikely to heal on their own, they say, doctors can better target technologies to the wounds likely to need them most.

In a separate NIAMS-supported study, Vincent Falanga, M.D., at the Roger Williams Medical Center in Providence, R.I., and his colleagues applied a classification system for both diabetic and venous ulcers to evaluate healing following the use of a bioengineered skin. The scoring system evaluated both the appearance of the natural skin and the appearance of the bioengineered skin 7 and 14 days after application in order to try to predict which wounds would heal and how quickly. The researchers say applying a system like this, once it is validated, would reduce the time and the expense it would take to conduct trials on treatments for skin ulcers, because scientists would not have to wait until wounds were completely healed to determine if a treatment was effective.

The researchers say both studies have the potential to help people with chronic skin wounds by determining which ones require special treatment and by facilitating the process by which those treatments are developed and studied and ultimately brought to market.

The mission of NIAMS, a part of the Department of Health and Human Services?National Institutes of Health, is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS Web site at http://www.niams.nih.gov.

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Margolis DJ, et al. The accuracy of venous leg ulcer prognostic models in a wound care system. Wound Repair Regen 2004;12(2):163-168.

Saap LJ, et al. Clinical classification of bioengineered skin use and its correlation with healing of diabetic and venous ulcers. Dermatol Surg 2004;30(8):1095-1100.