The term “chronic wound” describes a wound that occurs in a patient who has physiologic impairments to healing (Table 1). These pathophysiologic processes predispose cutaneous wounds to deviate from the characteristics of acute wound healing. Although a chronic wound is not always slow to heal, it should be considered “emergent” in that it is often a non-healing wound. An estimated 3 to 6 million chronic skin ulcers occur in patients every year in the United States. The most common underlying conditions are venous reflux, pressure, and diabetes mellitus 1,2,3,4,5
In the vast majority of surgical procedures, nearly all acute wounds heal by an orderly and timely process6, with a strength and integrity similar to normal skin. 7, 8 Wounds refractory to moist healing, however, may be candidates for growth factor therapy, which is assumed to stimulate missing or dysfunctional components of the chronic wound9–11. An angiogenic growth factor may promote closure of chronic wounds exhibiting hypoxia and compromised vascularity.
Vascular endothelial growth factor (VEGF) is one such candidate. It functions as an endothelial cell mitogen 12–17, chemotactic agent 18, 19, and inducer of vascular permeability 20, 21,22–26. Other angiogenic growth factors such as basic fibroblast growth factor (bFGF) and transforming growth factor β (TGF-β) have been described, but VEGF is unique for its effects on multiple components of the wound healing cascade, including angiogenesis and recently shown epithelization and collagen deposition. 27. Purified growth factors 28 and cultured human cells 29–31 have both been approved by the Food and Drug Administration to accelerate closure of non-healing wounds. This has transformed the field of wound healing by establishing the efficacy of a topical growth factor and cell therapy. Since angiogenesis maintains a critical role in wound healing, in the future, VEGF (alone or in combination therapy) may be utilized on patients with nonhealing wounds. This review the role of angiogenesis by VEGF in wound healing.