Why Do Promising Wound Therapies Fail?

David G. Armstrong DPM MD PhD

Is a histologically hostile environment causing promising treatments for chronic wounds to fail? My coauthor and I tackle this question in a recent review for Nature Reviews Endocrinology.1

As we say in the review, “As with so many other areas in medicine, the field of tissue repair and wound healing is littered with early-stage promise in preclinical models followed by late-stage disappointment in human trials.”1 If we understand that the wound environment is histologically hostile, many of the types of treatments we have endeavored to use in this area come into question.

Why do I say this? It’s really because we very often tackle a wound that is inadequately debrided and dump a poor, hapless protein or a poor, hapless biologic or other types of therapies into the wound, watch the wound therapy product get destroyed and blame that product next week when the wound has not progressed. What is very exciting about many therapies that are currently being developed is that they can perhaps coax this hostile environment into being more hospitable.

While technology can help us, I think we can help ourselves. That’s why we have always been proponents of aggressive surgical debridement, aggressive vascular intervention and aggressive offloading. I think when we get the principles right, we’re really going to marry technology with our tenacity as a multidisciplinary team to try to make a difference. 


1. Armstrong DG, Gurtner GC. A histologically hostile environment made more hospitable? Nat Rev Endocrinol. 2018; epub July 27.

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